Focus on proteinuria.

The treatment of glomerular proteinuria may be directed at: (1) control of basic disease processes; (2) interference with mediator systems; (3) modulation of the physiological determinants of glomerular permselectivity. Glucocorticoids and immunosuppressant agents largely exert their putative beneficial effects through actions on basic processes. Agents which affect mediator systems show great promise but the multiplicity of mediators may frustrate therapeutic efforts. Altering the physiologic determinants of proteinuria, as with diet, angiotensin-converting enzyme inhibitors and nonsteroidal anti-inflammatory agents may be quite useful. The antiproteinuric effects of these maneuvers may not only reduce the impact of proteinuria per se but also retard the rate of progression of renal failure which so frequently accompanies many of the states of abnormal glomerular proteinuria.