Nephrosis

Description:

Nephrosis (nephrosis; nefr-  + ‑оз) — the general name of damages of kidneys with pathological changes of preferential renal tubules (from slight dystrophy to a necrosis) which are shown a nephrotic syndrome.

Nephrosis symptoms:

The lipoid nephrosis (a nephropathy with the minimum changes) occurs both at children, and at adults.
It is characterized by a high proteinuria, a disproteinemia, a hypoproteinemia, a lipidemia (hypercholesterolemia) and hypostases.

Nephrosis reasons:

The reason causing development of a lipoid nephrosis is unknown; it is not excluded that it is about a dysplasia of podocytes. The pathogeny of a lipoid nephrosis does not differ from a nephrotic syndrome of any etiology. The dystrophy and a necrobiosis of an epithelium of tubules arising for the second time in connection with changes of the glomerular filter become leaders and considerably define all clinical manifestations characteristic of a nephrotic syndrome.

Treatment of the Nephrosis:

    * A diet — at a renal failure liquid reception restriction, electrolyte-deficient, amount of protein, optimum on age
    * Infusional therapy (albumine, реополиглюкин and др)
    * Diuretics

diuretics play a large role in treatment of a disease of kidneys, however at uncontrolled and their prolonged use there can occur sharp loss of sodium and decrease in volume of the circulating blood, a hypopotassemia and a metabolic acidosis. The artificial diuresis by means of high doses of diuretics, as well as ultrafiltration, in the conditions of a sharp hypoalbuminemia or the expressed renal failure can be complicated by unhandy hypovolemic shock or further decrease in glomerular filtering. Therefore treatment by diuretics is recommended to be carried out most quickly and to renew only in cases of noticeable decrease in a diuresis and increase of hypostases.

Usually apply furosemide to treatment of nephrotic hypostases – 20 – 400 mg inside, 20 – 1200 mg intravenously) which renders rather powerful and bystry, though short-term, action. Like furosemide also Acidum etacrynicum (50 – 200 mg/days) works. More weakly hypothiazid which diuretic effect is observed in 1 – 2 h after reception of 25 - 100 mg of drug works. An important role in fight against hypostases is played by kaliysberegayushchy diuretics – Triamterenum, amiloride, especially Spironolactonums (Aldactonum, верошпирон). Veroshpiron apply in a dose from 25 to 200 - 300 mg a day, He most эффектииен in combination with tiazidovy diuretics, furosemide. Hypostases – at the nephrotic syndrome caused by an amyloidosis differ in big resistance to diuretics.

    * Heparin
    * Antibacterial therapy
    * Corticosteroids

Glucocorticoids (Civil Code) — Prednisolonum (PZ) (медопред, преднизол, Prednisolonum) and Methylprednisolonum (MT) (Methypredum, solu-Medrolum) — are the first drugs of the choice at immunosuppressive treatment of GN. Groups of companies influence redistribution of immunocompetent and inflammatory cells, interfering with their receipt in the inflammation center, suppress their sensitivity to inflammation mediators, oppress secretion of such pro-inflammatory cytokines as FNO-α, IL-1, IL-2, IL-6. Groups of companies start processes of a gluconeogenesis, promoting inclusion of antibodies in carbohydrate metabolism and by that reducing their quantity, tone up a capillary wall and reduce a hyperemia due to activation and swelling of pericytes. Introduction of high doses of group of companies in the form of "pulses" of MT oppresses formation of DNA antibodies, stops formation of cell-bound immune complexes, reduces their weight and promotes an exit from subendothelial layers of a glomerular bazelny membrane, increases glomerular filtering and a renal blood stream. Groups of companies are appointed to children in all cases for the first time arisen NANOSECOND, at a recurrence gormonochuvstvitelny NANOSECOND (as a rule, NSMI), at the progressing current of GN, in combination with other immunodepressants and so forth.

Three modes of group of companies of therapy are put into practice.

Constant oral administration of PZ in a dose of 1-2 mg/kg in 2–4 receptions taking into account daily activity of bark of adrenal glands (the maximum doses of drug in the morning with the subsequent decrease, the last reception no later than 16:00) is appointed in an initiation of treatment for achievement of remission.

The alternating (alternative) mode of reception of PZ is used upon transition to a maintenance therapy. Consists in reception of a daily dose of PZ every other day that allows to lower considerably at preservation of clinical effect by-effects: acute — sleeplessness, euphoria, psychosis, increase in appetite; chronic — hypostases, obesity, a myopathy, striya, a skin atrophy, a hirsutism, an acne, osteoporosis, a cataract, increase in the ABP, steroid diabetes; adrenal crisis — acute adrenal insufficiency at sharp drug withdrawal. Also there is an option of the alternating mode with reception of PZ daily within 3 days, then 3–4 days of a break. By efficiency both modes of alternating reception of PZ are approximately identical.

Pulse therapy of MT is used for achievement of very high concentration of group of companies in plasma. About 30 mg/kg of MT (no more than 1 g on pulse) once in 48 h consist in intravenous drop administration within 20–40 min. The number of introductions, and also a single and total dose are defined by the chosen scheme of therapy of this pathology.

Side effects of glucocorticoids can be the following: sleeplessness, euphoria, psychosis, increase in appetite, hypostases, obesity, a myopathy, striya, a skin atrophy, a hirsutism, an acne, osteoporosis, a cataract, increase in the ABP, steroid diabetes, adrenal crisis (acute adrenal insufficiency at sharp drug withdrawal)

    * Cytostatics

Cytostatic (cytotoxic) drugs (TsS). Alkylating agents: cyclophosphamide (Cyclophosphanum, Cytoxanum) also hlorambutsit (Chlorbutinum, leukeranum) — break cell fission due to linkng with nucleic acids of nuclear DNA. Come to an organism in an inactive state, become more active in a liver. Affect not selectively all sharing cells (non-selective immunosuppressants).

Cyclophosphamide is appointed in or in the form of "pulses". Inside drug is appointed at the rate of 2,0–2,5 mg/kg/days to 8–12 weeks at treatment hormonedependent or chastoretsidiviruyushchy NANOSECOND against the background of a gradual dose decline of the PZ alternating mode, and also at a gormonorezistentnost.

Pulse therapy cyclophosphamide is carried out against the background of alternating course PZ at hormonedependent and gormonorezistentny by NANOSECOND at the rate of 12–17 mg/kg intravenously kapelno. The quantity of "pulses" and a time interval between them depend on the chosen scheme of therapy. Other option — "pulse" once a month within 6–12 months, in a cumulative dose is not higher than 250 mg/kg.

Hlorambutsil is accepted by per os in a dose of 0,15-0,2 mg/kg/days during 8–10 weeks for treatment hormonedependent and chastoretsidiviruyushchy NANOSECOND, is more rare at gormonorezistentny than NANOSECOND, against the background of alternating course PZ with gradual decrease.