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5 tips to ensure good efficacy of nephrotic syndrome
5 tips to ensure good efficacy of nephrotic syndrome. Nephrotic syndrome (NS) should not be satisfied only with quick remission (the short-term effect is better), but at the same time it should be guaranteed not to be repeated after the cure (the long-term effect should also be good), which needs to be considered at the beginning of the medication.
Nephrotic syndrome (NS) is one of the most common diseases among hospitalized patients in nephrology, and most of them require renal puncture for pathological diagnosis. In primary nephrotic syndrome (PNS), the common pathological types are minimal change (MCD), membranous nephropathy (MN), mesangial proliferative nephritis (MsPGN), mesangial proliferative nephritis (MPGN) and focal nodules Segmental glomerulosclerosis (FSGS) and so on.
The diagnosis of idiopathic membranous nephropathy (IMN) can also be made through blood sampling to check the anti-M-type phosphatase A2 receptor (PLA2R) antibody, without renal puncture. The diagnosis of secondary nephrotic syndrome requires a comprehensive examination and condition analysis of the patient before the final diagnosis can be made.
Nephrotic syndrome (NS) is a clinical diagnosis, and it is consistent with the 24-hour urine protein quantification (adults) ≥ 3.5 g and plasma albumin ≤ 30 g/L of kidney disease, can be diagnosed as nephrotic syndrome, and high edema and hyperlipidemia Not a requirement. That is, patients with nephrotic syndrome can show “three highs and one low” (high urine protein, high edema, hyperlipidemia, and low plasma albumin), but not all of them show “three highs and one low”, and some can be expressed as “One high and one low” (high urine protein and low plasma albumin).
The ultimate goal of treatment is to reduce urine protein and correct plasma albumin, protect kidney function and prevent recurrence. This is because long-term proteinuria is not only the loss of nutrients, but also promotes progressive damage to kidney function. Plasma albumin has been at a low level for a long time, which is not only a problem of malnutrition, but also life-threatening thrombosis and embolic diseases. Therefore, it is necessary to grasp the key points in the treatment to ensure a good treatment effect. There are many tricks in this.
The following five tips are the key to ensuring the good curative effect of nephrotic syndrome. It can be said that this is the three correctness of reducing protein, protecting the kidney and preventing recurrence.
Tip 1: Treat the underlying disease and urine protein at the same time
Membranous nephropathy (MN) in primary nephrotic syndrome is the underlying disease, and lupus nephritis (LN) in secondary nephrotic syndrome is the underlying disease. The large amount of proteinuria and underlying diseases that they exhibit should be treated. And it should be treated at the same time.
Glucocorticoid is one of the drugs of choice for the treatment of nephrotic syndrome (NS). It can reduce urine protein during the treatment of nephrotic syndrome (NS). In other words, the use of glucocorticoids is to treat the underlying disease and to reduce urine protein.
If after using hormones, the patient’s urine protein still does not fall to normal, and when it is necessary to increase protein-lowering drugs (such as tripterygium wilfordii polyglycoside tablets), the underlying disease must also be considered. In a word, the use of any drug should consider the treatment of the underlying disease and urine protein at the same time, so as to protect and have a better effect.
Tip 2: The treatment of primary disease and complications are sequential
The occurrence and development of nephrotic syndrome (NS) is a dynamic process, and complications can occur at the beginning of the disease. Without timely treatment or in the course of treatment, as the disease progresses, such as hypertension (renal hypertension), electrolyte disorders (such as hyponatremia, hypokalemia, hypochloremia, hyperkalemia, etc.) ), various complications such as thrombosis and embolic diseases (low extremity vein thrombosis and renal vein thrombosis, etc.).
It is necessary to take measures to treat these complications during the treatment of the primary disease. Treat the complications first, and treat them later. It may even require preventive use of certain drugs (such as anticoagulants) to reduce the possibility of Various complications occurred. Antihypertensive therapy, correction of electrolyte imbalance and anticoagulation therapy are the key areas that need attention, which also play a certain auxiliary role in reducing protein and protecting the kidneys.
Tip 3: The basic treatment and the palliative treatment complement each other
The use of hormones and immunosuppressive agents is to treat the root cause, because immune inflammation is the pathogenic mechanism of nephrotic syndrome (NS); the use of diuretics and the correction of electrolyte disorders are the symptoms of treatment, which is due to edema and hypokalemia Hyperemia or hyponatremia are signs of nephrotic syndrome (NS).
The use of hormones and immunosuppressive agents to treat the root cause is to finally eliminate the various abnormal manifestations of nephrotic syndrome. The use of diuretic drugs and other palliative treatments can reduce symptoms and maximize the efficacy of the root cause drugs. Therefore, the permanent treatment and the palliative treatment are complementary, and both need and are indispensable, so as to ensure a better curative effect. At the same time, it is also the three correctness of reducing protein, protecting the kidney and preventing recurrence.
Tip 4: Use immunosuppressants and improve immunity simultaneously
Drugs such as glucocorticoids and immunosuppressive agents will have a relatively large inhibitory effect on the immune function of patients with kidney disease, leading to a further decline in their immunity, which is manifested as a decline in factor B, a low blood IgG level, a decline in white blood cell function, and low transferrin and Hypozincemia and so on. Nephropathy patients with weakened immunity are more likely to develop infectious diseases, and infectious diseases in turn affect or aggravate the condition of patients with nephrotic syndrome (NS).
Therefore, it is necessary to improve the patient’s immunity while using immunosuppressive agents. Several methods can be adopted: do not use hormones and immunosuppressants for a long time or in large doses as much as possible, and do not use multiple immunosuppressants at the same time. At the same time, add cordyceps preparations and traditional Chinese medicine to enhance immune function, and take personal protection at ordinary times. Prevent colds and other infectious diseases.
Tip 5: Consider both short-term and long-term effects
Nephrotic syndrome (NS) should not be satisfied only with quick remission (the short-term effect is better), but at the same time it should be guaranteed not to be repeated after the cure (the long-term effect should also be good), which needs to be considered at the beginning of the medication.
Patients using glucocorticoids (such as methylprednisolone) should start using sufficient doses, the total treatment time should be sufficient, the reduction after remission should be slow, the condition should be maintained for a long time after the disease is stable, and the drug should be stopped after the cure for a long time. For patients with toxic drugs (such as cyclophosphamide), the total dose for adults should not be less than 6000mg; for patients with immunosuppressive agents (such as tacrolimus), the blood concentration at the beginning of treatment must be up to standard; use integrated traditional Chinese and western medicine treatment For the patients, the initial treatment should be based on western medicine and western medicine and supplemented by the treatment of traditional Chinese medicine. The treatment in the recovery period should be mainly based on the treatment of traditional Chinese medicine and the treatment of western medicine and western medicine.
In this way, it can not only protect and have a good short-term effect, but also have a good long-term effect.
Mastering the above five tips is the key to ensuring good results in the treatment of nephrotic syndrome
(source:chinanet, reference only)