Tham Txog Txoj Kev Npaj Kho Mob Rau IgA Nephropathy
Feb 10, 2023
1. IgA nephropathy muaj ntau
IgA nephropathy yog cov kab mob glomerular tshaj plaws. Nyob rau hauv cov nqe lus ntawm kev kho mob, nws yog tsim nyog los tsim ib tug tag nrho thiab tus kheej txoj kev npaj rau cov neeg mob raws li proteinuria, hematuria, ntshav siab, lub raum ua haujlwm, thiab raum pathological hloov. Tam sim no cia peb tham txog cov qauv kev kho mob rau IgA nephropathy.
Nyem rau cistanche tubulosa vs deserticola rau kab mob raum
2. Kev ntsuam xyuas thiab kev tswj xyuas
Txhawm rau kho IgA nephropathy zoo dua, cov neeg mob yuav tsum tau muab cov ncauj lus kom ntxaws txog lub raum biopsy (xws li lub teeb microscopy, fluorescence, thiab electron microscopy) thaum mus ntsib kws kho mob.
Cov neeg mob yuav tsum tsis tu ncua xyuas cov khoom hauv qab no:
1. Kev tso zis tso zis ntxiv rau cov quav
2. Cov ntshav niaj hnub
3. 24- teev tso zis protein ntau
4. Cov protein tso zis rau creatinine piv
5. Kev ua haujlwm siab, lub raum ua haujlwm, ntshav qab zib, ntshav rog, kuaj ntshav electrolyte
6. Ntsuas ntshav siab hauv tsev txhua hnub (sab sawv ntxov thiab yav tsaus ntuj)
Ua raws li txhua 1 mus rau 3 lub hlis. Yog tias qhov xwm txheej tsis ruaj khov, qhov zaus ntawm kev rov kuaj xyuas dua thiab mus ntsib yuav tsum tau nce ntxiv.
3. Txhim kho kev txhawb nqa zoo
Txhua tus neeg mob yuav tsum tau txais kev saib xyuas zoo, suav nrog kev hloov hauv kev ua neej, kev tswj ntshav siab, sartan lossis peril, linden, thiab hydroxychloroquine.
1. Kev hloov kev ua neej
Nrog rau kev noj zaub mov tsis muaj ntsev thiab rog tsawg, tswj qhov hnyav, ua kom muaj zog, ua kom muaj zog tiv thaiv kab mob, zam khaub thuas, ua npaws, hnoos, raws plab, ua xua, thiab lwm yam.
2. Kev tswj ntshav siab
Ntshav siab lub hom phiaj qis dua 130/80mmHg. Qhov zoo tshaj hauv qab 120. Feem ntau tsis tsawg dua 90.
3. Cov tshuaj Sartan thiab Puli
Lawv yog cov tshuaj antihypertensive lawv tus kheej, tab sis lawv tuaj yeem txo cov proteinuria thiab ncua kev ua haujlwm ntawm lub raum tsis zoo. Tsuav cov ntshav siab tsis tshua muaj qis ( kiv taub hau, amaurosis, thiab lwm yam tsos mob ntawm hypovolemia) feem ntau pom zoo.
muaj
Irbesartan (75-300mg)
Valsartan (80-160mg)
Nuoxintuo (50-200mg)
…
4. Cov tshuaj sau npe
(Dapagliflozin, Empagliflozin, thiab lwm yam) yog sodium-glucose cotransporter 2 inhibitors (SGLT2i), uas yog lawv tus kheej cov tshuaj hypoglycemic, thiab cov kev tshawb fawb tau pom tias lawv muaj txiaj ntsig zoo hauv kev kho IgAN. Xav txog kev siv cov tshuaj no.
5. Hydroxychloroquine
Cov kev tshawb fawb tsis ntev los no tau pom tias nws tuaj yeem txo cov proteinuria hauv cov neeg mob IgA nephropathy. Qhov koob tshuaj ib txwm yog 200mg ob zaug ib hnub.
6. Ntses roj
Cov kev tshawb fawb tau pom tias cov roj ntses loj ntau tau zoo rau kev kho mob ntawm IgA nephropathy, tuaj yeem txo cov proteinuria, ncua kev tsis zoo ntawm cov kab mob raum, thiab txo cov kev pheej hmoo ntawm cov hlab plawv thiab cov hlab ntsha hauv cov neeg mob. Rau cov neeg mob uas muaj kev lag luam zoo, cov roj ntses uas tsim nyog tuaj yeem txiav txim siab.
7. Probiotics
Ntau thiab ntau cov kev tshawb fawb tau pom tias muaj kev sib raug zoo ntawm cov kab mob hauv plab hnyuv thiab qhov pib thiab kev loj hlob ntawm IgA nephropathy. Kev noj cov tshuaj probiotics kom zoo yog muaj txiaj ntsig zoo rau kev tswj hwm kab mob ntawm cov neeg mob, thiab rau qee qhov, zam tsis txhob kis kab mob thiab ua rau hnyav dua. Rau cov neeg mob uas muaj kev lag luam zoo, nws raug nquahu kom noj probiotics kom tsim nyog.
Nws yuav tsum raug sau tseg tias peb hom tshuaj, sartan / pril, Liejing, thiab hydroxychloroquine, tuaj yeem ua rau creatinine nce me ntsis. Yog li ntawd, qib ntawm creatinine yuav tsum tau saib xyuas zoo tom qab siv, thiab kev siv tshuaj thiab kev kho mob ntawm cov tshuaj yuav tsum tau hloov kho raws li qhov tshwm sim.
4. Kev kho tshuaj hormones
Hormone therapy for IgAN can reduce proteinuria, protect renal function, and reduce or delay renal tissue damage. The guidelines suggest that for patients who have received at least 3 months of optimal supportive treatment but still have proteinuria >1 g / d, kev kho glucocorticoid yuav tsum tau muab rau 6 lub hlis.
Txawm li cas los xij, yuav tsum ceev faj txog qhov ua rau muaj kev pheej hmoo ntawm kev kis mob hnyav, ua rau cov piam thaj tsis txaus siab, thiab qhov hnyav nce hauv cov neeg mob. Koj tuaj yeem xaiv ib koob tshuaj tag nrho (1 mg / kg / d) lossis koob tshuaj qis (0.5 mg / kg / d), thiab kev kho mob yog 6 mus rau 9 lub hlis. Ob txoj haujlwm muaj txiaj ntsig zoo sib xws hauv kev txo cov proteinuria thiab tiv thaiv lub raum. Nws raug pom zoo tias cov neeg mob uas siv cov tshuaj hormones ua ke nrog sulfonamides los tiv thaiv kev kis kab mob.
Lus Cim: Nws tsis pom zoo kom noj cov tshuaj hormones ntev (feem ntau 6-8 lub hlis yog txaus), vim tias cov tshuaj hormones tshwm sim ntau heev thiab hnyav heev!
5. Kev kho tshuaj tiv thaiv kab mob
Tsuas yog cov tshuaj tiv thaiv kab mob pom zoo rau kev kho IgA nephropathy yog mycophenolate mofetil (Cellcet, Cycopine), thiab ntau lwm yam tshuaj tiv thaiv kab mob (cyclophosphamide, cyclosporine, tacrolimus, leflunomide) kuj siv tau, tab sis cov nyhuv tsis meej.
Mycophenolate mofetil ua ke nrog cov tshuaj corticosteroids qis muaj qhov kho kom zoo dua qub thiab muaj kev phiv tsawg dua.
Rau cov neeg mob uas muaj mob hnyav (ntau dua proteinuria, ua rau lub raum tsis ua haujlwm sai), kev hloov pauv pathological nrog ntau qhov mob hnyav (xws li crescents), tshwj xeeb tshaj yog rau cov neeg mob uas tsis zoo rau cov tshuaj hormones ib leeg, kev siv mycophenolate mofetil tuaj yeem suav tias yog ester.
Rau cov neeg mob siv mycophenolate mofetil, ua ke nrog sulfonamides tiv thaiv kab mob.
6. Mucosal immune targeted therapy
Mucosal tiv thaiv kab mob yog qhov chaw tseem ceeb ntawm IgA ntau lawm, suav nrog cov hnyuv, kab mob ua pa, thiab lwm yam lymphoid cov ntaub so ntswg. Cov kev tshawb fawb tau pom tias hauv zos tsom budesonide (TRF-budesonide, NEFECON) tuaj yeem txo cov proteinuria thiab ua kom lub raum ua haujlwm. Cov tshuaj yuav tsum muaj nyob rau hauv kev ua lag luam hauv tsev thaum kawg ntawm lub xyoo, tab sis tus nqi siab heev.
7. B cell targeted therapy
B cell activation plays lub luag haujlwm tseem ceeb hauv IgA nephropathy, thiab inhibiting B cell ua haujlwm tau zoo rau kev kho mob ntawm IgA nephropathy. BAFF/APRIL blockers xws li Tetacept. Cov kev tshawb fawb tau pom tias kev tswj hwm ib lub lis piam (240mg) tuaj yeem txo cov proteinuria thiab tiv thaiv lub raum ua haujlwm. Qhov tsis zoo yog tias tus nqi siab.
8. Hom 1 tshwj xeeb: Cov kab mob tsawg heev
Qee cov neeg mob uas muaj IgA nephropathy manifest nephrotic syndrome thiab pathological hloov ntawm lub raum biopsy yog me me (M{{0}}E0S0T0C0). Clinically, steroids txhim kho sai, tab sis lawv muaj feem cuam tshuam. Cov neeg mob zoo li no yuav tsum tau kho raws li kev hloov pauv nephropathy tsawg kawg nkaus, thiab corticosteroids, tacrolimus, cyclosporine, lossis rituximab tuaj yeem siv. Ntawm lawv, rituximab tuaj yeem txo qis tus naj npawb ntawm rov qab thiab cov tshuaj hormones, nrog rau cov txiaj ntsig zoo thiab ob peb cov kev mob tshwm sim.
9. Hom 2 tshwj xeeb: IgA vasculitis
Cov neeg mob me me uas muaj IgA nephropathy mob hnyav, uas qhia tau tias lub raum tsis txaus sai sai (glomerulonephritis sai heev), thiab kev hloov pauv pathological nrog ntau tus crescents (C1 lossis txawm C2). Cov neeg mob zoo li no yuav tsum tau kho rau IgA vasculitis nrog corticosteroids (methylprednisolone 500-1000 mg) thiab cyclophosphamide (04-1.0 g) pulse therapy. Cov neeg mob mob tuaj yeem txiav txim siab siv rituximab rau kev kho mob, cov txiaj ntsig zoo dua thiab cov kev mob tshwm sim me me.
10. Lwm yam tshuaj tshiab
Kev ua kom muaj kev sib txuas ntxiv thiab tsim cov txheej txheem ua kom cov membrane nres tuaj yeem ua rau txoj kev loj hlob ntawm IgAN, thiab inhibition ntawm IgAN-txog kev ua kom tiav txoj hauv kev tuaj yeem muaj txiaj ntsig zoo rau cov neeg mob IgAN. Tam sim no, ntau cov tshuaj rau kev kho mob ntxiv-cov phiaj xwm tau ua tiav. Cov txiaj ntsig tau los ntawm kev sim tshuaj ntawm tus po tyrosine kinase inhibitor Fostamatinib thiab proteasome inhibitor bortezomib uas inhibit mesangial cell activation tseem tsis tau luam tawm tag nrho.
11. Cov ntsiab lus
Hauv cov ntsiab lus, kev kho mob ntawm IgAN tab tom yuav ua rau lub hnub nyoog kub ntawm "ib puas paj tawg", tab sis kev saib xyuas zoo tshaj plaws tseem yog qhov kev kho mob ntawm IgAN. Cov tshuaj tshiab rau kev kho mob ntawm IgAN tau ua tiav thawj zaug. Rau cov kev kho mob tshiab sib txawv, yuav ua li cas xaiv lub sijhawm thiab cov tshuaj yog qhov nyuaj.
Yog xav paub ntxiv: Ali.ma@wecistanche.com
