Reason:
In NS with hypovolemia and vascular diseases, patients are very sensitive to the changes of blood volume and blood pressure, and mild loss of body fluids, improper diuresis and hypotension lead to ARF.
Renal interstitial edema;
In severe proteinuria, the protein cast blocks the renal tubules;
RAS activity increases, renal arterioles contract and glomerular filtration rate decreases, leading to acute renal failure.
Preventive measures:
Timely, appropriate and rational use of diuretics;
In severe hypoproteinemia, protein should be supplemented before diuresis;
It is advisable for edema patients to reduce 1kg every day;
For patients with significantly higher RAS activity, diuretics should be used with caution;
When other body fluids are lost, replenish water in time.
What are the side effects of hormones?
The common side effects of hormones are:
Centripetal obesity;
Diabetes;
Osteoporosis;
Gastrointestinal symptoms: malignant tumor, vomiting, stress ulcer, etc.
What is refractory nephrotic syndrome?
Refractory nephrotic syndrome includes the following two categories:
Primary nephrotic syndrome (PNS) is ineffective after 8~ 12 weeks of intensive treatment, also known as hormone resistance.
Prednisone can be relieved after treatment, but it often recurs (3 recurrences in one year or more than 2 seizures in half a year), which is called hormone dependence.
How to treat "hormone dependent" nephrotic syndrome?
"Hormone-dependent" nephrotic syndrome refers to patients with nephrotic syndrome who are effective in hormone therapy, but their condition recurs during hormone reduction. For the treatment of such patients, we should pay attention to the following points:
The dose of hormone should be gradually reduced: 8~ 12 weeks after the start of treatment, the dose should be gradually reduced. When prednisone is 20mg daily, it can be used every other day gradually, and the total course of treatment can last for one year.
Combined use of cytotoxic drugs: these drugs combined with hormones can consolidate the curative effect and easily reduce hormones.
Avoid incentives: For patients with stable condition and no recurrence, we should avoid virus infection, bacterial infection, allergic reaction, overwork and other incentives.
Under what circumstances should cytotoxic drugs be used together?
When the primary nephrotic syndrome cannot achieve clinical remission after adequate adrenocortical hormone treatment, or the hormone is effective but recurs in remission, cytotoxic drugs can be used in combination.
In addition, for patients with severe pathological types that are not easily induced by hormone alone, such as mesangial capillary nephritis, focal segmental glomerulosclerosis or membranous nephropathy, cytotoxic drugs can be combined in the initial treatment.
What is IgA nephropathy?
AiIgA nephropathy refers to primary glomerular disease with IgA or IgA deposition in mesangial area, accounting for 20-40% of primary glomerular diseases in China. The pathogenesis of IgA nephropathy is not completely clear. It is generally believed that IgA is a glomerular disease caused by immune complex.
The main pathological type is mesangial proliferative glomerulonephritis. In addition, there are mild pathological glomerulonephritis, focal proliferative glomerulonephritis, capillary glomerulonephritis, crescentic glomerulonephritis, focal segmental glomerulosclerosis and proliferative sclerosing glomerulonephritis.
What are the clinical manifestations of IgA?
The clinical manifestations of IgA nephropathy are mainly divided into four subtypes:
Recurrent hematuria without edema, hypertension and persistent proteinuria;
Asymptomatic proteinuria with or without microscopic hematuria;
Acute nephritis syndrome;
Nephropathy proteinuria and nephrotic syndrome. IgA nephropathy is often complicated with hypertension, and chronic renal failure is not uncommon.
Laboratory examination: Except for abnormal urine test, IgA in blood of half patients increased, and immune complex in blood of 60% patients increased.
How to diagnose and differentiate IgA nephropathy?
The diagnosis of this disease depends on the immunopathological results of kidney specimens, that is, immunoglobulin mainly composed of IgA is deposited in the mesangial area or the vascular wall of hair cells in granular form.
The diagnosis of this disease requires the removal of secondary IgA deposits:
Henoch-Schonlein Purpura Nephritis: There are often typical extrarenal manifestations, such as skin purpura, joint swelling and pain, abdominal pain, black stool and so on.
Cirrhosis;
Lupus nephritis: immunopathology "full house red", clinical multi-system involvement.
What is the prognosis of IgA nephropathy?
Factors affecting prognosis are:
Male patients, patients with older onset age have poor prognosis.
Patients with recurrent gross hematuria
What is the prognosis of membranous nephropathy?
Membranous nephropathy is a slow-developing and relatively benign disease. The natural remission rate of children is as high as 50%, and that of adults is about 15%~20%. About 15% of patients with membranous nephropathy develop uremia 5~ 10 years after onset, and about 25% of patients have a slow decline in renal function, and renal failure does not occur until 15~20 years later.
Factors affecting prognosis are:
Age: The prognosis of children is better than that of adults.
Degree of proteinuria: The heavier the degree of proteinuria, the worse the prognosis.
The prognosis of patients with gross hematuria is poor.
The prognosis of patients with decreased renal function at onset is poor.
The prognosis of patients with pathological tubulointerstitial changes is poor.
What is methylprednisolone pulse therapy?
Methylprednisolone is a synthetic steroid hormone with strong immunosuppression. Its advantage is that it can give full play to its immunosuppression and minimize its side effects. Methylprednisolone pulse therapy is often used for glomerular diseases with strong immune response such as acute nephritis and lupus nephritis.
Methods: methylprednisolone 1 g was injected intravenously, 1 time every day, and 1 course of treatment for 3-4 days. According to the clinical efficacy and side effects of the drug, decide whether to repeat the treatment. The common side effects of methylprednisolone pulse therapy include gastrointestinal bleeding, electrolyte disorder, arrhythmia, increased serum creatinine and urea nitrogen, water and sodium retention, hypertension and mental symptoms.
What is the mechanism of cyclosporine A in treating nephritis?
Cyclosporine A selectively acts on T lymphocytes, which has a strong inhibitory effect on the cellular and humoral immune responses of thymus-dependent antigens. Its mechanism of action is to inhibit interleukin -2 and? The production and release of interferon can inhibit the function of helper T lymphocytes and reduce the T4/T8 ratio. In recent years, it has been used to treat nephrotic syndrome. When hormone resistance, dependence, or long-term use of adrenocortical hormone has serious side effects, but the combined use of cytotoxic drugs is ineffective, cyclosporine A can be considered.
Cyclosporine A is effective for minimal change nephrotic syndrome, and about 80% cases can induce remission, but it is ineffective for other types of nephritis, especially when used alone. When cyclosporine A is used to treat nephrotic syndrome, there is a drug dependence problem, and it is easy to relapse after stopping the drug. The main side effects of long-term use of cyclosporine A include renal function damage, renal tubular function damage, hypertension, hirsutism, gingival hyperplasia and liver function damage.
What is urinary tract infection?
Urinary tract infection refers to urinary tract inflammation caused by the proliferation of a large number of microorganisms in the urinary tract, with or without clinical symptoms. According to different microorganisms, it can be divided into bacterial infection and fungal infection. According to the different etiology, pathophysiology and treatment methods, urinary tract infection can be divided into simple urinary tract infection and complex urinary tract infection.
Patients with uncomplicated urinary tract infection usually have no physiological or anatomical abnormalities of urinary tract, and have no recent history of urological surgery and interventional therapy. Its typical clinical manifestations are bacteriuria or pyuria, and some patients have hematuria. According to the infection site and clinical severity, it can be divided into acute cystitis (lower urinary tract infection) and acute pyelonephritis (upper urinary tract infection).
What are the causes of urinary tract infection?
80% of uncomplicated urinary tract infections are caused by Escherichia coli, 10~ 15% by staphylococcus and Klebsiella, and only 2~5% by denatured bacteria. However, the spectrum of bacteria complicated with urinary tract infection is much wider. Escherichia coli is still the main pathogen, but many other gram-negative bacteria such as denaturing bacteria, Serratia, Klebsiella and Pseudomonas can cause urinary tract infection. In patients with diabetes or low immunity, mold infection is increasing.
What are the ways of urinary tract infection?
There are three common ways of urinary tract infection:
Upward infection;
Blood infection;
Direct infection.
What are the main clinical manifestations of cystitis?
Cystitis is usually called lower urinary tract infection. The symptoms are frequent urination, urgency and pain, and there may be discomfort in the bladder area, but generally there is no obvious systemic infection. Leukocytosis, about 30% hematuria, occasionally gross hematuria.
Systemic symptoms of infection: such as chills, fever, headache, nausea, vomiting, loss of appetite, etc. Often accompanied by an increase in white blood cell count and an increase in erythrocyte sedimentation rate. Systemic hypertension and azotemia.
The clinical manifestations of acute pyelonephritis are different. Severe cases can be manifested as septicemia caused by gram-negative bacilli and abscess in or around the kidney. About 20% patients with acute pyelonephritis have positive blood culture.
What are the main clinical manifestations of chronic pyelonephritis?
The course of chronic pyelonephritis is often hidden. Urinary tract infection: not obvious, generally will not show. A few patients may have symptomatic pyelonephritis intermittently, but the more common manifestations are intermittent asymptomatic bacteriuria, and/or intermittent frequent urination, urgency and other symptoms, as well as intermittent low fever.
Chronic interstitial nephritis:
If polyuria and nocturia increase, dehydration is easy to occur;
Electrolyte disorder, such as low sodium, low potassium or high blood potassium;
Renal tubular acidosis may occur.
These renal tubular dysfunction is often more prominent than glomerular dysfunction.
What is asymptomatic bacteriuria?
Asymptomatic bacteriuria means that patients have true bacteriuria without any symptoms of urinary tract infection, which is often found in healthy people through screening or routine bacteriological examination of urine due to other kidney diseases.
The pathogenic bacteria of asymptomatic bacteriuria are mostly Escherichia coli, which can persist, but often disappear and reappear alternately. The patient can be asymptomatic for a long time, and there is no obvious abnormality in urine routine. Intermittent acute urinary symptoms such as frequent micturition, urgent micturition and dysuria will appear in the course of the disease. Among asymptomatic bacteriuria patients, the incidence of symptomatic urine sensation, decreased renal function and renal scar formation is significantly higher than that of normal people.
What is urethral syndrome?
Urethral syndrome only has bladder irritation symptoms such as frequent urination, urgency and pain, and many tests have no real bacteriuria.
There are two types:
Infectious urethral syndrome: about 75%, mainly proteinuria caused by chlamydia and mycoplasma infection;
Cell-free urethral syndrome: about 25%, no leucorrhea, negative pathogen detection, unknown reasons, may be related to mental factors.