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Treatment of nephrotic syndrome with hormones and immunosupp

Dec 31, 2016
A hormone (prednisone) treatment:
Course of treatment: the course of treatment for 6 months for the course of treatment, more suitable for the initial treatment of patients with a course of treatment for a long period of 9 months, more suitable for recurrent.
Dose: l) induction remission phase:
Sufficient prednisone 1.5 2mg/kg / D (weight for height standard), maximum dose of 60mmg/ D orally, urine protein negative after 2 weeks of consolidation. The total amount of not less than 4 weeks, up to 8 weeks.
2) consolidation and maintenance phase:
In the original two days enough 2 / 3, the next day morning meal for 4 weeks, then gradually reduced, every 2~4 weeks by 2.5 - 5mg;
Reduced to 0.5 - 1mg / kg maintained in March, after every 2 weeks minus 2.5 - 5mg to stop drug.
(1) for the use of sufficient hormone over 8 weeks, in remission after induction by transitional reduction method, and then entered the maintenance phase of consolidation. Transitional reduction methods are as follows: 2 / two days to maintain 3 day morning meal, the other will rest for two days the amount of 1 / 3 weight in the morning meal service, and gradually to 2 - 4 weeks after the reduction, the maximum daily amount of not more than 60mg.
(2) the frequency of recurrence: tail therapy NS may in prednisone 0.5 0.25mg/kg level selected can maintain remission dose, long time remain unabated.
(3) nephrotic syndrome medrat (methylprednisolone) pulse therapy, renal pathological basis should be the choice of indications.
Two, immune inhibitors:
Suitable for steroid resistance, frequent relapse, hormone dependence, as well as the emergence of severe hormonal side effects. In addition to paying attention to indications, we should try to combine the clinical and pathological features, especially pay attention to the contraindications and side effects of drugs, in order to achieve a good therapeutic effect.
Immune inhibitors can be used:
Daily oral cyclophosphamide: 2.0~2.5mg/kg for 8~12 weeks. The total dose of less than 200 mg/kg, or intravenous pulse therapy 8~12mg/kg? D, every 2 weeks for 2D, or 1 times a month, a dose of 750mg/m2?. Notice the recent side effects of this drug application (such as leukopenia, liver function damage), pay attention to the impact of hemorrhagic cystitis and need to pay attention to water, and pay attention to the total accumulation amount (<150~200mg/kg) to prevent long-term damage to the gonads. The drug can be used to prolong the remission period and reduce the recurrence, and can improve the effect of hormone resistance on hormones.
Cyclosporin A: dose is generally 5mg/kg, oral treatment for about 6 months, suitable for hormone sensitive but toxic side effects or contraindications and some hormone resistance. Because the drug can cause irreversible damage to the renal tubule, it is necessary to select indications for monitoring drug concentration.
Tripterygium wilfordii glycosides: the daily dose of 1mg/kg or double dose, the maximum dose of 30~45mg/d, the course of treatment for 3~6 months, pay attention to white blood cells, abnormal liver function and gastrointestinal reactions, and may have a certain impact on gonadal function.
Methylprednisolone pulse therapy: methylprednisolone pulse therapy with strong methyl NS, should be chosen based on the pathological indications (such as FSGS). Other: azathioprine, chlorambucil or mycophenolate mofetil.
Three, immunomodulator treatment:
Adjuvant therapy with general acting hormones is suitable for patients with frequent infections, frequent relapses or hormone dependence. Levamisole: dose of 2.5mg/kg day medication course in June.
Four, the prognosis of nephrotic syndrome
1) clinical cure: complete remission, stop treatment 3 years without recurrence. 2) complete remission: blood, urine and biochemical examination is completely normal. 3) partial remission: positive proteinuria (30). 4) remission: urine protein is more than 30.

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