Therapeutic principle of mesangial proliferative glomerulonephritis2017-05-21 15:34
Mesangial proliferative glomerulonephritis is a pathological diagnosis of glomerulonephritis characterized by diffuse glomerular mesangial cell proliferation and / or increased mesangial matrix. Caused by a variety of causes, with varying clinical conditions.
(1) prevention and treatment of infection, removal of inducements: positive symptoms such as upper respiratory tract infection should be treated actively. For patients with isolated or recurrent gross hematuria, tonsillectomy is feasible if necessary.
(2) symptomatic treatment: including diuresis, control blood pressure and so on.
(3) reducing proteinuria and protecting renal function: angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor antagonists (ARB) are available. Pay attention to regular monitoring of blood pressure and renal function.
Treatment was performed according to clinical manifestations and pathological changes
(1) the clinical manifestations of simple hematuria, pathological changes of mild mesangial proliferation in MsPGN patients, the prognosis is good, no special treatment, should avoid infection of the upper respiratory tract, blood pressure control, so as not to accelerate the disease progress.
(2) for MsPGN patients with nephritic syndrome and mild to moderate mesangial hyperplasia, ACEI/ARB was the first treatment. For clinical manifestations of nephrotic syndrome, according to the severity of the disease, different treatment options should be adopted, and appropriate use of hormones or combination of immunosuppressive agents, to reduce proteinuria and reduce kidney pathological changes.
(3) hypertension and chronic renal insufficiency in patients with MsPGN, the pathological changes were accompanied by severe mesangial proliferation, mesangial sclerosis or glomerular sclerosis, tubular atrophy, interstitial fibrosis, the response to hormone therapy is poor, poor prognosis. Such patients should strictly control blood pressure, use ACEI/ARB drugs and anticoagulant or antiplatelet therapy, according to chronic nephritis treatment, in order to protect renal function and delay the progression of kidney disease.
The prognosis was mainly related to the clinical manifestations, the degree of renal pathological changes, and the response to treatment. Most patients with mild pathological MsPGN have a better prognosis and respond well to treatment, but some patients are prone to relapse. The prognosis of the patients with high blood pressure, renal impairment, persistent proteinuria, insensitivity to hormone therapy, and pathological changes of kidney is severe mesangial hyperplasia with sclerosis.