The pharmacology of old and new agents for specific therapy of primary glomerular diseases

A wide variety of pharmacologic agents having diverse mechanisms of action and potential adverse events are widely used in treatment of primary glomerular diseases. However, the indications for treating specific disease entities still represent a matter of controversy and discussion among nephrologists. Indeed, randomized controlled trials are relatively few in number and are often small, underpowered, and of short duration. Conversely, drugs such as glucocorticoids (GCs) and cytotoxic agents may exert beneficial effects in some glomerular diseases, but may also be responsible for disquieting adverse events that can discourage their use in patients with indolent glomerulonephritis. Recently, a number of biological agents have been developed to spare the use of potentially toxic agents while targeting the immune cells implicated in the pathogenesis of glomerular diseases. Thus far, however, many of them have failed to find a role in the clinical management of glomerular diseases. This chapter reports the main characteristics of the pharmacological classes of immunosuppressive agents that may be used in primary glomerular diseases.