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Accelerated nephritis of elderly acute treatment of this pha

Dec 31, 2016
Specific treatment method is as follows:
(1) cortical hormone and immunosuppressive drugs: the steroid hormones and cytotoxic drugs based on conventional treatment combined with methyl prednisolone (methyl prednisolone) 1 g intravenous drip, 1 / d or the next day 1, 3 ~ 4 times for a period of treatment, intermittent reusable 3 ~ 4 days after 1 ~ 2 course of treatment.Again to take prednisone (prednisone) 1 mg/(kg · d).This treatment should be used for serum creatinine is less than 707 (including mol/L (8 mg/dl), too late, affect curative effect and the shock therapy than simple oral prednisone (prednisone) and cytotoxic drugs curative effect is improved obviously.In Ⅱ, Ⅲ type patients, 70% patients can out of dialysis, maintain normal renal function, curative effect will hold more than 2 years.In recent years, there are reports application cyclophosphamide intravenous therapy (1 times a month, 0.5 ~ 1 g/m2 body surface area), a total of 6 months (6), with a prednisolone (methyl prednisolone) 500 ~ 1000 mg/d, a total of 3 days followed by oral prednisone (prednisone) 60 ~ 100 mg/d, after 3 months gradually reduced to 30 mg/d then gradually down.After this treatment not only better, reduce urinary protein, kidney function, and the decrease in the number of cells crescent.
Methyl prednisolone (methyl prednisone) therapy for immune complex type (Ⅱ type) and Ⅲ type (small vasculitis) has good curative effect, for type Ⅰ effect is not obvious.
And scholars argued that hormone therapy is to use a prednisolone (methyl prednisolone) vein.30 mg/kg, single dose not more than 1 g, 200 ~ 1000 mg a day or a prednisolone (methyl prednisolone) intravenous drip, and within 20 ~ 30 minutes every day or the next day, the total no more than 3 g.Then the oral prednisone (prednisone) (1 mg/kg per day) for at least 3 ~ 6 months.Oral or intravenous glucocorticoid for Ⅰ radical nephritis relatively ineffective, in the accelerated nephritis of Ⅱ and Ⅲ efficacy as plasma exchange.Combined application of immunosuppressant, not only can reduce the dose and duration of glucocorticoid, and what is more important to slow down the rate of deterioration of renal function seems to be more effective.Especially in patients with ANCA associated acute nephritis, pure application of glucocorticoid therapy after 6 months, the incidence of renal failure was 50%, and the incidence of treatment with glucocorticoid and cyclophosphamide was only 25%.
(2) plasma exchange therapy: often need to apply this therapy with steroids and cytotoxic drugs, in order to prevent the immune and inflammatory process "bounce".Commonly used dose of prednisone (prednisone) 60 mg/d, cyclophosphamide 3 mg/(kg · d) or azathioprine 2 mg/(kg · d).In more than 50 immune inhibitor reduction.
Current data suggest that plasma exchange therapy for this disease Ⅰ model has good curative effect, especially in the early disease, did not become less urine kidney failure, serum creatinine < 530 mu mol/L (6 mg/dl) before treatment, open, most patients can gain better, and circulating antibodies in 1 ~ 2 weeks to disappear.Antibodies after turn Yin continue to use prednisone (prednisone) therapy for months just remove.Although the therapy of Ⅱ type also have certain curative effect, but because of the current application a prednisolone (methyl prednisolone) impact is more convenient, safe, cheap, therefore has not use plasma exchange.
(3) the quadruple therapy (also called haart) : corticosteroids, cytotoxic drugs, anticoagulation and inhibit platelet aggregation drugs used in combination.
Kincaidsmith clinically, Australia has for the treatment of 19 cases of the disease patients (13) is more than 50% have a crescent lesion, including 8 cases of more than 80% of glomerular involvement), received the effect of diuresis and improve renal function, for 5 months ~ 5 years and 9 months.Among them 17 cases after treatment had review renal biopsy, 15 cases crescents disappear, 2 cases of most absorption.Similar results, although there are some reports, but most of the other was not so sure effect, so it is difficult to make a conclusive assessment of this scheme.
Specific method is: (1) heparin in 200 ~ 500 ml 5% glucose liquid drip into the, to prolong clotting time 1 times or decreased urinary FDP to adjust quantity index, total 5000 ~ 20000 u, all day 5 ~ 10 days after the use of oral anticoagulants (such as warfarin) treatment.(2) oral antiplatelet aggregation drugs, such as dipyridamole (dipyridamole) and sulfonated pyrazole ketones (benzene sulfonic sanzuotong), cyproheptadine hydrochloride (cyproheptadine hydrochlofide), etc.(3) or cyclophosphamide azathioprine usage with the foregoing.(4) prednisone 60 ~ 120 mg, the next one, or add a prednisolone (methyl prednisolone) an intravenous drip.
2. Treatment of recurrence and increase Ⅰ type and Ⅲ type in this disease has the possibility of recurrence after illness and ease, can relapse within a few months to several years.With the treatments available to ease again.Illness is often associated with infection treatment process, should actively controlling infection.

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