Positive control autoimmune inflammatory response, inhibiting mesangial proliferative lesions, preventing and delaying chronic renal fibrosis form.
General treatment
In active disease, should pay attention to rest and maintain water and electrolyte balance. Edema, proteinuria should be salt, water restrictions and avoid the intake of high protein food. To prevent purpura recurrence increased kidney damage, should pay attention to the prevention of upper respiratory tract infection, chronic infection cleared disease (such as chronic tonsillitis, pharyngitis), actively looking for a possible allergen, avoid contact again.
medical treatement
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(1) isolated hematuria or pathology I level:
Only allergic purpura treated accordingly, microscopic hematuria currently have no exact effect reported in the literature. Should closely monitor changes in condition, it is recommended minimum follow-up 3--5 years.
(2) Isolated proteinuria, hematuria and proteinuria or pathological stage IIa:
Angiotensin-converting enzyme inhibitors (ACEI) and (or) angiotensin receptor blocker (ARB) class of drugs have lower proteinuria role. TWP 1mg / (kg · d), 3 times orally, the daily dose does not exceed 60mg, course of three months. However, it should be noted that the gastrointestinal tract, liver damage, bone marrow suppression and possible side effects of gonadal injury.
(3) non-proteinuria or renal disease pathology II b, Ⅲa level:
With TWP 1 mg / (kg · d), orally 3 times daily maximum amount of not more than 60mg, course of 3 to 6 months. Or hormone combined with immunosuppressive therapy, such as hormones and cyclophosphamide, combined with cyclosporine A or tacrolimus.
(4) nephrotic syndrome or pathological Ⅲb, IV level:
the group of clinical symptoms and pathological lesions are heavier, are more inclined to use hormone combined with immunosuppressive therapy, which most certainly is the efficacy of corticosteroids combined with cyclophosphamide ( CTX) treatment. If the clinical symptoms of severe, diffuse disease or pathology associated with crescent formation, the choice of methylprednisolone pulse therapy, 15 ~ 30mg / (kg · d) or 1000mg / (1.73 m2 · d), the daily maximum amount of not more than 1g, every day or every other day impact, 3 times for a course of treatment. CTX dose of 0.75 ~ 1.0g / m2 intravenous infusion once a month, with six consecutive months, instead of every intravenous infusion of 1 March, the total is generally not more than 8g. Renal insufficiency, CTX dose should be halved.
Other treatment options combined hormone tacrolimus, mycophenolate combined hormone mofetil, azathioprine combined hormone therapy.
Plasma therapies
Clinical manifestations of rapidly progressive glomerulonephritis, renal biopsy showed a large number of crescent formation (> 50%) of nephritis, progression to end-stage renal failure risky, such heavy cases should take active treatment measures, such as plasmapheresis.- Clinical studies have shown that in hormones and cytotoxic drugs on the basis of joint plasmapheresis, or plasma exchange alone, reduce kidney damage, rate of progression of renal failure.
