Chronic glomerulonephritis: Master five comprehensive treatment measures

Chronic nephritis is medically known as chronic glomerulonephritis. The most basic clinical manifestations include high blood pressure, edema, hematuria, proteinuria, etc. There are many causes of the disease. Although the disease progresses slowly, it is extremely harmful. For patients with chronic glomerulonephritis, the following comprehensive treatment measures must be understood.

1. Actively control high blood pressure and reduce urine protein

Hypertension and proteinuria are important factors that accelerate glomerular sclerosis and promote the deterioration of renal function. Actively controlling hypertension and reducing proteinuria are two important links. Chronic nephritis often causes sodium retention and volume-dependent hypertension, so hypertensive patients should limit salt intake (NaCl <6g/d); thiazide diuretics such as hydrochlorothiazide can be used. When Ccr <30ml/min, thiazides are ineffective and loop diuretics should be used instead, but they are generally not suitable for excessive and long-term use. In addition to lowering blood pressure, ACEI or ARB also has a kidney-protective effect of reducing proteinuria and delaying the deterioration of renal function. It is the first choice for treating hypertension and/or reducing proteinuria in chronic nephritis. Usually, to achieve the goal of reducing urine protein, the dosage used is often higher than the conventional antihypertensive dosage. Patients with renal insufficiency should prevent hyperkalemia when using ACEI or ARB. When the serum creatinine is greater than 264μmol/L (3mg/d1), the serum creatinine and serum potassium must be closely monitored to prevent side effects. In addition, β-receptor blockers, calcium channel blockers, etc. can also be used in combination or selectively.

2. Limit the amount of protein and phosphorus in food

Patients with renal insufficiency and azotemia should limit their protein and phosphorus intake, adopt a high-quality low-protein diet, or add essential amino acids or α-keto acids.

3. Glucocorticoids and cytotoxic drugs

Since chronic nephritis includes many diseases, whether this type of drug should be used should be treated differently. However, if the patient has normal renal function or only mild damage, normal kidney volume, mild pathological type (such as mild mesangial proliferative nephritis, early membranous nephropathy, etc.), and more urine protein, it can be tried if there are no contraindications, and if it is ineffective, it can be gradually withdrawn.

4. Anticoagulant, fibrinolytic and antiplatelet drugs

This type of drug can inhibit fibrin formation, platelet aggregation, and reduce tonic activity, but its efficacy is uncertain.

5. Avoid factors that aggravate kidney damage

Avoid factors that may cause worsening of renal function, such as infection, fatigue, pregnancy and nephrotoxic drugs (such as aminoglycoside antibiotics, Chinese medicine containing aristolochic acid, etc.).