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 renal damage, hypertension, proteinuria, and ultimately end-stage kidney disease. Fortunately, modern nephrology offers a multifaceted pharmacological approach that combines anti-inflammatory, immunomodulatory, renoprotective, and anticoagulant therapies—tailored to disease severity, histopathological findings, and individual patient risk profiles.

First-Line Immunosuppressive Therapy: Corticosteroids

Glucocorticoids remain the cornerstone of initial treatment for many forms of immune-mediated CGN, particularly membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis. Prednisone tablets and prednisolone acetate are the most widely prescribed oral corticosteroids due to their potent anti-inflammatory and lymphocyte-suppressing effects. Dosing is typically initiated at a higher level (e.g., 0.5–1 mg/kg/day) and gradually tapered over several months to minimize relapse while reducing long-term side effects such as osteoporosis, hyperglycemia, and adrenal suppression.

Advanced Immunosuppression: Targeted Agents

When corticosteroids alone prove insufficient—or when patients experience frequent relapses or steroid-dependent disease—clinicians often escalate to second-line immunosuppressants. These fall into two major categories:

Cytotoxic Agents

Cyclophosphamide, an alkylating agent, has been used for decades in severe or refractory CGN. While highly effective at halting immune-driven injury, its use requires careful monitoring for hematologic toxicity, bladder irritation (hemorrhagic cystitis), and long-term malignancy risk—necessitating concurrent mesna administration and regular bloodwork.

Calcineurin Inhibitors (CNIs)

Cyclosporine soft capsules and tacrolimus offer a more targeted alternative with a favorable efficacy-to-toxicity ratio in many patients. These agents inhibit T-cell activation without broad cytotoxicity. Therapeutic drug monitoring is essential to maintain trough levels within the narrow therapeutic window—optimizing renal protection while avoiding nephrotoxicity and hypertension.

Complementary & Adjunctive Therapies

Beyond core immunosuppression, evidence-based adjunctive treatments play a critical role in slowing disease progression and preserving kidney function:

Renoprotective Herbal Formulations

In integrative clinical practice—particularly where traditional medicine is well-regulated and standardized—Tripterygium glycosides tablets (TGT) have demonstrated measurable benefits in reducing proteinuria and stabilizing eGFR in randomized controlled trials. Similarly, Jinshuibao capsules (fermented Cordyceps sinensis extract), Huangkui capsules (Abelmoschus manihot extract), and Astragalus membranaceus capsules are supported by growing preclinical and clinical data for antioxidant, anti-fibrotic, and podocyte-stabilizing effects—making them valuable additions to conventional regimens under physician supervision.

Anticoagulation and Antithrombotic Support

Patients with significant proteinuria (>3.5 g/day) face elevated risks of hypercoagulability and venous thromboembolism. In such cases, warfarin or direct oral anticoagulants (DOACs) may be considered—not only for thrombosis prevention but also for mitigating microvascular injury in the glomerular capillary bed. Anticoagulation decisions must balance bleeding risk, renal clearance, and drug–drug interactions—especially with CNIs or antiplatelet agents.

Personalized Care Is Key

No single "best medication" fits all CGN patients. Treatment selection depends on biopsy-proven diagnosis, estimated glomerular filtration rate (eGFR), degree of proteinuria, comorbidities (e.g., diabetes, cardiovascular disease), age, and reproductive considerations. Regular follow-up—including urine albumin-to-creatinine ratio (UACR), serum creatinine, electrolytes, and blood pressure tracking—is essential to assess response and adjust therapy proactively. Emerging biologics like rituximab and newer CNI-sparing protocols continue to reshape treatment paradigms—highlighting the importance of care in specialized nephrology centers.