A kidney friend often asks the kidney online: “urinary protein 1+/2+/3+, what medicine is good” class problem.
Proteinuria is one of the most common manifestations of kidney disease, but kidney disease is not a disease, but it contains hundreds of different types of kidney disease, and the medicines for different patients are very different.
The drug regimens for lowering urinary protein can be roughly divided into non-immune regimens (RAS blockade). agents, SGLT2i, etc.) and immunization regimens (hormones, immunosuppressants, biological agents). In order to let kidney friends have a basic understanding of nephrology drugs, we will talk about it in detail next.
1.
RAS blocker
< p>Any drug with the word “Puri” or “Sartan” in its name is a RAS blocker.
represents a drug (only some are listed):Benazepril, enalapril, ramipril, irbesartan, valsartan, losartan, etc.
Oral time: A fixed time in the morning, noon and evening, for orthostatic hypotension The patient may consider taking the medicine before going to bed; it is not affected by meals, and can be taken before or after meals
< span>Features:Urine protein can be reduced by about 50% or more, and the maximum protein reduction effect can be achieved within a few weeks to several months. Commonly used in IgA nephropathy, secondary FSGS, hypertensive nephropathy, diabetic nephropathy and other types of nephropathy
Mechanism of action : Focus on non-immune treatment, reduce urinary protein by reducing intraglomerular hypertension, high filtration, anti-fibrosis, etc., and significantly delay renal function Reduced effect, and cardiovascular protection
Can the drug be stopped : Depending on the situation, some patients use it for life; some patients can discontinue the drug
< p>Contraindications:Contraindicated in severe bilateral renal artery stenosis, hyperkalemia, pregnant women
Whether it can be used during pregnancy and breastfeeding: No
side effects span>: Overall, the safety is good, and the long-term application has few side effects. Dry cough (mainly seen in pupils, not sartans); can lead to hyperkalemia in some patients, and the side effects of hyperkalemia are more likely to occur in patients with renal insufficiency; hypotension;
Notes:< span>During medication, patients must follow up regularly to monitor blood pressure, serum potassium, and serum creatinine; the drug may increase serum creatinine at the initial stage of medication. Please use contraception
2.
SGLT2i
Any drug with the three characters “gliflozin” in its name belongs to SGLT2i
< /p>
representative drugs:dapagliflozin, empagliflozin, canagliflozin, etc. span>
Oral Time: morning, meal Before and after meals
Features: It can reduce urinary protein by 30% or more, and the maximum protein reduction effect can be achieved within a few weeks to several months. Commonly used in IgA nephropathy, secondary FSGS, diabetic nephropathy and other types of nephropathy
Mechanism of action : Focus on non-immune treatment, by reducing intraglomerular high pressure and hyperfiltration, etc. , reducing urinary protein, has significant delay span>Role of reduced renal function, and significantly lower risk of cardiovascular events
Can it be discontinued: Depending on the situation, some patients use it for life
Contraindications:dialysis patients
Whether it can be used during pregnancy and lactation:No
Side effects: Overall, the safety is good, and long-term use has fewer side effects. Dehydration, urinary tract infection, ketoacidosis, etc.
Notes:During medication, patients must drink plenty of water to ensure adequate water intake and prevent urinary tract infections; the The drug may also increase serum creatinine in the early stage of administration, don’t panic, this isnormalnormal phenomenon, serum creatinine No need to stop the drug within 30% increase
3.
Glucocorticoids
often referred to as “hormones”
< strong>Representative drugs:Prednisone, prednisolone, methylprednisolone
Oral time: strong>The best time to take the medicine is morning7-8 o’clock; /p>
Features:It has a strong effect of reducing urinary protein and is often used for massive proteinuria of patients with nephrotic syndrome, minimal change disease, intermediate to high risk primary membranous nephropathy (membranous nephropathy hormones are not used alone), primary FSGS, membranous proliferative glomerulonephritis, crescentic nephritis, lupus nephritis, or high IgA nephropathy and IgA vasculitis-related nephropathy (purpura kidney), interstitial nephritis and other types of nephropathy at risk of progression
It is usually not used in patients with mild nephropathy with less proteinuria; it is not effective for patients with advanced nephropathy with few active renal lesions and severe sclerosing fibrosis
Mechanism of Action: focuses on immunitysexual therapy , has a strong anti-inflammatory effect and a certain immunosuppressive effect, and quickly controls the renal inflammatory response
Whether it can be stopped: Usually it can be stopped, ranging from six months to several years
Whether it can be used during pregnancy and lactation: If necessary
Taboo: Prohibited for activities such as viruses, bacteria, fungi, etc. Sexually infected, highly obese, severely mentally ill patients
Side effects: various Infection, big face, acne, increased blood sugar, blood pressure and lipids, osteoporosis, cataract, glaucoma, gastric ulcer, necrosis of femoral head, insomnia, etc.; overall, long-term high-dose application of the drug has many side effects, and the pros and cons need to be carefully weighed
Notes:Except in rare exceptional cases , the drug should not be stopped suddenly, and the dose reduction plan should be strictly followed by doctor’s advice, otherwise it may cause various severe hormone withdrawal symptoms; during long-term use, patients must be regularly followed up to monitor blood routine, blood pressure, blood sugar, blood lipids, ophthalmology, bone mineral density, etc. . Due to low immunity during the medication period, special attention should be paid to preventing infection
4.
< p>calcineurin inhibitors
Representative drugs: tacrolimus, cyclosporineOral timing:Two doses 12 hours apart, 1 hour before or 2 hours after meals Features:It has a strong effect of lowering urinary protein and is often used for hormone-dependent/recurrent minimal disease, intermediate and high-risk primary membranous nephropathy, and primary FSGS , diffuse or focal proliferative lupus nephritis and other types of nephropathy, and lifelong maintenance medication for kidney transplant patientsIt is usually not used for mild cases with less proteinuria Nephropathy patients; poor effect on patients with advanced renal disease with few active renal lesions and severe sclerosing fibrosisMechanism : Has a strong immunosuppressive effectCan the drug be discontinued: Except for kidney transplant patients, generally Withdrawal, course for at least 1-2 yearsCan the drug be used during pregnancy and lactation:if necessarytaboo span>: Contraindicated in patients with active infectionsSide effects: various infections, elevated blood sugar, blood pressure, lipid uric acid, hyperkalemia , nephrotoxicityPrecautions:This type of drug has high requirements on blood drug concentration, too high concentration may cause Nephrotoxicity occurs, and if the concentration is too low, the desired effect may not be achieved; during taking the medicine, do not eat grapefruit or grapefruit juice, which can affect the blood drug concentration; patients are regularly followed up to monitor blood drug concentration, blood pressure, liver and kidney Function, electrolytes, blood lipids, blood uric acid, blood sugar. Due to low immunity during the medication period,pay special attention to preventing infection
5.
cyclophosphamide
Intravenous or oral:Swallow whole, do not crush or chew. Morning dosing is preferred to ensure adequate hydration throughout the day; do not take before bed
Features:< /strong>It has a very powerful effect on intractable urinary protein/repeatedIt has a strong effect in patients with relapse, and is mainly used for critical lupus nephritis, high-risk membranous nephropathy, hormone-dependent/recurrent minimal change nephropathy, FSGS, severe IgA nephropathy, crescentic nephritis, etc.< p>
Not usually used in patients with mild renal disease
Mechanism of action: extremely powerful immunosuppressive effect
Whether Can Stop : Can Stop
Whether Can be used during pregnancy and breastfeeding: no
Contraindications: Contraindicated in severe myelosuppression, severe liver and kidney damage, active infection, severe bone marrow transplantation, and pregnancy (at least 3-6 months of drug withdrawal before pregnancy)
Side Effects: The drug belongs to chemotherapy for cancer patients Drugs,more side effects. Side effects have a greater relationship with the cumulative dose (that is, the amount of the drug added up before and after). Myelosuppression, infection, reproductive toxicity, infertility (the cumulative dose may be fine within 6-8g, and has little effect on the patient’s future fertility), nausea, vomiting , alopecia, hemorrhagic cystitis, when the cumulative dose of cyclophosphamide is greater than 36g, it may induce lymphoma and leukemia
Notes: Many people are afraid to use cyclophosphamide because of the side effects of cyclophosphamide. In fact, we do not need to use such drugs for a long time to control kidney disease. When the accumulated amount of cyclophosphamide is large , the doctor can choose other drug relay. For example, young patients are concerned about reproductive toxicity. When the cumulative amount of cyclophosphamide exceeds 6-8g, doctors can use other immunization programs such as tacrolimus. Therefore, it should be used without excessive fear. For some patients with severe renal disease, it is well used. Cyclophosphamide is a good drug that is cheap and effective span>To minimize bladder toxicity, increase fluid intake and drink plenty of fluids during medication. Due to low immunity during the medication period,especiallypay attention to preventing infection
6.
Mycophenolate mofetil
< span>Representative drug:Mycophenolate mofetilOral time: Once in the morning and evening, it is recommendedtake the medicine on an empty stomach (for stable patients, it can be taken with food to reduce gastrointestinal discomfort)Features:< /strong>Commonly used in type III or IV lupus nephritis, steroid-dependent resistance and hormone-dependent primary FSGS patients, idiopathic/primary Membrane proliferative nephropathy mediated by immune complexes, as well as some IgA nephropathy, kidney transplantation, etc.It is usually not used in patients with mild nephropathy with less proteinuria; for patients with less active kidney disease and sclerosing fibrosis Poor effect in patients with severe intermediate and advanced renal disease Can the drug be discontinued: Generally, the drug can be discontinued, and the course of treatment should be at least 1-2 yearsWhether it can be used during pregnancy and lactation: NoContraindications< /span>: Contraindicated in pregnancy and lactation, active infectionsSide effects: Various Infection (especially vigilant against Pneumocystis carinii infection → this kind of deadly threat, especially for kidney friends who are immunocompromised! Tell everyone who takes hormones and immunosuppressants); bone marrow transplantation; elevated transaminases; gastrointestinal reactions, etc. Notes:The drug is non-gonadaltoxic, does not affect fertility, but is teratogenic to the fetus (withdrawal for at least 6 weeks for pregnancy) Therefore, please pay attention to strict contraception during taking the medicine, and regularly monitor blood routine and liver function. Due to low immunity during the medication period,especiallypay attention to preventing infection
7.
Leigong Teng
Representative drugs: Tripterygium wilfordii tablets, Tripterygium wilfordii polyglycosides tablets, Kunming Shanhaitang tablets, Kunxian Capsules, Torch Flower Root TabletsFeatures: span>There are immunosuppressive drugs in traditional Chinese medicine, which have a better effect on reducing urinary protein and are not easy to cause infection. This is its advantage compared with other western medicine immunosuppressants
< span>Can the drug be discontinued: depends on the situation
Whether it can be used during pregnancy and breastfeeding:No
< span>Side effects: reproductive toxicity, long-term high-dose use (more than 3 months) can lead to ovarian dysfunction, irregular menstruation, amenorrhea, oligospermia in men, infertility nurture. Some patients may feel that it’s okay to have menstruation anyway, and some even foolishly think that menstruation is too troublesome and it’s better, but for younger women, reproductive toxicity is not only manifested in amenorrhea, ovarian failure, and decreased estrogen. It can also lead to a series of various side effects similar to early menopause,such as increased risk of cardiovascular disease, bone loss, emotional problems, rough skin, etc.
< span>
Therefore, although Tripterygium wilfordii has a good effect on reducing proteinuria and does not have the obvious side effect of causing serious infections similar to other immunosuppressants, it is still not a drug that can be used casually. , especially for young patients, please find a reliable doctor to weigh the pros and cons of use
p>
8.
Hydroxychloroquine
Oral Time: It is recommended to take it with meals to reduce gastrointestinal discomfort
Features:< /strong>For IgA nephropathy, lupus nephritis, etc., can continue to reduce urinary protein by 50% on the basis of RAS blocker
Mechanism of Action: Hydroxychloroquine can act through multiple mechanisms The role of immune regulation
Can the drug be discontinued< /span>: Depending on the situation, some patients use it for a long time; some patients can gradually discontinue the drug
< span>Contraindications:Retinopathy
Whether it can be used during pregnancy and breastfeeding: if necessary p>
Side Effects: Overall, the safety profile is good, Hydroxychloroquine is not a hormone, nor is it Immunosuppressants are immuneimmunomodulators that do not increase the risk of infection and tumor due to immune suppression. Hydroxychloroquine’s side effects, eyestoxicity are the biggest concerns for many people, Hydroxychloroquine can indeed cause blurred vision, severe retinopathy, and even blindness. However, the overall incidence of eyes is not high (4%), so patients who need to use hydroxychloroquine do not need to worry too much and do eye examinations. Especially for patients who need to use hydroxychloroquine for a long time (> 5-10 years), pay attention to regular retinal examinations. Early eye lesions caused by hydroxychloroquine are usually reversible if they are stopped in time.
Precautions:Check the fundus for any problems before taking the medicine; Long-term use For patients with hydroxychloroquine (>5 years), pay attention to regular annual follow-up in the ophthalmology department
span>
9.
Rituximab
Intravenous: Infusion once a week to several months, different patients have different regimens, every intravenous infusion requires a hospital stay for 1 day span>Features:novel biologics, More expensive, forintermediate-high-riskprimary membranous nephropathy,hormone-dependent/frequently recurring minimal disease and FSGS , lupus nephritis, ANCA-related small vessel vasculitis, renal damage, membranoproliferative glomerulonephritis, etc.< span>Not usually usedpatients with mild nephropathy span>Mechanism of action: targeted elimination of immune B lymphocytes
Whether the drug can be stopped: Can stop the drug, 2~4 times a course of treatment
Whether it can be used during pregnancy and breastfeeding:No
Side effects: Short-term side effects are mainly reflected in infusion reactions, such as headache, fever, etc.; long-term side effects are mainly Various infections
taboo : havemore serious active infections, such as hepatitis B and hepatitis C with active viral replication; Patient is severely immunocompromised; has severe heart failure or other serious heart disease
Note Matters: Due to low immunity during the medication period, especiallypay attention to the prevention of infection
Limited to the length of the article, we did not list all the drugs with proteinuria , choose the most commonly used drugs to introduce their characteristics, if you want to ask if you can use it and how to use it, please consult a doctor who understands your condition. You can also download the Kidney Online APP and consult the doctors on our platform (search for Kidney Online in the usual place under the software, the yellow icon is just there)
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