紫癜性肾炎的治疗

2019/12/19TheFirstHospitalofXinxiangMedicalCollege1紫癜性肾炎的治疗ThetreatmentofHSPN朱铁锤2019/12/19TheFirstHospitalofXinxiangMedicalCollege2概述继发于过敏性紫癜，最严重的并发症20-40%儿童HSP50-85%成人HSP影响预后及病程决定因素2019/12/19TheFirstHospitalofXinxiangMedicalCollege32019/12/19TheFirstHospitalofXinxiangMedicalCollege42019/12/19TheFirstHospitalofXinxiangMedicalCollege5治疗肾外表现的治疗HSPN的治疗2019/12/19TheFirstHospitalofXinxiangMedicalCollege6肾外表现的治疗解热镇痛药物抗组胺及解痉药物糖皮质激素2019/12/19TheFirstHospitalofXinxiangMedicalCollege7HSPN的治疗糖皮质激素•尿常规轻度改变：镜下血尿轻微蛋白尿•肾功能正常•肾活检轻微改变局灶性增生•杀鸡焉用宰牛刀2019/12/19TheFirstHospitalofXinxiangMedicalCollege8HSPN的治疗糖皮质激素•肾炎综合征肾病综合征急进性肾炎•系膜增生性肾炎伴局灶或弥漫性新月体膜增殖性肾炎•舍我其谁？2019/12/19TheFirstHospitalofXinxiangMedicalCollege9HSPN的治疗糖皮质激素•是否应用•多少剂量•多久疗程•多大疗效•上帝知道，他老人家说：一个字乱两个字真乱三个字就是乱2019/12/19TheFirstHospitalofXinxiangMedicalCollege10HSPN的治疗应用糖皮质激素最大学派•急性肾炎综合征泼尼松1-2mg/kg.d疗程2-3月•大量蛋白尿MP冲击治疗15-30mg/kg.d必要时追加1-2疗程泼尼松1-2mg/kg.d维持疗程6个月2019/12/19TheFirstHospitalofXinxiangMedicalCollege11刘志红、黎磊石的不同声音•轻度（镜下血尿少量蛋白尿1.5g/24h）•泼尼松0.6mg/kg.d四周后改隔日顿服10mg维持蛋白尿持续转阴停药•雷公藤多苷1mg/kg.d新肾炎胶囊100mgbid•总疗程oneyear2019/12/19TheFirstHospitalofXinxiangMedicalCollege12刘志红、黎磊石的不同声音•中度（肉眼血尿大量镜下血尿蛋白尿2.0g/24h高血压轻度肾功能损害肾小球弥漫增殖或局灶节段硬化新月体30%）•MP0.5X3D泼尼松0.5mg/kg.d四周后改隔日顿服10mg维持蛋白尿持续转阴停药•雷公藤多苷1mg/kg.d新肾炎胶囊100mgbid•总疗程twoyear2019/12/19TheFirstHospitalofXinxiangMedicalCollege13刘志红、黎磊石的不同声音•重度（肉眼血尿大量蛋白尿高血压肾功能损害急进性肾炎肾小球重度增殖或膜增殖样病变大量新月体）•MP0.5X3D泼尼松0.5mg/kg.d四周后改隔日顿服10mg维持•富翁MMF2.0/D半年1.5/D半年1.0/D1年•负翁CTX•雷公藤多苷1mg/kg.d新肾炎胶囊100mgbid•总疗程twoyear2019/12/19TheFirstHospitalofXinxiangMedicalCollege14邓安国说：•急性肾炎综合症泼尼松0.8-1.0mg/kg.d6-8周减量总疗程6月•较重急性肾炎综合症especially弥漫增生泼尼松4周无效CTX总疗程可12月•大量蛋白尿或NS泼尼松1.0mg/kg.d若无效连用雷公藤多苷或MMF若4周还无效应用MP冲击•急进性肾炎MP或CTX冲击病情凶险双冲击2019/12/19TheFirstHospitalofXinxiangMedicalCollege15HSPN的治疗免疫抑制剂•属上层建筑•一般治疗无效的肾炎综合征、肾病综合征急进性肾炎2019/12/19TheFirstHospitalofXinxiangMedicalCollege16HSPN的治疗免疫抑制剂CTX•2-3mg/kg.d口服或静注•CTX冲击10mg/kg.dX2dX4-5次后每3月1次2019/12/19TheFirstHospitalofXinxiangMedicalCollege17HSPN的治疗免疫抑制剂硫唑嘌呤•2-3mg/kg.d•6-12月疗程注：也有人说3个月2019/12/19TheFirstHospitalofXinxiangMedicalCollege18HSPN的治疗免疫抑制剂MMF2.0/d半年1.5/d半年1.0/d1年LEF50mgX3d20mg维持2019/12/19TheFirstHospitalofXinxiangMedicalCollege19HSPN的治疗•血小板抑制剂•抗凝剂•抗氧化剂•ACEIandARB2019/12/19TheFirstHospitalofXinxiangMedicalCollege20HSPN的治疗•IVIG•血浆置换•间歇白细胞去除法•自体或异体光量子血疗法2019/12/19TheFirstHospitalofXinxiangMedicalCollege21HSPN的治疗Totheend•血液透析•腹膜透析•肾移植2019/12/19TheFirstHospitalofXinxiangMedicalCollege22That,sallLet,sendThankyou