September 30, 2022

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Key points to treat “Kidney”  “Urine protein” “Blood creatinine” together

Key points to treat “Kidney”  “Urine protein” “Blood creatinine” together

 

Key points to treat “Kidney”  “Urine protein” “Blood creatinine” together.For a variety of kidney diseases, lowering urine protein and lowering blood creatinine can be performed at the same time, but you need to pay attention to 5 points!

Key points to treat "Kidney"  "Urine protein" "Blood creatinine" together


Patients with nephropathy who have only elevated urine protein but not elevated serum creatinine are relatively mildly ill. When an increase in urine protein of a patient with kidney disease and an excess of blood creatinine appear in the same patient with kidney disease at the same time, it usually indicates a serious or very serious condition.

Patients with nephropathy who have only elevated urine protein but not elevated serum creatinine are relatively mildly ill. When an increase in urine protein of a patient with kidney disease and an excess of blood creatinine appear in the same patient with kidney disease at the same time, it usually indicates a serious or very serious condition. At this time, the nephrologist should not only focus on urine protein or blood creatinine, but should consider the patient’s condition. A comprehensive analysis of the causes or triggers of elevated urine protein and excessive serum creatinine, and more importantly, is to figure out what kind of kidney disease is the primary cause of their elevated.

Generally speaking, when urine protein rises to a small amount of proteinuria and is accompanied by excessive blood creatinine, tubulointerstitial nephritis is often considered first, such as chronic drug-induced interstitial nephritis progressing to chronic renal insufficiency or acute drug-induced hypersensitivity. Acute kidney injury complicated by nephritis; increased urinary protein levels to moderate urinary protein levels accompanied by excessive blood creatinine levels, glomerulonephritis is usually considered first, such as IgA nephropathy Hass 4 (ie diffuse proliferative glomerulonephritis); If urine protein rises to a large proteinuria level and is accompanied by excessive blood creatinine, it should be considered as nephrotic syndrome, such as membranous nephropathy and minimal changes, as well as allergic purpuric nephritis and lupus nephritis.

Patients with nephropathy who have both urine protein and blood creatinine increase, should the urine protein be treated first, or the blood creatinine first? In addition to the elevated blood creatinine associated with chronic renal insufficiency, such as IgA nephropathy, membranous nephropathy, minimal change, allergic purpura nephritis and lupus nephritis, etc., just talk about which one is the first The “false proposition” means that there is no first lowering of urine protein or blood creatinine first, but by treating the primary disease, the patient’s urine protein and blood creatinine will then decrease, or even fall to the normal range.

And they have a common feature, that is, patients with elevated urine protein also have acute renal failure, and it is not “prerenal” related to hypovolemia or “postrenal” related to urinary tract obstructive diseases. , But “renal” acute renal failure related to glomerulonephritis.

For example, IgA nephropathy with a moderate or higher urine protein level combined with acute renal failure, minimal changes with large proteinuria levels and idiopathic acute renal failure with membranous nephropathy, high or high urine protein with allergic purpura nephritis Acute renal failure complicated by acute renal failure, and acute renal failure complicated by “Ⅲ+Ⅴ” or “Ⅳ+Ⅴ” type lupus nephritis with obvious urine protein.

Obviously, their urine protein and blood creatinine are both elevated. Its medication treatment should be aimed at its primary disease, namely IgA nephropathy, membranous nephropathy, minimal change, allergic purpura nephritis and lupus nephritis.

Because they have a common pathogenesis, that is, most glomerular diseases are immune-mediated inflammatory diseases, and the immune response is the initiating mechanism of glomerular diseases. On this basis, inflammation such as complement, cytokines and reactive oxygen species The mediator participates in causing glomerular damage, causing proteinuria and increased serum creatinine.

Therefore, treatment requires the use of glucocorticoids and immunosuppressive drugs that are effective against immune inflammation. Suitable hormones and immunosuppressants can be selected according to their respective conditions, such as methylprednisolone, methylprednisolone, and acetic acid Nisone, mycophenolate mofetil, hydroxychloroquine, leflunomide, tripterygium glycosides and Kunxian capsules, etc., and biological agents such as rituximab and belimumab can also be selected.

However, it is possible to simultaneously reduce urine protein and blood creatinine for the above kidney diseases. The following five points should be noted.


1. It is necessary to determine that the increase in blood creatinine is acute

Patients with kidney disease have high urine protein, and the increase in serum creatinine is acute, and it is possible to decrease it before they can “use” or “dare to use” glucocorticoids and immunosuppressants. If the increase in blood creatinine is chronic and there are no acute or aggravating factors, it will not only fail to lower blood creatinine, but it may bring serious consequences, including the continued increase in blood creatinine and various side effects caused by drugs.


2. Exclude prerenal and postrenal acute kidney injury


Prerenal acute kidney injury is mainly caused by acute bleeding, severe diarrhea, excessive sweating, and severe water loss caused by various other reasons. Postrenal acute kidney injury is mainly caused by stones, tumors, blood clots, and prostate hypertrophy. The drainage pathway is blocked. These two types of blood creatinine increase cannot be used to reduce creatinine with the above treatment methods. Therefore, these two reasons need to be excluded.


3. People with infectious diseases should fight infection first

Before determining the use of glucocorticoids and immunosuppressive drugs to reduce urine protein and blood creatinine at the same time, it is necessary to find out whether there are infectious diseases, especially bacterial infectious diseases. If there is an infectious disease, active anti-infective treatment should be given first, and further treatment can be adopted after the infection is completely cured.


4. The use of hormones and immunosuppressants is not the whole treatment


Nephropathy has both high urine protein and excessive serum creatinine, and the patient’s condition is often “complex”, usually accompanied by abnormalities in other indicators, such as low plasma albumin, hyperlipidemia, immunodeficiency, hypercoagulability and Blood electrolyte disorders, etc., this requires the use of hormones and immunosuppressive therapy, but also must be combined with treatments such as anticoagulation, lipid lowering, correcting electrolyte disorders, and enhancing immune function. Even the use of hormones and immunosuppressants to reduce protein and creatinine is not the whole treatment.


5. Long-term medication is usually needed to consolidate the effect

Different from the increase in blood creatinine caused by prerenal and postrenal acute kidney injury, the treatment of increased blood creatinine and urine protein caused by glomerulonephritis in renal acute kidney injury usually requires long-term medication, perhaps 4 6 weeks or 2-3 months of medication can reduce urine protein and blood creatinine to normal or basically normal range, but after that, medication is still needed to consolidate the effect, in order to ensure a good long-term effect.

Conclusion:

IgA nephropathy, membranous nephropathy, minimal change, allergic purpura nephritis and lupus nephritis, and other glomerular diseases, may have increased urine protein and serum creatinine, and “glucocorticoids and immunosuppressants” are mainly used The treatment plan of “lowering urine protein and lowering blood creatinine” can be performed at the same time, but the above five points should be noted.

 

(source:internet, reference only)


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