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2013年3月4日星期一

Mild diffuse mesangial proliferative glomerulonephritis


Health counseling description:
Male, 28 years of age, premorbid physical health, nutritional status in general. Genetic and other medical records. August 18, 2004 at the First Affiliated Hospital of Anhui Medical University, do renal biopsy and pathological diagnosis: mild diffuse mesangial proliferative glomerulonephritis. Discharged on August 26, August 28 to work special rest after work. 1 treatment: According to Su daily one, 10mg / tablets. Every day at noon to eat. Jinshuibao eat some time disabled, astragalus, Eucommia, American ginseng soaked in water instead. 2, diet, and no significant change, eat meals, no special attention to diet. 3, restful sleep: pay attention to rest after discharge, and now want to review the exam, reduced sleep time, but the sleep quality is acceptable. 4 work: engaged in the management of heavy manual labor, but the work is quite busy. Heavy workload, did puncture the side of the feeling of fatigue, the other side without feeling, I suspected puncture sequelae, doctors say my psychological effect. 6 week sex life. Adhere to medication after discharge. Attachment: renal biopsy report an optical microscope: light microscopy 10 points Ye ball hardened ball and crescent formation, increased the number of cells increased mesangial cells (2? 4 ), increased mesangial matrix and mesangial area widened capillaries River (?) open cavity of erythrocyte, no thickening of the basement membrane normal balloon. Mild tubule? Interstitial lesions, vacuolar degeneration of tubular epithelial cells, interstitial infiltration of inflammatory cells, fibrosis? Immunofluorescence: visible glomerular mesangial area IgG + +, IgM + +, C3 + + particulate deposition. April 28, 2004, urine protein + +, hematuria + + +, begin to eat traditional Chinese medicine treatment May 8 to check results as before, or protein + +, hematuria + + +, the doctor gave for the Chinese medicine. May 23 urine protein + + + (increase a +), hematuria + + +. Such as hypertension, edema. The doctor told me this afternoon to go to the hospital with a renal biopsy report. Do not know will not use hormones it. Consult a doctor, I have treated such a long time, why did not effect it? I know that certainly can not be cured, the worst development to uremia, a kidney transplant or die. However, if the treatment effect is good, my illness will control to what extent? Or the best results, what is it?
Kidney disease experts answer:
Hello, can reference below. Non-IgA mesangial proliferative glomerulonephritis (nonIgamesangial proliferative glomerulonephritis) refers to the light microscope, pathological changes of diffuse mesangial cell proliferation and / or widened mesangial matrix, a group of diseases. Over the report of this group of diseases, the incidence of significant differences in primary nephrotic syndrome, such as this group of diseases in the United States accounted for less than 10%, but it is very common in our country, however, accounted for about 30% of primary renal ball diseases renal biopsy number may be as high as 40%. This difference is related to geography, species, environmental factors such as sample preparation, in which the course of the disease when the biopsy stage and assessment standards. Mesangial proliferative glomerulonephritis only on a pathological description of the concept, so it contains a variety of situations. Much overlap between the primary glomerular disease, mesangial proliferative glomerulonephritis with minimal change nephropathy and focal segmental glomerulosclerosis. Minimal change nephropathy may be associated with a certain degree of mesangial proliferative mesangial glomerulonephritis focal segmental heavier even focal segmental sclerosis; performance plus repeat renal biopsy conversion and the inconsistency of the response to treatment, and thus that of the three histological types may just be different with a disease severity. As for mesangial proliferative glomerulonephritis whether the as an independent disease, as well as its relationship with minimal change nephropathy and focal segmental glomerular sclerosis, remains to be further proved. Not yet penetrated within this group of diseases under an optical microscope with acute post-streptococcal glomerulonephritis (endothelial cells diffuse mesangial proliferative glomerulonephritis) dissipated period, as well as early mesangial capillary glomerulonephritis (referring mesangial the subcutaneous) often can not distinguish. Immunofluorescence examination, the type and intensity of positive immunofluorescence was also very different: IgA-based, or IgA nephropathy; mainly IgM and / or C3 mesangial deposition, it was called "IgM nephropathy , contingent has not yet been recognized; mainly Ig and / or C3 deposition also has a variety of modes; otherwise no immunofluorescence positive material deposited. Secondary glomerular diseases have similar morphology performance even more, such as: systemic lupus erythematosus, anaphylactoid purpura, rheumatoid arthritis, hereditary nephritis, pulmonary hemorrhage - nephritis syndrome, Kimura's disease and D-penicillamine induced renal damage; vasculitis is very similar, but often accompanied by necrotic changes in glomerular vascular plexus. Discussed in this section refers to the primary mesangial proliferative glomerulonephritis, and does not include the aforementioned diseases. 】 【Treatment when the patient's renal biopsy showed mild mesangial proliferative without immunoglobulin deposition or focal segmental glomerulosclerosis signs superimposed, often benign prognosis. Such patients have a good reaction, most of the sugar adrenal corticosteroids, the only course of treatment to be extended; them invalid, or only partially alleviate the patient or repeated relapse patients, the use of cytotoxic drugs, such as cyclophosphamide or the chlorambucil or Liu Zuopiao Yin, effective or increase the response rate and reduce the recurrence. Glucocorticoid adrenal hormone reaction when adult patients with nephrotic syndrome, renal biopsy and moderate to severe diffuse mesangial proliferation with focal segmental glomerulosclerosis performance superimposed, often poor, tend to be persistent protein urine and slow progression to renal insufficiency. These patients with balloon adhesions, small ball hardened even worse damage, tubular atrophy and interstitial fibrosis. Type of disease in the trial of prednisone standard dose after 8 weeks, such as invalid should be changed every other day treatment and reduce dose, depending on the condition to decide the course of treatment and attention to preventing and reducing the side effects of hormone therapy. International Children's Kidney Disease Cooperative Study results show significant mesangial cell proliferation, prolonged hormone treatment to more than one year were more satisfied. This program must still cautious use in adults. Typical mesangial proliferative glomerulonephritis associated with IgM-based sediment, its response to steroid therapy, easy progress into focal segmental glomerulosclerosis. In short, the favorable response of patients on hormone therapy, the prognosis is usually good, despite the the proteinuria dissecting heavy Shiyou alleviate only a few develop into end-stage renal disease; hormone-free reaction performance continuous nephrotic syndrome patients, the prognosis The poor, however, its speed is not consistent with the occurrence of renal failure. Whether the cytotoxic drugs can slow down the rate of progress is not clear. It is estimated, that focal segmental glomerulosclerosis performance overlap and no response to steroid therapy, renal failure often occurs in 5 to 10 years after onset. Severe mesangial proliferative glomerulonephritis superimposed focal segmental glomerulosclerosis associated with nephrotic syndrome and renal failure patients in the three years for the kidney transplant, have reported a high incidence of transplant renal recurrent nephritis.

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