Zhou Xun chief physician of the Department of Nephrology
There is a type of nephritis, which is the most common primary glomerulonephritis (there is no one), this nephritis is IgA nephropathy, which is also one of the main causes of uremia. That is, chronic renal failure and uremia developed from IgA nephropathy are relatively common.
When talking about IgA nephropathy, both nephritis and kidney disease are mentioned. So, is IgA nephropathy chronic nephritis or nephrotic syndrome? From the perspective of pathology and diagnosis, the name of IgA nephropathy is nephropathy, while its pathological type is mesangial hypertrophic nephritis; from the perspective of clinical and laboratory indicators, IgA nephropathy can be manifested as both chronic nephritis syndrome and nephrotic syndrome.
Presents with chronic nephritis syndrome, usually with proteinuria, hematuria, and hypertension as the basic clinical manifestations, the disease is prolonged, the progression of nephropathy is relatively slow, and renal dysfunction (decreased glomerular filtration rate) can occur to varying degrees.
Manifested by nephrotic syndrome, usually with a large amount of proteinuria, hypoproteinemia, can be accompanied by edema, hyperlipidemia and hypertension and other abnormalities, such as can not be timely and standardized treatment, the progression of the disease is relatively fast, and the renal function progressive deterioration.
Therefore, in different patients, the performance of IgA nephropathy is not the same, in addition to the manifestation of chronic nephritis syndrome and nephrotic syndrome, IgA nephropathy can also be manifested as occult nephritis, acute renal failure, chronic renal insufficiency and rapidly progressive nephritis and so on. Among them, the prognosis of occult nephritis is the best, acute renal failure is expected to be reversed, chronic renal insufficiency is more likely to gradually develop into uremia, and the progression of uncontrolled rapidly progressive nephritis will be very fast.
Although the manifestations of IgA nephropathy can be described as diverse, the vast majority of patients still present with "slow" chronic nephritis syndrome or "somewhat urgent" nephrotic syndrome. They are less likely to progress to uremia, the main reason is that the patient's 24-hour urine protein ratio is relatively high or very high, so it is very important to reduce urine protein treatment.
Regarding the treatment of IgA nephropathy to reduce urine protein, in Western medicine, there are mainly the following two treatment options to choose from.
Sartans or ply drugs, both of which are RAS blockers, i.e. renin-angiotensin-aldosterone inhibitors. As the main treatment or basic treatment of IgA nephropathy, this type of drug not only has the effect of lowering blood pressure and thus protecting the kidneys, but also has the effect of protecting kidneys and lowering proteins that do not depend on blood pressure. With long-term use, the effect of lowering protein and delaying kidney failure will be better.
Not all IgA nephropathy requires this regimen, and only those patients who meet the criteria are considered for a "hormone + immunosuppressant" regimen. The "eligibility" mentioned here needs to be combined with specific patients, such as IgA nephropathy that manifests as nephrotic syndrome, or IgA nephropathy with a 24-hour urine protein quantification of more than 1.0 grams, which can be considered and can obtain a good protein-lowering effect.
Regarding the treatment of IgA nephropathy to reduce urine protein, in Western medicine, there are three major treatment advances to choose from recently.
Originally used for the treatment of hypoglycemic hypoglycemia in diabetic patients, dapagliflozin has been found to have a lowering of urine protein and kidney protection effect on diabetic nephropathy. Further studies have found that dapagliflozin also has a very good effect on non-diabetic nephropathy in reducing urine protein and protecting kidneys. It has been approved for the treatment of protein-lowering and delayed renal failure in IgA nephropathy.
Hydroxychloroquine sulfate, which is an immunomodulator, has fewer side effects than immunosuppressants. Originally used for the treatment of malaria and lupus nephritis. In recent years, studies have found that hydroxychloroquine sulfate can also reduce urine protein and delay the progression of renal failure in patients with IgA nephropathy. The relevant guidelines have approved it for the treatment of IgA nephropathy, and the efficacy is good.
An innovative drug independently developed by the mainland and also a targeted drug, Tetacip was conditionally approved for marketing in China in March 2021. It is effective in the treatment of systemic lupus erythematosus (SLE). Recent studies have confirmed that tetazep also reduces urine protein in patients with IgA nephropathy and can delay the progression of slow kidney disease. However, the drug also needs to be approved by the relevant authorities.
If the above-descending protein drugs and treatment regimens are available, they must be selected under the guidance of a treating physician.
It was released simultaneously with the WeChat public account of the same name "Kidney First", and the article was original by Zhou Xun. Unauthorized reproduction is not permitted.