General treatment
Patients have severe edema, hypoalbuminemia require bed rest. The edema disappeared, the general situation improves, can receive up activities.
Given the normal amount of 0.8 ~ 1.0 g / (kg · d) high-quality protein (rich in essential amino acids based animal protein) diet. To ensure adequate per day per kilogram of body weight calories should be less than 30 ~ 35kcal. Despite the large number of patients with urinary protein loss, but because of the diet increased glomerular filtration high in protein, may aggravate kidney disease proteinuria and promote progress, it is now generally do not advocate the application.
When edema should be low in salt (<3 g / d) diet. To reduce hyperlipidemia, feed rich in saturated fatty acids should be less (animal fat) diet and eating foods rich in polyunsaturated fatty acids (such as vegetable oil, fish oil), and rich in soluble fiber (such as beans) diet .
Symptomatic treatment
1. Diuretic swelling
(1) thiazide diuretics: Important role in medullary thick ascending limb loop segment and anterior distal convoluted tubule, by inhibiting the reabsorption of sodium and chloride, potassium excretion increased diuresis. The long-term use should prevent hypokalemia, hyponatremia.
(2) Retention of potassium-sparing diuretics: Important role in the distal convoluted tubule of the posterior segment, natriuresis, row of chlorine, but retain potassium for patients with hypokalemia. When used alone, a diuretic effect was not significant, with thiazide diuretics. Common triamterene or aldosterone antagonist spironolactone. The long-term use is necessary to prevent hyperkalemia should be used with caution in patients with renal insufficiency.
(3) Loop diuretics: lMPORTANT role in the ascending limb of the loop core sodium, potassium and chloride reabsorption has a potent inhibitory effect. Common furosemide (Lasix) and bumetanide (d urinary amine) (equivalent to the dose of furosemide role more than 40 times), sorted by mouth or intravenously. Osmotic diuretics administered in immediately after application, the better. Application of loop diuretics is required to protect against hyponatremia and hypokalemia, hypochloremic alkalosis occurs.
(4) Osmotic Diuretics: Through a transient increase in plasma colloid osmotic pressure, can cause tissue moisture into the bloodstream. They are also through glomerular filtration, resulting in a tubular inner solution hyperosmolar state, reduce water and sodium reabsorption and diuretic. 40 used without dextran sodium (low molecular weight dextran) or starch plasma generation (plasma 706) (molecular weight was 25000 ~ 45000) intravenously. Followed by the addition of loop diuretics may enhance the diuretic effect. But for oliguria (urine output <400 mL / d) should be used with caution in patients with these drugs, because of its easy and tubular secretion Tamm-Horsfall protein and glomerular filtration of albumin to form tubes, tubular obstruction and for his leadership role in hypertonic degeneration of renal tubular epithelial cells and induced necrosis "osmotic nephrosis", leading to acute renal failure.
(5) Increase the plasma colloid osmotic pressure of plasma or plasma albumin infusion: All may increase the plasma colloid osmotic pressure, and promote tissue back to the absorption of moisture and a diuretic such as furosemide glucose solution and then intravenously slowly, sometimes you can get a good diuretic effect. But because of the entry of the protein are within 24 to 48 hours is excreted in the urine, can cause glomerular and tubular filtration high metabolism, resulting in visceral glomerular lesion of tubular epithelial cells, promote renal interstitial fibrosis technology, light effect of glucocorticoid treatment, delaying remission, severe cases can damage kidney function. Should be strictly controlled, severe hypoproteinemia, edema, but very oliguria (urine output <400 mL / d) of NS patients, the case must be considered diuretic use, but also to avoid the too frequent excessive. Use cautiously in patients with heart failure.
NS patients on diuretics principle is not too much too fast to avoid hypovolemia, increased blood clotting tends to induce thrombosis, embolism complications.
Reduce urinary protein
persistent proteinuria itself can cause high glomerular filtration, tubular aggravation - interstitial injury, promote glomerular sclerosis, glomerular disease, affects an important prognostic factor. Has been shown to reduce urinary protein can effectively retard deterioration of renal function.
Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor blockers (ARB) plus effectively control hypertension, but may be by reducing glomerular pressure and glomerular basement membrane to the direct impact of high permeability molecule, can not rely on systemic blood pressure lowering effect of reducing urinary protein. Or ARB with ACEI reduce urinary protein, usually the dose should be used in large doses than conventional blood pressure in order to obtain a good effect.
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