What is the nephrotic syndrome? What are the medical treatme2017-01-24 11:09
What is the nephrotic syndrome? What are the medical treatments for this disease?
Nephrotic syndrome (NS) may be caused by a variety of causes, the glomerular basement membrane permeability increased, manifested as proteinuria, hypoalbuminemia, edema, hyperlipidemia is a clinical syndrome.
Nephrotic syndrome (nephroticsyndrome, NS) is a common clinical syndrome and its diagnostic criteria: proteinuria (>3.5g/24hr); the serum albumin <30g/L 3 4; edema; hyperlipidemia. The first two conditions for diagnosis. NS is pided into two categories: primary and secondary. In this paper, we mainly focus on the treatment of primary NS.
(a) symptomatic treatment
1, low salt diet: edema should be low salt (<3g/d).
2, diuretic swelling:
Thiazide diuretics: suitable for mild edema patients, commonly used hydrochlorothiazide once 25mg, 3 times a day, long-term use should be to prevent hypokalemia, hyponatremia.
The retention of potassium diuretics: suitable for hypokalemia, commonly used spironolactone 20mg once a day, 1 ~ 2 times; or triamterene 50mg once a day, 1 ~ 2 times. Diuretic alone was not significant and could be used in combination with thiazide diuretics. The long-term use of the need to prevent hyperkalemia in patients with renal insufficiency should be used with caution.
The loop diuretics: suitable for moderate and severe edema were common furosemide 1 20 ~ 120mg, 1 ~ 5mg or bumetanide a day, orally or intravenous injection. Loop diuretics should beware of hyponatremia and hypokalemia, hypochloremia alkalosis.
The dextran or plasma substitute commonly used: sodium dextran 40 (low molecular dextran) or hetastarch (706 generation plasma, a molecular weight of 25 thousand ~ 45 thousand), a 250 ~ 500ml intravenous drip, 1 times a day. S with loop diuretics can enhance the diuretic effect. But the oliguria (1 urine <400ml) patients should be used with caution or avoid. NS patients to avoid excessive diuresis and excessive, so as not to cause the lack of blood volume, increase the tendency of high blood viscosity, thrombosis, embolism complications.
3, reduce urinary protein: ACEI or ARB has no dependence on reducing systemic blood pressure to reduce the role of urinary protein, the application of its urine protein, the dose should be larger than the conventional antihypertensive dose, in order to obtain good results. A serious shortage of blood volume or the application of strong diuretic should be used with caution, so as not to induce acute renal insufficiency.
(two) anti-inflammatory and immunosuppressive therapy
1, glucocorticoid hormone: by inhibiting inflammation, immune response, inhibition of aldosterone and vasopressin secretion, influence glomerular basement membrane permeability and the comprehensive effect of diuresis and elimination of urine protein effect. The use of principles and programs:
The amount of initial: commonly used drugs for the prednisone 1mg/kg day, orally for 8 weeks, when necessary, may be extended to 12 weeks; focal segmental glomerular sclerosis patients should be extended to 3 to 4 months.
The slow reduction: 10% every 2 to 3 weeks Jianyuan dosage sufficient after treatment, when reduced to 20mg/ when the symptoms should be more easily repeated, slow reduction.
Long term maintenance: the last effective dose (10mg/ days) to maintain about half a year. Can take orally or in full amount of maintenance medication during the two day of the next day a single service, to reduce the side effects of hormone. Edema serious, liver function damage or prednisone poor efficacy, can be replaced with P Nixonn Ron (dose) or Kap Ni Ron (Kap Ni Ron 4mg is equivalent to 5mg of prednisone) oral or intravenous drip. Dexamethasone has a long half-life and side effects.
According to the treatment of patients with response to glucocorticoids, which can be pided into "hormone sensitive" (after 8 ~ 12 weeks, NS response) "hormone dependent type" (to a certain extent that hormone reduction and steroid resistant relapse) "(treated) three categories, each into a step difference treatment.
Patients with long-term use of hormones may be infected, drug-induced diabetes, osteoporosis and other side effects, a small number of cases may also occur avascular necrosis of the femoral head, need to strengthen monitoring, timely treatment.
2, immunosuppressive drugs can be used for "hormone dependent" or "hormone resistance" in patients with hormone therapy. If there is no hormone contraindications, generally not as the first choice or treatment alone.
(1) cyclophosphamide is the most commonly used cytotoxic drugs at home and abroad, by hepatic microsomal hydroxylation in vivo, produce metabolites of alkylation and has strong immunosuppressive effects. The application of a dose of 2mg/kg, 1 to 2 times a day orally; or a 200mg day, intravenous injection of 1 times. Cumulative amount of 8 ~ 10g after drug withdrawal. The main side effects were bone marrow suppression and toxic liver damage, and gonadal inhibition (especially male), alopecia, gastrointestinal reaction and hemorrhagic cystitis.
(2) selective inhibition of adjuvant T cells and cytotoxic effect of T cells, as second-line drugs for the treatment of hormone and cytotoxic drugs ineffective NS. Commonly used amount of 3 to 5mg/kg a day, pided into oral fasting for 2 times, taking medication during the monitoring and maintenance of the blood concentration of the valley for the value of 100 ~ 200ng/ml. Medication 2 to 3 months after the slow reduction, treatment for six months to one year. Side effects of liver and kidney toxicity, hypertension, hyperuricemia, hirsutism and gingival hyperplasia. Easy to relapse after stopping the drug is the inadequacy of the drug.
(3) mycophenolate mofetil (mycophenolatemofetil, MMF) in vivo metabolism of mycophenolic acid, the inosine monophosphate dehydrogenase inhibitor, classic synthesis pathway inhibitory guanine nucleotide, therefore, selective inhibition of T proliferation and antibody B lymphocytes to achieve the purpose of treatment. Commonly used for a day 1.5 ~ 2G, pided into 2 oral, sharing from 3 to June