Infection Infection is a common complication of nephrotic syndrome (NS), including bacterial, viral and fungal infections, among which hematogenous disseminated tuberculosis and deep fungal infection are the most serious, which can threaten...
Infection is a common complication of nephrotic syndrome (NS), including bacterial, viral and fungal infections, among which hematogenous disseminated tuberculosis and deep fungal infection are the most serious, which can threaten the patient's life.
The principle of prevention and cure of infection is: do not blindly give patients who taking hormone and cytotoxic drugs the antibiotics to prevent infection, which not only can not prevent bacterial infection, will lead to anti fungal infection. Once the patient is infected, treatment should be performed as soon as possible selecting drugs that sensitive, potent, no renal toxicity (such as isoniazid for hematogenous disseminated tuberculosis, rifampicin, ethambutol and pyrazinamide four treatment, fluconazole intravenous infusion therapy for deep fungal infection), and strengthen support treatment. Repeated infection, can be supplemented with immune enhancement agent (such as thymosin intramuscular injection, intravenous immunoglobulin 5g/d) treatment, reduce the incidence of infection.
Unfractionated heparin was added to normal heparin 125U[(1mg/ (kg) d), 10% of glucose was added to 100 ml, and then /d. 2 to 4 weeks for 1 courses.
Low molecular weight heparin sodium was injected subcutaneously with low molecular weight heparin sodium 4000 IU, for a period of 1 /d, for a period of 2 to 4 weeks, followed by repeated treatment according to the condition of the disease. Laboratory monitoring is not required.
Anticoagulant drugs commonly use warfarin 0.05 ~ 0.4mg/ (kg? D), the 1 oral. Half-life of 32 ~ 46 hours, up to the peak of third days, can be maintained for 4 days. Prothrombin time should be monitored.
Antiplatelet drugs commonly used the following 3 types: dipyridamole (Pan Shengding), the initial dose was 25 ~ 50mg, 3 /d, after rising to 75 ~ 100mg, 3 /d, for 4 weeks or more to take effect, use time of 0.5 to 1 years, also can use 4 ~ 6 mg/ (kg? D), 3 oral dosage, adverse reactions vascular headache, nausea and vomiting may occur when. Aspirin: 50 ~ 150mg/d, small dose only inhibit thromboxane, and make the platelet depolymerization, large doses of prostacyclin was also used to inhibit the role of this disappeared. Salvia miltiorrhiza injection: 0.4 ml/kg intravenous drip, the 1 /d, with a time of 10 ~ 14 days.
Thrombolytic therapy for thrombosis within 3 days, the dose of urokinase is from 1.5 to 30 thousand U/ days, intravenous drip, every 4 to 6 hours, 1 times, 2 weeks for a course of treatment.
The use of statins, such as lovastatin and pravastatin, can lower cholesterol.
Nephrotic syndrome in children with fluid loss should be added in a timely manner containing sodium liquid, children with long-term use of hormones can be given to hydrocortisone hydrocortisone, wealthy patients can use plasma and substitutes.
The following aspects: the supply of appropriate treatment in patients with protein diet: ensure food daily total calories (by 125.5 ~ 146.4 kJ/kg, 30 ~ 35kcal/kg) of the premise, should pay attention to the amount and quality of dietary protein. High protein diet will increase urinary protein excretion and damage to the kidneys which has long been abandoned, the current daily protein intake to 0.8 ~ 1.0g/kg is appropriate. In recent years, the study found that the composition of dietary protein (amino acid composition) also affect the excretion of urinary protein, so some scholars advocate that NS patients should be more into soy protein based vegetarian diet, rather than eating animal protein, this view should also be taken seriously. To promote the synthesis of protein in liver: once with anabolic hormones (such as nandrolone), but the effect is not large and has much adverse reaction. Beijing Medical University kidney disease research institute after years of research recommended using Chinese Angelica (30g), astragalus (60g) Decoction (1 daily) to promote protein synthesis, has been widely applied. NS patients due to metal binding proteins and endocrine hormone binding protein being loss through urine can cause active vitamin D and microelements of iron, zinc and copper deficiency, which should be treated by diet and supplements.
The main therapeutic measures of acute renal failure are as follows: 1. In addition to maintaining life, and can be supplemented in plasma products after dehydration, in order to reduce the organization (including renal interstitial edema). Diuresis. The reaction to the loop diuretic should be actively given to flush out the tubular obstruction. The active treatment of glomerular diseases. Due to the majority of cases of idiopathic acute renal failure is minimal change disease, so the treatment (such as methylprednisolone therapy) response is very good, with the increase of urine volume in acute renal failure but if disease reversal, focal segmental glomerular sclerosis and other hormone resistant diseases, patients poor prognosis of acute renal failure may not be restored.
Renal tubular dysfunction. Studies found that the mechanism of renal tubular dysfunction in children with nephrotic syndrome is the large number of reabsorption of renal tubular protein, so that the renal tubular epithelial cells damaged. The results for the patients are diabetes mellitus, amino acid, high phosphate urine, renal tubular potassium loss and high chloride acidosis. It’s often showed poor prognosis in children with renal tubular dysfunction.
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