Mistakes in the treatment of IgA nephropathy - series III

Common symptoms of IgA nephropathy: gross hematuria

The onset of gross hematuria following mucosal (usually upper respiratory tract) infection is a typical manifestation of IgA nephropathy. This kind of gross hematuria is usually transient, and the attack time is within 1 week, usually 1-3 days. With infection control, the symptoms will also disappear, and generally will not cause renal function damage (but not all). Therefore, it is very important to find the focus of chronic infection and prevent infection for the recurrent macroscopic hematuria, mainly respiratory tract infection, such as oral cavity, periodontal disease, tonsil, etc.

For recurrent bacterial tonsillitis, the latest guidelines of Kidney Disease: Improving Global Outcome (KIDIGO) pointed out that there is no strict randomized controlled trial at the current stage to verify the exact effect of tonsillectomy, so it is necessary to repeatedly evaluate and decide whether to perform tonsillectomy in those paroxysmal gross hematuria closely related to tonsillitis. In some studies (the quality is not high enough and there are drug interference factors), tonsillectomy is considered to be effective, but other retrospective studies have not found the efficacy of tonsillectomy. Therefore, there is still controversy in the academic community about whether such patients should undergo tonsillectomy.

RAS blocker has no effect?

RAS blocker is one of the most widely used drugs for nephrotic patients, which can reduce blood pressure and urine protein. It mainly includes two kinds of drugs, angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB). ACEI mainly includes captopril, benazepril, etc. ARB mainly includes telmisartan, valsartan, losartan, etc.

In clinical practice, we will encounter some patients who take RAS blocker to lower urinary protein effectively, while others have poor effect. When the effect is not good, it is not urgent to change the medicine immediately, but should find out the reason. It is likely that the patient did not carry out salt restriction, because the high-salt diet may lead to the resistance of RAS blockers. In general, the high-salt diet will lead to the ineffectiveness of RAS blockers. According to the standard, salt can be limited to less than 6g/day to see the effect.

Revise the content of high-quality low-protein diet in the "Mistakes in the Treatment of IgA Nephropathy - Series II".

In the second part of the series, we introduced the low-salt, high-quality and low-protein diet in detail, but the proposed combination of energy is not up to the standard. While ensuring the total protein intake of 0.6g/kg of standard body weight per day, more than 60% of the protein comes from high-quality protein, 30-35 kcal/kg of body weight per day must also be guaranteed. When matching with high-quality low protein, the part with insufficient calories should use starch, such as wheat starch (or other starch), or a small amount of vegetable oil to supplement the lack of energy. (Thank Dou Pan, the chief physician of the Department of Nutrition, Peking University First Hospital, for his correction.)

There is a lot of knowledge about nephrosis nutrition, and diet plays a very important role in delaying nephrosis and controlling the disease. If you want to control diet and more in line with your own dietary habits, it is recommended to find a professional nutritionist for guidance.