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What Are The Common Treatments For IgA Nephropathy

2019-03-03 13:52

IgA Nephropathy is the most common chronic glomerulonephritis. It is one of the main causes of uremia, which often occurs in naked hematuria after a cold.

Causes of IgA nephropathy

After infection of respiratory mucosa, gastrointestinal mucosa and genital mucosa, human body will produce a large number of glycosylated IgA1, which stimulates the abnormal immune system, forms immune complex, and induces immune inflammation in the kidney. This is IgA nephropathy.

IgA nephropathy caused by different infections has different severity. Some are asymptomatic hematuria, some are naked hematuria, some are mild albuminuria, some are massive albuminuria, some will be accompanied by hypertension, crescent formation, and eventually turn to uremia, some have no obvious symptoms throughout their lives, in a word, the difference is quite large. Hematuria with mild to moderate proteinuria is more common in clinic, 40% of patients with hypertension.

If the urinary protein exceeds 3.5g/24h, or if there is naked hematuria or hypertension, it indicates that the disease will progress faster, often within 10-20 years to uremia. If there is only a small amount of occult blood and urinary protein, the prognosis is generally better.

How should IgA nephropathy be treated?

1. Puli/sartan drugs

IgA nephropathy with hypertension often indicates poor prognosis and should be treated actively. Puli/sartan antihypertensive drugs should be the first choice for treatment. They can also reduce urinary protein while lowering blood pressure.

In most patients with IgA nephropathy with elevated blood pressure, one antihypertensive drug is often ineffective and requires combination of calcium antagonists (horizon antihypertensive drugs), diuretics and beta-blockers (Lol antihypertensive drugs).

2. Chinese Medicine

IgA nephropathy has not yet been treated with specific drugs. Many patients have not completely alleviated urinary protein after routine treatment. Generally, traditional Chinese medicine is needed for treatment. Patients can use traditional Chinese medicine after syndrome differentiation in large-scale Chinese medicine hospitals, which can improve marked efficiency.

3. fish oil

The effect of fish oil is not clear, but the side effects are small. Some IgA nephropathy patients have decreased urinary protein after taking fish oil. After 3 months of pralidol/sartan treatment, if 24-hour urinary protein level has not been reduced to less than 1 g, fish oil treatment may be considered. Generally, imported fish oil has higher purity and obvious efficiency. After taking, pay attention to monitoring urinary protein and serum creatinine to see if it is effective.

4. Hormones and immunosuppressants

If the 24-hour urinary protein of IgA nephropathy patients has not been reduced to less than 1 g after treatment with pril/sartan and traditional Chinese medicine, it is necessary to consider the use of hormones (prednisone) and/or other immunosuppressive agents to inhibit renal inflammation and alleviate proteinuria.

IgA nephropathy is generally not too sensitive to hormones, and its side effects are large, so it is necessary to carefully grasp the indications. "Low-dose hormone + leflunomide" is often better than hormone alone, and its side effects are smaller and safer.

5. Tonsillectomy

Tonsillectomy can alleviate clinical symptoms, reduce proteinuria and delay disease progression, but not all IgA nephropathy requires tonsillectomy, which needs to be weighed. If frequent tonsillectomy infection causes IgA nephropathy recurrence, tonsillectomy may be performed.

6. Other treatments

Most IgA nephropathy patients have low immunity and need antibiotics after bacterial infection.

Patients with edema need diuretic treatment. Thiazide diuretics (such as hydrochlorothiazide tablets) or loop diuretics (furosemide) can be used.

Patients with elevated cholesterol may use statins (such as atorvastatin or simvastatin).

Some diuretics and lipid-lowering drugs also have the effect of reducing urinary protein.

In conclusion, IgA nephropathy patients generally do not progress very fast, but lack of specific drugs, long-term uncontrollable prone to renal failure. Most patients need standard comprehensive treatment and follow-up once a month to 3 months. To avoid renal failure and uremia, we should keep communication with doctors and adjust drugs in time during treatment.

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