How is Henoch-Schonlein Purpura Nephritis Treated?

Henoch-Schonlein purpura nephritis is a disease that many friends have not heard of. Henoch-Schonlein purpura nephritis is actually a disease caused by a series of pathological symptoms such as Guo Mingxing's purpura, which eventually leads to kidney damage. There must be targeted treatment for Henoch-Schonlein purpura nephritis.

1. Treatment principles

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

2. General treatment

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. Prevent upper respiratory tract infections, clear chronic infection lesions, find allergens, and avoid re-contact.

3. Medication

(1) Isolated hematuria or pathological grade I Henoch-Schönlein purpura should only be treated accordingly. Changes in the condition should be closely monitored, and follow-up for at least 3 to 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) drugs have the effect of reducing proteinuria, such as tripterygium wilfordii glycosides. But be aware of its side effects.

(3) Non-nephrotic proteinuria or pathological grade IIb or IIIa can be treated with tripterygium wilfordii polyglycosides or hormones combined with immunosuppressants, such as hormones combined with cyclophosphamide, combined with cyclosporine A or tacrolimus.

(4) Nephrotic syndrome or pathological grade IIIb or IV

Both clinical symptoms and pathological damage are severe, and the current treatment method is to use hormones combined with immunosuppressants, among which the most effective treatment is glucocorticoids combined with cyclophosphamide (CTX). If the clinical symptoms are severe, the pathology is diffuse or accompanied by crescent formation, methylprednisolone pulse therapy can be used.

(5) Rapidly progressive nephritis or pathological grade IV or V

If the symptoms are severe and the disease progresses rapidly, triple to quadruple therapy is often used. The commonly used regimen is: 1 to 2 courses of methylprednisolone pulse therapy, followed by oral prednisone + cyclophosphamide (or other immunosuppressants) + heparin + dipyridamole treatment.

4. Plasma exchange

Clinical manifestations of Henoch-Schonlein purpura nephritis are rapidly progressive nephritis, and renal biopsy shows a large number of crescent formations (>50%). Active treatment measures such as plasma exchange should be taken. It can reduce kidney damage and slow down the progression of renal failure.