Primary small vascular inflammatory renal injury

【-- Outlined by the primary vasculitis (mainly seen under the microscope more arteritis and Wegener granulomatosis) caused by bad segmental death glomerulonephritis, accompanied renal dysfunction a disease, most of the patients serum anti-neutrophil cytoplasmic antibody (anti-neutrophil cytoplas mic autoantibodies ANCA) positive. 【-- A diagnosis, medical history and symptoms were in the older, well-fat autumn season, most of the patients had influenza-like drug allergies or the precursor performance. Often irregular fever, rash, joint pain, muscle pain, weight loss, abdominal pain and gastrointestinal symptoms; lung and renal involvement is consistent performance for allergic asthma, hemoptysis, or difficult to control lung infections; Some patients have sinusitis, otitis media performance and eye (conjunctivitis and keratitis granuloma, sclera outer-yim, iridocyclitis and influencing choroid); Early kidney involvement have hematuria, about 1 / 3 were macrohematuria, most accompanied by proteinuria or nephrotic syndrome, hypertension rare or less, half were rapidly progressive glomerulonephritis performance, if timely and effective treatment, Some patients with renal function may fully restored. Two and physical activity found more common view fever, a mild anemia, eyelid or lower extremity edema. Some patients have rashes or eye performance. 3, auxiliary inspection (1) urine checks have different degrees of proteinuria, hematuria and urinary tube. (2) Most patients anemia, blood leukocytes increased, occasionally increased eosinophils. (3) acute phase of ESR and C-reactive protein quantitative than normal. Γ - globulin often increase. (4) Most ANCA positive diagnosis is primary vasculitis an important basis; ANCA lesions may reflect the activity or recurrence for about four weeks before there can be positive ANCA. (5) Ccr often different degrees, BUN, creatinine increase. (6) chest X-ray performance alveolar hemorrhage, pneumonia or lobular limitations cavity necrotizing pneumonia; CT scanning can be found sinus or eye disease; ultrasound examinations showed that renal size of normal or increased. (7) for the early diagnosis of renal biopsy can help this disease. 4, the differential diagnosis should be taken to exclude Goodpasture syndrome, rapidly progressive glomerulonephritis. systemic lupus erythematosus, anaphylactoid purpura, rheumatoid arthritis with vasculitis, cold gammopathy and so on. 【Treatment measures -- one, early diagnosis and early treatment of this disease is the key to improve the prognosis, Conventional be used glucocorticoids and cytotoxic drugs in combination, can be assigned standard hormone therapy plus CTX. treatment maintain two or more years. 2, acute renal function deterioration in patients in dialysis premise of the standard as soon as possible to give hormone therapy plus CTX shock treatment, or methylprednisolone pulse therapy plus CTX shock treatment. Plasma replacement therapy is effective, especially for the role of pulmonary hemorrhage sure and swift. If high blood volume with severe, intractable heart failure emergency dialysis should make it out of danger. to create conditions for drug treatment and gain time. Three of treatment, generally include : rest, diet, diuretic, lower blood pressure, control and anticoagulation complications. under the condition of the patient with primary reference to the treatment of glomerulonephritis. 4, the static point of high dose immunoglobulin and application of monoclonal antibodies against T cell therapy may have some effect. 5, end-stage renal failure in patients with chronic renal failure treatment.