1 . Restrictions on high-protein diet of patients with renal insufficiency should try using low-protein diet. Low-protein diet can reduce urinary protein excretion , thereby reducing high filtration glomerular and tubular high metabolic state , and reduce the formation of ammonia in the proximal tubule , thereby reducing ammonia via the alternative pathway of complement activation caused tubulointerstitial inflammatory injury , delaying the progress of renal failure, protein intake is limited to 0.6 ~ 0.8g / (kg · d) generally provides high-quality protein such as eggs , milk, meat and other essential amino acids plus therapy and spiritual provide α- keto acid kidney ; supplement renal ammonia will provide the essential amino acids the body . Meanwhile appropriate increase in carbohydrates , the body in order to achieve the basic needs and prevent negative nitrogen balance. For only proteinuria , and normal renal function , protein intake may be relaxed to 0.8 ~ 1.0g / (kg · d). In the low-protein diet should also be taken to limit the intake of phosphorus , calcium supplementation attention to correcting high phosphorus calcium status , reduce secondary hyperparathyroidism should be given another low- purine diet cupping network , in order to reduce the excretion of uric acid generation and to reduce high hyperuricemia.
2 control of hypertension in the progression of chronic nephritis , renal unit is kept healthy high compensatory hemodynamic status , systemic hypertension may further aggravate the disease causes progressive glomerular injury . Active control of hypertension prevents renal damage significantly increased sodium retention for those who , diuretics can be the first choice. If renal function is good to add thiazides ; For persons with poor kidney function (GFR <25ml/min) loop diuretics should be used instead , pay attention to the prevention of electrolyte imbalance , to prevent exacerbation of hyperlipidemia and hypercoagulable state . Commonly used in clinical health search antihypertensive drugs:
( 1 ) angiotensin-converting enzyme inhibitors (ACEI): ACEI has good renal protective effect of the drug in reducing systemic hypertension , while also reducing the pressure to reduce glomerular glomerular hemodynamics Learn reduce urinary protein , thereby delaying renal glomerulosclerosis progress , commonly used in clinical ACEI are: ① captopril ( captopril , Capoten ) : general dose every 25 ~ 50mg, 3 times / d before meals , not to exceed the maximum daily dose of 450mg children begin to 1mg/kg daily maximum dose 6mg/kg, orally 3 times . ② enalapril ( benzene fat captopril ) : The drug -free thiol of ACEI, its dose is small, strong, and long duration of action , side effects. The usual dose is 5 ~ 10mg, 1 times / d. ③ benazepril ( Lotensin ): 10mg, 1 times / d. ④ perindopril ( Jaster ): 4mg, 1 times / d; ⑤ cilazapril ( suppression Ping Shu ): 2.5mg, 1 times / d. Applications should be noted that side effects such as hyperkalemia , anemia , rash , itching, dry cough , hypogeusia few patients have neutropenia, some scholars reported that ACEI can cause interstitial nephritis, a transient increase in serum creatinine . Such drugs should be used with caution in search of health , especially those with renal dysfunction, such as Scr> 2 ~ 4mg/dl (188 ~ 376μmol / L), should be disabled .
( 2 ) calcium antagonists : the treatment of hypertension and worsening of renal function have a more positive effect , ACEI , calcium antagonists , and now these two drugs as first-line antihypertensive drugs. Calcium antagonists inhibit the role of Ca2 + influx , direct relaxation of vascular smooth muscle , dilation of peripheral arteries and reduce peripheral vascular resistance , so that the systemic blood pressure , in addition, calcium antagonists can reduce oxygen consumption and anti-platelet aggregation, in order to achieve reduce kidney damage and stabilize renal function . Often used long-acting calcium antagonists : ① amlodipine ( Norvasc ) 5 ~ 10mg, 1 ~ 2 times / d; ② nifedipine ( thanks to the heart through ) 30 ~ 60mg, 1 times / d; ③ nicardipine ( perdipine ) 40mg, 1 ~ 2 times / d; ④ nitrendipine (nitrendipine) 20mg, 1 ~ 2 times / d, it should be noted as possible dihydropyridine nifedipine ( nifedipine ) used in the process adverse reactions, some people think that these drugs can increase the glomerular filtration status , increased cardiovascular risk factors.
(3) β- blockers : renin -dependent hypertension has a good effect . The drug can reduce the effect of reducing the renin cardiac output without affecting renal blood flow and glomerular filtration rate should be aware that some β- blockers , such as metoprolol ( metoprolol ) , atenolol lol ( atenolol ) has certainly antihypertensive effect , but the drug excreted by the kidneys and therefore need time to adjust medication doses and prolonged time in renal insufficiency .
(4) α1- blockers : prazosin has a vasodilator effect , can dilate small arteries and small veins. Generally start small dose and gradually increased to 6 ~ 12mg / d, should be taken to prevent orthostatic hypotension .
( 5 ) vasodilator drugs: such as hydralazine ( hydralazine ) have a good antihypertensive effect, generally a daily dose of 200mg, and β- blockers in combination, can reduce side effects and improve efficacy.
3 anticoagulant drugs and inhibition of platelet aggregation in patients with chronic nephritis fewer large number of thrombosis, embolism complications, but renal histopathology often can be found in the glomerular capillary FRA platelet aggregation and fibrin deposition , anticoagulation and platelet aggregation suppressing drugs reduce renal pathological damage to delay the progress of nephritis , renal protection , especially for proliferative nephritis is particularly important for a clear and certain hypercoagulable state can lead to a hypercoagulable state of pathological type ( such as membranous nephropathy , mesangial capillary proliferative glomerulonephritis ) can be prolonged medication to stabilize renal function , reduce the role of renal pathological injury.
Common anti-platelet drugs : dipyridamole ( dipyridamole ) 75 ~ 100mg, 3 times / d. Aspirin 75 ~ 100mg1 times / d.
Anticoagulants : Heparin 1000 ~ 12500U deep intramuscular injection, 8 hours or 5000 ~ 6000U 100ml normal saline infusion, 20 to 30 drops / min; warfarin starting dose 5 ~ 20mg / d, to 2.5 ~ 7.5mg / d maintenance therapy.
4 . Hormones and cytotoxic drugs cupping network for such applications in chronic nephritis is currently no unified view , nephrotic syndrome, mild mesangial proliferative glomerulonephritis , may respond well to the hormone , focal segmental glomerulosclerosis , membranous nephropathy hormone may be valid under pathological types, such as normal or mildly impaired renal function , proteinuria ≥ 2.0g/24h no contraindications to try hormones and cytotoxic drugs .
5 Other factors that aggravate kidney damage prevention actively prevent and treat infectious diseases as respiratory tract infections, urinary tract infections , can cause and aggravate avoid abrupt deterioration of renal function . Avoid using easily induced renal toxicity or renal dysfunction drugs, such as aminoglycoside antibiotics , non-steroidal anti-inflammatory , sulfa drugs , etc., associated with hyperlipidemia, hyperglycemia on hyperuricemia and other related treatment should be given . Should also note that maintain water , electrolyte and acid-base balance and prevention of heart failure occurred.
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