Guidelines for diagnosis and treatment of nephritis (Reprint)

Navigation:Home > Nephrology > Kidney Trouble > Guidelines for diagnosis and treatment of nephritis (Reprint)

Guidelines for diagnosis and treatment of glomerulonephritis (RPM)Guidelines for diagnosis and treatment of glomerulonephritisRecommended by

Content

Guidelines for diagnosis and treatment of glomerulonephritis (RPM)

Guidelines for diagnosis and treatment of glomerulonephritis

Recommended by the Ministry of health in October 2001 issued a guide to the diagnosis and treatment of glomerulonephritis, for your reference.

Main recommendations

The recommended levels (A, B, C, GPP) and the level of evidence (I - IV) are defined as follows:

Recommended level

Grade A (evidence level I a, I b): at least one of the articles in the literature that are of good quality and consistent with this particular recommendation is a randomized controlled trial.

Grade B (evidence level II A, II B, III): Based on the non randomized clinical studies that are well done but not specifically directed at the recommendations themselves.

Grade C (level of evidence IV): the need for clinical experience from expert committee reports or opinions and / or respected authority, the lack of direct application of high-quality clinical research.

Good Practice Points (GPP): guidelines for best clinical practice based on guidelines for clinical experience.

Evidence level

Level I a: based on meta-analysis of randomized controlled trials.

Level I b: was based on at least one randomized controlled study.

Level II a: is based on at least one well-designed nonrandomized study.

Level b: is based on a good quasi experimental study of at least one other type.

Level III: evidence based on well-designed non experimental, descriptive studies, such as comparative studies, association studies, and case studies.

Level IV: evidence from an expert committee report or an authoritative person's perspective and / or clinical experience.

The main recommendations were graded according to the "level" and "level of evidence", "recommended level" in the recommendations of the sentence (omitted Grade); "level of evidence" in the end of the sentence (omitted Level).

Treatment of hematuria and proteinuria

B: of patients with microscopic hematuria (red blood cell = 5 / HPF) should be excluded from kidney / urinary tract disease. (III)

B: suggested that a phase contrast microscopy was performed under standard conditions to differentiate between glomerular and non glomerular hematuria. (III)

B: should monitor renal function and blood pressure every 6 to 12 months in patients with simple asymptomatic microscopic hematuria. (III)

B: does not require a complete Department of Urology examination for patients with asymptomatic microscopic hematuria under the age of 40, such as the lack of clinical features of malignancy. (III)

The prognosis of B: patients with orthostatic proteinuria is good, and no follow-up is needed. (III)

B: has a good prognosis in patients with intermittent proteinuria, but it should be followed up 6 times a month until the disappearance of proteinuria. (III)

B: patients with persistent proteinuria have a high risk of developing renal insufficiency and should continuously monitor their blood pressure and renal function. (III).

B: = 1g/ D persistent proteinuria in patients with renal pathological changes and prognosis, should carry out renal biopsy examination. (III)

B: should be examined further in patients with microscopic hematuria and proteinuria, especially in patients with red cell type, hypertension and / or renal insufficiency. (III)

B: should be performed in all patients with gross hematuria, including ultrasonography, intravenous pyelography, and bladder endoscopy. (III)

General measures for the treatment of glomerular disease

B: = 140/ 90 mmHg on blood pressure in patients with renal disease should be treated to delay the deterioration of renal function rate. (II B)

B: for serum creatinine < 600 mol/ L, total urinary protein excretion rate was higher than 1g/ D patients, recommended antihypertensive target for < 125/ 75 mmHg (mean arterial pressure < 92 mmHg). (III)

C: for serum creatinine < 600 mol/ L, total urinary protein excretion rate is less than 1g/ D patients, recommended antihypertensive target for < 130/ 80 mmHg (mean arterial pressure < 98 mmHg). (IV)

A: is the preferred treatment for hypertension in patients with glomerulonephritis

Because of its good renal protection. (I b)

Angiotensin converting enzyme inhibitors are superior to calcium channel blockers in the treatment of hypertension in patients with glomerulonephritis, because they provide better protection against B. (III)

B: angiotensin II receptor antagonists may be used as an alternative to angiotensin converting enzyme inhibitors in the treatment of hypertension in patients with glomerulonephritis. (III)

GPP: angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists may be used to reduce proteinuria in patients without hypertension.

GPP: for patients with creatinine > and 265 mol/ L, the use of angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists should be particularly cautious and should be monitored regularly for serum creatinine and serum potassium levels.

A: should be considered in patients with severe renal insufficiency (creatinine > 350 mol/ L), but should be carefully considered to avoid malnutrition and its potential adverse consequences. (I a)

A: lipid lowering therapy does not provide renal protection in patients with glomerular disease. (I b)

C: lipid lowering therapy may benefit cardiovascular disease in patients with glomerular disease. (IV)

Treatment of minimal change nephritis

A: by dose of prednisolone as the initial treatment of minimal change disease caused by nephrotic syndrome. (I b)

A: reduction and discontinuation of prednisolone in nephrotic syndrome should be alleviated after. (I b)

B: can be treated with cyclophosphamide in patients with nephrotic syndrome caused by a small, sexually transmitted disease, with frequent relapses, hormone dependence, and steroid resistance. (III)

GPP: patients who are prepared to receive cyclophosphamide should be advised of the potential risk of infertility and infertility in the treatment.

Cyclosporine A A: may be used in the treatment of nephrotic syndrome caused by minimal change nephrotic syndrome with frequent relapses, hormone dependence, and steroid resistance. (I b)

B: should be regularly monitored for renal function in patients with nephrotic syndrome treated with cyclosporine A. After 1 years of treatment with cyclosporine A, a renal biopsy should be repeated to detect histological evidence of renal toxicity. (III)

Treatment of focal segmental glomerulosclerosis

B: large dose of prednisolone should be caused by as first-line treatment in patients with focal segmental glomerulosclerosis in nephrotic syndrome. After remission should be slow reduction, the total treatment period of at least 6 months. (III)

B: should be treated with cyclophosphamide in patients with steroid dependent nephrotic syndrome or hormone related side effects caused by focal segmental glomerulosclerosis. (III)

B: cytotoxic therapy can be used as an alternative therapy for steroid resistant nephrotic syndrome caused by focal segmental glomerulosclerosis. (III)

GPP: patients who are prepared to receive cyclophosphamide should be advised of the potential risk of infertility and infertility in the treatment.

Focal segmental glomerulosclerosis A: steroid resistant nephrotic syndrome resulting from may consider the use of cyclosporine A, the initial daily dose of 3 mg/ to 5 kg, if not reach sustained remission, requires a long time to maintain remission. (I b)

C: there is no reliable evidence that nephrotic syndrome due to focal segmental glomerulosclerosis may benefit from other therapies. (IV)

Treatment of IgA nephropathy

C: is not recommended for the treatment of IgA nephropathy in patients with Simple Hematuria without proteinuria, and should be monitored regularly (once every 3 to 12 months). (IV)

C: for asymptomatic hematuria and urinary protein between 0.15 to 1g/ D, the lack of other clinical and histological indications of IgA nephropathy patients with no treatment options available for recommendation. Every 3 to 12 months should be monitored a urine protein. (IV)

A: recommends the use of angiotensin converting enzyme inhibitors in the treatment of hypertension in patients with IgA nephropathy (I b)

A: for normal blood pressure, urine protein is more than 1g/ D in patients with IgA nephropathy, recommended the use of angiotensin-converting enzyme inhibitors. (I b)

B: for the treatment of patients with IgA nephropathy, angiotensin II receptor antagonists and angiotensin converting enzyme inhibitors have similar indications. (II a)

B: angiotensin II receptor antagonists and angiotensin converting enzyme inhibitors can be combined in the treatment of urinary protein is more than 1g/ D in patients with IgA nephropathy. (II B)

A: = 1g/ D for urinary protein in patients with IgA nephropathy, suggest that combined use of dipyridamole and low dose warfarin. Renal dysfunction is not a contraindication for its use. (I b)

A: supplementation with fish oil is not good for every IgA nephropathy patient. (I a)

C: supplementation with fish oil may be used for urinary protein > 3g/ D in patients with IgA nephropathy. (IV)

B: for renal biopsy histology suggest minor tissue of IgA nephropathy patients should use prednisolone, initial dose of 1 mg/ daily kg, 4 to 6 weeks after the reduction, the total course of treatment for 3 ~ 4 months. (II B)

B: for renal biopsy histology suggest minor tissue of patients with IgA nephropathy, if relapse, hormone resistance or hormone dependent, should use cyclophosphamide, a daily dose of 1.5 mg/ to 2 kg, for 2 to 3 months in parallel with a small dose of prednisolone. (II a)

C: for renal biopsy histology suggest minor tissue of patients with IgA nephropathy, if the failure of treatment with glucocorticoid and cyclophosphamide, use of cyclosporine A, initial dose of 5 mg/ daily kg treatment for 6 to 12 months, while giving small doses of prednisolone. (IV)

C: is not minor histological changes in patients with IgA nephropathy, and slight histological lesions were similar, using prednisolone, cyclophosphamide and cyclosporine A. (IV)

GPP:, however, the response to treatment in these patients is not optimistic, and therefore should be avoided in the immune suppression of nonresponders.

C: for patients with acute renal failure caused by a large number of crescentic IgA nephropathy, it is recommended to use standardized therapy for other types of crescentic glomerulonephritis. First, then changed to oral methylprednisolone, prednisone, cyclophosphamide, dipyridamole and law. Plasmapheresis and intravenous immunoglobulin therapy may also be used. (IV)

C: is not recommended for the treatment of patients with acute renal failure caused by histological changes in mild IgA nephropathy. (IV)

GPP: does not recommend a specific therapy for patients with recurrent IgA nephropathy after renal transplantation, and the treatment is similar to that of the primary disease.

Treatment of membranous nephropathy

C: patients with membranous nephropathy should be excluded from secondary causes, especially autoimmune diseases, infections, drugs and malignancies. (IV)

Patients with primary membranous nephropathy with stage III or IV nephropathy with nephrotic syndrome or histological changes, should be treated with immunosuppressive therapy because of the risk of developing end-stage renal failure (B:). (II B)

B: for patients with non nephrotic syndrome with proteinuria, normal renal function, or histological changes in patients with stage I or II, there is no evidence that immunosuppressive therapy is beneficial. (II B)

B: should be treated with immunosuppressive therapy in patients with primary membranous nephropathy with progressive renal insufficiency. (III)

Nephrotic syndrome induced by A: membranous nephropathy may be administered alone to induce remission of proteinuria. (I b)

A: there is no evidence that hormone therapy has long-term efficacy in patients with membranous nephropathy. (I a)

B: oral cyclosporine A 6 mg/ kg per day may be used to treat children with nephrotic syndrome. (III)

Cyclosporine A can be maintained for 2 years in children with nephrotic syndrome treated with GPP.

 

www.Cure001.comwww.Cure999.com

Cerebral Vascular Disease,Acne,Heart Disease,Deaf,Headache,Std,Condyloma Acuminatum,Fibroid,Pneumonia,Brain Trauma,。 Rehabilitation Blog 

Rehabilitation Blog @ 2017