Wk 10 Glomerular Disease

Question 1

Glomerular Disease

Types:

Answer 1

1. Focal or diffuse mesangioproliferative glomerulonephritis: IgAN
2. Focal or diffuse proliferative or necrotizing glomerulonephritis (PIGN, Lupus)
3. Crescentic glomerulonephritis: Anti-GBM, ANCA-GN; conventional tx mandatory
4. Focal or diffuse sclerosing glomerulonephritis
5. Conventional tx also mandatory for acute nephritis & rapidly progressive nephritis

Question 2

Focal or diffuse Mesangio-proliferative glomerulonephritis:

IGA Nephropathy (IgAN);
Cause:
Patient monitoring:
Herbs:

Answer 2

1. Most common, especially in SE Asia, Mediterranean
2. Cause: dysglycosylation of IGA1-> immune complexes-> glomerular deposition-> inflammation-> hematuria, proteinuria, renal failure
3. Patient monitoring: proteinuria suggests progression, BP & biopsy not indicative of course
4. Herbs: aloe vera gel, Artemisia absinthium, Astragalus, codonopsis, cordyceps, Centella

Question 3

IGA Nephropathy (IgAN) Herbs:

Answer 3

1. Aloe vera gel,
2. Artemisia absinthium,
3. Astragalus
4. Codonopsis,
5. Cordyceps,
6. Centella

Question 4

Focal or diffuse proliferative or necrotizing glomerulonephritis:

Lupus Nephropathy;
LABS:
HERBS:

Answer 4

1. Immune complex & complement mediated, more common in women & African American.
2. Labs: ANA sensitive, anti-Sm specific
3. Herbs: Astragalus, flax, turmeric

Question 5

Lupus Nephropathy HERBS:

Answer 5

1. Astragalus,
2. flax,
3. turmeric

Question 6

Focal or diffuse proliferative or necrotizing glomerulonephritis; (PIGN)

Post-Infectious GN;
LABS:
TX:

Answer 6

1. Delay 10-20 days after infection (unlike IgAN)
   Rapid onset edema, HTN, oliguria, heavy proteinuria, hematuria, low urine sodium
2. Labs: elevated ASO titers, reduced complement
3. TX: treat infection, symptoms, inflammation modulators, immunomodulators

Question 7

Minimal change GN;

ELECTRON MICROSCOPE:
CLINICAL:
HERBS:
TX:

Answer 7

1. Nephrotic syndrome w/ peak incidence 24-36 months
2. Electron microscopy: foot processes swollen & fused. Biopsy normal
3. Clinical: look for allergies, intestinal permeability, probiotics, restrict sodium
4. Herbs: lespedeza cuneata, angelica sinensis, *Astragalus membranaceus, codonopsis pilosula
5. TX: corticosteroids

Question 8

Focal Segmental Glomerulosclerosis (FSGS);

RISKS:
HERBS:
HEPARIN:
NUTRIENTS:

Answer 8

1. Can cause nephrotic syndrome or asymptomatic proteinuria
2. Fibrosis of glomeruli, require kidney biopsy to diagnose
3. Risk factors: metabolic syndrome
4. Antifibrotic herbs: Centella, Silybum, salvia, schisandra
   Other herbs ganoderma lucidum
5. Heparin: inflammation & immunomodulating (oral & injection)
6. Nutrients: CoQ10, Vitamin E, ARG/ADMA

Question 9

Membranous & Membranoproliferative GN;

Answer 9

1. MGN associated w/ Hep BV
   MPGN associated w/ Hep CV
2. S/SX: nephrotic syndrome, acute nephritis, asymptomatic proteinuria, recurrent painless gross hematuria
3. TX: all types remove triggers (diet), treat cause, nephroprotectives
   a. Immune complex mediated: immunomodulators (Astragalus)

b. Complement mediated: complement inhibitors (eculizumab)
* **Herbal complement inhibitors: croton draco, pueraria montana, petasites hybridus, alisma orientale, ephedra, ulex europaeus

c. Elemental diet , Vitamin E, ARB drugs, rheum palmatum, Arctium lappa

Question 10

Minimal change GN;

HERBS & Tx:

Answer 10

4. Herbs: lespedeza cuneata, angelica sinensis, astragals membranaceus, codonopsis pilosula
5. TX: corticosteroids

Question 11

Focal Segmental Glomerulosclerosis (FSGS);

Antifibrotic herbs:

Answer 11

Antifibrotic herbs: Centella, Silybum, salvia, schisandra

Other herbs ganoderma lucidum

Question 12

Membranous & Membranoproliferative GN;

Herbal complement inhibitors:

Answer 12

Herbal complement inhibitors: croton draco, pueraria montana, petasites hybridus, alisma orientale, ephedra, ulex europaeus