How to treat purpuric nephropathy?

The harm caused by purpuric nephritis is relatively serious, so certain principles must be adhered to in the treatment work, and the immune inflammatory response must be actively controlled. Patients should pay attention to rest, maintain water and electrolyte balance, and use drugs scientifically.

1. Treatment principles

The treatment plan for purpuric nephritis should be selected according to the patient's age, clinical manifestations and degree of renal damage.

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

2. General treatment

During the active period of the disease, you should 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. To prevent recurrence of purpura and aggravate kidney damage, attention should be paid to preventing upper respiratory tract infections, clearing chronic infection lesions (such as chronic tonsillitis and pharyngitis), actively looking for possible allergens, and avoiding re-contact.

3. Drug treatment

(1) Isolated hematuria or pathological grade I:

Only Henoch-Schonlein purpura is treated accordingly, and there is currently no literature report on the definite efficacy of microscopic hematuria. Changes in the condition should be closely monitored, and follow-up for at least 3-5 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. Tripterygium wilfordii polyglycosides 1 mg/(kg·d), taken orally in 3 divided doses, with the daily dose not exceeding 60 mg, for 3 months. However, attention should be paid to its side effects such as gastrointestinal reactions, liver damage, bone marrow suppression and possible gonadal damage.

(3) Non-nephrotic proteinuria or pathological grade II b or IIIa:

Take 1 mg/(kg·d) of tripterygium wilfordii glycosides orally in 3 divided doses. The maximum daily dose should not exceed 60 mg. The course of treatment is 3 to 6 months. Or hormone combined with immunosuppressant therapy, such as hormone combined with cyclophosphamide, combined with cyclosporine A or tacrolimus treatment.