FSGS Symptoms

Today we take focal segmental glomerular sclerosis (FSGS) as an example to explain how to treat refractory proteinuria.

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Treatment for FSGS Patients with Refractory Proteinuria

2018-11-07 03:54

Treatment for FSGS Patients with Refractory ProteinuriaChronic kidney disease can be roughly divided into glomerular disease and renal tubular disease. For patients with obvious proteinuria, it is usually glomerular disease.

Most patients with proteinuria do not require hormones and immunosuppressive agents and can be cured with other drugs.

In 40 percent of patients with high levels of proteinuria, their proteinuria can get long-term remission after taking hormones. In patients whose proteinuria can not get remission or get relapses frequently, it is refractory proteinuria.

With refractory proteinuria, it is usually required to do renal biopsy to clarify the pathological type, and then use the combination of hormone and immunosuppressants for treatment.

In general, refractory proteinuria belongs to refractory nephropathy such as focal segmental glomerular sclerosis (FSGS), membranous proliferative nephropathy, and crescent nephritis.

Today we take focal segmental glomerular sclerosis (FSGS) as an example to explain how to treat refractory proteinuria.

FSGS can be divided into three categories: primary, secondary and genetic. 100% of the patients have proteinuria, 60% of the patients have proteinuria more than 3.5g/ day (large amount of proteinuria), and one-third of the patients have hypertension and impaired renal function during the onset of the disease.

If not treated actively, more than 50% of patients will progress to uremia within 5 to 10 years.

Treatment methods for FSGS

1. Hormones + immunosuppressants

For example, prednisone is 1mg/kg/ day (or methylprednisolone 0.8mg /kg/ day);

Plus immunosuppressant:

(1) Preferred cyclophosphamide should be 0.4-0.6g at each time, and intravenous drip is done once every other week, with the total dose not exceeding 0.1-0.15g /kg.

(2) Or cyclosporins are taken on an empty stomach twice a day at 4-5 mg/kg, and then reduced slowly after 2-3 months. It can be maintained for a long time with a small dose of 3mg/kg per day for a total of about half a year.

(3) For patients whose cyclosporin therapy is not effective, tacrolimus can be used for 0.05 ~ 0.1 mg/kg per day, and the blood drug concentration is 5-10 ng/ml.

In the initial treatment, there may be no effect, and FSGS often require 3 months of hormonal + immunosuppressive therapy to have a significant effect.

Sixty percent can be controlled with hormones and immunosuppressants.

2. Chinese medicine

We found that glomerular sclerosis belongs to mucus, turbidity and stagnation in traditional Chinese medicine, requiring traditional Chinese medicine treatment of activating blood, dredging collaterals and dispersing blood stasis, which can further reduce urinary protein and prevent recurrence.

3. Rituximab or plasma exchange

If you are the unfortunate 40% and Chinese medicine does not have the desired effect, try Rituximab or plasma exchange. Although these two treatments are effective, they are relatively expensive. The cost of plasma exchange is nearly 10,000 RMB per time and the cost of rituximab is about 100,000 RMB.

4. Complication prevention

In addition to treatment of refractory proteinuria, all kinds of antihypertensive, lipid-lowering, anticoagulant and antithrombotic therapy should be performed to prevent the occurrence of dangerous complications.

For more information on FSGS treatment and refractory proteinuria treatment, please leave a message below or contact online doctor.

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