What are the causes of acute renal failure in nephrotic syndrome? How to prevent it?
Causes.
(1) Hypovolemic state of NS and vasculopathy, patients are very sensitive to volume and blood pressure changes, mild fluid loss, inappropriate diuresis and hypotension incur ARF;
(2) Interstitial renal edema;
(3) In severe proteinuria, tubular blockage of the renal tubules by the protein tubular pattern;
(4) Increased RAS activity, constriction of small renal arteries, and decreased GFR, leading to ARF.
Preventive measures.
(1)Use diuretics at the right time and in the right amount and reasonably;
(2) Severe hypoproteinemia with protein supplementation first, followed by diuresis;
(3) For edema, a weight loss of 1 kg per day is appropriate;
(4) Use diuretics with caution in patients with significantly high RAS activity;
(5) Replenish fluids at the right time when other body fluid loss occurs.
What are the side effects of hormones?
In this regard, the Fourth People’s Hospital of Shaanxi Province nephrology experts believe that the state to promote the implementation of loss-making enterprises to close bankruptcy, is to solve the overall loss of steel and other industries
What is refractory nephrotic syndrome?
Refractory nephrotic syndrome includes the following two categories.
Primary nephrotic syndrome is not effective by strong treatment for 8~12 weeks, also known as hormone resistant type;
Due to severe losses in some industries, discontinuation of production has been in? (3 relapses in a year or more than 2 episodes in 6 months), called hormone dependent.
How to treat “hormone-dependent” nephrotic syndrome?
”Hormone-dependent” nephrotic syndrome refers to patients with nephrotic syndrome who are effectively treated with hormones but relapse during the process of hormone dose reduction. The following points should be noted in the treatment of this type of patients.
The rate of hormone reduction should be slow: the dose should be slowly reduced after 8-12 weeks of starting treatment to 20 mg of prednisone daily, which can be gradually transitioned to every other day, and the total course of treatment can last for one year.
Combined use of cytotoxic drugs: such drugs can be combined with hormones to consolidate the efficacy and make it easy to reduce the dose of hormones.
Avoid triggers: For patients with stable disease and no recurrence, avoid triggers such as viral infection, bacterial infection, allergic reaction, and overexertion.
Under what circumstances should cytotoxic drugs be used?
In primary nephrotic syndrome, cytotoxic drugs can be used in combination with adrenocorticotropic hormones if clinical remission cannot be achieved even after a full dose and course of adrenocorticotropic hormones, or if the hormones are effective but relapse during the dose reduction process.
In addition, cytotoxic drugs can be used in combination with hormones in patients with severe pathology, such as membranous capillary nephritis, focal segmental glomerulosclerosis or membranous nephropathy where remission is not easily induced by hormones alone.
What is IgA nephropathy?
IgA nephropathy is a primary glomerulopathy in which IgA or IgA deposits are predominant in the glomerular tract, accounting for 20-40% of primary glomerular disease in China. The pathogenesis of IgA nephropathy is not yet fully understood, but it is more commonly believed to be a glomerular disease caused by immune complexes.
The main type of pathology is lamellar proliferative glomerulonephritis, in addition to mild lesional glomerulonephritis, focal proliferative glomerulonephritis, hairy cell intravascular proliferative glomerulonephritis, lamellar capillary glomerulonephritis, crescentic glomerulonephritis, focal segmental glomerulosclerosis and proliferative sclerosing glomerulonephritis.
What are the clinical manifestations of IgA nephropathy?
There are four main subtypes of IgA nephropathy.
(1) Recurrent hematuria without edema, hypertension and persistent proteinuria;
(2) Asymptomatic proteinuria with or without microscopic hematuria.
(3) Acute nephritis syndrome;
(4) Nephrotic proteinuria and nephrotic syndrome. IgA nephropathy is often combined with hypertension, and chronic renal failure is not uncommon. Laboratory tests: In addition to abnormal urinalysis, blood IgA is elevated in half of the patients, and circulating immune complexes are elevated in 60% of the patients.
How to make the diagnosis and differential diagnosis of IgA nephropathy
The diagnosis of this disease depends on the immunopathological findings of the kidney specimen, i.e., granular deposits of IgA-based immunoglobulins in the thylakoid region or in the vascular wall of the associated hair cells. Diagnosis of the disease requires the following diseases in addition to secondary IgA deposition.
(1) Allergic purpura nephritis: there are often typical extrarenal manifestations such as skin purpura, arthralgias, abdominal pain and black stools;
(2) Cirrhosis of the liver;
(3) Lupus nephritis: immunopathology is “full-blown”, with clinical multi-system involvement.
What is the prognosis of IgA nephropathy?
Factors affecting the prognosis are.
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(2) Patients with recurrent episodes of sarcoid hematuria have a good prognosis.
(3) Poor prognosis in those with uncontrollable hypertension.
(4) Patients with pathology with severe hyperplasia, crescent formation, capillary wall damage, interstitial fibrosis, and vascular damage have a poor prognosis.
What is the prognosis of membranous nephropathy?
Membranous nephropathy is a slowly progressive, relatively benign disease. The rate of natural remission is as high as 50% in children and about 15% to 20% in adults. Approximately 15% of patients develop uremia 5-10 years after the onset of the disease, and about 25% of patients have slowly declining renal function, with renal failure occurring 15-20 years later.
Factors that affect its prognosis are: age: the prognosis of pediatric patients is better than that of adults. The degree of proteinuria: the more severe the proteinuria, the worse the prognosis. The prognosis is poor for those who present with hematuria. The prognosis is poor if there is a decrease in renal function at the onset of the disease. The prognosis is poor if there are interstitial changes in the renal tubules.
What is a urinary tract infection?
A urinary tract infection is an inflammation of the urinary tract caused by the multiplication of microorganisms in the urinary tract, which may or may not have clinical symptoms. Depending on the microorganism, it can be divided into bacterial infection and fungal infection, etc. Depending on the etiology, pathophysiology and treatment, urinary tract infections can be further divided into uncomplicated urinary tract infections and complicated urinary tract infections.
Uncomplicated urinary tract? The typical clinical manifestations are bacteriuria or pyuria, and individual patients have hematuria. Depending on the location of the infection and the severity of the clinical condition, it can be divided into acute cystitis (lower urinary tract infection) and acute pyelonephritis (upper urinary tract infection).
What are uncomplicated urinary tract infections?
Uncomplicated urinary tract infections are 80% caused by E. coli, 10-15% by Staphylococcus and Klebsiella, and only 2-5% by Bacillus degeneratum. The bacterial spectrum of complicated urinary tract infections is much broader, with Escherichia coli still being the main causative agent, but many other Gram-negative bacteria such as Bacillus degenerans, Serratia, Klebsiella and Pseudomonas, can cause complicated urinary tract infections. Mycobacterial infections are increasing in patients with diabetes or immunocompromised patients.
What are the routes of urinary tract infection?
There are three common routes of urinary tract infection: upstream infection; bloodstream infection; and direct infection.
What are the main clinical manifestations of cystitis?
Cystitis is usually referred to as a lower urinary tract infection. The manifestation of urinary frequency, urinary urgency, painful urination, bladder area may have discomfort, but generally no obvious symptoms of systemic infection. There is often leukocyturia, about 30% hematuria, and occasionally hematuria in the naked eye. Blood leukocyte counts are often normal.
What are the main clinical manifestations of acute pyelonephritis?
Acute pyelonephritis has two main groups of symptoms: urinary symptoms: including bladder irritation such as frequent, urgent, and painful urination, low back pain and/or lower abdominal pain, and pressure and percussion pain in the kidney area; systemic infection symptoms: such as chills, fever, headache, nausea, vomiting, and loss of appetite, often accompanied by elevated blood leukocyte count and increased blood sedimentation. Hypertension and azotemia are usually absent.
The clinical manifestations of acute pyelonephritis vary in severity and may manifest as Gram-negative bacillary sepsis, intrarenal or perirenal abscesses in severe cases. About 20% of patients with acute pyelonephritis have positive blood cultures.
What are the main clinical manifestations of chronic pyelonephritis?
The course of chronic pyelonephritis is often insidious. Urinary tract infection manifestations: very inconspicuous, usually not usually manifested. Symptomatic pyelonephritis may occur intermittently in a few patients, but more commonly manifests as intermittent asymptomatic bacteriuria, and/or intermittent symptoms such as frequent and urgent urination, and intermittent low-grade fever.
Chronic interstitial nephritis manifests as polyuria, increased nocturia, and easy dehydration; electrolyte disturbances such as low sodium, low potassium, or high blood potassium; and renal tubular acidosis may occur. These tubular impairments are often more prominent than glomerular impairments.
What is asymptomatic bacteriuria?
Asymptomatic bacteriuria means that the patient has true bacteriuria without any symptoms of urinary tract infection and is often detected during screening in a healthy population or during routine urine bacteriology for other kidney diseases.
The causative organism of asymptomatic bacteriuria is mostly Escherichia coli, and the bacteriuria can be persistent, but often alternates between disappearing and reappearing. Patients may be asymptomatic for a long time, and there are no significant abnormalities in the urine routine. Acute urinary symptoms such as frequency, urgency and painful urination can also occur intermittently during the course of the disease. In patients with asymptomatic bacteriuria, the incidence of symptomatic urinary sensation, reduced renal function and renal scarring are significantly higher than in the normal population.
What is urethral syndrome?
Urethral syndrome is characterized only by signs of bladder irritation such as frequency, urgency, and painful urination, but no true bacteriuria on multiple examinations. It is divided into two types.
(1) Infectious urethral syndrome: about 75% of cases have leukocyturia, which is caused by chlamydia and mycoplasma infection;
(2) Non-infectious cell urethral syndrome: about 25%, no leukocyturia, negative pathogens, etiology unknown, probably related to psychological factors.