Effective Medications and Comprehensive Treatment Strategies for Chronic Glomerulonephritis

Chronic glomerulonephritis (CGN) is a progressive kidney disorder characterized by persistent inflammation of the glomeruli—the tiny filtering units in the kidneys. Left unmanaged, it can lead to irreversible kidney damage, hypertension, proteinuria, and eventually chronic kidney disease (CKD) or end-stage renal failure. Fortunately, modern nephrology offers a well-established, multi-targeted pharmacological approach that combines anti-inflammatory, immunomodulatory, renoprotective, and antithrombotic therapies.

First-Line Anti-Inflammatory Therapy: Corticosteroids

Corticosteroids remain the cornerstone of initial treatment for many forms of CGN—especially those with significant immune-mediated activity, such as IgA nephropathy, membranous nephropathy, or lupus nephritis. Prednisone acetate tablets and prednisolone acetate tablets are the most widely prescribed oral glucocorticoids due to their potent anti-inflammatory and immunosuppressive effects. Dosing is typically initiated at a higher level (e.g., 0.5–1 mg/kg/day), then carefully tapered over several months based on clinical response and urinary protein levels—minimizing long-term side effects like osteoporosis, hyperglycemia, and adrenal suppression.

Advanced Immunosuppression: Targeting Underlying Autoimmunity

When corticosteroids alone are insufficient—or when patients experience frequent relapses—clinicians often escalate to more selective immunosuppressants. These fall into two key categories:

Cellular Toxicity Agents

Cyclophosphamide, an alkylating agent, has long been used in severe, rapidly progressive CGN. Though highly effective, its use requires close monitoring for hematologic toxicity, bladder irritation (prevented with mesna), and increased risk of malignancy—making it better suited for short-term induction therapy under expert supervision.

Calcineurin Inhibitors (CNIs)

Cyclosporine soft capsules and tacrolimus offer a more targeted alternative with fewer systemic toxicities. Both inhibit T-cell activation and reduce podocyte injury—critical in preserving glomerular filtration. Tacrolimus, in particular, is increasingly favored for its superior efficacy-to-safety ratio in focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD). Therapeutic drug monitoring (TDM) is essential to maintain trough levels within the narrow therapeutic window and avoid nephrotoxicity.

Complementary Renoprotective & Antifibrotic Support

Beyond immunosuppression, preserving residual kidney function is equally vital. Several evidence-informed adjunctive agents play critical roles:

• Jinshuibao capsules—a standardized fermentation product derived from Cordyceps sinensis—have demonstrated antioxidant, anti-apoptotic, and antifibrotic properties in clinical trials, helping slow eGFR decline.
• Huangkui capsules, formulated from Abelmoschus manihot, significantly reduce proteinuria and improve histopathological markers in IgA nephropathy patients.
• Astragalus membranaceus capsules support endothelial health and modulate inflammatory cytokines—often used alongside conventional therapy to enhance overall renal resilience.

Anticoagulation and Vascular Protection

Patients with heavy proteinuria (>3 g/day) or nephrotic syndrome face elevated risks of hypercoagulability and thromboembolic events—including renal vein thrombosis. In such cases, warfarin remains a first-line anticoagulant, especially when INR can be reliably monitored. Newer direct oral anticoagulants (DOACs) like apixaban or rivaroxaban are gaining traction in select populations, though data specific to CGN-related thrombosis remains limited. Always consult a nephrologist before initiating anticoagulation—risk-benefit assessment must account for bleeding risk, platelet function, and concurrent medications.

Tailored, Patient-Centered Care Is Key

No single "best" drug exists for chronic glomerulonephritis—treatment must be individualized based on histologic subtype, disease activity, comorbidities, age, and genetic factors. Regular follow-up—including urine albumin-to-creatinine ratio (UACR), serum creatinine, eGFR, and blood pressure tracking—is essential. Emerging biologics (e.g., rituximab, belimumab) and novel antifibrotic agents are also under active investigation in clinical trials, promising even more precise and safer options in the near future.