Friday, July 27, 2012

Treat different types of lupus nephritis


Treatment of lupus nephritis keep type matching issues of concern are the majority of patients, Shijiazhuang kidney disease hospital for brief treatment of lupus nephritis keep matches the type of
Cytotoxic drugs in the treatment of the beginning of the application, can also be added with the hormone is not satisfied with the results. Studies have shown that, added to enhance the efficacy of cytotoxic drugs can reduce the hormone dosage. To cyclophosphamide (CTX) pulse therapy, 750mg/M2 in normal saline slow intravenous infusion in more than one hour, 1 time / month, once every six months. Timely treatment is critical to improve the prognosis of patients with lupus nephritis. Traditional medicines in the treatment of lupus nephritis is a hormone, its dosage should be based on the extent of clinical manifestations and histological changes. Clinical practice, the combination of cytotoxic drugs than simply better the effect of hormone therapy. (1) lupus nephritis workers do not require special treatment, follow-up observation. (2) lupus nephritis type Ⅱ Ⅱ a type only some mild mesangial lesions without treatment; Ⅱ b lesions with proteinuria more than] g/24h serum high titers of anti-dsDNA and low C3 complement The hyperlipidemia prednisone 20mg / d, once every six weeks - 3 months, after reduction to maintain. (3) the same lupus nephritis III type and type Ⅳ two types of treatment options, the prognosis is similar. Because the incidence of ESRD in 10 years up to 50% or more, it should strengthen treatment. 1) glucocorticoids: prednisone-based drugs, conventional dosage of 0,8-1mg, kg_1, d_1, after 8 weeks of treatment, tapering, the reduction rate must be controlled, maintenance treatment to 10_20mg / d for at least two years. Methylprednisolone pulse necessary to give 0,75 g, m2_1 d_1 infusion for three consecutive days as a course. Methylprednisolone followed by prednisone maintenance therapy, efficacy, side effects. Need to be adjusted when the following conditions occurs glucocorticoid medication: difficult to control diabetes or high blood pressure, severe osteoporosis, steroid psychosis, severe infection and severe myopathy. 2) cytotoxic drugs: even without cytotoxic drugs, glucocorticoid treatment of proliferative glomerulonephritis, the treatment more fully in combination with cytotoxic drugs, but cytotoxic drugs often take 3-4 months before onset. Cytotoxic drugs in the treatment of the beginning of the application, can also be added with the hormone is not satisfied with the results. Studies have shown that, added to enhance the efficacy of cytotoxic drugs can reduce the hormone dosage. To cyclophosphamide (CTX) pulse therapy, 750mg/M2 in normal saline slow intravenous infusion in more than one hour, 1 time / month, once every six months. The absence of disease activity every three months the impact of a stable after treatment for 1-2 years may be considered withdrawal. Side effects: In addition to the common side effects, but also the occurrence of menstrual disorders (16% -20%), reproductive failure (19%), hemorrhagic cystitis (17%), bladder (2%). Used in conjunction with small doses of glucocorticoids can enhance efficacy and reduce toxicity. CTX medication need to be adjusted in the following circumstances: refractory hemorrhagic cystitis, severe nausea, vomiting, radiotherapy, previous history of cancer, bone marrow suppression caused by reduced blood cell damage resulting from blood (peripheral blood cells decreased excluded).

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