How to treat purpura nephritis

Purpura nephritis is a relatively common kidney disease and also an adverse symptom caused by purpura. If purpura nephritis occurs, it needs to be treated promptly. After all, the kidneys have a very important impact on the overall functioning of the human body. So, if a patient has purpura nephritis, how should it be treated? Here I will introduce to you the treatment methods of purpura nephritis!

1. Treatment principles

Actively control immune inflammatory responses, inhibit glomerular mesangial proliferative lesions, and prevent and delay the formation of chronic renal fibrosis.

2. General treatment

Pay attention to rest and maintain water and electrolyte balance. Patients with edema and heavy proteinuria should be given a low-salt diet, limit water intake, and avoid high-protein foods. Prevent upper respiratory tract infections, clear chronic infection lesions, find allergens, and avoid re-contact.

3. Medication

(1) Isolated hematuria or pathological grade I: only appropriate treatment should be given for Henoch-Schonlein purpura. Changes in the condition should be closely monitored, and follow-up for at least 3 to 5 years is recommended.

(2) Isolated proteinuria, hematuria and proteinuria or pathological grade IIa Angiotensin-converting enzyme inhibitors (ACEI) and/or angiotensin receptor blockers (ARB) have the effect of reducing proteinuria, such as tripterygium wilfordii glycosides. But be aware of its side effects.

(3) Non-nephrotic proteinuria or pathological grade IIb or IIIa: Treatment is with tripterygium wilfordii polyglycosides or hormones combined with immunosuppressants, such as hormones combined with cyclophosphamide, combined with cyclosporine A or tacrolimus.

(4) Nephrotic syndrome or pathological grade IIIb or IV: The clinical symptoms and pathological damage are both severe. Currently, the treatment is mostly based on hormones combined with immunosuppressants. Among them, the most effective treatment is glucocorticoids combined with cyclophosphamide (CTX). If the clinical symptoms are severe, the pathology is diffuse or accompanied by crescent formation, methylprednisolone pulse therapy can be used.

(5) Rapidly progressive nephritis or pathological grade IV or V. The symptoms are severe and the disease progresses rapidly. Triple to quadruple therapy is often used. The commonly used regimen is: methylprednisolone pulse therapy for 1 to 2 courses, followed by oral prednisone + cyclophosphamide (or other immunosuppressants) + heparin + dipyridamole.

4. Plasma exchange

Clinical manifestations of Henoch-Schonlein purpura nephritis are rapidly progressive nephritis, and renal biopsy shows a large number of crescent formations (> 50%). Active treatment measures such as plasma exchange should be taken. It can reduce kidney damage and slow down the progression of renal failure.