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How to Treat the Membranous Nephropathy


2015-02-12 09:25

How to Treat the Membranous NephropathyThe Membranous Nephropathy is a noun of pathomorphism diagnosis and is a common pathogeny. The characteristic pathological alteration is that large number of immune complex deposition in the capillary loops of epithelial side of glomerulus. If you have any question please ask our ONLINE DOCTOR directly for free.

Treatment involves the use of non-immunosuppressive therapy in all patients. In patients who do not respond adequately to non-immunosuppressive therapy or those patients who have a higher risk of progression to end-stage renal failure are generally offered immunosuppressive therapy as well. Several immunosuppressive regimens have been shown to be successful. Agents that have been utilized include corticosteroids (e.g. prednisone), cytotoxic agents, calcineurin inhibitors, mycophenolate, rituximab, eculizumab, and ACTH. These agents modify the immune response and help decrease the formation of immune deposits in the glomerular basement membrane.

Non-immunosuppressive therapy is directed at control of edema, hypertension, hyperlipidemia, and proteinuria; it is similar to that used for Nephrotic Syndrome of any cause. Blood pressure control is important for both renal and cardiovascular protection. For patient with proteinuria of more than 1 gram per day, the target for blood pressure is 125/75 mm Hg. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are cardioprotective and can reduce proteinuria and slow progression of renal disease. Patients with significant proteinuria almost always have elevated serum cholesterol and triglyceride levels. Although not proven, it is recommended to use statin agents to reduce cholesterol levels.

Apart from the above the therapy, there exist the Immunotherapy.

For the patients with urine protein ration less 3.5g/day, plasma-albumin is normal or decrease slightly and normal kidney function.

1). Control blood pressure: blood pressure control the less 125/70mmHg, ACEI or ARB is the first choice of the drugs.

2). anticoagulant therapy: for the high incidence of venous thrombosis for the patients membranous nephropathy. It is preventable. There are risk factors (urine protein more than 8g/day, plasma-albumin less 20g/L,) in the patients. They should take the active measures. Low moleodcular heparin is the first choice drug. If patients got the long-term hypoalbuminemia, they can consider changing the oral warfarin anticoagulant therapy.

3) Low-protein diet: many patients with proteinuria intake protein limited 0.8g and given sufficient heat. The total heat be guaranteed 146.54kg (35kcal).

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