With plasmaphérès treat chronic renal failure in stage 4 attracted chronic glomerulonephritis

1.The medical record summary
1. the patient Li Xiaoxia, 43, comes from Huxian district of the province of Xi'an
2. the symptoms described by the patient: intermittent edema of the lower extremities for five years, fatigue, abnormal renal function 3 months.
3. history of the disease: before age 5, he has no obvious incentive, the patient appeared edema of the lower extremities, no rash, no joint pain, went to the doctor at a local hospital to check the urine, examination showed: protein 2, occult blood +, she took Chinese edicinales herbesm in 2 years, and it has shown no significant improvement in the review, and then she is went to the doctor at the hospital accessory Jiaotong University in Xi'an, in June 2009, the B-ultrasound shows: 9.5cm the left kidney, right kidney 9.1 cm; Renal biopsy showed: chronic renal failure attracted chronic glomerulonephritis, give prednisone 40 mg orally, take it every morning in 2 months, still no significant improvement; receive treatment in a hospital in Xi'an nephropathy in August 2009, gives antipyretic tablet orally nephritis, adheres to a one-month treatment, the urine test had no significant change continues processing taking Chinese medicines; there three months she felt lfaible, and tests of renal function showed: blood creatinine 291.5umol / L, uric acid 599umol / L, hemoglobin 67g / L For more effective treatment, the patient arrives at our hospital.
4.temps inlet
On February 19, 2012
2..Les admission tests:
1. Arterial voltage: 130 / 90mmHg, 164cm height, weight 47 kg
2. urine test for protein + 2, + occult blood
3. The proportion of the morning urine: 1.008, pH 5 5, urine RBC52.40 / ul fine granule tubes 25-30 / HP
4. urinary excretion of protein 24 hours: 2.59 g / 24h
5.Sang: total protein 58.6g / L Albumin 35.4g / L ALT5.1U / L, AST 11.4U / L, hemoglobin 92g L
6 .Analyse blood lipids: TG 2.18mmol / L CHOL3.48mmol / L HDL 0.75mmol / L LDL1.74mmol / L Lpa129mg / L
Blood creatinine 317umol / L urea nitrogen 12.4mmol / L, uric acid 501umol / l
Blood: K + 4.08mmol / L, Na + 142mmol / L, Cl-108mmol / L Ca1.8 mmol / L, CO2 16.7mmol / L PO4 1.89mmol / L
3.La admission diagnosis
Initial disease diagnosis: chronic glomerulonephritis, nephropathy AIGA
Functional diagnosis: chronic renal failure in stage 4
The diagnosis of complications: renal hypertension, renal anemia, electrolyte imbalance and imbalance of acid-base.
4.l'effet treatment
1. After admission, treat complications with Western medicine; the exchange of plasma treatment was given to 2 March
2 Micro-Chinese medicine, prevent renal fibrosis and to prevent the reaction of the ignition of an injury;
3, repair the results of treatment were as shown --Bra:
plasma
Arterial tension draft proportion globule protein
Before treatment 130/90 1008 2 52.40 / ul
After treatment 100/70 1.025 + 8.6 / ul
urinary protein 24 hour tube k + Na + Cl- Co2 PO4
2.59 25-30 4.08 142 108 16.7 1.89
1.23 8-10 4.3 137 102 22 0.93
Albumin creatinine blood urea nitrogen uric acid
35.4g / L 12.4 317 501
45.6g / L 257 336 9.6
5.The views of experts:
1.la this patient nephropathy is caused by immune injury
2.la patient reaches the immune injury for these reasons:
①D'abord, many of IgA to start the inflammatory response
② damage the function of glomerular and tubular function;
③ started renal fibrosis, fibrosis has not been developed a controlled portion of the scar tissue, promotes the deterioration of renal function
3. cold bactériennese of infections such as by the antigen-mediated immune response in patients with glomerular damage intrinsic Immunotherapy.
4, the effect of plasmapheresis treatment is to clear the objects of immune injury in the patient, to reduce kidney damage; and clean in the disordered state of the environment in and promote a stable arterial pressure and do normal endocrine kidney.

5, the cleaning of a large number of immune damage substances, plasmapheresis clean obstacles for the recovery of the kidneys and activate the function of Immunotherapy, in inhibiting the inflammatory response and to improve the local microcirculation.