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The accelerated nephritis chronic treatment of the elderly

Dec 31, 2016
Necessary to recognize the disease activity to chronic disease control has not stopped after lesions (glomerular sclerosis, tubular atrophy and interstitial fibrosis) development.
For judgment cannot rely on the course of the disease chronic phase, because some patients condition in a few weeks to end-stage;Also does not depend on whether the clinical appear less urine and kidney failure, because the clinical manifestations and pathological changes.Therefore, whether into the course of the chronic phase, depending on whether the dominant pathological changes of chronic changes.
(1) stop the inflammation suppression therapy: the application for chronic patients long-term immune inflammation inhibition of drug side effects are also is serious, but Ⅲ type in with some chronic lesions can still try to strengthen treatment, could achieve a certain effect.General should be changed to at this time to reduce chronic treatment of glomerular filtration pressure, protection of residual renal function.
Hemodialysis: (2) in the acute phase serum creatinine > 530 (including mol/L (6 mg/dl or higher) should start as early as possible hemodialysis treatment, for the immune inflammation suppression therapy "protect".If can't recover the glomerular filtration function will rely on dialysis for a long time.
(3) renal transplantation: relapse again after transplantation is the disease (especially Ⅰ type), should pay attention to the problems in Ⅰ type of recurrence after transplantation was 10% ~ 30%.Later on, therefore, should be in a stable condition for a kidney transplant.In Ⅰ type anti GBM patients should monitor blood, antibody concentration after drop to normal antibody concentration as a medicine for months, but to lower the recurrence rate below 10%.The same type of Ⅲ should also be monitoring the blood level of ANCA in deciding drug withdrawal transplantation is timing.
New therapy advocates IL type 1 receptor antagonist and Ⅰ TNF alpha receptors, soluble dimers P55 chain, can inhibit crescents formation.
Reports the GBM and ANCA associated radical resistance glomerular nephritis patients, a large number of gamma globulin intravenous blood effectively, but also a matter of debate.
4. The preferred scheme Rapid onset of the disease, the disease progresses quickly, options rely mainly on renal biopsy.Crescent shape such as renal biopsy is cells, the elderly more belong to Ⅰ type or Ⅲ type, type Ⅲ patients used a prednisolone (methyl prednisolone) 1.0 g/d, 3 days in a row, and then with oral prednisone (prednisone) 0.5 ~ 1 mg/(kg · d), taking gradually reduced after 3 ~ 6 months, or intravenous drip cyclophosphamide 1.0 g/d, a total of 6 months.Ⅰ patients used plasma exchange, once a week, at the same time, add with oral prednisone (prednisone) 30 ~ 50 mg/d, cyclophosphamide 100 mg/d.Antibodies in the blood circulation, disappear after 1 ~ 2 months, will prednisone (prednisone) gradually removed, cyclophosphamide total 6 ~ 8 g, the treatment is expensive, the pathological diagnosis of fiber crescents, only for hemodialysis.

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