Nephritis Patients With Only Proteinuria Need To Do These 6 Points To Control The Disease!

Nephritis has different clinical manifestations according to the course of the disease. Some patients with nephritis have undergone several examinations and found that they have no other symptoms except that the urine protein is positive. How should such patients control the disease? In fact, in the treatment of this chronic nephritis, it is very important to do these 6 points well!

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What is chronic nephritis?

Chronic nephritis is a group of glomerular diseases with proteinuria, hematuria, and high blood pressure as the basic clinical manifestations. According to the etiology, we divide nephritis into primary glomerulonephritis and secondary glomerulonephritis: Primary glomerulonephritis refers to nephritis without a clear cause, while secondary glomerulonephritis is nephritis caused by other diseases, such as systemic lupus erythematosus, allergic purpura, vasculitis, and other diseases.

The "inflammation" of chronic glomerulonephritis is not an infectious inflammation caused by microorganisms such as bacteria and viruses, but a sterile inflammation caused by autoimmune damage induced by infection of the respiratory tract, digestive tract, and urinary tract. That is to say, chronic nephritis is caused by The own immune system damaging its own glomeruli.

Although primary nephritis has no definite cause, it is mostly caused by respiratory, gastrointestinal, and urinary tract infections, and is aggravated by infection.

In addition to the most common IgA nephropathy and membranous nephropathy, primary nephritis includes minimal change disease, non-IgA mesangial proliferative glomerulonephritis, mesangial capillary glomerulonephritis, For other types such as focal segmental glomerulosclerosis, the treatment methods and prognosis of different types of nephritis are different, so chronic nephritis generally requires renal biopsy for pathological classification and then combined with urine protein quantification for precise treatment.

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This patient developed proteinuria. First of all, proteinuria should be quantified, that is, a urine protein quantification should be performed. On the one hand, the need for renal biopsy should be determined according to the quantification. After the pathological results are clear, the selection of hormones can be determined according to the urine protein quantification; On the other hand, urine protein quantification is also an important indicator to measure the severity of the disease and to judge whether the treatment effect is good or bad.

How to treat chronic nephritis to control the progression of the disease?

Only proteinuria, no high blood pressure, generally speaking, the condition is not too serious. The treatment measures for chronic nephritis include treatment of the cause (suppression of immunity), strict control of blood pressure, reduction of proteinuria, and delaying the progression of kidney disease.

1. Suppression of immunity:

As mentioned above, because autoimmunity is involved in the pathological process of chronic nephritis, chronic nephritis often requires immunosuppressive therapy. Hormone therapy for chronic nephritis is strictly regulated: under what circumstances? How much? How long does it take? How to reduce weight? The guidelines clearly state:

For example, IgA nephropathy progresses faster and is more likely to have impaired renal function, so immunosuppressive therapy should be more active. It is generally recommended that if the quantitative urine protein is ≥1 g/d, or the pathological crescent appears, hormone therapy should be used; and For membranous nephropathy, the use of corticosteroids should be considered only when the quantitative urine protein is ≥3.5g/d.

The dose of steroids is 1 mg/kg/d of prednisone or 0.8 mg/kg/d of methylprednisolone, and the dose is decreased after 1 to 3 months of adequate treatment. For many types of nephritis such as IgA nephropathy, membranous nephropathy, and secondary lupus nephritis, in addition to hormone therapy, it is also necessary to use combined immunosuppressive therapy, such as cyclophosphamide, cyclosporine A, tacrolimus. Secretary and so on.

2. Strictly control blood pressure and lower urine protein:

Antihypertensive therapy can not only inhibit the damage to the glomeruli caused by hypertension, but also significantly delay the progression of nephropathy, and antihypertensive drugs such as prilub or sartan also have the effect of lowering urinary protein. Angiotensin-converting enzyme inhibitors (ACEI, Puli class) or angiotensin receptor blockers (ARB, sartan class) antihypertensive drugs are the first choice, and the dose can be 2 to 4 times the antihypertensive dose.

In addition, most patients need to take two or more drugs to control blood pressure, often combined with long-acting calcium antagonists, as well as diuretics, beta-blockers, and other antihypertensive drugs.

3. Swelling:

Giving thiazide diuretics or loop diuretics can remove excess fluid from the body and help control blood pressure. Combined use with ACEI or ARB can increase the antihypertensive effect.

4. Adjust your lifestyle:

Reduce salt intake, eat light, balanced meals, do not overeat; drink more water appropriately, do not hold back urine; persist in exercising, control weight; avoid colds, avoid streptococcal infection, and use antibiotics to treat pharyngitis and tonsillitis thoroughly. Tonsils are removed if necessary.

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For patients with decreased renal function, a low-salt, low-fat, high-quality low-protein diet should be used. The daily protein intake is 0.6~0.8g/kg. High-quality proteins such as milk, eggs, and refined meat can be selected. Soy protein is also a high-quality protein. , can also be eaten in moderation. For those who have a strict high-quality low-protein diet and economic conditions permit, they can take compound alpha-keto acid, which not only supplements essential amino acids, reduces the burden on kidneys, but also combines urea nitrogen to improve protein metabolism.

5. Avoid drug abuse:

Some so-called "kidney-protecting" drugs are not only useless and may even be harmful, it is very important but often overlooked that patients with chronic nephritis should avoid drug abuse.

The use of antipyretic analgesics (non-steroidal anti-inflammatory drugs), aminoglycoside antibiotics, and traditional Chinese medicines containing aristolochic acid and heavy metals should be minimized. Most cold medicines contain antipyretic and pain relievers, so you must be cautious when taking cold medicines. There is no need to take medicine for common colds, and antibiotics can be used after bacterial infection.

6. Strictly control blood sugar and blood uric acid:

Long-term diabetes and high uric acid also lead to kidney damage, and lowering blood sugar and uric acid can delay the progression of kidney disease. Glycated hemoglobin should be controlled below 7%, and blood uric acid should be controlled below 360 µmol/L.

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