Thursday, July 4, 2013
Treatment principles of Purpura Nephritis
HSPN should be treated with different schedules according to patients’ ages, clinical presentations, and the levels of kidney damage.
Positively control immune inflammatory response; restrain glomerular mesentery proliferative lesion; prevent and delay the forming of chronic renal fibrosis lesion.
Treatment
Pain killers may be needed for the abdominal and joint pains. It is uncertain as to whether HSP needs treatment beyond controlling the symptoms. Most patients do not receive therapy because of the high spontaneous recovery rate. Steroids are generally avoided.However, if they are given early in the disease episode, the duration of symptoms may be shortened, and abdominal pain can improve significantly. Moreover, the chance of severe kidney problems may be reduced.However, some evidence suggests that steroids do not decrease the likelihood of developing long-term kidney disease.
Evidence of worsening kidney damage would normally prompt a kidney biopsy. Treatment may be indicated on the basis of the appearance of the biopsy sample; various treatments may be used, ranging from oral steroids to a combination of intravenous methylprednisolone (steroid), cyclophosphamide and dipyridamole followed by prednisone. Other regimens include steroids/azathioprine, and steroids/cyclophosphamide (with or without heparin and warfarin). Intravenous immunoglobulin (IVIG) is occasionally usually.
Plasma exchange
PN, whose clinical presentations are progressive nephritis and a large number of crescents (>50%) formation in kidney biopsy, has a high risk of developing terminal renal failure. For these severe cases, they should be take positive measures, such as plasma exchange. It’s indicate in clinical practice that using hormone and cytotoxic drugs, using together with plasma exchange,or using plasma exchange alone, can reduce renal damage and delay the development of renal failure.
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