KDIGO Kidney International supplementary material released the guidelines for management of glomerular diseases. ( image source: http://library.med.utah.edu/WebPath/RENAHTML/RENAL102.html)
Topic: Minimal change disease in Adults
1. Initial treatment - Steroids ( Grade 1C) 1mg/kg or alternating 2mg/kg QOD for 4 weeks minimum if complete remission achieved and 16weeks if complete remission not achieved (2C)
2. Taper after remission over 6 months( Grade 2D)
3. If cannot tolerate steroids, oral cyclophosphamide or CNIs can be used( Grade 2D)
4. For relapses, use the same steroid protocols
5. For frequently relapsing and or steroid dependent minimal change, oral cylcophosphamide can be used at 2-2.5mg/kg.day for 8 weeks( 2C)
6. For frequently relapsing and or steroid dependent minimal change, oral cyclosporine can be used at 3-5mg/kg.day or tacrolimus 0.05-0.1mg/kg/day in divided doses for 1-2 years (2C)
7. MMF 500-1000mg BID for 1-2 years for intolerance also to 5,6 ( 2D)
8. Re-evaluate patients with resistant minimal changes for secondary causes.
9. For initial episode of nephrotic syndrome associated with MCD, statins and ACEI/ARBS not be used in normotensive individuals for proteinuria ( 2D).
10. MCD with AKI, treat with renal repalcement therapy if need be but with steroids.
take a look at full recommendations at http://www.nature.com/kisup/journal/v2/n2/pdf/kisup201218a.pdf
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