Laboratory tests
① General inspection: The majority of patients (80%) had a moderate anemia (anemia pigmented cells are positive) rarely showed hemolytic anemia, thrombocytopenia, 1/4 patients with pancytopenia, 90% accelerate ESR. Globulin patients was significantly higher.
② Immunological tests:
(1) Antinuclear Antibody: Sensitivity of antinuclear antibodies in 90%, but lower specificity in mixed connective tissue disease, rheumatoid arthritis, Sjogren's syndrome etc can be positive. Therefore, this test is not the only indicator for diagnosis, can be used as indicators of disease activity reference, however, its titer and severity of renal disease or not has nothing to do.
(2) anti-dsDNA antibodies: an antibody that is diagnostic marker of SLE, the sensitivity of 72%, the change in titer and is closely related to the activity occasionally lupus.Sólo syndrome in sjogren, active rheumatoid arthritis and hepatitis are positive.
(3) antibodies and anti-anti-RNP Sm: Sm antibodies common in 25% -40% of patients illness, common anti-RNP antibodies in 26% -45% of patients. Anti-Sm antibody specificity in the diagnosis of systemic lupus erythematosus high.
(4) anti - histones: Common in 25% -60% of patients. Specificity are better, although common in rheumatoid arthritis and Sjogren's syndrome etc.
(5) antibodies and anti-anti -SSB SSA: The first is common in 30% -40% of patients, the latter is only 0-15% .Both antibodies were mainly observed in Sjogren's syndrome.
(6) Other antibodies: SLE and a variety of other autoantibodies, such as hemolytic anemia, anti-erythrocyte antibodies, necrotizing vasculitis and neutrophil cytoplasmic antibodies (ANCA) etc. in recent years special attention antiphospholipid antibodies, common in 34% of patients .
(7) Complement: C3, C4, CH50 can reduce, in particular, C3 decreased activity of lupus is a sensitive and reliable determine indicators.
(8) Band lupus Skin: Epidermis of non-lesional skin and dermis town link, using direct immunofluorescence, may have IgG and (o) C3 granulated calm band yellow-green fluorescence. The disease is common in patients with more than 70%.
(9) Other: Rheumatoid factor (RF) and cold globulin test can be positive activists pathological changes.
Above is the differential diagnosis of lupus nephritis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and Fitness has all the information? If you have any problem, you can consult our experts online or leave a message below!
2014年12月23日星期二
The consolidation and treatment of nephrotic syndrome
Nephrotic syndrome in the most common clinical nephropathy, this easy disease attacks repeatedly, and the varied and complex clinical symptoms. Therefore, the remission of nephrotic syndrome in a critical period of rehabilitation must meet consolidation therapy to prevent recurrence of the disease.
First, counseling is key. Patients with nephrotic syndrome keep a good attitude is very important to establish the confidence to overcome the disease. The patient nephrotic syndrome, besides the doctor in the hospital has not been informed of knowledge during recovery at home, it is best to know more about some of the basics of nephrotic syndrome and care, if the patient or their families should have such a concept.
Second, work and rest can be combined, some say the nephrotic syndrome should be bed rest, and he did, but it should be appropriate to look out activities, should not be too tired, work and rest can be combined.
Third, unauthorized drugs should be cautious, patients with kidney disease should avoid unauthorized medicines, many of the toxic side effects of drugs on the kidney, often lead to disease recurrence or worsening. The patient must nephrotic syndrome orientation doctor. Rational use of medicines Since the daily supervision of doctors and nurses, medication very regular patient, the disease may also improve stability during hospitalization, consolidation therapy in patients outside the hospital, also subject to prescription. According to changes in their status, follow the additional reduction of medication.
Finally, to restore a reasonable diet. Diet is also very easy to lead to recurrence of nephrotic syndrome. Patients should be based on its condition, specific diet, reasonable diet for kidney disease, which for the rehabilitation of nephrotic syndrome have a very important role.
First, counseling is key. Patients with nephrotic syndrome keep a good attitude is very important to establish the confidence to overcome the disease. The patient nephrotic syndrome, besides the doctor in the hospital has not been informed of knowledge during recovery at home, it is best to know more about some of the basics of nephrotic syndrome and care, if the patient or their families should have such a concept.
Second, work and rest can be combined, some say the nephrotic syndrome should be bed rest, and he did, but it should be appropriate to look out activities, should not be too tired, work and rest can be combined.
Third, unauthorized drugs should be cautious, patients with kidney disease should avoid unauthorized medicines, many of the toxic side effects of drugs on the kidney, often lead to disease recurrence or worsening. The patient must nephrotic syndrome orientation doctor. Rational use of medicines Since the daily supervision of doctors and nurses, medication very regular patient, the disease may also improve stability during hospitalization, consolidation therapy in patients outside the hospital, also subject to prescription. According to changes in their status, follow the additional reduction of medication.
Finally, to restore a reasonable diet. Diet is also very easy to lead to recurrence of nephrotic syndrome. Patients should be based on its condition, specific diet, reasonable diet for kidney disease, which for the rehabilitation of nephrotic syndrome have a very important role.
2014年12月22日星期一
Clinical manifestations of lupus nephritis
Systemic manifestations
Systemic manifestations of lupus nephritis with fever, arthritis and skin damage the mucous membrane is the most common. With the participation of the system there are liver, heart, central nervous system and blood-forming organs, one third of patients have poliserositis (pleura and pericardium) ect. Pulmonary hemorrhage may also be a major manifestations of this disease, Goodpasture there with small vessel vasculitis and phase identification, Raynaud's phenomenon is common in 40% of patients.
Renal manifestations:
① Subclinical or type "silence": No behavior of renal disease, negative urine. But pathological examination often have different degrees of injuries.
② In light type: 30% to 50%, no clinical symptoms, just mild and moderate proteinuria (
③ The type of nephrotic syndrome: About 40% to 60%, showed massive proteinuria, hypoproteinemia and edema, occasional high cholesterol, blood pressure have late disease, renal dysfunction, most patients developed renal failure.
④ The type of chronic nephritis: About 35% to 50% have high blood pressure, varying degrees of proteinuria, urine has a large number of red blood cells and tube, more related to renal dysfunction.
⑤ The type of acute nephritis: The demonstrations are the clinical manifestations of acute nephritis.
⑥ Rapidly progressive glomerulonephritis type: oliguric acute renal failure appears on the short term. Or for mild converte nephrotic syndrome. Pathology revealed glomerulonephritis.
⑦ Type tubulointerstitial injury: Clinical manifestations is renal tubular acidosis, nocturia, hypertension, urinary β2 - microglobulin increased, half of the patients, the low renal dysfunction.
⑧ Type of antiphospholipid antibodies: The main clinical manifestations is the large and small arterial and venous thrombosis and embolism, and reduce platelet and abortion.
⑨ Type of acute renal failure: acute oliguric renal failure and appears in the short term, pathological manifestations is acute tubular necrosis.
⑩ Type of chronic renal failure: Different degrees of proteinuria, hematuria and edema, renal dysfunction there.
Above mentioned are the clinical manifestations of lupus nephritis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and Fitness has all the information? If you have any problem, you can consult our experts online or leave a message below!
Systemic manifestations of lupus nephritis with fever, arthritis and skin damage the mucous membrane is the most common. With the participation of the system there are liver, heart, central nervous system and blood-forming organs, one third of patients have poliserositis (pleura and pericardium) ect. Pulmonary hemorrhage may also be a major manifestations of this disease, Goodpasture there with small vessel vasculitis and phase identification, Raynaud's phenomenon is common in 40% of patients.
Renal manifestations:
① Subclinical or type "silence": No behavior of renal disease, negative urine. But pathological examination often have different degrees of injuries.
② In light type: 30% to 50%, no clinical symptoms, just mild and moderate proteinuria (
③ The type of nephrotic syndrome: About 40% to 60%, showed massive proteinuria, hypoproteinemia and edema, occasional high cholesterol, blood pressure have late disease, renal dysfunction, most patients developed renal failure.
④ The type of chronic nephritis: About 35% to 50% have high blood pressure, varying degrees of proteinuria, urine has a large number of red blood cells and tube, more related to renal dysfunction.
⑤ The type of acute nephritis: The demonstrations are the clinical manifestations of acute nephritis.
⑥ Rapidly progressive glomerulonephritis type: oliguric acute renal failure appears on the short term. Or for mild converte nephrotic syndrome. Pathology revealed glomerulonephritis.
⑦ Type tubulointerstitial injury: Clinical manifestations is renal tubular acidosis, nocturia, hypertension, urinary β2 - microglobulin increased, half of the patients, the low renal dysfunction.
⑧ Type of antiphospholipid antibodies: The main clinical manifestations is the large and small arterial and venous thrombosis and embolism, and reduce platelet and abortion.
⑨ Type of acute renal failure: acute oliguric renal failure and appears in the short term, pathological manifestations is acute tubular necrosis.
⑩ Type of chronic renal failure: Different degrees of proteinuria, hematuria and edema, renal dysfunction there.
Above mentioned are the clinical manifestations of lupus nephritis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and Fitness has all the information? If you have any problem, you can consult our experts online or leave a message below!
The lupus nephritis disease care
1. Psychological care: Disease or take hormones can cause change posture and appearance, unable to bear children, and some loss of function in patients with severe, the depressed patient, overloaded thought lost confidence in life, rejects an treatment. The family members should talk to the patients, allowing patients to feel the warmth and love of people around social, to increase confidence in treatment, and explains reactions are reversible.
2. Diet Care: You have to eat out high-calorie, high in vitamins, low salt diet, in addition to kidney failure can give a high protein diet, use conditional long-term milk, especially colostrum, because the colostrum contains many antibodies, increased immunity.
3. Day care: Outdoor activities can be coated chloroquine face cream, wear long sleeves, wear a wide-brimmed hat, reduce sunlight, prevent skin damage is severe. Interior must there curtain. Good oral care, available in 4% sodium mouthwash to prevent fungal infections, have an oral fungal infection taking nystatin 500,000 units three times a day, or a solution of 1-4% clotrimazole rinsing 3 4 times daily. For finger, toes, nose, earlobes and other parts of the widespread melting arteritis Raynaud's phenomenon, should keep warm and avoid freezing necrosis distal limb.
4. Care medicines: Expert Treatment of lupus nephritis patients should be instructed to correct the use of corticosteroids. After control of the disease can be taken daily or every other day, 07 8:00 a.m.-taking medicine, in order to reduce the inhibitory effect of drugs on the adrenal cortex, and method of making the drug less, so as not to cause a phenomenon of "rebound".
5. To prevent colds and infections: Once the infection, antibiotics should be used much immediately. When patients with lupus nephritis home care, to prevent colds currently hot note. If after a cold, to follow doctor's orders, small renal toxicity taking medicines for colds, for example Victoria c silver fins, oral SHL, Isatis ect.
6. Be careful rehabilitation: Patients with lupus nephritis should have enough sleep, to reduce fatigue while it may be appropriate to participate in various activities, housework and abundance of recreational activities, farmers can be hand light work.
7. Patients with lupus nephritis episodes alternate referral if symptoms recur, it is necessary to consult a doctor.Dosage fatigue, infections, birth often relapse incentives should be taken to avoid. Women of childbearing age should contraception, multiple organ damage should terminate the pregnancy. For organ damage is not apparent, long illness yet, in families, no person urgent desire fertility, under the direction of physicians also have safe delivery, mother and safe preceding child, but should be done under strict medical supervision .
? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and fitness has all the information? If you have any problem, you can consult our experts online or leave message below, you can also send e-mail to enfermedad-renal@hotmail.com.Podemos answered now!
2. Diet Care: You have to eat out high-calorie, high in vitamins, low salt diet, in addition to kidney failure can give a high protein diet, use conditional long-term milk, especially colostrum, because the colostrum contains many antibodies, increased immunity.
3. Day care: Outdoor activities can be coated chloroquine face cream, wear long sleeves, wear a wide-brimmed hat, reduce sunlight, prevent skin damage is severe. Interior must there curtain. Good oral care, available in 4% sodium mouthwash to prevent fungal infections, have an oral fungal infection taking nystatin 500,000 units three times a day, or a solution of 1-4% clotrimazole rinsing 3 4 times daily. For finger, toes, nose, earlobes and other parts of the widespread melting arteritis Raynaud's phenomenon, should keep warm and avoid freezing necrosis distal limb.
4. Care medicines: Expert Treatment of lupus nephritis patients should be instructed to correct the use of corticosteroids. After control of the disease can be taken daily or every other day, 07 8:00 a.m.-taking medicine, in order to reduce the inhibitory effect of drugs on the adrenal cortex, and method of making the drug less, so as not to cause a phenomenon of "rebound".
5. To prevent colds and infections: Once the infection, antibiotics should be used much immediately. When patients with lupus nephritis home care, to prevent colds currently hot note. If after a cold, to follow doctor's orders, small renal toxicity taking medicines for colds, for example Victoria c silver fins, oral SHL, Isatis ect.
6. Be careful rehabilitation: Patients with lupus nephritis should have enough sleep, to reduce fatigue while it may be appropriate to participate in various activities, housework and abundance of recreational activities, farmers can be hand light work.
7. Patients with lupus nephritis episodes alternate referral if symptoms recur, it is necessary to consult a doctor.Dosage fatigue, infections, birth often relapse incentives should be taken to avoid. Women of childbearing age should contraception, multiple organ damage should terminate the pregnancy. For organ damage is not apparent, long illness yet, in families, no person urgent desire fertility, under the direction of physicians also have safe delivery, mother and safe preceding child, but should be done under strict medical supervision .
? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and fitness has all the information? If you have any problem, you can consult our experts online or leave message below, you can also send e-mail to enfermedad-renal@hotmail.com.Podemos answered now!
Disease prevention of lupus nephritis
This article is regarding prevention of disease lupus nephritis? If you are interested, please read next paragraph!
Note genetic predisposition: The incidence of systemic lupus erythematosus close relatives about 5% to 12%, the incidence of monozygotic twins 69%, women are prone populations, which suggests that estrogen related to the pathogenesis of lupus nephritis. therefore, for patients with autoimmune diseases should be on high alert, once the disease should think yes or no have an autoimmune disease, Once the patient has to be actively tried to prevent the emergence of lupus nephritis.
The greater virus infection due to the virus infection concerns appearance of systemic lupus erythematosus. Therefore, we should actively treat a variety of viral infections. Especially for viral upper respiratory tract as "mild illness" should not be taken lightly. Attention to drug toxicity, drug-related lupus there hydralazine, procainamide, isoniazid, methyldopa, quinidine ect, both were common, especially. So for no genetic basis of lupus erythematosus patients, it should be noted that these drugs can induce lupus.
Avoid exposure to sunlight, UV irradiation aggravate lupus nephritis disease is more common. Due to ultraviolet rays can change the DNA thymine dimers, allowing increased antigenicity, promote systemic lupus erythematosus occurs. Therefore, patients with lupus nephritis in daily life should avoid prolonged exposure to sunlight, to reduce excessive ultraviolet radiation caused kidney damage.
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Note genetic predisposition: The incidence of systemic lupus erythematosus close relatives about 5% to 12%, the incidence of monozygotic twins 69%, women are prone populations, which suggests that estrogen related to the pathogenesis of lupus nephritis. therefore, for patients with autoimmune diseases should be on high alert, once the disease should think yes or no have an autoimmune disease, Once the patient has to be actively tried to prevent the emergence of lupus nephritis.
The greater virus infection due to the virus infection concerns appearance of systemic lupus erythematosus. Therefore, we should actively treat a variety of viral infections. Especially for viral upper respiratory tract as "mild illness" should not be taken lightly. Attention to drug toxicity, drug-related lupus there hydralazine, procainamide, isoniazid, methyldopa, quinidine ect, both were common, especially. So for no genetic basis of lupus erythematosus patients, it should be noted that these drugs can induce lupus.
Avoid exposure to sunlight, UV irradiation aggravate lupus nephritis disease is more common. Due to ultraviolet rays can change the DNA thymine dimers, allowing increased antigenicity, promote systemic lupus erythematosus occurs. Therefore, patients with lupus nephritis in daily life should avoid prolonged exposure to sunlight, to reduce excessive ultraviolet radiation caused kidney damage.
? If you want to know more, comment below or chat online!
Clinical expression of FSGS
? What clinical expression of FSGS? Focal segmental glomerular sclerosis is morphology names pathology diagnosis, expression of FSGS is partial (focal) glomeruli and (or) some glomerular capillary loops (segments) lesions. The characteristic of focal lesions of FSGS, perform diagnostic heavily influenced by the organization derivative. First, the involvement of the deep medullary renal cortex along glomerular lesions, may appear obvious first tubular - interstitial injury. Proteinuria, nephrotic syndrome are the major clinical manifestations. The response to treatment of various diseases are poor, showed a chronic progressive disease process, eventually chronic renal failure occur. The disease is seen at any age, more common in children and adolescents. The average age of onset is 21 years. The male to female ratio was 2.2: 1. The disease incidence of several different reports, the incidence of children FSGS about 7% - 15% .Adults nephrotic syndrome patients, approximately 15% and 20% of FSGS. In recent years, tended to increase the incidence. Racial differences FSGS, multiple black.
The clinical expression
No single feature, idiopathic FSGS more with insidious onset of kidney disease as the first comprehensive, 10% to 30% of adult patients with mild proteinuria FSGS may manifest as asymptomatic proteinuria may be associated with common microscopic hematuria (2/3) with gross hematuria. Early in the disease appeared in blood pressure, renal dysfunction and acute renal tubular injury, but most patients during slowly. Upper respiratory tract infection, vaccination and other factors that may aggravate symptoms.
laboratory inspection
Over 80% of patients showed no selective proteinuria, molecular weight proteins in urine (such as IgG, C3, α2 macroglobulin) based. See pleomorphic red urine. Often, the performance of renal tubular dysfunction, such as renal tubular acidosis, low molecular weight proteinuria, glucosuria, urine dilution concentration function abnormalities. Common hypoalbuminemia and hypercholesterolemia, decreased serum IgG. Normal complement. 20% to 30% of patients positive for circulating immune complexes.
The clinical expression
No single feature, idiopathic FSGS more with insidious onset of kidney disease as the first comprehensive, 10% to 30% of adult patients with mild proteinuria FSGS may manifest as asymptomatic proteinuria may be associated with common microscopic hematuria (2/3) with gross hematuria. Early in the disease appeared in blood pressure, renal dysfunction and acute renal tubular injury, but most patients during slowly. Upper respiratory tract infection, vaccination and other factors that may aggravate symptoms.
laboratory inspection
Over 80% of patients showed no selective proteinuria, molecular weight proteins in urine (such as IgG, C3, α2 macroglobulin) based. See pleomorphic red urine. Often, the performance of renal tubular dysfunction, such as renal tubular acidosis, low molecular weight proteinuria, glucosuria, urine dilution concentration function abnormalities. Common hypoalbuminemia and hypercholesterolemia, decreased serum IgG. Normal complement. 20% to 30% of patients positive for circulating immune complexes.
The pathogenesis of lupus nephritis
Lupus nephritis (LN) is systemic lupus erythematosus (SLE) involving the kidneys caused by an immune complex glomerulonephritis, is SLE major cause of death and major complications. Lupus Erythematosus (systemic lupus erythematosus, SLE) is a clinical manifestation of multiple system damage symptoms of chronic systemic autoimmune disease, having anti-nuclear antibody-based serum from a number of different autoantibodies. This disease in remission and acute episodes are characterized by alternating, no offal (kidneys, central nervous system) bad prognosis damage. The prevalence of this disease in our country 1/1000, higher than in Western countries report 1/2000, is more common in women, especially women of childbearing age 20-40 years old.
Pathogenesis
This disease is endogenous body (in person) antigens produce immune complex disease. B cells of SLE patients, the proliferation of highly active, producing a variety of autoantibodies, such as anti-nuclear antibody, anti -single- stranded, double-stranded DNA antibodies, the anti - histones, the anti - RNP antibody -SM anti ect. All of the above substance are anti - nuclear (antigen) antibody. Other anti - cytoplasmic antigen-antibody, for example anti - anti -plaquetas ect erythrocyte antibodies - ribosomal against blood cell surface antigens, anti drug - lymphocytes, antibodies. These antigens and antibodies to form immune complexes disease, deposited in various body tissues, eliciting an immune response, various tissue and organ damage. The SLE is a heterogeneous disease, different patients may variar.Calma immune abnormalities in glomerular immune complexes via the classical pathway of complement activation, the patients serum complement Clq, C3, C4 ingredients are significantly reduced, the strings solution prepared and levels of factor B in normal or slightly decreased. In addition, infiltration of white blood cells, platelets, and intrinsic renal cells in the inflammatory state, is capable of producing a variety of cytokine-mediated inflammatory more injuries.
Pathogenesis
This disease is endogenous body (in person) antigens produce immune complex disease. B cells of SLE patients, the proliferation of highly active, producing a variety of autoantibodies, such as anti-nuclear antibody, anti -single- stranded, double-stranded DNA antibodies, the anti - histones, the anti - RNP antibody -SM anti ect. All of the above substance are anti - nuclear (antigen) antibody. Other anti - cytoplasmic antigen-antibody, for example anti - anti -plaquetas ect erythrocyte antibodies - ribosomal against blood cell surface antigens, anti drug - lymphocytes, antibodies. These antigens and antibodies to form immune complexes disease, deposited in various body tissues, eliciting an immune response, various tissue and organ damage. The SLE is a heterogeneous disease, different patients may variar.Calma immune abnormalities in glomerular immune complexes via the classical pathway of complement activation, the patients serum complement Clq, C3, C4 ingredients are significantly reduced, the strings solution prepared and levels of factor B in normal or slightly decreased. In addition, infiltration of white blood cells, platelets, and intrinsic renal cells in the inflammatory state, is capable of producing a variety of cytokine-mediated inflammatory more injuries.
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