I'm sorry to hear of this with Pebbles, Dr. Levy. Here's a synopsis of the current therapy for glomerulonephritis - the most devastating sequela of Lyme nephropathy...
1) The underlying infection must be addressed directly with doxycycline dosed at 10 mg/kg orally every 12-24 hours or amoxicillin dosed at 11 mg/kg every 8-12 hours. Treatment is continued for 4 weeks to try to eliminate the carrier state.
2) If respirations are compromised by large volume pleural effusion or severe ascites, centesis is indicated.
3) Oxygen support may be required for dogs with pulmonary embolism.
4) Proteinuria reduction via ACE inhibitor treatment consists of enalapril at 0.5 mg/kg orally every 12-24 hours or benazepril at 0.5 mg/kg daily up to a maximum of 2 mg/kg daily.
If proteinuria persists despite ACE inhibition, I consider adding angiotensin II receptor antagonists.
5) If hypertension perists despite ACE inhibitor use, calcium channel blockers may be indicated.
6) Anticoagulant therapy should be considered to reduce the risk of thromboembolic disease.
7) Uremic dogs may require fluid therapy.
8) Immunosuppressive treatment may be useful in ~50% of protein losing nephropathy cases.
The prognosis is best if the Borrelia can be eliminated. If that's not possible - and that's often the case - survival is variable but disease is usually progressive over months to 1-2 years. The prognosis is worse when azotemia/uremia is/are present at diagnosis. In general, the prognosis is poor when glomerulonephropathy is associated with borreliosis. Please respond with further questions or concerns if you wish.