What are the types of nephritic syndrome? How to treat it?

As the pressure of life continues to increase, many people are plagued by various diseases. Among them, nephritic syndrome is relatively common in life. So what are the types of nephritic syndrome? How to treat it?

【Pathogenesis】

It is now generally recognized that the pathogenesis of kidney disease is the immune response process of anti-basement membrane antibody nephritis. Due to certain pathogenic factors that primarily damage the alveolar septum and pulmonary capillary basement membrane, the latter stimulates the body to produce anti-pulmonary basement membrane antibodies, which cause a series of alveolar immune reactions under the action of complement, etc. Because there are cross-antigens between the alveolar wall basement membrane and the glomerular basement membrane, endogenous anti-alveolar basement membrane antibodies can also react immune to the glomerular basement membrane and damage the glomeruli.

【Classification】

Nephritic nephrotic syndrome can be divided into rapidly progressive nephritic nephrotic syndrome and chronic nephritic nephrotic syndrome according to different pathological damage characteristics and progression degree.

Rapidly progressive nephritis and nephrotic syndrome is a clinical syndrome characterized by rapid progression of proteinuria and hematuria to anuria or oliguria and acute renal failure.

Chronic nephritis and nephrotic syndrome is a group of diseases originating in the glomerulus and composed of multiple causes and pathological types. The main clinical features are long-term persistent abnormal urine test results, such as proteinuria and/or hematuria, slowly progressive renal function damage, varying degrees of hypertension and/or edema, and ultimately condensed kidney and end-stage renal failure. Without correct and effective treatment, the prognosis is poor.

【diagnosis】

The diagnosis can be made based on repeated hemoptysis, hematuria, X-ray signs and positive hemosiderin cells in sputum. If there are only pulmonary manifestations, it must be differentiated from idiopathic pulmonary hemosiderosis. It is easier to diagnose after the onset of renal symptoms, but it must be differentiated from necrotizing vasculitis with pulmonary and renal manifestations and uremia with hemoptysis. Typical cases have obvious pulmonary hemorrhage and glomerulonephritis, plus positive anti-basement membrane antibodies, which usually allow for a diagnosis. However, some patients have atypical clinical manifestations, with one symptom being the most prominent, which is easily overlooked, leading to missed diagnosis or misdiagnosis. Therefore, patients with unexplained hemoptysis, especially young men, who have hematuria, proteinuria, lung X-ray changes, especially those with anemia and progressive renal dysfunction in a short period of time, should highly consider the possibility of this disease. Renal or lung biopsy can help confirm the diagnosis.

【treat】

Regardless of the type of nephritic syndrome, most of them are caused by various factors leading to renal ischemia and hypoxia, which cause damage to vascular endothelial cells, attract inflammatory mediators in the blood circulation, and trigger local pathological changes in the glomeruli. Therefore, in the treatment of nephritic syndrome, we should start from the following points:

1. "Grasp the source and expand blood vessels" to dilate renal arteries at all levels, improve local microcirculation disorders, increase effective perfusion, and relieve the hypoxia of damaged kidneys. Prevent the aggravation of inflammatory response and reduce the factors that cause glomerular damage.

2. Inhibit the activity and inactivation of a series of nephrotoxic factors such as inflammatory mediators, cytokines and growth factors, thereby blocking the continued damage to damaged kidney functional cells, promoting their reversal to normal metabolic function, and reducing pathological changes in glomeruli.

3. Patients with nephritis, nephropathy and renal syndrome are prone to hypoproteinemia, which leads to blood concentration, hypercoagulable and high-viscosity state, increased inhibitory fibrinolytic ability of lipoprotein Lp(a), increased fibrinogen activators, increased fibrin clots, decreased dissolving ability, and thus thrombosis. On the other hand, renal endothelial cells have anticoagulant and anti-thrombosis functions. When the kidneys are ischemic and hypoxic, the endothelial cells will be damaged, platelet function will be hyperactive, platelet adhesion and aggregation will increase, resulting in a decrease in anticoagulant function, thrombosis, and further development of renal fibrosis. Therefore, anticoagulant treatment should be carried out in time to prevent the above situation from occurring.

4. If nephritic syndrome is not effectively blocked in the initial stage of renal fibrosis, the formation of ECM will aggravate the damage to renal functional cells during the progression of renal fibrosis. Therefore, the decomposition of this part of the extracellular matrix (ECM) can block renal fibrosis and restore renal function.

5. Repair: provide necessary nutrients to repair damaged kidney functional cells.