The Research With Regard To The Curative Effect Of Corticosteroids And Immunosuppressive Agent In Treating Patients With Primary Glomerular Disease

Objective Currently believe that the majority of primary or secondary glomerular diseases are mediated by the immune response of inflammatory disease. Thus, hormones and immunosuppressive drugs in the treatment of glomerular diseases occupy an important position. Numerous studies show that a reasonable application of hormone and / or immunosuppressive agents for the treatment of glomerular diseases standardized, can effectively control the progress of glomerular disease, reduce end-stage renal diseases. Primary glomerular disease, because of its unknown etiology, the pathological symptoms similar to those between the types and the pathogenesis is not clear, the diagnosis and treatment have brought a lot of inconvenience, but On the same kinds of pathological types of glomerular disease, all countries, all regions have different treatment methods. Therefore we focused on patients with primary glomerular disease hormone and / or immunosuppressant treatment efficacy , side effects and other related aspects of systematic review and analysis during 2 years in renal medicine in our hospital, hoping for further research clinical work, as well as providing important guidance to relevant information. Materials and Methods 160 cases of patients treated in kidney Section in our hospital from 2006 to 2008, the clinical diagnosis are consistent with chronic glomerulonephritis and nephrotic syndrome, exclusion of secondary glomerular diseases group, 72 cases of male, 88 cases of female, average age 37 years old, two persons less than the 14-year-old (9-year-old and 12-year-old), were not related. Of which 97 cases of chronic glomerulonephritis, 63 cases of primary nephrotic syndrome, renal biopsy in 116 cases, not done in 44 cases of renal biopsy.Pathological type showed mesangial proliferative glomerulonephritis of 33 cases, focal segmental glomerulosclerosis in 25 cases ,10 cases of minimal change nephropathy, 17 cases of membranous nephropathy, 28 cases of IgA nephropathy, mesangial capillary glomerulonephritis in 1 case, crescentic glomerulonephritis in 1 case,1 case for glomerular necrosis.All cases will be divided according to clinical manifestation of nephrotic syndrome and chronic glomerulonephritis group, are in line with the internal medicine of the sixth printing plate to develop the diagnostic criteria, and without the application of glucocorticoid contraindication.63 cases of primary NS patients, A group of 15 cases, the treatment given to the foundation. 48 cases of group B, patients were given based therapy plus hormone therapy (methylprednisolone sodium succinate 500mg / d, the impact of the treatment of three days, then oral prednisone acetate tablets changed by 1mg / kg ? d). 97 cases of chronic glomerulonephritis, C group 64 cases, to give basic treatment.33 cases of group D, patients were given hormone (prednisolone acetate oral tablets, 40mg/d) At the same time, plus immunosuppressive agents (leflunomide) treatment. Observation and comparison of the urine, 24 h urinary protein, plasma albumin changes, and to monitor the general situation of adverse reactions recorded before and after treatment . In addition, hormone therapy for refractory or relapsing nephrotic syndrome, including nine cases of methylprednisolone pulse therapy and then to oral hormone therapy, but after eight weeks does not work, there are 12 cases of relapse after remission cases. (including biopsy examination 12 cases, minimal change nephropathy two cases, mesangial proliferative glomerulonephritis 1 case,4 cases of membra- nous nephropathy, focal segmental glomerulosclerosis in 2 cases, IgA nephropathy in 2 cases, crescentic glomerulonephritis 1 cases), plus the impact of treatment with cyclophosphamide. Result The results of this study show that patients with nephrotic syndrome of the hormone therapy group and the control group after treatment compared with a remission rate of significant difference,,and the reduction of urine protein or serum albumin are better than the pick-up in the control group. Two groups the incidence of adverse reactions have significant differences. Application of the impact of a three-day prednisolone sodium succinate, and then oral prednisone acetate in treatment of eight weeks, is still invalid or relapse after remission of refractory nephrotic syndrome cases continues to increase with cyclophosphamide treatment, the course of treatment was found to be effective to eliminate or reduce proteinuria and improve serum albumin, adverse reactions in small and difficult to relapse. Patients with chronic glomerulonephritis treated group and control group after treatment compared with a remission rate of significant difference, urine protein, urine red blood cells are better than the reduction in the control group, and the hormone treatment group plus immunosuppressant had no significant adverse events, and did not affect the continued efficacy of the treatment and mitigation. Clinical diagnosis of chronic glomerulonephritis patients with renal biopsy, as compared with the same pathological type of the control group and treatment group effect, between the two groups showed a significant difference. 116 cases of a routine biopsy, carried out in accordance with the different pathological types by comparison. The treatment of hormone or immunosuppressive agents as the first group, the basis of treatment for the second group, , Respectively, of the remission rate of pathological types of comparison, in which mesangial proliferative glomerulonephritis, focal segmental glomerulonephritis, IgA nephropathy, membranous nephropathy were significantly different, but minimal change nephrotic group no significant difference in remission rates. Conclusions This study showed that patients with nephrotic syndrome for 3 consecutive days using high-dose intravenous methylprednisolone sodium succinate, and then the application of adequate oral prednisone acetate tablets by 1mg/kg ? d, results show that the hormone therapy group from onset time was shorter than in the control group, clinical symptoms and signs improved significantly, thereby greatly reducing the length of stay, At the same time, in reducing symptoms and can quickly play the role of immune suppression and anti-inflammatory, the effective reduction of proteinuria, serum albumin increased, reducing the chance of infection, a low incidence of adverse reactions,so this is a safe and effective treatment. In addition, the study shows that medium amount of hormone (prednisolone acetate oral tablets, 40mg/d) plus immunosuppressive drugs (leflunomide) for the control of chronic nephritis have a role in proteinuria, with a total effective rate was 90.91%, significantly lower urinary protein and urinary red blood cell levels, and adverse reactions occurred, it can be used as treatment a choice of chronic nephritis. Refractory nephrotic syndrome for the use of high-dose CTX therapy can control the disease quickly and efficiently to speed up the relief of refractory NS, the total effective rate was 76.19%, before and after the impact of urinary protein, plasma albumin, creatinine, blood urea nitrogen values were significantly different, with no serious side-effects. However, the observation and study of the subject was limited by the time, so the application of hormone and / or immunosuppressant treatment of long-term efficacy and adverse reactions has yet to be observed and recorded for further follow-up and research.