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Individualized treatment of nephrotic syndrome

Dec 31, 2016
(1) primary nephrotic syndrome caused by minimal change and mild mesangial proliferative glomerulonephritis

The initial treatment can use hormone, and small dose, recurrence (especially recurrent cases) should be treated with hormone cytotoxic drugs (often choose cyclophosphamide, also available nitrogen mustard, which reduce the recurrence of similar effect) combined treatment of adults about 15% were refractory nephrotic syndrome in these patients. (especially for hormone dependent patients) trial of cyclosporine A.
(2) primary nephrotic syndrome due to membranous nephropathy
The treatment of membranous nephropathy should be combined with hormone and cytotoxic drugs (cyclophosphamide or A), and it can also be used in the treatment of cyclosporine. Glucocorticoid combined with mycophenolate mofetil for treatment of membranous nephropathy (including part II) cases, it also has a good effect. Patients with membranous nephropathy are mostly middle-aged and old people, and they are prone to serious side effects, so it is necessary to pay attention to them, so the invalid cases (especially the second stage) after the regular treatment should be reduced and stopped. In addition, membranous nephropathy is prone to thromboembolic complications, attention should be paid to prevention and treatment.
(3) primary nephrotic syndrome with severe mesangial proliferative glomerulonephritis and focal segmental glomerulosclerosis
Treatment of hormone and cytotoxic drugs (or mycophenolate mofetil) combined application, without obvious side effect, hormone drug interaction takes longer (or 6 months), reducing the rate of drug maintenance treatment to more slowly, more long. For some invalid cases (especially those with hormone dependence), cyclosporine A may also be used.
(4) primary nephrotic syndrome caused by mesangial capillary nephritis
Disease progression is rapid, easy to end renal failure. The goal of treatment is to delay renal damage, and is not easy to achieve. The pathological type of nephrotic syndrome can refer to the above treatment of severe mesangial proliferative nephritis and focal segmental glomerulosclerosis, do not advocate the use of cyclosporine A, has proven ineffective. Some scholars claim that the nephritis patients should be long-term antiplatelet agents (aspirin dipyridamole 300mg/d or 100mg/d) and angiotensin converting enzyme inhibitor, thought to delay the progression of renal damage is good.

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