Membranous nephropathy is a very common nephrotic syndrome. Unlike other pathological types that also manifest as nephrotic syndrome, membranous nephropathy is less sensitive to hormones and the treatment effect is often unsatisfactory.
Membranous nephropathy is not sensitive to hormones?
According to the latest pathological studies, we have found that the occurrence of membranous nephropathy is related to the antiphospholipase A2 receptor at the glomerular podocytes.
As a sudden infection (such as a cold) or other factors that cause decreased immunity, this receptor will be exposed, causing antibody attack, that is, anti-phospholipase A2 receptor antibody.
When receptors and antibodies are combined, they become immune complexes. This immune complex located at the glomerular podocyte, in turn, will attract complement attack, the two further combined to form a membrane attack complex.
The birth of this compound will gradually lead to podocyte damage and thickening of the basement membrane.
This is the origin of membranous nephropathy.
According to the pathological changes of nephron, we will divide membranous nephropathy into four phases:
First issue
The immune complexes have just begun to deposit on the basement membrane and have not caused structural changes.
Phase II
The deposition of immune complexes gradually increased, the basement membrane began to thicken, and the spikes formed.
Three issues
The basement membrane is further thickened and the nails are enlarged and fused.
Four issues
The immune complexes are gradually absorbed and the spikes form a chain-like change.
Among them, the first and second phases of treatment are relatively easy, because the nephron has not been substantially damaged, but the podocytes are slightly damaged, and the urine protein can be suppressed, and the disease can be cured.
In the third period, with the thickening of the basement membrane, the glomerular filtration barrier gradually lost its function, preventing protein leakage and increasing the difficulty of treatment.
The effect of hormone therapy on membranous nephropathy is not ideal, because from the third phase, the main reason for protein leakage is no longer the inflammatory response caused by complement and immune complexes, but the podocyte damage, basement membrane thickening caused by small kidney Destruction of the ball through the barrier.
The main role of hormones is to inhibit the inflammatory response. There is not a good way for the abnormal changes of the podocyte and basement membrane, only a slight decrease in the permeability of some renal cells, but for the case of a large number of leaky proteins, the effect is minimal.
The treatment at this time should be divided into two aspects:
First, increase the intensity of the inflammatory response
The commonly used method is to increase other immunosuppressants, such as cyclophosphamide, tripterygium, cyclosporine, etc. The purpose of doing so is to suppress the existing inflammatory reaction and minimize the damage of the nephron.
Second, to strengthen the activity of the remaining nephron
Doctors prefer to use proprietary Chinese medicines such as Jinshuibao and Bailing, mainly to allow them to exert their qi and blood circulation.
Because the kidney itself is a group of two capillaries that dilate blood vessels and improve blood circulation, it can effectively help the nephron to obtain enough nutrients, especially for those kidney units that temporarily stop working under the influence of inflammatory reactions.
Some doctors suspected that the effect of proprietary Chinese medicines was not good enough, and the same purpose was used when using traditional Chinese medicine formulas that countered the evidence.
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