Primary inflammatory kidney damage small vessels

[Outlined] By the primary vasculitis (mainly seen under the microscope more than arteritis and Wegener's granulomatosis) necrotizing-induced segmental glomerulonephritis, accompanied renal insufficiency of a disease, most patients with anti - Neutrophil cytoplasmic antibody (anti-neutrophil cytoplasmic autoantibodies, ANCA) positive. [Diagnosis] First, history and symptoms More common in middle-aged, a good autumn and winter seasons, most of the patients have flu-like drug allergies or performance of the precursors. Often irregular fever, rash, joint pain, muscle pain, weight loss, abdominal pain and gastrointestinal symptoms, lung and kidney involvement consistent level of performance as allergic asthma, or difficult to control hemoptysis lung infection; some patients have sinus Yan, otitis media performance and eye (conjunctivitis, granuloma keratitis, sclera outer Yan, iridocyclitis and choroidal Yandeng); Hematuria have early kidney involvement, about 1 / 3 with gross hematuria, with the majority Proteinuria or nephrotic syndrome, hypertension rare or less half a hasty glomerulonephritis performance, if timely and effective treatment, some patients may renal function fully restored. Second, found that physical examination More common activities of fever, a mild anemia appearance, eyelid or lower extremity edema. Some patients have skin rash or eye performance. Third, support checks (A) urine routine examination have different levels of proteinuria, hematuria type and the urine. (B) most of the patients anemia, increased blood leukocytes, occasionally eosinophil increased. (C) acute ESR fast, C-reactive protein than normal. CHANG γ-globulin increase. (D) the majority of ANCA positive, is the primary vasculitis confirmed the important basis; ANCA reflects the activities of the disease or relapse and recurrence of about four weeks ago to appear ANCA positive. (5) Ccr often different levels drop, BUN, creatinine increase. (6) chest X-alveolar hemorrhage more performance, lobular pneumonia or limitations cavity necrotizing pneumonia; CT scan can be found or orbital sinus disease; B super-examination showed normal or increased renal size. (7) for the early diagnosis of renal biopsy can help this disease. 4, differential diagnosis Goodpasture Syndrome attention should be ruled out, radical nephritis, systemic lupus erythematosus and Henoch-Schonlein purpura, with rheumatoid arthritis vasculitis, cryoglobulinemia hyperlipidemia and other diseases. [Treatment] First, early diagnosis and treatment of this disease is to improve the prognosis of the key, should be routinely used glucocorticoid and cell poison combination of the principles, standards can be given hormone therapy plus CTX, treatment of more than 2 years. Second, acute renal function deterioration of the patients, should be subject to dialysis as soon as possible to standard hormone therapy plus CTX shock therapy, or shock therapy Liuzhou methylprednisolone plus CTX shock therapy. Plasma replacement therapy also have a certain effect, especially in the role of pulmonary hemorrhage sure, quickly. If high blood volume with severe, intractable heart failure should an emergency dialysis to tide over the dangerous phase, to create conditions for drug treatment and gain time. Third, general treatment: including rest, diet, diuretic, reducing blood pressure, and prevention of complications of anticoagulation, with the condition should be based on Glomerulonephritis reference to the primary treatment. 4, static, large doses of immunoglobulin and application of monoclonal antibodies and other anti-T-cell therapy may have a certain effect. 5, end-stage kidney failure patients on the treatment of chronic kidney failure.