Treatment of progressive chronic nephropathy
The progressive chronic nephropathies can evolve in time to terminal renal disease, even when the responsible agent of the appearance of the disease has been removed or eliminated.

This forms of nephropathies are frequently associated with arterial hypertension and loss of proteins in urine, both worsening factors for the progression of the pathology. Controlled clinical trials have demonstrated that specific treatments as for hypertension, with the use of drugs that reduces loss of urinary proteins, are useful to decrease the velocity of glomerular filtration decline.

In some cases, there have been stabilization or improvement of glomerular filtration. These treatments allowed to delayed the beginning of dialytic therapy or transplant resource.

Chronic Nephropathy progression monitoring and therapy assessment
It is important, therefore, to measure in which grade the results obtain in the controlled clinical trials are reached effectively in clinical practice. To achieved this goal, the “Remission Clinic” Network proposes to include trained specialists involved in the care of chronic renal diseases with the following objectives:

- implement updated information on this clinical problem
- coordinate and unified therapeuthic strategies in relation with actualized recommendations
- collect clinical data for assessment of therapy quality for the Network and singles centres Network

Registration to the Network
Registration to the Remission Clinic Network need confirmation through an email sent to remissionclinic@marionegri.it. It required: name and surname, address and telephone contact of the local principal investigator.

Tool for data collection
The Remission Clinic Network is based on the collection of data through an information system. The Network offers to the centres an online system for the collection and analysis of the clinical data or allows transference of data from existent information systems. The analysis and the use of data is in agreement with participants centres.

The Remission Clinic in low income countries
The International Remission Clinic program has been designed for both high-, medium-, and low-income countries. However, not all health systems allow free (or at very low cost) access to the classes of drugs proposed in the multi pharmacologic approach of the Remission Clinic protocol. Thus in some settings, patients can best afford long-term treatment with drugs such as ARBs, statins or other new agents. In this scenario, the physicians may prescribe generic drugs (usually cheaper than trade-name drugs), pending their efficacy and safety profiles is well documented. If this approach is not feasible, physicians should use an ACEi as first line drug to target proteinuria (ACEi up-titration if needed) combined with any other available cheap anti-hypertensive drugs to achieve blood pressure control ( < 120/80 mm Hg ).

Thus, patients classified in “Group I” at enrollment into the Remission Clinic will receive an ACEi, eventually just up-titrating the dose. Patients in “Group II” will remain on ACEi only and the drug dose will be gradually increased up to the maximum tolerated dose. Patients belonging to “Group III” at study entry, but unable to continue long-term ARB, will be shifted to an ACEi, up-titrating the drug dose if needed. Similarly, patients in “Group IV” (ACEi plus ARBs) at enrollment, unable to continue long-term treatment with ARBs, will remain on ACEi alone. The drug will be up-titrated to the maximum tolerated dose. Follow-up visits to assess response, tolerability and dose adjustment will be performed accordingly to the protocol described above.

© 2009-2019 Mario Negri Istitute  - All Rights Reserved - Credits