Friday, August 3, 2012

Treatment Principles for chronic nephritis


Chronic glomerulonephritis referred to as chronic nephritis is proteinuria, hematuria, hypertension, edema associated with slower progression of renal dysfunction for clinical characteristics of a group of glomerular diseases. Diversification of different pathological type, duration and onset of clinical manifestations, the symptoms may all have, or only a part of. Most persistent disease, the slow progress of the lesions of some patients with acute exacerbation and progress. Chronic nephritis can occur at any age, young or middle age males. Multi-onset slowly, the occult, history for years. Condition when the light weight, the progressive development of chronic renal failure.


Of patients with early weakness, fatigue, back pain, loss of appetite and other symptoms, edema dispensable, and usually not serious. Some patients may have no obvious clinical symptoms, which we call the "silent period". More than a urine test abnormalities in laboratory tests, proteinuria persists, usually less than 3.5g / d in the range of non-nephrotic syndrome, and there are varying degrees of glomerular hematuria and tube. Blood pressure may be normal or slightly elevated. With normal renal function or mild impairment (endogenous creatinine clearance rate or mild azotemia) for several years or decades, renal function gradually deteriorated and the corresponding clinical manifestations, such as: anemia, blood pressure increased, and eventually developed into uremia.


The treatment of chronic nephritis, in order to prevent or delay kidney function deterioration, improve and relieve symptoms and prevent complications as the main purpose. General comprehensive prevention and control measures and prevention principles are as follows:


(1) general principles of the measures of chronic nephritis, long duration, the condition is often repeated, to encourage patients to enhance the confidence to overcome the disease.


Should work and rest have degrees. Serious illness, bed rest should be obvious clinical manifestations. Stable condition, may be appropriate to get out of bed; mild, may be appropriate to do some light work or work, study, recovery of the disease.


Dietary salt restriction and control of protein intake. The diet should be given a high quality protein, according to the degree of renal dysfunction to control protein intake, and general control in the daily 30g ~ 40g, and appropriate to fill the shortage of kidney spirit (α-keto acids) or the kidney will be ammonia, to supplement the body of essential amino acids . Low-protein diet may be appropriate to increase the intake of carbohydrates (sugars) in order to prevent negative nitrogen balance. Massive proteinuria but normal renal function should be to relax the protein intake, but not more than the intake of daily 1g/kg.


(2) to prevent the occurrence of renal damage factors for upper respiratory tract infection, catching a cold, should be actively treated to prevent their entry into the renal toxicity of drugs or poisons, Hyperlipidemia, hyperglycemia, hyperuricemia and other symptomatic treatment to prevent the above factors further aggravate kidney damage.


(3) active control of hypertension, angiotensin-converting enzyme inhibitors (ACEI) and calcium channel blockers, to treat renal Pi hypertension and renal function deterioration. β-blockers, renin-dependent hypertension, there are good results. These drugs are fat-soluble, and from renal excretion, so Renal insufficiency, the dosage should be adjusted, and extend the treatment time.


(4) of anticoagulation and antiplatelet agents and the application of these drugs has a good stable renal function, reduce the role of the renal pathological damage. When the patient has a clear hypercoagulable state and certain pathological types could easily cause a hypercoagulable state, such as membranous nephropathy, mesangial capillary proliferative glomerulonephritis, and so on, can a long time.


(5) the application of hormones and cytotoxic drugs that generally do not advocate the application of these two types of drugs. But others believe that, with normal renal function, normal kidney size, such as mild mesangial proliferative nephritis and $ contraindications, you can use these two types of drugs, ineffective can be removed gradually.

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