Questions about the kidneys
Problem description:
What good method is there to treat nephritis,
There is a glomerular necrosis, which is not too serious now.
Analysis:
Ylbj/ Drugs/Neck/Magic Soldier Turn to the Imperialist /200608/ 1 15307
Treatment of acute glomerulonephritis
Acute glomerulonephritis (hereinafter referred to as acute glomerulonephritis) broadly refers to a group of glomerular diseases with different etiology and onset, and the onset is urgent, with hematuria, proteinuria, hypertension and edema as the main symptoms. It can be caused by many reasons, mostly glomerulonephritis after acute streptococcal infection. The course of disease is mostly within 1 year, which is a common and frequently-occurring disease in internal medicine and pediatrics. School-age children are the most common, followed by young people, and middle-aged and elderly people are rare. This section will focus on nephritis after acute streptococcus infection, which will be described later.
Acute glomerulonephritis generally belongs to the categories of edema, geomantic omen and kidney wind in traditional Chinese medicine.
Characteristic treatment
1. Shen Yan antipyretic tablet: composed of cogongrass rhizome, forsythia suspensa, Schizonepeta tenuifolia, almond, areca nut peel, etc. Has the functions of expelling wind, clearing heat, dispersing lung qi and promoting diuresis. It can be used for patients with wind-heat type acute nephritis caused by the flood of geomantic omen. Dosage: 4-5 tablets each time, 3 times a day.
2. Shenyan Xiao Zhong Tablet: It consists of Rhizoma Atractylodis, Cortex Phellodendri, Ramulus Cinnamomi, Alismatis Rhizoma, Pericarpium Arecae, Pericarpium Citri Tangerinae, etc. Has the functions of invigorating spleen, eliminating dampness, activating yang and promoting diuresis. Can be used for treating acute nephritis of water-dampness type. Dosage: 4 ~ 5 tablets each time, 3 times a day.
3. Shenyanling: It is composed of Eclipta prostrata, Radix Rehmanniae, Radix Paeoniae Rubra, Herba Portulacae, Fructus Gardeniae, Sanguisorba officinalis, Cirsium japonicum and Rhizoma Dioscoreae. Has the effects of nourishing yin, clearing away heat, cooling blood and stopping bleeding. It has certain curative effect on patients with persistent hematuria in recovery period of acute nephritis. Dosage: 6 ~ 7 tablets each time, 3 times a day.
(a) the general treatment of patients without obvious edema, hypertension, hematuria, proteinuria is not serious, no renal insufficiency, can take care of themselves, and even engage in light manual labor, but to prevent respiratory infections, avoid fatigue, do not use drugs that are toxic to the kidneys. Those who have obvious hypertension, edema or renal insufficiency in a short period of time should stay in bed, and the salt intake should be limited to 2 ~ 3g. For those who lose more protein in urine and have acceptable renal function, animal proteins with higher biological potency should be supplemented, such as eggs, milk, fish and lean meat. For patients with decreased renal function (endogenous creatinine clearance rate is about 30 ml/min), protein should be appropriately limited to about 30g, and appropriate amount of essential amino acids should be supplemented orally when necessary.
(2) hormone and immunosuppressant therapy
(3) Treatment of azotemia
1. If azotemia appears for the first time in a short period of time, or has a progressive aggravation recently, people should stay in bed and limit excessive activity.
; 2. Dietary nutrition For people without obvious edema and hypertension, there is no need to limit the intake of water and sodium salt. It is very important to increase water appropriately to increase urine output. For patients with mild to moderate azotemia, the intake of protein should not be restricted to maintain the positive nitrogen balance in the body, especially for patients who lose more protein every day. When a large amount of proteinuria is accompanied by mild azotemia, plant proteins such as soybeans can be increased. Protein intake should be appropriately restricted for those who have severe azotemia or progressive azotemia recently.
3. With regard to urine volume and urine osmotic concentration, the urine osmotic concentration of patients with chronic nephritis in azotemia is usually below 400 mo * * */L. If the daily urine volume is only 1L, which is not enough to discharge nitrogen-containing solute, then the urine volume should be above1.5l.. This can be achieved by drinking water or light tea properly and stopping taking diuretics when necessary.
4. Controlling hypertension, chronic nephritis, azotemia's disease and renal hypertension often indicates poor prognosis, and persistent or severe renal hypertension may aggravate azotemia. Although the use of commonly used antihypertensive drugs can reduce peripheral vascular resistance, it may not necessarily reduce glomerular vascular resistance. The increased resistance of afferent and efferent arterioles of glomerulus reduces the filtration function of glomerulus. Whether calcium channel blockers, such as nifedipine, can reduce glomerular pressure and protect renal function is still controversial. It has been recognized that angiotensin converting enzyme inhibitors can not only reduce the peripheral vascular resistance, but also inhibit the renin-angiotensin system in tissues, reduce the tension of glomerulus and efferent arterioles, and improve the hemodynamic changes in glomerulus. ACEI can also reduce bradykinin degradation in tissues and enhance bradykinin expansion. Bradykinin can release arachidonic acid from cell membrane phospholipids, promote prostaglandin production and enhance vasodilation. ACEI still inhibited the contraction of mesangial cells induced by angiotensin ⅱ. These mechanisms are reflected in renal tissue and can improve the hemodynamics of glomerulus. ACEI can also reduce or inhibit the effect of angiotensin ⅱ on the proliferation and hypertrophy of myocardial and vascular smooth muscle and the thickening of vascular wall media in patients with moderate and severe hypertension and myocardial hypertrophy, which is very helpful to prevent the thickening of vascular wall and the proliferation and hypertrophy of myocardial cells in patients with chronic nephritis and hypertension. However, ACEI can reduce the tension of glomerular efferent arterioles and sometimes reduce glomerular filtration rate. Therefore, the dosage of ACEI in azotemia should not be too large, and the renal function should be closely observed, and it is even more inappropriate to use potassium-preserving diuretics to avoid hyperkalemia. The commonly used drugs are captopril 12.5 ~ 25 mg once, 2 ~ 3 times a day; Or benazepril (Lotensin) 1 ~ 2 times, each time 10mg, or enalapril 10mg, 1 time, every day. Or 2.5 ~ 5 mg of sinapril daily 1 time. Benazepril, sinapril and enalapril are all long-acting ACEI. If hypertension cannot be controlled, amlodipine (lolol) 5 ~ 10 mg can be added twice a day.
5. Treatment of azotemia in the treatment of nephrotic syndrome: GFR of chronic nephritis often decreases in different degrees in the edema stage and edema regression stage of nephropathy. It is related to the following factors: ① the degree of pathological activity; ② Renal interstitial edema; ③ glomerular ultrafiltration coefficient decreased; ④ Decreased blood volume (7% ~ 38% cases); ⑤ High catabolism in vivo caused by a large number of hormones; ⑥ Use drugs harmful to kidney; ⑦ Interstitial nephritis; ⑧ Renal vein thrombosis. It is often not easy to judge the cause in time in clinic. In addition to the first (1), 6, 6, need to be handled in time. If there is no infection, sometimes you need to wait patiently and don't be too active. Combined with acute interstitial nephritis, whether it is the immune reaction of the disease itself or the drug allergic reaction, the use of short-term high-dose hormones can often alleviate azotemia and should be dealt with in time.
6. Anticoagulant therapy In our hospital, more than 400 patients with glomerulonephritis and renal fibromatous necrosis in hypercoagulable state were treated with heparin 50 ~ 80mg/ day and urokinase 20 ~ 80,000 u/d intravenous drip (2 ~ 8 weeks), and the renal function was often improved to varying degrees without serious bleeding. For patients with refractory or refractory renal vein thrombosis, 200,000 U urokinase was injected through renal artery and intravenous catheter to treat renal vein thrombosis, and good results were achieved.
7. Treatment of hyperuricemia A few patients with chronic nephritis in azotemia are complicated with hyperuricemia. The increase of serum uric acid is not directly proportional to the decrease of endogenous creatinine clearance rate, indicating that hyperuricemia is not the result of azotemia. Reducing serum uric acid with allopurinol can improve renal function, but the dosage should be small, the medication time should be short and the dosage should be reduced quickly. Drugs that increase uric acid excretion should not be used.
8. In other glomerulonephritis, inflammatory cells infiltrated in renal tissue can produce a large number of oxygen free radicals, and mesangial cells can also produce reactive oxygen species through immune complexes, membrane attack complexes and platelet activating factors. Oxygen free radicals can directly damage or destroy glomerular basement membrane and epithelial cells through membrane lipid peroxidation. In addition, many patients with glomerular diseases have low antioxidant capacity, which is manifested by the decrease of blood antioxidant enzymes such as serum superoxide dismutase and antioxidants such as vitamins B2, E, zinc and selenium. Therefore, how to inhibit the generation of oxygen free radicals in renal tissue, whether to use antioxidants and which antioxidants to use are all issues worthy of further observation and accumulation of experience. Chronic nephritis nephrotic syndrome is often accompanied by hyperlipidemia in different degrees. As we all know, hypercholesterolemia, especially low density lipoprotein degeneration, can trigger the production of lipid peroxide in renal tissue, accelerate glomerular sclerosis and renal tubular injury. Increasing serum albumin level can reduce blood lipid concentration.
In a word, patients with chronic nephritis in azotemia are at the crossroads towards chronic renal failure or stable condition. Azotemia's or azotemia, which first appeared in a short time, should be carefully searched for the cause, and should not be simply considered as the stage of the development of chronic nephritis. Many cases can maintain good renal function for a long time after removing the inducing factors.