A typical symptom caused by pathological injury of kidney disease is proteinuria, according to different pathological types and degrees of injury, different patients have initial diagnosis, urine routine examination and quantitative determination of urine protein are not small differences. Some people have only a slight protein loss in the early stage, urine protein 1 +-2+, the quantitative amount is usually less than 3 grams, while some people have a large amount of proteinuria loss, urine regular protein 3 +-4+, quantitative more than 3.5 grams, and a small number of people even have a loss of up to a dozen grams.
Regarding proteinuria, most kidney friends are more concerned about several issues:
How to stop the loss of protein in the urine? Can a large amount of proteinuria turn negative? How to avoid the recurrence of urine protein?
Clinically, many patients who have encountered this situation have repeatedly taken a large amount of proteinuria after medication, and they cannot turn negative for a long time.
A patient with membranous nephropathy contacted me in the headlines and learned through communication that his pathological damage was very serious. Proteinuria loss at first admission is up to 16 grams. The whole person was severely edematous, accompanied by hypoproteinemia and hyperlipidemia, and the situation was critical at that time.
Last week, I came to review, the overall condition is relatively stable, there is no recurrence in half a year, and the current urine protein quantification is 0.28 grams. This is a level he has not reached before.
Proteinuria 16 grams drops to less than 0.5 grams, what is the key?
The patient (Xiao An) is not very old, 31 years old, the first diagnosis of kidney disease was in May, the detection of urine protein 3+, urine protein quantification at 3.6 grams. During the period there are no uncomfortable symptoms, start taking hormone therapy. In less than a month, he slowly began to develop edema, and there was chest tightness, dizziness and discomfort, and after a month, he felt that the effect of hormone control was not very good. The doctor suggested that he have a kidney puncture, thinking that he was young and afraid of leaving sequelae, he refused.
But the condition became more and more serious, and gradually got out of control.
When he was admitted to the hospital in June, his urine routine check urine protein 4+, 24 hours of urine protein quantification reached 16 grams, the total protein dropped to more than 30 grams, severe malnutrition, blood lipid levels exceeded.
In response to his situation, he immediately consulted with Chinese and Western medicine experts, formulated a plan to continue to control kidney inflammation with hormones, increase immunosuppressants including tacrolimus to enhance the immune effect of hormones, and combine traditional Chinese medicine foot baths and fumigation with oral drugs to strengthen blood circulation, alleviate the patient's water and sodium deficiency, and supplement protein therapy, regulate protein balance in the blood, and improve blood lipid balance.
After less than one and a half months of treatment, the condition was basically controlled and stabilized, the quantitative amount of urine protein in the re-examination dropped to 1.3 grams, the edema was effectively alleviated, the patient lost weight, and his own state recovered. After discharge, continued maintenance therapy for immune function enhancement.
During the review, the quantitative drop dropped to 0.63 grams. This month is to review quantitatively further stabilize at 0.28 g while the blood is completely eliminated.
The patient came to the whole state better this time, through the detection of his immunity has improved, appropriate adjustment of medication, and gradually reduce the amount of medication.
As far as the patient's situation is concerned, many patients cannot lower or repeat the urine protein, and there may be some misunderstandings in medication.
The first aspect is that the control of hormones alone is not up to standard and is maintained continuously. This is the case in most patients, and poor hormone control can stretch for a long time and increase the dose. However, there is no adjustment of the drug to control the root cause of impaired kidney function and protein loss, resulting in delayed treatment of the disease, and the follow-up adjustment plan for disease treatment will reduce to a certain extent.
The second aspect is that the medication is not comprehensive and irregular. The appearance of proteinuria is often accompanied by a number of comorbidities, some patients have severe edema, hypoproteinemia is more critical than the price, at this time or blindly only pay attention to protein reduction, without systematic control, often not easy to achieve the effect.
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