Primary vasculitis how to treat kidney damage?

(1) corticosteroid and cytotoxic drugs : prednisolone initial treatment dose of 1 mg / kg · d, Kingston service or sub-service time, General adequate 4 ~ 8 weeks, every other day to 1mg/kg Kingston service, the Department of 2 months, thereafter every two weeks - a reduction 5mg until complete withdrawal. The entire course of not less than six months. Some scholars maintain a small amount of prednisone (10 ~ 20 mg / d) to maintain two years, or even longer. Cyclophosphamide usually prednisone therapy after 10 ~ 14 days, early treatment of oral dose of 3mg/kg a ~ d, generally choose 2 mg / kg · d, lasted 12 weeks. By Primary vasculitis recurrence rate of 30% ~ 50%, in order to reduce and avoid relapse after withdrawal. should maintain a longer time on cell poison. Application of cyclophosphamide long-term side effects, Europe and the United States after the application of scholars recommended azathioprine, 2mg/kg d oral, as maintenance therapy 1.5 ~ 2 years, or even longer, should normally not be less than one-half years. Wegener granulomatosis patients should be appropriately extended. In recent years, many scholars recommend intravenous cyclophosphamide pulse therapy. Every time the initial dose of 15 mg / kg or 1.0 g / time, once a month, for six months, subsequent maintenance therapy for 2 ~ March 1 meeting, the same dosage, time to two years, at least not in one short year. This method relatively the same time a total dose of the oral dose is about 1 / 3, it may reduce hemorrhagic cystitis, gonadal injury incidence of side effects, long-term treatment-induced reduction in the incidence of malignant tumors. On renal function deterioration of the ANCA associated glomerulonephritis severe Primary vasculitis patients should be used methylprednisolone pulse therapy, each 0.8-1.0g per day or every other day, three times for a course of treatment, illness need a week to repeat. (2) plasma replacement therapy : a life-threatening pulmonary hemorrhage Primary vasculitis patients Plasma replacement therapy on pulmonary hemorrhage role more sure and swift. Initial treatment generally use the enhanced plasma replacement therapy, each replacement plasma 3-4L, once daily for seven consecutive days. thereafter every other day or several times a day, to pulmonary hemorrhage or other significant activity indicators such as high-titer ANCA under control. Plasma exchange was available albumin or fresh plasma, if necessary, the two alternate use. Plasma replacement therapy during the same time, given the necessary two-3mg/kg of cyclophosphamide and prednisone 1mg/kg d d, in the body to prevent the loss of a substantial amount of immunoglobulin synthesis and after counter-jump. (3) Other therapy : ① immunoglobulin : HCT d, intravenous drip, a five-day course. Infection and other reasons can not use corticosteroid and cytotoxic drugs, it could try. ② antilymphocyte antibody : Joint application of anti-CD4 and anti-human CD52 monoclonal antibody of, some of refractory Wegener granulomatosis induced remission. ③ anti-infection treatment : two each cotrimoxazole, 2 times a day treatment of 24 months. ④ immunosorbent assay specificity : ANCA specific to the target antigen-binding resins, Adsorption for the corresponding serum ANCA. ⑤ dialysis and renal transplantation : About 10% ~ 20% Primary vasculitis patients into irreversible end-stage renal failure, need to rely on the maintenance dialysis. Primary vasculitis and kidney damage recurrence tendency renal transplantation has been reported to suffer again. 