Most nephrotic syndromes have the clinical manifestations of “three highs and one low”: massive proteinuria, urine protein >3.5g/d; hypoalbuminemia, plasma albumin <30g/L; edema; hyperlipidemia (increased cholesterol), of which the first two are necessary for diagnosis.
Nephrotic syndrome is caused by glomerular lesions, and its onset is chronic, with slow onset and time-consuming treatment. In addition, the prognosis of nephrotic syndrome varies greatly among individuals.
Studies have shown that the factors that determine the prognosis include the following.
1. type of pathology.
The type of pathology is the most basic factor that determines the different prognosis of patients with nephrotic syndrome. In general, the prognosis of microscopic lesions or mild tegumentary hyperplastic glomerulonephritis is better than other pathological types.
2. Clinical factors.
Prolonged massive proteinuria and hypertension can affect the prognosis. In addition, different primary diseases are also important factors affecting prognosis.
3, The presence of recurrent infections, thrombosis and other complications also affect the prognosis of the disease.
4.The treatment is not standardized.
Although the prognosis of different individuals with nephrotic syndrome varies greatly, the following treatment principles should be followed for primary nephrotic syndrome, regardless of the type of pathology.
1, general treatment.
Pay attention to rest, avoid exertion and cold; bed rest is required for severe edema and hypoproteinemia; give low salt (<3g/d) high quality protein (1g/kg.d) low fat diet.
2. Symptomatic treatment.
Diuresis and decongestion; reduction of urinary protein (routine application of ACEI and/or ARB agents unless contraindicated); antihypertensive therapy.
3, anticoagulation therapy.
In the anticoagulation at the same time can adjuvant antiplatelet therapy; plasma albumin <20g / L
Anticoagulation therapy should be started immediately; Thrombolysis or thrombolysis should be given as soon as possible if thrombosis occurs; bleeding due to drug overdose should be avoided in both anticoagulation and thrombolysis.
4. Main treatment – suppress inflammation and immune response.
Hormones, cytotoxic drugs (cyclophosphamide, nitrogen mustard, etc.) and immunosuppressants (cyclosporine, enzyme phenolate, tacrolimus, etc.) are commonly used. When applying hormones, attention should be paid to their side effects, and calcium supplementation and stomach protection should be routinely applied.
5.Chinese medicine treatment.
The efficacy of Chinese medicine alone in the treatment of nephrotic syndrome is slow, and it is generally advocated to be applied in combination with hormones or cytotoxic drugs, such as Lei Gong Tang, Bai Ling capsule, Kunming Shan Hai Tang, Jin Shui Bao, etc.
6, complication prevention and control.
Complications in patients with nephrotic syndrome are an important factor affecting the prognosis and should focus on preventing and controlling infections, especially infections of the whistle tract, digestive tract and urinary tract are most common. In addition, acute renal failure, protein and fat metabolism disorders should be prevented and treated. In conclusion, in the pathogenesis of nephrotic syndrome, standardized and combined multi-drug therapy should be taken for different individuals so that it acts on different pathogenic aspects, which will undoubtedly help to improve the level of efficacy and promote the recovery of patients.