Chronic glomerulonephritis (chronic glomerulonephritis) is a group of chronic progressive glomerular diseases caused by multiple etiologies and presenting multiple pathological types.
Chronic glomerulonephritis is a group of chronic progressive glomerular diseases caused by multiple etiologies and presenting multiple pathological types. Patients often present with varying degrees of edema, high
The patients often show different degrees of edema, high blood pressure, proteinuria and hematuria, and kidney function often deteriorates gradually until end-stage renal failure.
Diagnostic criteria
(1) Most patients have a slow onset, and a few with post-infection onset have an acute onset (even acute nephritis syndrome).
(1) Most patients have a slow onset, and a small number of post-infection patients have a rapid onset (or even acute nephritis syndrome), with delayed and gradual progress.
(2) present with varying degrees of edema, hypertension, proteinuria (urine protein quantification is often >lg/d, but <3, 5g/d), and
hematuria (as glomerular-derived hematuria) and tubular urine.
(3) Gradual development of renal decompensation (initial decrease in glomerular filtration rate, followed by increase in serum creatinine) until progression to
(3) Gradual development of renal decompensation (initial decrease in glomerular filtration rate and subsequent increase in serum creatinine) until end-stage renal failure, often accompanied by renal anemia.
(4) Ultrasound examination of both kidneys is normal or reduced in size.
If possible, a renal puncture biopsy can be performed to clarify the type of pathology. Chronic nephritis can present a variety of pathological types, such as systemic
The most common types of chronic nephritis are: membranoproliferative glomerulonephritis, membranoproliferative glomerulonephritis, focal segmental glomerulosclerosis, and IgA including all of the above.
The results of this study are summarized below. In addition, a few membranous nephropathies are also included. The rate of progression of different pathological types of disease varies.
The rate of progression of different pathological types of disease varies, but all of them can progress to sclerosing glomerulonephritis in later stages.
Principles of treatment
The treatment of this disease should focus on protecting the residual kidney function and delaying the progression of kidney damage.
1.General treatment
(1) Diet Low salt (<3g salt per day); protein intake should be limited when renal function is not warranted (see
(Chapter 53: Chronic renal failure).
(2) Rest Mildly ill patients with normal renal function can participate in light work appropriately; severely ill and renal insufficiency patients should
rest.
2.Symptomatic treatment
(l) Diuresis Use thiazide diuretics and potassium-protective diuretics in mild cases and tab diuretics in severe cases.
(2) Blood pressure should be strictly controlled to 130/80mmHg, and even lower if tolerated, especially for those with urinary egg
This is especially important for those with urine protein > lg/d. However, in elderly patients or those with a combination of chronic stroke, individualized blood pressure targets should be set.
The goal of lowering blood pressure should be set individually, often only to 140/90 mmHg.
For the treatment of hypertension in chronic nephritis, a combination of antihypertensive drugs is often used at the beginning of treatment, often with angiotensin-converting enzyme inhibitors or angiotensin inhibitors.
Angiotensin-converting enzyme inhibitors or angiotensin AT1 receptor blockers are often used in combination with dihydropyridine calcium channel blockers or (and) diuretics.
In case of ineffectiveness, other antihypertensive drugs are combined.
Serum creatinine >265 μmoL/L (3 mg/dl) is not a contraindication to angiotensin-converting enzyme inhibitors or angiotensin AT1 receptor blockers.
However, care must be taken to be vigilant for the development of hyperkalemia.
3. Measures to delay the progression of renal damage
Strict control of hypertension is an important measure to slow down the progression of renal damage, in addition to this, the following treatments can be used.
(1) angiotensin-converting enzyme inhibitor (ACEI) or angiotensin ATl receptor blocker (ARB) without hypertension
It can reduce urine protein and delay the progression of renal damage, and should be taken for a long time. See Appendix I for precautions
”Commonly used drugs for kidney disease”.
(2) Lipid-regulating drugs For people with mainly high plasma cholesterol, hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) should be taken.
Inhibitors (statins); those with mainly increased serum triglycerides should be treated with fibrates derivatives (beta
(See Appendix I “Commonly used drugs for kidney disease” for details).
(3) Anti-platelet drugs: 300 mg/d of oral dipyridamole or 100 mg/d of aspirin.
If there are no side effects, these two types of drugs can be taken for a long time, but should be used with caution when platelet function is impaired in renal insufficiency.
(4) Drugs to reduce blood uric acid When the glomerular filtration rate is <30 ml/min due to renal insufficiency, drugs to increase uric acid excretion are no longer appropriate.
Only drugs that inhibit uric acid synthesis (such as allopurinol and febuxostat) should be used, and the medication should be adjusted according to the renal function.
The dose should be adjusted according to the renal function.
In addition to the above medications, it is also important to avoid all factors that may aggravate renal damage, such as not using nephrotoxic drugs (including western drugs and febuxostat).
In addition to the above drug treatment, it is also very important to avoid all factors that may aggravate renal damage, such as not using nephrotoxic drugs (including western and traditional Chinese medicine), preventing infection (once it occurs, anti-infective drugs that are not nephrotoxic should be used promptly), and avoiding labor.
(once it occurs, anti-infective drugs without nephrotoxicity should be used in time for treatment), avoid strain and pregnancy, etc.
4. Glucocorticoids and cytotoxic drugs
Generally, they are not used. As for more urine protein, kidney pathology shows active lesions (such as glomerular cell hyperplasia, small cell crescent formation, and renal
As for patients with high urine protein and active renal pathology (such as glomerular cell hyperplasia, small cell crescent formation, and interstitial inflammatory cell infiltration, etc.), can they be considered as appropriate? The decision needs to be made
The decision needs to be made individually and carefully.
If chronic nephritis has progressed to chronic renal insufficiency, it should be treated as non-dialysis therapy for chronic renal insufficiency.
If it has progressed to end-stage renal failure, renal replacement therapy (dialysis or kidney transplantation) should be administered, as described in Chapter 53, “Chronic renal failure”.
chronic renal failure”.