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Prevention and treatment of complications of nephrotic syndr

Dec 31, 2016
1 infection
Infection is a common complication of nephrotic syndrome, including bacterial, viral and fungal infections, including hematogenous disseminated tuberculosis and deep fungal infection is the most serious, can threaten the lives of patients. Principle of prevention and cure:
Do not give hormone and cytotoxic drug treatment of patients and antibiotics "prevention" infection, not only can not prevent the infection of fine seeding bacteria, and can easily lead to fungal infection.
The infection, which should be treated as soon as possible the selection of drug sensitive, potent, no renal toxicity (such as isoniazid, ethambutol and pyrazinamide. Quadruple therapy, hematogenous disseminated tuberculosis with deep fungal infection with intravenous fluconazole therapy), and strengthen support treatment.
The repeated infection, supplemented by immune enhancer (such as thymosin intramuscular injection, intravenous immunoglobulin 5g) treatment, reduce infection. 2 thrombosis and embolism
Thrombosis and embolism are another common complication of nephrotic syndrome. Prevention of this complication, the main measures are:
The antiplatelet therapy (aspirin dipyridamole 300mg/d or 100mg/d);
The plasma protein was lower than that of 20g/L patients with nephrotic syndrome, anticoagulant therapy: often treated with heparin calcium 50mg, Q12 subcutaneous injection of H 1 (heparin calcium absorption and metabolism is slow, so it can be injected two times daily), or heparin sodium 25mg, Q6 H (a subcutaneous injection of heparin sodium absorption in vivo metabolism must be fast, 4 ~6 the H effect disappeared, repeated injection), to keep the blood coagulation time (up to 2 times the normal test tube method);
The thromboembolic event, thrombolytic therapy as soon as possible (6 h, 3 days is still expected to be effective: (200 thousand) the clinical commonly used urokinase /d intravenous drip), tissue type plasminogen activator in recombinant plasminogen activator (rT-PA) was better than urokinase thrombolysis, it can try out. Appear thromboembolism patients need continuous anticoagulation for more than half a year, to prevent new recurrent thromboembolism, now often choose oral anticoagulants (such as taking warfarin or other double coumarin preparations), prothrombin time was required to maintain the normal 2 times.
3 hyperlipidemia
As long as it is difficult to estimate the rapid remission of NS (such as hormone resistance or steroid dependent nephrotic syndrome), lipid metabolism disorders to continue for a long time, lipid-lowering therapy should be started as soon as possible. Lipid lowering therapy can reduce the incidence of hyperlipidemia, which can reduce the incidence of complications, such as atherosclerosis, thrombosis and renal damage. Patients with high serum cholesterol should be the first choice for the treatment of hydroxy methyl two acyl coenzyme A (HMG-GoA) reductase inhibitors; to increase serum triglycerides, should be the first choice for treatment of acid derivatives. Have a certain degree of liver toxicity and muscle toxicity, and should not be used. Both of the coumarin drugs to enhance the anticoagulant effect, and when the use of coumarin drugs as appropriate reduction.
Drug treatment must be combined with diet therapy in order to obtain the best results. With less dietary saturated fat and cholesterol (mainly animal fats), rich in polyunsaturated fatty acids (soybean oil, corn germ oil and sesame oil containing ETA 6 fatty acids, fish oil rich in 3 fatty acids) and sterols (sunflower oil, rice oil and rapeseed oil sterol rich sugar, add soluble fiber foods (oats, cereal bran).
4 low serum albumin
The main treatment steps are as follows:
Appropriate protein diet. To ensure that the patient's total daily food calories 30~35cal/kg, attention should be paid to the amount and quality of dietary protein. High protein diet can increase urinary protein excretion and damage the kidneys, the daily protein intake of 0.8~1.0g/kg. The composition of dietary protein (amino acid composition) also affect the excretion of urinary protein, promote the nephrotic syndrome should be more into soy protein based vegetarian, rather than multi animal protein.
To promote the synthesis of protein in liver: a study of the Medical University of Beijing Institute of kidney disease after years of study recommended by Chinese angelica 30g, Astragalus 60g Decoction one dose daily, can promote protein synthesis, has been applied.
The reduction in urinary protein loss by ACEI (such as: benazepril, ramipril), reduce glomerular hypertension, high perfusion and high filtration, and can improve the glomerular filtration membrane permeability and reduce urinary protein (reduced 30%~50%). The therapeutic effect of angiotensin II receptor antagonist is similar to ACEI in some aspects, and has good application prospect.
Nephrotic syndrome due to in vivo metal binding proteins and endocrine hormone binding protein with loss of urine, and lead to active vitamin D and microelements of iron, zinc and copper deficiency should be treated through diet and supplements. Take 25 or 1.25 (OH) D3 (OH) 2D3 in the treatment of active vitamin D deficiency and hypocalcemia best effect.
5 idiopathic renal failure
Hemodialysis: in addition to maintaining life, can be added in the plasma after the appropriate dehydration, in order to reduce the organization (including renal interstitial edema);
The diuretic: still a reaction to the loop diuretics, should actively give, to wash away the tube type tubular obstruction
Active treatment of primary glomerulopathy. Because the most cause of idiopathic acute renal failure cases of small lesions of primary disease, the intensive treatment (such as methylprednisolone therapy) was very good. With the increase of urine volume in acute renal failure but if disease reversal, focal segmental glomerular sclerosis in hormone refractory disease, poor prognosis of patients with acute renal failure may not be restored.

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