Each IgA nephropathy patient's condition is not the same, some are only the quiet blood gas accompany, no wind and waves; some slow development, about 25% of patients slowly develop to uremia after 20 years; some are fast Progressive crescent, renal failure occurs in a short period of time (a few months).
The fancy symptoms and prognosis of IgA nephropathy tell us that it is not a single disease but a group of clinical syndromes.In conclusion, our understanding of the disease can no longer rest on the surface of "I am IgA nephropathy, which is treated according to IgA nephropathy." This damn disease is forcing us to make a detailed breakdown.
The classification of IgA nephropathy
How to divide it? According to the pathological grade it? However, the five grading of renal biopsy showed no specific morphological features and was essentially useless for treatment. Currently a new global IgAN clinical pathological type plan has been launched, hoping to be applied in the near future clinical.
The classification of clinical treatment is helpful, academician Li Lei, who according to the clinical treatment of IgA nephropathy, a total of 7 kinds:
1. Isolated microscopic hematuria (IH)
Low awareness, referral rate is poor, the prognosis is better than other types.
2. Repeated gross hematuria (RGH)
Often caused by tonsil infection hematuria, most advocate the removal of tonsils.
3. Urine test abnormal type
Features: The most common clinical, insidious onset, mainly for less ~ moderate proteinuria, often accompanied by microscopic hematuria. No high blood pressure, normal renal function, but if not actively treated, there may be high blood pressure and renal failure.
treatment:
Puli class, sartan drugs as the basis for treatment
24-Hour Urine Protein Quantification 1. Ig ~ 3.4g patients with IgA nephropathy treated with hormones or immunosuppressive agents, including mycophenolate mofetil.
3.5g or more proteinuria in patients with reference to type 5.
4. crescent size
Features: Renal biopsy showed glomerular crescent formation, a large number of microscopic hematuria or persistent gross hematuria, with hypertension or renal insufficiency, the majority of patients within 4 years of progression to uremia.
5. A large number of proteinuria type
Features: Typical nephrotic syndrome, no or only a small amount of microscopic hematuria, may have high blood pressure, renal insufficiency and renal tubular dysfunction.
Treatment: This type of IgA nephropathy, tubulointerstitial lesions lighter, hormone therapy can be used, if effective, with hormone maintenance.
However, patients with severe tubulointerstitial lesions, or renal insufficiency, hormone or cytotoxic drugs less effective, mainly symptomatic treatment, protection of renal function, to avoid excessive immunosuppressive agents such as infection caused by the merger Symptoms, is not recommended for mycophenolate mofetil and cyclophosphamide.
Hypertension
This is an independent type of IgA nephropathy that needs to be clearly defined
7. End-stage renal failure type
Kidney failure has occurred, irreversible
In general, the current medical community is still a lack of effective treatment of IgA nephropathy.
This is the largest number of kidney disease, one in four will develop uremia, are you in it?
However, a specific Swedish drug for IgA nephropathy has started clinical trials. The current experiment smoothly, drop the protein effect gratifying, may be available soon, tomorrow we continue to talk IgA nephropathy new drugs.
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