1. Glucocorticoid therapy
Glucocorticoids (abbreviated hormone) for kidney disease is primarily an anti-inflammatory effect. Can reduce oozing of acute inflammation, the lysosomal membrane stability, reduce fibrin deposition, reducing capillary permeability and reduce leakage of urine protein. Furthermore, it can still inhibit the proliferative response of chronic inflammation, decrease the activity of fibroblasts, reduce tissue repair induced fibrosis. Glucocorticoid response to disease depends largely on the effectiveness of the pathological type, minimal change and certainly more rapid efficacy. Using the principles and programs in general are: ① Enough initial dose: Drugs used commonly prednisone, oral eight weeks, if necessary, be extended to 12 weeks. ② Reduce the dose slowly, proper treatment every 2 to 3 weeks after the original amount least 10%, when it is reduced to 20 mg / day or so easily when symptoms recur, be the slower reduction. ③ Long-term maintenance: Finally, the minimal effective dose and then maintained for several months to six months. Volume can be taken full day Dayton clothing or the amount of maintenance medication every other day during the second clothing Dayton, in order to reduce side effects of hormones hormones. Severe edema, liver dysfunction or poor efficacy of prednisone, prednisolone can be replaced by mouth or intravenously.
According to the patient for the treatment of glucocorticoid response, which can be classified as "sensitive to hormones" (Al treatment in 8 to 12 weeks, NS response), "hormone-dependent" (Hormones reduce the dose to a certain extent that relapse) and "steroid resistant" (invalid hormone therapy), the additional treatment of the respective are different.
Prolonged use of steroids can occur in infected patients, drug-induced osteoporosis and other side effects diabetes, sometimes femoral head avascular necrosis, the need to strengthen supervision and timing also may occur.
2. I cytotoxic drugs
The invalid hormonal therapy, or the type of hormone-dependent or recurrent that can help in the treatment of cytotoxic drugs. Because these drugs have gonadal toxicity, liver damage and large doses can cause cancer risk, therefore, indications and drug treatment should be carefully handled. Currently these drugs, cyclophosphamide (CTX) and the acidic environment of benzene nitrogen (CB1348) more clinical application.
3. Immunosuppressive
Currently immunosuppressant cyclosporin A, tacrolimus (FK506) and mycophenolate mofetil is used clinically leflunomide etc.
Immunosuppressive past often combined with glucocorticoid treatment of many different pathological types of nephrotic syndrome, in recent years, is also recommended in some patients due to glucocorticoids relative contraindication or intolerance (if diabetes is not controlled, mental factors, severe osteoporosis), and some patients do not want to accept glucocorticoid therapy or in patients with contraindications exist, can be used alone immunosuppressive therapy (including boots) certain pathological types of nephrotic syndrome, and focal segmental glomerulosclerosis, membranous nephropathy , minimal change nephropathy etc.
Corticosteroids and immunosuppressive agents (including cytotoxic drugs) may have a variety of treatment programs NS, in principle, should be to improve efficiency and minimize side effects is appropriate. If hormone therapy, duration of treatment, and whether to use and the choice of (cytotoxic drugs) immunosuppressive agents in patients with glomerular disease should be combined with other pathological type, age, renal function and if the situation is different contraindications relating treated differently, depending on the role of immunosuppressive agents proposed goals, develop an individualized treatment plan. In recent years, according to the findings of evidence-based medicine, for different pathological types, propose appropriate treatment.
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