In the clinical work of Kidney Disease, some patients with long-term non-remission of urinary protein are often treated, and the urinary protein can not be reduced after medication.
Urinary protein in patients with nephropathy can not be reduced mostly because of the treatment is not standardized, the most common are several:
Focal segmental glomerulosclerosis and amyloid nephropathy are the most commonly misdiagnosed diseases. Pathologically, they are somewhat similar to those of minimally invasive nephropathy, so they are misdiagnosed as minimally invasive nephropathy, and subsequent treatment is incorrect.
2. Drug withdrawal occurs when hormone is ineffective after 8 weeks
Most patients use hormones, urinary protein will be significantly reduced within 4 weeks, some kidney diseases need immunosuppressive agents (hormones can be combined). But not all hormone-effective patients were effective within 4 or 8 weeks.
For example, membranous nephropathy, it may take 12 weeks for hormone plus immunosuppressive agent to be effective, or focal segmental glomerulosclerosis, it may take 16 weeks (about 4 months) for hormone to be effective.
3. Minimal lesions/membranous nephropathy with hormones only
Most children with nephrotic syndrome are minimal change nephropathy. The preferred drug for minimal change is hormone, but not hormone only. Some patients with minimal change nephropathy are prone to frequent recurrence.
If the proteinuria of minimally invasive nephropathy recurs repeatedly, cyclophosphamide can be added for a period of time; patients who are not suitable for cyclophosphamide can use cyclosporine (cyclosporine starts at a small dose, gradually increases, and decreases slowly after effect).
If hormones are not suitable for patients with membranous nephropathy, immunosuppressive agents alone are acceptable.
If patients with membranous nephropathy are resistant to the "hormone+immunosuppressive" regimen, they can be treated with rituximab, which can further improve the remission rate of urinary protein by 60%-65%.
4. Low immunity without paying attention to immunity
Patients with high urinary protein must pay attention to plasma albumin.
If urine protein is lost too much, the protein in blood will decrease and hypoproteinemia will occur (plasma albumin is less than 30g/L). If the plasma albumin is too low, the immunity of the human body will be reduced, and infection will often occur, leading to the protracted illness. Therefore, patients with high urinary protein should pay attention to the level of plasma albumin and infuse human serum albumin when necessary.
There are also immune tests, peripheral blood lymphocyte count needs to be more than 600/mm3, CD4 cell count needs to be more than 200/mm3, these two indicators are too low and easy to infection, thymosin or/and immunoglobulin improve immunity.
Influenza vaccines and pneumococcal vaccines are recommended to prevent colds in patients with common colds. Nephrotic patients without contraindications are recommended to be injected.
5. Other issues
For those allergic to pollen, dust mites, pets, cats and dogs, they need to stay away from these allergens, such as Henoch-Schonlein purpura nephritis, minimal change nephropathy and other kidney diseases, which are easy to relapse due to exposure to allergens.
If the tonsils of IgA patients are frequently infected, tonsillectomy may be considered.
Human serum albumin infusion can improve immunity, but it can not be excessive infusion, which may lead to severe vacuolar degeneration of renal tubules (large intestine-like changes), so that hormones are ineffective, we should wait for several months, after the repair of tubular lesions, then use drugs.
There are also some patients who have repeatedly tossed high urine protein at home, so we will not start to talk about it here.
Not all urinary proteins can be alleviated eventually. After western medicine combined with traditional Chinese medicine treatment based on syndrome differentiation and methods that should be used are ineffective, we can use pril/sartan drugs, diuretics, lipid-lowering and other means to minimize urinary proteins, which can be reduced a little is a success point. The patients who are delayed because of non-standardized diagnosis and treatment should seek standardized treatment in hospitals with strong strength of Nephrology as soon as possible.
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