Some patients commented that they encountered such problems in treatment:
A 38-year-old The male patient was diagnosed with membranous nephropathy. He said that he had just been diagnosed with membranous nephropathy for 3 months. After the diagnosis, he had been taking medicine, but his urine protein was still 3+. He felt that his condition had not improved at all.
I met such a patient at the outpatient clinic yesterday, male, 43 years old, diagnosed with hypertensive nephropathy. It has been two years, and he has been receiving treatment locally before. His creatinine is currently 330. He feels that after two years of treatment, it has not decreased but has increased a little. Is there any possibility of recovery?
Maybe some patients have a similar situation. Actively cooperate with control, but the result is not what you want. In fact, the thoughts of most kidney friends are understandable. Those with mild disease want to recover as much as possible, and those with severe disease want to stabilize for a long time without relapse, but sometimes the results are not achieved after a period of treatment. , a little disappointed or confused.
What are the factors related to whether the recovery of kidney disease is fast or slow, or whether it can be improved or maintained for a long time?
The influence of pathological type accounts for 50%
For the above two patients, the specific pathological types are different, which directly affect the degree of progression, symptoms and indications, and drug regimens. This is not comparable.
Usually after the patient has symptoms of kidney disease first, it is decided whether to further diagnose the pathological type according to the recovery of their own condition.
The pathological type is a qualitative indicator. If membranous nephropathy is found, it is impossible to have lupus kidney or other types of kidney disease. This is the result of the patient’s renal immune status and the development of the kidney disease itself, which basically determines half of the outcome of the treatment.
Although the pathological type cannot be determined, each kidney disease In the process of pathological development, it is also basically developed according to the stage of renal disease, that is, the compensation period of renal disease to the final terminal stage (stage 1-5). Therefore, it is necessary to control and stabilize the disease in stages, and at the same time take into account the development of pathology, it is easier to maintain the disease at a stable level for a long time. The prognosis won’t be too bad.
The first patient with membranous nephropathy is currently in the second stage, which is not a bad pathological type. It has a certain self-healing property. If the urine protein continues to not decrease, it may not belong to this category of self-healing. It needs to be maintained for a long time. If the drug is mainly hormones, the urine protein cannot be lowered. It needs to see whether there is dependence or resistance, and at the same time pay attention to the regulation of self-immunity.
Treatment timing plays a decisive role
Many patients may say that this is already the case when they are discovered, and there is no way to seize the opportunity. In fact, we say that the timing of treatment is not simply a time, it is today or tomorrow. Rather, the timing of treatment is determined after assessing the progression of the disease.
For example, some patients have just increased creatinine 130, but it is still in the early stage, so the symptoms are not obvious. In terms of reducing urinary protein and eliminating edema, this is actually a big misunderstanding.
creatinine 130 and rose to 230 It seems to be in a stage, but in fact, the kidney function damage is not a level.
Wait until the creatinine rises significantly, the best time for treatment has been missed.
Many kidney patients do not know how to correct when the creatinine is 130, or the doctor has not told that if it is controlled, it is recommended to review it regularly.
At this stage, a low creatinine value does not mean that the renal function is intact. At this time, it is necessary to maintain the creatinine at this level. It is time to pay attention to the detoxification of renal function, which mainly includes renal blood flow and the survival status of glomeruli and tubules. Conditioning when necessary, not necessarily a therapeutic drug, but also an adjuvant drug.
It is one thing to cure and not to cure it, but it is another thing to cure it and actively cure it. It also determines that the disease has different results.
drug regimen doUse
If the first two aspects are implemented, the rest is how to deal with it. The first question that patients leave a message is that they should change the medicine when the treatment fails?
Take membranous nephropathy as an example. The current treatment for membranous nephropathy is the same as most types of nephrotic syndrome. The small hormone and cyclosporine are the main ones, and the large hormone cyclophosphamide is the main one. At the same time, it can be combined with tacrolimus and rituximab, which has a good remission on the disease. Whether to change the medicine depends on the treatment time and the stability of the overall condition. If the overall condition is stable, there is no need to change the medicine, and it cannot just look at a single indicator.
The change of creatinine value depends on the overall renal function. If the glomerular filtration rate is significantly decreased, below 60, the annual creatinine value is 10 units The growth of left and right is acceptable, but it is necessary to be alert to the rapid increase of creatinine in a short period of time. Aiming at the problem of elevated creatinine, we should not simply reduce the index when taking medication, but should pay attention to the metabolism of toxins, and the problem should be fundamentally solved during administration.
If kidney friends have kidney failure, high creatinine and other kidney problems, they need to answer
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