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Membranous nephropathy - treatment

2017-03-01 11:54

1 non immune therapy

In the urine protein quantitative <3.5g/ days, serum albumin was normal or slightly reduced, normal renal function in young patients.

(1) the control of blood pressure and blood pressure is below 125/70mmHg, and the drug is the first choice of angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor antagonist (ARB).

(2) anticoagulant therapy for patients with membranous nephropathy in patients with high incidence of venous thrombosis, anticoagulant therapy can be prevented. Patients with high risk factors (urinary protein for >8g/ days, plasma protein <20g/L, diuretics or prolonged bed rest) should be actively treated with anticoagulation. Drug of choice of low molecular weight heparin injection, such as long-term patients with hypoproteinemia, consider switching warfarin therapy, but the need to closely monitor the coagulation function.

(3) dietary protein intake should be limited to 0.8g/ (kg = D) in patients with a low protein diet and a large amount of protein intake, while adequate heat should be given to 146.54kJ (35kcal) / (kg / D).

(4) other treatments include edema, hyperlipidemia, etc..

2 immunotherapy

Immunosuppressive therapy depends on the extent, duration, and status of renal function. It is generally believed that >3.5g/ patients with proteinuria and renal dysfunction, or proteinuria >8g/ days of high-risk patients should be treated with immunotherapy.

The evaluation and therapeutic effect of membranous nephropathy immune therapy, there is great controversy, overall that inpidual application of glucocorticoids (hereinafter referred to as invalid, hormone hormone) + cyclophosphamide (CTX) or cyclosporine A (CsA) treatment, can make some patients achieved clinical remission. The effect of judgment may not be the pursuit of achieving complete remission (proteinuria less than 0.3g/ days), partial remission (proteinuria less than 3.5g/ days or decreased urine protein >50%, serum albumin >30g/L) also can effectively improve the prognosis of patients.

 

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