What Medication is Used to Treat Glomerulonephritis?

Approximately 10-15% of end-stage renal disease cases in the U.S. are caused by glomerulonephritis. The specific medication used to treat glomerulonephritis depends heavily on its underlying cause, whether it is an autoimmune disease, infection, or another condition.

Quick Summary

Treatment for glomerulonephritis involves medications targeting inflammation and managing complications like high blood pressure, with specific drugs chosen based on the underlying cause, whether it's an autoimmune issue, infection, or other condition.

Key Points

• Immunosuppressants: Medications like corticosteroids (prednisone) and cytotoxic drugs (cyclophosphamide, mycophenolate) are used when an autoimmune disorder is the cause of glomerulonephritis.

• Blood Pressure Control: ACE inhibitors, ARBs, and diuretics are crucial for managing high blood pressure and proteinuria, which helps protect kidney function.

• Targeted Therapies: Newer drugs such as budesonide, sparsentan, belimumab, and voclosporin provide more specific treatment for certain types of glomerulonephritis, like IgA nephropathy and lupus nephritis.

• Antibiotics: These are only effective when an active bacterial infection is the cause of the glomerulonephritis, but they may not prevent the kidney inflammation itself.

• Individualized Treatment: There is no single medication for glomerulonephritis; treatment is personalized based on the specific type, severity, and underlying cause of the condition.

The treatment for glomerulonephritis is not a one-size-fits-all approach but a highly individualized plan tailored to the root cause of the kidney inflammation. Medications range from supportive therapies to control symptoms and protect kidney function to powerful immunosuppressants that halt the autoimmune processes attacking the glomeruli. Timely and appropriate intervention is critical to slow disease progression and prevent irreversible kidney damage.

Understanding the Therapeutic Approach

Glomerulonephritis (GN) is a broad term for several diseases that cause inflammation of the glomeruli, the tiny filters within the kidneys. The treatment strategy is determined by the specific type of GN, its severity, and whether it is acute (sudden onset) or chronic (long-lasting). Key therapeutic areas include suppressing the immune system, managing blood pressure and fluid balance, and addressing any underlying infections.

Primary Immunosuppressive Medications

When glomerulonephritis is caused by an autoimmune disorder—where the immune system mistakenly attacks the kidneys—immunosuppressive drugs are used to calm the immune response and reduce inflammation.

Corticosteroids

• Prednisone and Methylprednisolone: These are common, powerful anti-inflammatory and immunosuppressive agents. High-dose intravenous corticosteroids may be used initially in severe, rapidly progressive glomerulonephritis, followed by a tapering oral course. While effective, long-term use is associated with side effects such as weight gain, bone loss, and increased infection risk.

Other Immunosuppressants

• Cyclophosphamide: A cytotoxic agent used in more severe cases, especially for rapidly progressive GN and lupus nephritis. It is often combined with corticosteroids.
• Mycophenolate Mofetil (MMF): An immunosuppressant prescribed for various forms of GN, particularly lupus nephritis. MMF is often used for induction and maintenance therapy.
• Azathioprine: Used for maintenance therapy, often after successful induction with more potent drugs like cyclophosphamide.
• Rituximab: A monoclonal antibody targeting B-cells, used for certain autoimmune-related GN, such as ANCA-associated vasculitis and lupus nephritis.

Medications for Blood Pressure and Symptom Management

Controlling high blood pressure is a cornerstone of treatment for many types of glomerulonephritis, as it helps reduce protein leakage into the urine and protects the kidneys from further damage.

• ACE Inhibitors and ARBs: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are often the first choice for managing high blood pressure and proteinuria in chronic kidney disease and GN. They help relax blood vessels and lower pressure within the glomeruli.
• Diuretics: These medications, or 'water pills', help the kidneys remove excess fluid and sodium from the body, thereby reducing swelling (edema) and controlling blood pressure. Furosemide is a common example.
• Calcium Channel Blockers: Another class of medication used to lower blood pressure by relaxing blood vessels.

Targeted Therapies for Specific Glomerulonephritis Conditions

In recent years, more specific therapies have emerged for particular types of GN, offering more targeted and effective treatment with potentially fewer side effects.

• IgA Nephropathy (IgAN): The FDA has approved several new drugs for IgAN.
  • Budesonide (Tarpeyo®): A targeted-release corticosteroid that acts directly on the gut's mucosal immune system where much of the problematic IgA is produced.
  • Sparsentan (Filspari®): A dual endothelin and angiotensin receptor antagonist that helps reduce proteinuria.
  • Iptacopan (Fabhalta®): A complement factor B inhibitor that targets the immune system.
• Lupus Nephritis: Specific targeted therapies are now available in addition to standard immunosuppression.
  • Belimumab (Benlysta®): A monoclonal antibody approved for lupus nephritis.
  • Voclosporin (Lupkynis®): A calcineurin inhibitor approved specifically for lupus nephritis.

Antibiotics for Infection-Related Glomerulonephritis

When GN is triggered by a bacterial infection, such as post-streptococcal glomerulonephritis (PSGN), antibiotics may be used to eliminate any remaining bacteria. In many cases of PSGN, the nephritis begins after the initial infection has resolved, so antibiotics are not always effective against the kidney damage itself but are still necessary if the infection is active.

Glomerulonephritis Medication Comparison

Medication Class	Primary Use	Mechanism	Specific Medications	Side Effects/Considerations
Corticosteroids	Immune suppression, inflammation reduction	Suppresses the immune system; potent anti-inflammatory action	Prednisone, Methylprednisolone	Weight gain, bone loss, increased infection risk, high blood sugar
ACE Inhibitors/ARBs	Blood pressure control, proteinuria reduction	Relaxes blood vessels, lowers pressure in glomeruli	Lisinopril (ACEI), Losartan (ARB)	Cough (ACEI), dizziness, hyperkalemia (high potassium)
Diuretics	Fluid and salt removal, edema, BP control	Increases urine output by helping kidneys excrete sodium and water	Furosemide (Lasix)	Dehydration, electrolyte imbalances, frequent urination
Targeted IgAN	Proteinuria reduction in IgA Nephropathy	Reduces IgA production or blocks inflammatory pathways	Budesonide, Sparsentan, Iptacopan	Specific to drug (e.g., budesonide side effects are generally milder than systemic steroids)
Targeted Lupus	Reduces inflammation in Lupus Nephritis	Neutralizes specific immune factors (BAFF), inhibits T-cell activation	Belimumab, Voclosporin	Headache, nausea, infections (Belimumab); increased BP, kidney issues (Voclosporin)
Alkylating Agents	Severe autoimmune GN	Disrupts cell reproduction, suppressing the immune system	Cyclophosphamide	Increased risk of infection, bone marrow suppression
Antibiotics	Infection-related GN	Eradicates bacterial infection	Penicillin, Erythromycin	Side effects vary depending on the antibiotic used

Supportive and Non-Pharmacological Treatments

Medications are often used alongside non-drug treatments to manage symptoms and improve outcomes. These include:

• Dietary Changes: Reducing sodium intake helps control blood pressure and edema. Limiting protein, potassium, and phosphorus may be necessary to reduce the burden on the kidneys.
• Dialysis: If the kidneys fail, dialysis may be required to filter the blood and remove waste products.
• Plasmapheresis: A procedure to remove harmful antibodies from the blood, sometimes used for rapidly progressive GN.

Conclusion

The medication plan for glomerulonephritis is highly specific and depends on a thorough diagnosis, including identifying the underlying cause. From potent immunosuppressants for autoimmune conditions to supportive blood pressure management and newer targeted therapies for specific disease types like IgA nephropathy, the treatment landscape is complex. Working closely with a nephrologist and other specialists is essential to select the most effective and least burdensome medication regimen, alongside necessary lifestyle adjustments, to protect kidney function and improve patient outcomes. Based on information from the National Kidney Foundation, proper diagnosis and management are key to preventing the progression to end-stage renal disease.

Key Factors Influencing Medication Choice

Diagnosis is critical for effective treatment. Different medications are prescribed for autoimmune vs. infection-related causes, for example. Management of comorbidities is vital for kidney protection. Medications like ACE inhibitors and diuretics help control high blood pressure and fluid buildup, which can exacerbate kidney damage. Targeted therapies offer newer options for specific types of GN. For conditions like IgA nephropathy and lupus nephritis, newer drugs provide more focused treatment with fewer side effects. Side effect management is an important part of the care plan. With immunosuppressants, balancing the benefits of reducing inflammation against the risks of increased infection and other side effects is a constant consideration. Lifestyle modifications are essential for supportive care. Diet and fluid management complement pharmacological treatments and help reduce the burden on the kidneys.

Frequently Asked Questions

What medications are most commonly prescribed for glomerulonephritis?

Commonly prescribed medications include immunosuppressants like corticosteroids (prednisone), mycophenolate mofetil, and cyclophosphamide for autoimmune causes, as well as blood pressure medications like ACE inhibitors and ARBs to protect the kidneys.

Do all types of glomerulonephritis require medication?

No, some cases of acute glomerulonephritis, such as post-streptococcal GN in children, may resolve on their own with supportive care. However, chronic or severe cases almost always require medication to prevent progression to kidney failure.

What is the difference between treating acute versus chronic glomerulonephritis?

Acute GN may sometimes require only supportive care or antibiotics for an active infection. Chronic GN, however, focuses on long-term management to slow disease progression, often using immunosuppressants and medications to control blood pressure and proteinuria.

Are there specific medications for IgA nephropathy?

Yes. Beyond blood pressure management, the FDA has approved targeted-release budesonide (Tarpeyo®), sparsentan (Filspari®), and iptacopan (Fabhalta®) for treating IgA nephropathy.

How are autoimmune causes of glomerulonephritis treated?

Autoimmune-related GN is often treated with immunosuppressants, including corticosteroids (like prednisone) and other drugs such as cyclophosphamide, mycophenolate mofetil, and rituximab, to dampen the immune response.

What role do blood pressure medications play in glomerulonephritis treatment?

Blood pressure medications, particularly ACE inhibitors and ARBs, are used to control hypertension and reduce the amount of protein leaking into the urine, which are key strategies for slowing the disease's progression.

Can I use over-the-counter medication if I have glomerulonephritis?

It is crucial to consult your healthcare team before taking any over-the-counter medicine or supplement. Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, should be avoided as they can cause kidney damage.