I. Clinical manifestations.
The clinical manifestations of purpura nephritis are classified into three types: mild, moderate and severe.
1, light.
Clinical manifestations- microscopic hematuria, small amount of proteinuria <30mg/kg24h, usually without hypertension and renal function impairment.
2.Medium.
Clinical manifestations are between light and heavy, and those who have one of the following conditions are both medium-sized HSPN.
① carnal hematuria or massive microscopic hematuria.
② urine protein > 30mg/kg24h.
(iii) with hypertension.
④with mild renal function impairment.
3.Heavy.
Clinical manifestations are carnal hematuria, massive proteinuria, hypertension, renal function impairment, and some patients show acute progressive glomerulonephritis.
In addition, extra-renal symptoms of allergic purpura: skin, gastrointestinal tract, joint symptoms, should be alert to the occasional occurrence of intussusception, intestinal necrosis, perforation and other serious complications, clinical also need to pay attention to a few children with gastrointestinal symptoms as the first symptoms of HSP, easy to misdiagnose surgical acute abdominal disease. Renal involvement usually occurs within 1 month of the onset of HSP (89.18%), with a peak incidence of 10-15 days in particular.
Clinical types of allergic purpura nephritis.
The minutes of the 2000 Zhuhai meeting of the Nephrology Group of the Chinese Academy of Pediatrics divided allergic purpura nephritis into six clinical types.
1, isolated hematuria or isolated proteinuria.
2, hematuria and proteinuria, with proteinuria relatively prominent.
3, acute nephritis type, manifesting as acute nephritis syndrome.
4, nephrotic syndrome type.
5, acute nephritis type with rapid onset of abnormal renal function.
6.Chronic nephritis type.
Second, pathological typing
1.Light microscopic changes are classified into six grades.
Grade Ⅰ: minor glomerular lesions
Grade II: simple thylakoid hyperplasia
Grade III: thylakoid hyperplasia with less than 50% glomerular crescent formation, segmental lesions (sclerosis, adhesions, thrombosis, necrosis)
Grade IV: lesions as Ⅲ, 50% to 75% of glomeruli with the above changes
Grade V: lesions with Ⅲ, more than 75% of glomeruli with the above changes
Grade VI: membrane proliferative nephritis changes
The above grade II, Ⅲ, Ⅳ, Ⅴ and the distribution of retinal lesions are divided into a (focal/segmental) b (diffuse lesions)
2. Immunopathological typing.
According to the different immune complexes deposited in the glomerulus are divided into four types.
(1) simple IgA deposition type
(2) IgA+IgG deposition type
(3) IgA+IgM deposition type
(4) IgA+IgG+IgM deposition type
There is a relationship between the type of immunopathology and pathological grading, especially the incidence of IgA+IgG+IgM grade IV-VI is higher, which is also one of the reasons affecting the prognosis.
III. Treatment
1.Light.
Chinese herbal medicine alone or in combination with Leigandia multi-glucoside.
2.Medium-sized.
Acute phase treatment
(1) Chinese herbal medicine identification treatment.
(2) Adequate amount of prednisone.
(3) Radix polyglycoside.
(4) Methylprednisolone (MP) shock if necessary according to renal pathology and clinical manifestations.
Maintenance treatment
The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor antagonist (ARB) is helpful to protect the kidney and control the development of chronic fibrotic lesions.
(iii) Heavy
Acute phase treatment
1.Therapeutic treatment with traditional Chinese medicine.
2.Sufficient amount of prednisone.
3.Regenerate polyglucoside.
4, according to renal pathology and clinical manifestations, methylprednisolone (MP) shock or MP and cyclophosphamide (CTX) double flush therapy if necessary.
Enzyme phenolate is also available.
If the efficacy is not significant after more than 6 months of the above treatment, the renal biopsy must be repeated and the treatment plan adjusted.
Chronic phase treatment
After the disease control enters the chronic phase, gradually stop hormones and continue to apply
1.Legendan polysaccharide.
2.Chinese medicine.
3.Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor antagonist (ARB), etc.