Management of glomerular XXXX : a commentary.

@entity1 @entity644 @entity8 @entity1289 @entity922
It is widely accepted that @entity644 reduction is an appropriate therapeutic goal in chronic @entity8 . Based on large @entity922 ( @entity922 ), @entity1289 inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy have emerged as the most important antiproteinuric and renal protective interventions. However, there are numerous other interventions that have been shown to be antiproteinuric and, therefore, likely to be renoprotective. Unfortunately testing each of these antiproteinuric therapies in @entity922 is not feasible. The nephrologist has two choices: restrict antiproteinuric therapies to those shown to be effective in @entity922 or expand the use of antiproteinuric therapies to include those that, although unproven, are plausibly effective and prudent to use. The goal of this work is to provide the documentation needed for the nephrologist to choose between these strategies. This work describes 25 separate interventions that are either antiproteinuric or may block injurious mechanisms of @entity644 . Each intervention is assigned a level of recommendation (Level 1 is the highest; Level 3 is the lowest) according to the strength of the evidence supporting its antiproteinuric and renoprotective efficacy. Pathophysiologic mechanisms possibly involved are also discussed. The number of interventions at each level of recommendation are: Level 1, n = 7; Level 2, n = 9; Level 3, n = 9. Our experience indicates that we can achieve in most @entity1 the majority of Level 1 and many of the Level 2 and 3 recommendations. We suggest that, until better information becomes available, a broad-based, multiple-risk factor intervention to reduce @entity644 can be justified in those with progressive @entity8 . This work is intended primarily for clinical nephrologists; therefore, each antiproteinuria intervention is described in practical detail.
