Chronic kidney disease is specifically divided into many types, the initial development of kidney disease of different pathologies is different, the sensitivity to medication in the later stage is different, and the prognosis will be much worse. Some kidney diseases can be reversed in the early stages, and after the disease is fully recovered, the basic control is stable. However, there are also a small number of types of kidney disease, which progress quickly, have poor drug effect, and the risk of kidney failure itself is high.
Therefore, the pathological type is also an important factor in determining whether the kidney function is stable and the prognosis of the disease. And at the beginning of the discovery of the disease by kidney friends, if the situation allows, as far as possible to clearly diagnose the pathology, it is more beneficial to the subsequent formulation of treatment plans, more effective medication, and can lay a better foundation.
Basically all pathological types are relatively easy to control and stable in the early stages. Two types of kidney diseases are rare uremias, and the overall progression is not rapid.
Today, I will name these two types of kidney diseases: minimal lesion nephropathy and membranous nephropathy (other types will be mentioned later).
<h1 class="pgc-h-arrow-right" data-track="31" > let's talk about minimal lesion kidney disease first! </h1>
Minimal lesion nephropathy is a more common type of kidney disease in chronic kidney disease, which occurs mostly in children. Many parents of children often ignore some of the child's early diseases and delay the diagnosis and treatment of the disease due to their lack of understanding and understanding of this type of kidney disease.
Although it occurs mainly in children, it is also found in some adults. Minimal lesion nephropathy belongs to a typical type of nephrotic syndrome type of kidney disease, which is manifested as "three highs and one low" symptoms, that is, a large amount of proteinuria, high edema, hyperlipidemia, hypoproteinemia, so it is relatively easy to control.
Generally through clinical experience, pediatric patients do not need a renal puncture due to factors such as age. Adult patients who do not have a long time to heal need to consider a renal puncture.
Can it get better without treatment? Sensitive to hormones
A small number of patients can get better without treatment, but they need to detect kidney function, and if they deteriorate, they need to be used in time, otherwise the risk of infection and kidney failure is higher.
Most patients with large amounts of urine protein are sensitive to hormones and are therefore still preferred, including in children. Clinical data show that the effect of hormones in children is better than that of adults.
About 90% of pediatric patients are relieved after one month of medication, most of them turn negative, and a small number of patients are about 2 months old. In contrast, adult patients in different periods of time to turn negative, the difference is larger, short 1 month or so urine protein can turn negative, long need 3 months or even longer, need to adhere to the drug, if not sensitive to consider adding immunosuppressants.
<h1 class="pgc-h-arrow-right" data-track="32" > talk about membranous nephropathy! </h1>
Membranous nephropathy is the same if left untreated in a small number of patients who can self-remission and fully recover. For patients with a large amount of proteinuria that has already appeared, the chance of self-remission is relatively small, and systematic medication control is also required.
Judging membranous nephropathy does not necessarily require renal puncture, there are two main directions: a large amount of urine protein more than 3.5g, or even more than 10 grams, is a typical manifestation, other types of nephropathy generally 4, 5 grams the highest, less common dozens of grams of the situation. Two tests for anti-PLA2R antibodies. That is, serum antiphospholipase A2 receptor antibody. If the indicator is positive, the odds of membranous nephropathy may be considered.
The main factors affecting the progression and prognosis of membranous nephropathy are urine protein and hypertension, so it is mainly to reduce the level of urine protein in the process of systemic medication. Generally, according to the size of the amount of protein lost in the urine, it is divided into three groups:
Urine protein quantification is less than 4 grams, and creatinine is not elevated, which is a low-risk group;
Urine protein quantification below 4-8 g, creatinine without or slightly elevated, for the medium-risk group;
Urine protein rations exceeding 8 g and creatinine gradually elevated are in the high-risk group.
The lower the urinary protein, the lower the effect on kidney function, the rate of increase in creatinine and the relatively low risk of kidney failure.
Hormones alone have limited effect and require a combination of other drugs
The pathological type of specific membranous nephropathy itself leads to a large amount of urine protein, and the reduction of urine protein levels with hormones alone is not ideal, which is not conducive to controlling the overall progression of the disease. A combination of immunosuppressants such as tacrolimus, cyclosporine, and cyclophosphamide is generally required. In addition, because some patients are accompanied by hypertensive symptoms, they can also take sartan or puri drugs, which play a certain role in lowering protein, can replace some hormones, reduce the side effects caused by hormones, and can also actively delay the progression of kidney function, which is more beneficial to the overall recovery of the disease.
If kidney friends who have been diagnosed with these two types of kidney disease, as long as they actively cooperate with medication and pay attention to the usual nursing care, the general problem is not big.
Kidney friends can click "Learn More" if there are other types of kidney disease problems, such as IgA kidney disease, polycystic kidney, nephritis, etc.