Zhou Xun, Chief Physician of the Department of Nephrology
Renal friends who have suffered from kidney disease for many years know that kidney disease has two major problems: first, there is a risk of developing uremia , and second, kidney disease is easy to relapse. Those kidney diseases that relapse and fail to resolve are more likely to develop into uremia. The author found that primary or secondary glomerular diseases such as Henoch-Schonlein purpura nephritis, IgA nephropathy, membranous nephropathy, minimal change nephropathy, lupus nephritis, and hepatitis B virus-related nephritis will Facing recurring problems with kidney disease. After kidney disease relapses, some patients may only have atypical manifestations such as abnormal urine tests, while some patients may have typical manifestations such as edema of the lower limbs and decreased urine output. Regardless of whether there are typical manifestations, the patient's condition will further change and progress, leading to short-term complications (such as thrombosis, embolism, infection, etc.) and long-term consequences ( chronic renal failure, uremia, chronic heart failure, etc.). Therefore, it is very important to actively seek effective treatments to prevent recurrence of kidney disease.
The following six commonly used drugs (types) can prevent recurrence of kidney disease. The key lies in how to use them rationally. Kidney friends can learn about it.
1. Glucocorticoids
Prednisone acetate, Methylprednisolone and methylprednisolone are all glucocorticoid drugs, which are mainly used for their anti-inflammatory and immunosuppressive effects, thus To achieve the therapeutic effect of preventing recurrence of kidney disease. All kinds of glomerulonephritis with higher urine protein can be selected and used according to the specific condition. The dosage of glucocorticoids can be started from low, medium and high doses all the way up to "blast" doses. For kidney disease that is prone to relapse, the principle that patients need to master is "the reduction should be slow enough and the maintenance time should be long, and hormone-dependent patients cannot stop taking the medicine casually."
2.sartan or chloride
valsartan , chloride Sartan and peredopril, etc., all have the words "sartan" or "pullin" in their names. They also belong to the RAS blocker class of drugs. They are non-immune treatment drugs and are mainly used. They can reduce the high pressure, high filtration and anti-fibrosis effects in the glomerulus, thereby achieving the therapeutic effect of preventing recurrence of kidney disease. Although they also belong to a large category of antihypertensive drugs, they are not only used by patients with kidney disease to lower blood pressure. For kidney diseases without contraindications to use, in order to prevent recurrence, patients should use the maximum required amount as much as possible and use it for as long as possible, so that the effect will be better.
3. Cyclophosphamide
Cyclophosphamide is a cytotoxic drug. It was originally an anti-tumor drug. Nephrologists mainly use it to inhibit the division of DNA in cells, thereby achieving the therapeutic effect of curing and preventing recurrence of kidney disease. Although its immunosuppressive effect is relatively strong, as long as its indications and usage methods are mastered, it can also have very good expected effects. Cyclophosphamide usually needs to be used in conjunction with glucocorticoids, that is, the combined effect will be better. As for how to use it, it can be used in small doses every other day, in larger doses every week or month, or in "shock" therapy with large doses right from the beginning. The key is to use a sufficient total dose.
4. Tacrolimus or cyclosporine
Tacrolimus or cyclosporine are calcineurin inhibitors. They were originally used to treat organ transplant rejection. Nephrologists mainly use it to treat organ transplant rejection. By strongly inhibiting the gene transcription of cytokine , it suppresses the abnormally activated immune system, thereby achieving the therapeutic effect of curing kidney disease and preventing recurrence of kidney disease. Tacrolimus or cyclosporine can be used alone or in combination with corticosteroids. The key to treatment is to adjust the blood concentration to an effective standard. The effective blood concentration of tacrolimus is 5-10ng/ml, and the effective blood concentration of cyclosporine is 100-150ng/ml.In addition, the dosage should be reduced slowly, the maintenance time should be long, and the drug must be discontinued with caution.
5. Mycophenolate mofetil
Mycophenolate mofetil is also a immunosuppressant . It is mainly used to treat kidney disease by inhibiting the proliferative response of B lymphocytes to T cells -dependent and -independent antigens, thereby Achieve the therapeutic effect of curing and preventing recurrence of kidney disease. Generally speaking, in the treatment of kidney disease, mycophenolate mofetil is not used alone, but is often used in combination with glucocorticoids or other immunosuppressants. In particular, the combination of "glucocorticoids + mycophenolate mofetil" is the best way to prevent partial It is one of the most effective combinations of drugs for the recurrence of kidney disease. It is often chosen for the treatment and prevention of recurrence of IgA nephropathy, minimal change nephropathy, lupus nephritis, etc.
6. Rituximab or belimumab
Rituximab or belimumab are biological agents. Their main mechanism for treating kidney disease is that they can selectively kill and eliminate B cells, reduce The production of circulating antibodies reduces the body's immune response, thereby curing kidney disease and preventing recurrence. Minimal change nephropathy, membranous nephropathy, focal segmental glomerulosclerosis and lupus nephritis are all options. Generally speaking, rituximab or belimumab cannot be used as the first-choice drug, but the second-choice drug. They can also prevent some kidney diseases that are prone to relapse from relapse or reduce the number of relapses.
The above six drugs (types) are drugs that nephrologists often use to treat frequent recurrences of kidney disease. They can be used alone, or two (types) of drugs can be used in combination to achieve better effects in treating kidney disease and preventing recurrence. . However, these drugs must be used under the guidance of a treating physician.
was published simultaneously with the WeChat public account of the same name "Kidney First". The article is Zhou Xun's original work and may not be reproduced without authorization.
