Fourth, the department diagnosis:
IGA nephropathy in renal biopsy specimens in diagnosis relies on pathological examination of the immune excellent, that is associated with glomerular capillary wall membrane area or based in Hangzhou, IgA immunoglobulin-like particles or clumps samples were deposited. Primary diagnosis of human IgA nephropathy, we must rule out cirrhosis, such as Henoch-Schonlein purpura due to secondary IgA deposition heart disease was established only after the meeting.
Fifth, treatment and prognosis, Dr.:
IgA nephropathy is the focus of pathology of renal immune same, but the particular clinical manifestations, pathology and prognosis of great variation of primary glomerular disease, its treatment should be accomplished according to the different projects promoted clinical, pathological comprehensive adhere to give a reasonable medical treatment.
First, hematuria, or (and) with mild proteinuria (<lg / d) no special treatment is generally known, to avoid fatigue, prevent colds and to avoid the use of nephrotoxic drugs. For tonsil surgery maternity repeated infection should be removed, can reduce the occurrence of gross hematuria, lower serum IgA levels, some patients can reduce urinary protein. But the surgery after the medical and infection control should be in stable condition for the case of the young. Generally good prognosis of such patients, renal function is expected to maintain a longer-term treatment in the normal range.
Second, proteinuria or renal pathological changes of integrated current with mild symptoms (such as minor glomerular lesions, mild mesangial proliferative glomerulonephritis, etc.), corticosteroids and cytotoxic drugs may be effective disease. In severe cases, such as pathological changes are often ineffective. Massive proteinuria in-depth long-term lack of control, often progress to chronic kidney sections heartfelt dried up, the prognosis is poor.
Third, rapidly progressive glomerulonephritis by renal biopsy pathology examination revealed deposition of IgA crescentic glomerulonephritis-based, clinically studied often has a sharp deterioration in renal function. These patients should be treated rapidly progressive glomerulonephritis immune health, such as physician pathology shows mainly cellular crescents should be strengthened by focusing therapy (methylprednisolone treatment of immune, long-term cyclophosphamide pulse therapy, etc.), if the patient has reached Dialysis indications (see Benpian Chapter), ministries should be treated with dialysis. Poor prognosis of these patients, the majority of patients with renal function can not be restored.
Fourth, chronic glomerulonephritis may develop chronic nephritis with reference to general principles of treatment of prominent, in order to delay the accumulation of renal function deterioration in the primary treatment for the strict purpose. With hypertension, active control of hypertension is extremely important for the protection of renal function. Angiotensin-converting enzyme inhibitor (ACEI) have better control of blood pressure and renal function deterioration role, and a decrease in urinary protein’s role. However, serum creatinine greater than 350μmol / L, generally not in favor of re-application of the main ACEL. In recent years, some studies have shown that high doses of long-chain ω-3 rich in poly-unsaturated fatty acids in fish oil, take 6 months to 2 years with good slow deterioration of renal function in IgA nephropathy and reduce the role of protein in urine, but More research remains to be further verified.
The latest evidence-based medical medical evidence that corticosteroids for urinary protein greater than lg / d in patients with normal renal function with long-term lower urinary protein and the role of preventing deterioration of renal function; for renal dysfunction serum creatinine <240μmol / L in patients , glucocorticoids in combination with cytotoxic drugs can significantly slow down the group of renal function deterioration. Overall results show that currently, one of the tables are for the experts to chronic nephritis IgA nephropathy, treatment of common diseases seems to be more active. This view proved to be more research.
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Diagnosis and treatment of IgA nephropathy |
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