Increase in serum creatinine level Caused by decreased glomerular Monitor serum creatinine level closely filtration rate due to during initial 3-4 weeks of therapy decreased intraglomerular and after each dose increase.
The stress of increased renal blood flow and inability of the glomerulus to regulate intraglomerular pressure, which normally remains unaltered during pregnancy, may exacerbate renal damage in pre-existing disease.
This may be straightforward if there is clear evidence of new active inflammation manifested by a new rise in the serum creatinine concentration, and recurrence of red blood cells and red cell casts in the urine sediment; however, tissue biopsy may be required in some patients to verify recurrent vasculitis rather than, for example, pulmonary infection or nonimmunologic progression of renal disease from glomerular ischemia and subsequent glomerulosclerosis during the healing phase or from nephron loss from glomerular hypertrophy and intraglomerular hypertension in the remaining functioning glomeruli.
12) There may be other preceding transient intraglomerular events that may also play a role, such as herniation of glomerular tuft into the origin of the tubule, formation of glomerular tip lesions with associated sclerosis of nearby capillary loops, and damage to the beginning of the proximal tubule.
11,14) This results in the persistence of autoreactive T cells and allows the release of structurally abnormal nucleosomes, as well as excess intraglomerular generation of nucleosomes that contribute to glomerular immune deposits.