, several small series and a number of case reports (100–150 patients) of the use of plasmapheresis (plasma exchange) in the treatment of BP. The regimens used, the additional therapy, and the results have been very variable. There is no evidence to support the use of plasmapheresis in routine treatment of BP, although at low corticosteroid doses a steroid-sparing effect was seen ( Strength of recommendation D, Quality of evidence II-i ). There may be a limited role for plasmapheresis in resistant cases of BP where side-effects are a major issue or the disease is uncontrolled 48 ( Strength of recommendation B, Quality of evidence III).
References: 1. Bikowski J, Pillai R, Shroot B. The position not the presence of the halogen in corticosteroids influences potency and side effects. J Drugs Dermatol . 2006;5(2):125-130. 2. Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. J Am Acad Dermatol . 2005; 53(1 Suppl 1):s50-s58. 3. US Food and Drug Administration NDA 017765. Promius Pharma, LLC, Princeton, NJ: Aug 1977. 4. Rosenthal AL. Clocortolone pivalate: a paired comparison clinical trial of a new topical steroid in eczema/atopic dermatitis. Cutis . 1980;25(1):96-98. 5. Kircik LH. A study to assess the occlusivity and moisturization potential of three topical corticosteroid products using the skin trauma after razor shaving (STARS) bioassay. J Drugs Dermatol . 2014;13(5):582-585. 6. Cloderm [package insert]. Princeton, NJ: Promius Pharma, LLC; 2017.
Before treating proteinuria, a proper diagnosis must be established to determine the primary cause. Commonly, proteinuria is a symptom of diabetic nephropathy, therefore, proper glycemic control must be observed to slow the progression of the condition. Typically, medical management involves angiotensin converting enzyme inhibitors as the first-line medication for proteinuria. In some instances when ACE inhibitors cannot control proteinuria, the patient is given angiotensin receptor blocker or aldosterone antagonist such as spironolactone to help in protein retention. If ACE inhibitor therapy is combined with these agents, caution must be observed as there is a risk of developing hyperkalemia. If proteinuria has an autoimmune origin, steroids and steroid-sparing agent in combination with the use of ACE inhibitors are used. In supplement to blood sugar and blood pressure control, dietary salt and protein is restricted. A dietician may be consulted for a healthy eating plan.