Care for children with renal consolidation should be meticulous

Care for children with renal consolidation should be meticulous

Nephrotic syndrome is a group of clinical syndromes caused by a variety of glomerular diseases. The patient often has high body edema, pale complexion, malaise, anorexia, diarrhea, oliguria, and severe kidney failure. At present, the treatment is difficult, and there is a certain recurrence rate, so many patients worried. Nephrotic syndrome can be cured? What about hormone therapy? Chinese medicine treatment can inventive? Our experts for the reader to address these concerns.

Nephrotic syndrome (referred to as kidney consolidation) is a group of clinical syndromes caused by a variety of glomerulopathy. These symptoms include massive proteinuria, hypoalbuminemia, edema, dyslipidemia, and lipid urine.

The function of the glomerulus is like a closely woven "screen mesh", which normally blocks some of the large proteins in the blood and prevents it from losing its body. But once the glomerulus is diseased, the mesh of the mesh is enlarged from small to large, and even the protein of the large molecule can pass through the net of the "bad sieve" and drain along with the urine. When adults lose more than 3.5 grams of protein per day, children lose more than 50 mg / kg of body weight per day, which is called massive proteinuria. Massive proteinuria and hypoalbuminemia are necessary conditions for the diagnosis of renal consolidation. Dyslipidemia and edema are not the necessary conditions for the diagnosis of renal complications, because some patients do not have obvious edema, and some blood lipids can be normal.

classification

According to different etiological factors, kidney consolidation can be pided into two major groups, primary and secondary.

Secondary renal consolidation is a glomerular lesion caused by other diseases. Other causes many children with genetic diseases, infection, allergic purpura see; in youth with systemic lupus erythematosus, infection, drug factors; elderly diabetic nephropathy, renal amyloidosis, multiple myeloma. According to statistics, half of the patients had definite secondary etiology.

Primary renal consolidation refers to the occurrence of primitive lesions in the glomerulus, such as acute nephritis, chronic nephritis, and glomerular nephropathy, and thus the nephrotic syndrome caused by such diseases.

Features

The urine protein urine routine examination found in urine protein or + + + + + + +, 24 hour urinary protein quantitative >3.5 grams. Some cases can be combined with hematuria.

Hypoalbuminemia due to a large number of proteins with loss of urine, so the patient's blood protein concentration, compared with normal people compared to the general low, nephrotic patients showed low serum albumin, serum albumin to less than 30 g / l.. Note, however, that proteinuria is not completely parallel with hypoalbuminemia. In addition, there may be changes in globulin, transporters, coagulation and fibrinolysis related proteins.

In the majority of patients with lipid urine, the total cholesterol, phospholipids and triglyceride increase in blood, and lipids can be found in urine (referred to as lipid urine).

Edema and edema often appear gradually. It is mainly seen in the ankle at the moment. It is sunken; the swelling of the eyelid and the whole body in the morning, and the ascites, pleural effusion or pericardial effusion in the severe cases. When edema is not severe, only weight gain is seen.

Hypertensive patients with renal hypertension around 1/3 can develop high blood pressure, edema, and about half of them have hypertension. Blood pressure usually ranges from 140 to 170/95 to 110 mmhg.

Complication

Secondary infection is the most common, respiratory tract infections, urinary tract infections, skin infections and peritonitis. Orthostatic hypotension can occur in patients with insufficient blood volume. (Note: orthostatic hypotension is hypotension from supine position to upright position or standing for a long time). Children are prone to heart failure, and elderly patients are prone to acute renal failure. In most patients with renal consolidation, the blood is in a hypercoagulable state and is at risk of thrombosis and embolism.

Answer

First, for the treatment of the cause; two is the treatment of complications, such as edema and dyslipidemia; three is the treatment of proteinuria, but can not simply eliminate or reduce proteinuria as the sole purpose. Some patients, despite strict and regular treatment, proteinuria is still unable to control, and significantly reduced renal function, the treatment of this patient should be converted to the protection of renal function mainly.

In recent years, more emphasis has been placed on low protein diet treatment, because high protein diet can lead to glomerulosclerosis. Daily intake of 0.7 to 1 grams of protein / kg body weight, mainly animal protein and soy protein.

Corticosteroids are preferred in the treatment of drugs, such as prednisone. For patients with severe renal pathological changes, the effect of prednisone treatment is not good, or repeated, the author can add immunosuppressive agents - cyclophosphamide. High coagulation can be combined with antiplatelet agents and anticoagulants. In recent years, angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists have been added, which have the potential to reduce urinary protein, protect renal function and lower blood pressure.

Traditional Chinese medicine treatment of kidney syndrome is based on syndrome differentiation and holistic treatment. Although the kidney synthesis is fierce, heavy illness, but as long as adhere to western medicine treatment in the long term, or to completely cure and good prognosis.

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