The IgA nephritis Western medicine treatment

(A) treatment
Past that the disease is no specific therapy, and relatively good prognosis and treatment measures are not very positive. But in recent years, along with in-depth understanding of the disease, many studies have shown that aggressive treatment can significantly improve the prognosis. IgA nephropathy from pathological changes to the clinical manifestations are very different, very different prognosis, therefore, must be done individualized treatment measures.
A general principle: control the infection, such as repeated episodes of oropharyngeal and upper respiratory tract infection helps reduce gross hematuria, tonsillectomy reduce the onset of gross hematuria remains controversial. Should actively control blood pressure of hypertension in patients with IgA nephropathy urine protein less than 1g/24 hours, target blood pressure control 130/80mmHg following the urine protein than 1g/24 hours, should be the target blood pressure control in 125/75mmHg less.
Adrenal corticosteroids and immunosuppressants onset nephrotic syndrome or rapidly progressive nephritic syndrome in children, and should be of corticosteroids and immunosuppressive therapy. Japan has conducted a nationwide multi-center controlled study, the use of prednisone and immunosuppressive treatment of IgA nephropathy in children, the proportion of its long-term renal insufficiency was significantly lower than the general treatment of children.
Kabayashi had retrospective study of two groups of patients, a group of 29 patients, proteinuria> 2g / d prednisone 1 to 3 years, 2 to 4 years of follow-up, early results show that hormone therapy (Ccr above 70ml/min time) is beneficial for stable kidney function and slow disease progression. Another group of 18 cases of proteinuria ~~ 2g / d of IgA nephropathy corticosteroid therapy, Dipyridamole (dipyridamole) and indomethacin (Indocin) and 42 cases of IgA patients as a control treatment group in stable renal buck and reduce proteinuria aspects, significantly better than the control group.
Lai et al reported a prospective randomized controlled trial, 17 patients daily doses of prednisone 4 months. 38 months compared with 17 cases in the control group, the average observed two groups of endogenous creatinine clearance was no significant difference, prednisone nephrotic syndrome patients with minor lesions, can significantly improve the response rate, but there are some adverse reactions. This research suggests that prednisone IgA nephropathy.
It was reported that a group of adult IgA nephropathy control study to examine the efficacy of azathioprine and prednisone. 66 patients azathioprine and prednisone, the results show that slow down the progress of IgA nephropathy is useful to compare with the control group of 48 patients who did not receive the treatment.
Recently, Nagaoka et al reported a novel immunosuppressant - mizoribine (mizoribine) for the treatment of children with IgA nephropathy, drug safety, easily tolerated, can be long-term use and can significantly reduce the degree of proteinuria and hematuria, repeated kidney in vivo Histological examination confirmed alleviate the severity of kidney tissue.
Cyclosporine reported less, Lai cyclosporine conducted a randomized, single-blind controlled trial, the treatment group and the control group, 12 cases of patients with proteinuria greater than 1.5 g / d, and creatinine clearance The rate of decline Ccr (77 ± 6) ml / min, to cyclosporine 12 weeks of treatment, the plasma concentration level of control at 50 to 100ng/ml. The results show a significant reduction in protein excretion, accompanied by increased plasma creatinine clearance rate, but these changes disappear after the termination of treatment.
In short, the efficacy of immunosuppressive agents in the treatment of IgA nephropathy has yet to be evaluated. The Woo and Wallker observed the effect of combination therapy of cyclophosphamide, warfarin, dipyridamole (dipyridamole) and hormone results compared with the control group, during treatment can reduce proteinuria and stabilize renal function, but the follow-up of 2 to 5 years after renal protection with the control group compared with no significant difference.
Immunoglobulin in an open prospective study, Postoker and others with high dose gamma globulin intravenous, 1 / d, each 2g/kg, qd for 3 months, then changed to 16.5% human serum gamma globulin intramuscular injection, each 0.35ml/kg, every half times, once every six months and found that, after treatment, urinary protein excretion decreased from 5.2g / d to 2.2g / d, hematuria, and white blood cells in urine disappear, the glomerular filtration rate reduced monthly rate by 3.78ml/min slow down to 0.
Fish oil (fish oil) IgA nephropathy patients lack of essential fatty acids, fish oil supplement essential fatty acids, thus preventing early glomerular damage. Fish oil rich in long-chain omega-3-polyunsaturated fatty acids, EPA (Eicosapentaenoic acid), DHA, these substances can be used instead of arachidonic acid, and play a role as a substrate for lipoxygenase and cyclooxygenase, changes in membrane liquidity, reduce platelet aggregation. Collected 20 cases of patients with IgA nephropathy in 1984 Hamazaki done a preliminary study, the treatment group receiving fish oil treatment, renal function remained stable, the control group did not receive fish oil, lower plasma creatinine clearance.
Donadio conducted a multi-center, double-blind, randomized controlled trial in 1994. A total of 55 patients were collected daily oral 12g of fish oil for the treatment group, 51 patients served olive oil for the control group, 68% of the basis of serum creatinine values ​​increased in selected cases, the initial primary endpoint was serum creatinine increase> 50% result is to observe the end of the treatment period (2 years), the fish oil group, only 6% of patients progress, up to 33% in the control group, for 0.03mg/dl annually serum creatinine increased rate in the treatment group, the control group was 0.14mg / dl. The ESRD incidence after four years, the control group was 40%, compared with 10% in the treatment group, the results are statistically significant, no patients discontinued therapy due to adverse events. That fish oil can slow the rate of decline in GFR. In 1999, the author has reported the results of the long-term follow-up of cases, that early and continued use of fish oil can significantly slow down the high-risk patients with IgA nephropathy, renal failure times.
5 Copp recently organized a six-year prospective multi-center double-blind randomized controlled study to investigate the long-term taking shellfish that benazepril, Plymouth [0.2mg / (kg · d)] of moderate proteinuria, renal children and young patients with IgA nephropathy better therapeutic efficacy, and the test is completed in 2004.
In the past been used phenytoin 5mg / (kg · d) treatment of IgA nephropathy found to decrease the level of serum IgA and polymeric IgA, and hematuria decrease in the number of attacks, but not reduce circulating immune complexes, and the long-term effect is not certainly, in recent years, has been rarely used.
Chinese medicine treatment of IgA nephropathy also have a certain effect, moderate proteinuria, use Tripterygium the lmg / (kg · d) treatment for 3 months, will receive significant effects.
6. Dialysis and renal transplantation feasible dialysis and transplantation in the treatment of patients with end-stage renal failure.
(B) The prognosis
Adult IgA nephropathy after 10 years, about 15% progress to the terminal renal failure, increased to 25% to 30% after 20 years. The prognosis of IgA nephropathy in children better than adults, Yoshikawa reported that after 20 years, 10% progressed to terminal renal failure. Many prognostic factors, severe proteinuria, hypertension, severe glomerulosclerosis and interstitial tubule lesions are indicators of poor prognosis; men also easy to progress; the gross hematuria prognosis still controversial. According to reports, IgA nephropathy patients from renal normal since annual GFR reduction rate of 1 ~ 3ml/min the performance nephrotic syndrome patients with IgA nephropathy GFR decreasing rate 9ml/min. With hypertension, GFR reduce speed to up to a year 12ml/min Therefore, control of blood pressure and proteinuria is essential in the treatment of IgA nephropathy.