Nephrologists: Never to be ignored in the treatment of lupus nephritis
problem:
1. What are the difficulties in the treatment of lupus nephritis?
2. What can't be ignored in the treatment of lupus nephritis?
Lupus nephritis is one of the organ damages caused by systemic lupus erythematosus. Although the cause of lupus erythematosus is not yet clear, it will produce a large number of autoantibodies, form immune complexes, and cause damage to the kidneys.
It should be noted that lupus erythematosus causes damage to multiple systems such as the skin, nervous system, cardiovascular system, respiratory system, and digestive system. Therefore, it is necessary to take into consideration the overall situation during the treatment of lupus nephritis.
There is a saying that lupus erythematosus damage to multiple systems is very similar to that of uremia. Therefore, lupus nephritis is also called "uremia that is not uremia."
Lupus nephritis does not have a uniform classification. The WHO classification is currently used. Lupus kidney is divided into six types:
1 mild lesion type
There was no injury or only minor injury to the kidneys. Kidney puncture showed a small deposition of immune complexes and almost no renal symptoms.
Treatment: This type is mainly for the treatment of lupus erythematosus, if properly controlled, can avoid the development of kidney damage.
2 mesangial proliferation
In the glomerular mesangial area, there is damage, mainly mesangial proliferation caused by the deposition of immune complexes. The clinical manifestations are mild hematuria and proteinuria.
Treatment: Urinary protein will further destroy the renal filtration barrier and need to be eliminated in time.
3 Focal segment proliferation
There is segmental glomerular lesions. In addition to hematuria and proteinuria, hypertension may occur in clinical manifestations. A small percentage of patients experience mild renal impairment (decrease in endogenous creatinine clearance). Some patients may show Nephrotic syndrome.
Treatment: The elimination of urine protein has become the focus of treatment, especially in patients with nephrotic syndrome. In addition, it is more important to clear immune complexes.
4 diffuse proliferation type
More than half of patients with lupus nephritis belong to this type. Almost all glomeruli have been damaged, and there is also severe tubulointerstitial damage. Proliferation in capillaries, thickening of capillary walls, formation of crescents, etc. occur, and glomerulosclerosis occurs in some patients. The clinical manifestations are severe hematuria, proteinuria, hypertension, nephrotic syndrome, etc., and most patients have renal insufficiency.
Treatment: In addition to the elimination of symptomatic treatment such as urinary protein, hematuria, and hypertension, plasma exchange is usually used to prevent further deterioration of the condition.
5 membranous nephropathy
Diaphragmatic spasm and diffuse thickening of the basement membrane is the main pathological changes of this type of clinical manifestations of nephrotic syndrome.
Treatment: Similar to membranous nephropathy, in the elimination of urine protein, but also use traditional Chinese medicine to clean immune complexes.
6 glomerular sclerosis
Deposition of immune complexes causes renal cell ischemia and hypoxia, causing glomerular massive sclerosis, and a dramatic decline in renal function. The clinical manifestations are mainly renal failure-related symptoms.
Treatment: Maintaining residual renal function and improving renal microcirculation can improve the quality of life of patients.
Please note: The above types can exist at the same time, and some types can be converted to each other.
1 Systemic lupus erythematosus (SLE) is a multi-system impaired systemic disease. It is important not to focus on kidney damage during treatment.
2 Lupus nephritis is a more serious form of systemic lupus erythematosus damage, so treatment can not be easily interrupted.
3 Elimination of urinary protein is only a means to avoid further damage to the renal filtration barrier. The focus of the treatment of lupus erythematosus nephritis lies in the clearance of immune complexes.
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