The treatment options of acute nephritis2017-03-06 14:34
The disease has a rapid onset, rapid progression, rapid deterioration and high mortality. Principles for early diagnosis, adequate treatment, and targeted combination therapy. To treat acute and chronic glomerular injury. A large number of crescents and fibrinoid necrosis, suggesting that lesions in the active stage, should be active in the treatment of fibrous crescents and tubulointerstitial fibrosis, suggesting that disease in chronic period, should pay attention to the protection of renal function; accompanied by systemic symptoms should be used cyclophosphamide and methylprednisolone (methylprednisolone) control the symptoms as soon as possible.
1 acute stage treatment
The key to the treatment of acute stage is to diagnose as early as possible, and to give timely measures to suppress the immune response and inflammatory process. According to the report, 339 cases of acute nephritis inflammation inhibitor strengthening treatment before 73% death or death (kidney dialysis and survival). The 5 year survival rate after treatment (not dependent on dialysis) reached to 60% ~ 80%, of which a group of 42 cases in the treatment of the patients (76%) after treatment, so that the effectiveness of modern treatment measures. Specific treatment methods are as follows:
(1) shock therapy
Corticosteroids and immunosuppressive drugs
On the basis of conventional therapy of steroid hormone and cytotoxic drugs on treatment with methylprednisolone, methylprednisolone is 1g or (15 ~ 30mg/kg) dissolved in 5% glucose solution 150 ~ 250ml, 1 ~ 2H intravenous infusion, 1 times /d, 3 times for a period of 3 to 4 days interval repeat 1 ~ the 2 course of treatment, during treatment and after treatment with prednisone (prednisone) 1mg/ (kg - D) orally maintenance treatment. 70% patients can get out of dialysis and maintain normal renal function for more than two years. Combined use of cyclophosphamide (CTX) high dose shock therapy can improve the curative effect, improve renal function, reduce urinary protein and reduce the number of cell crescent. Cyclophosphamide (CTX) dosage of 0.5 ~ 1g/m2 body surface area, a total of 1 times a month, a total of 6 ~ 12 times.
Plasma exchange therapy
This therapy is by releasing a large number of patients with anticoagulant blood after centrifugation or fiber membrane pore size of ultrafiltration, separated the plasma and blood cells and the plasma removal, each 2 to 4L every day or every other day, and then add the same amount of healthy fresh plasma or other substitutes. This method can remove the antigen, antibody, immune complex and inflammatory mediators in the circulation, enhance the phagocytic function of reticuloendothelial system, improve the stability of internal environment, conducive to disease recovery. Good plasmapheresis type effect, especially in the early stage of type I disease, not to oliguric renal failure, serum creatinine 530 mol/L (6mg/dl) before starting treatment, the circulating antibodies in 1 ~ 2 weeks away, the majority of the condition can be improved. Application of this therapy, the use of steroids and cytotoxic drugs to prevent recurrence of the disease. Commonly used drugs for prednisone (prednisone) 60mg/d, cyclophosphamide 3mg/ (kg - D) or azathioprine (kg 2mg/ D). Immunosuppressive drugs should be reduced in patients over 50 years of age.
Recurrence after transplantation is a problem that should be paid attention to. In type I, the recurrence rate was 10% to 30%. Therefore, it should be in the condition of stability after half a year of kidney transplantation. Type I patients should monitor blood titer of anti GBM antibody, and then continue to the drug to normal after several months, the recurrence rate is reduced to below 10%. In addition, the level of blood ANCA should be monitored to determine the time of drug withdrawal and transplantation.
2 treatment of recurrence and exacerbation
Type I and type III of this disease often recur after clinical remission, which can occur in a few months or years. Recurrence after repeated treatment can still be alleviated again. In the course of treatment, the disease is often associated with infection, it is necessary to actively eliminate infection and control infection.
3 chronic phase treatment
This lesion can control the disease activity, but cannot prevent the disease to chronicity (glomerular sclerosis, renal tubular atrophy and interstitial fibrosis) development. For the chronic disease of judgment, not only by the length of the course, does not depend on whether clinical oliguria and renal failure, because some patients within weeks to end-stage renal failure, clinical manifestations and pathological changes are not consistent. Therefore, whether or not to enter the chronic phase of the disease depends on whether the chronic changes in the pathological changes are dominant.