Friday, August 3, 2012

Treatment principle for nephrotic syndrome

Nephrotic syndrome, referred to as "renal comprehensive" (the abbreviation NS), is a clinical syndrome caused by a variety of reasons. It is not an independent disease, but many risk factors, the permeability of the glomerular capillary filtration membrane by injury, massive proteinuria is one of the main features of a syndrome.

Nephrotic syndrome manifested as massive proteinuria (Adult: 3.5g / d; Children ≧ 50mg / (kg · d)), hypoalbuminemia (<30 g / L), varying degrees of edema, high blood lipids ( commonly known as the "three high and one low) and because of proteinuria caused by other metabolic abnormalities. Nephrotic syndrome secondary to many diseases. Although the cause of the cause of the nephrotic syndrome, but are caused by the loss of large amounts of protein in the urine of the mutual impact of clinical and laboratory abnormalities. Therefore, lost a lot of protein in the urine is the decisive factor leading to changes in the nephrotic syndrome series. Massive proteinuria and hypoalbuminemia is not only the main features of the nephrotic syndrome, the main basis of the clinical diagnosis of nephrotic syndrome.

Nephrotic syndrome of primary and secondary points, the former more than the incidence of upper respiratory tract infection, was divided into type I and type Ⅱ; the latter is seen in diabetic nephropathy, renal amyloidosis, lymphoma, lupus nephritis, allergic purpura kidney, hereditary nephritis. The principles of treatment measures are as follows:

(1) general measures in order to rest and avoid strenuous exercise. Edema of bed rest; edema, indoor activities; urine protein g / d, you can restore an appropriate outdoor activities. Should be given to low-fat and adequate protein and calorie diet, protein may be a day 1.5g / k the amount of supply of heat may be a day 125 ~ 167kJ/kg supply. Edema, salt intake should be limited to, day 2 ~~ 3g. Appropriate to add calcium, iron and vitamin B, and D and folic acid and so on.

(2) prednisone treatment programs adrenal cortical hormone, is still the main drug in the treatment of nephrotic syndrome, one of the most commonly used is prednisone. Conventional prednisone treatment program, the initial dose daily 1mg/kg, 6 to 8 weeks to obtain the efficacy to reduce, as ordered, sequential, in order to reduce the occurrence of side effects.

(3) the application of cyclophosphamide for hormone invalid and frequently relapsing children and adult patients with nephrotic syndrome, can be used cyclophosphamide treatment has some effect. Dose prescribed by a doctor, should pay attention to the prevention and treatment of side effects.

(4) diuretics and albumin, diuretics applications, visualization edema. Light, single-use restrictions to control the salt intake; severe edema, and a variety of diuretics available in recent years, commonly used furosemide (furosemide). Greater than conventional-dose intravenous or several diuretics can enhance the diuretic effect. Such as intravenous albumin given furosemide (furosemide), more can enhance the diuretic effect.

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