Treatment of immunologically mediated glomerular disease.

Many immunologically mediated glomerular diseases can be successfully treated, but clinicians should be wary of unproven claims of efficacy, be cognizant of long-term deleterious effects of treatment, and should select patients with a careful eye on the natural history of the untreated disorder. It is hoped that as we gain a better understanding of the etiology and pathogenesis of the specific entities that a more rational form of therapy will emerge. The powerful tools of molecular biology and our better understanding of the inflammatory and scarring processes may provide new, highly effective and safe approaches to treatment. Like their predecessors, these approaches, however, will require very careful evaluation in human subjects by prospective controlled clinical trials. Even if we cannot favorably influence the immunological processes responsible for glomerular disease, attention to non-immunologic factors responsible for progression of disease, such as hypertension, may substantially slow the rate of progression of disease even in those patients whose fundamental disease process cannot be arrested or cured.