Treatment of polycystic kidney disease

Although the recent study of the pathogenesis of autosomal dominant polycystic kidney disease has made great progress, but so far there is no effective treatment, the main treatment is to control the complications, delay the progression of the disease. The principle of treatment of

autosomal dominant polycystic kidney disease is to reduce the birth rate, early diagnosis, strengthen patient education, regular inspection, and actively control the complications of patients with end-stage renal disease in a timely manner to take kidney treatment.

(A) general treatment

Pay attention to rest, avoid smoking, bogey drink tea, coffee and ethanol drinks, bogey chocolate, high blood pressure when the low-salt diet, late course recommended low-protein diet. Most patients do not need to change their lifestyle or limit physical activity early. When the cyst is large, should avoid the intense physical activity and abdominal damage. Patients should be followed up regularly.

(B) control of complications

1, the pain of some patients with pain is a transient, can be observed. If the pain is sustained or heavier may be analgesic, but an analgesic effect is poor. If the pain is serious, analgesics can not alleviate and affect the patient's life, you can carefully consider the surgical treatment.

2, bleeding has three kinds of situations: First, intracapsular hemorrhage, patients with sudden pain, but no visible hematuria; Second, cyst bleeding and urinary tract interruption, bleeding to a certain extent that is broken urinary tract, excreted, appear Naked hematuria; third is the renal capsule bleeding, large, no blood, blood pressure can be reduced. In addition to actively for hematuria due to the reasons such as cyst enlargement, hypertension, urinary tract infection and urinary tract stones and other treatment, bed rest is very important, commonly used hemostatic effect is not, and even the formation of blood clots, leading to urinary tract obstruction or Induced infection. Very few patients with large bleeding need blood transfusion therapy. Hemodialysis patients have been recurrent hematuria, should use small molecules or no heparin dialysis. For the large amount of bleeding, medical treatment ineffective, can be carefully considered surgical treatment.

3, high blood pressure: hypertension is one of the risk factors for renal function, should be effectively monitored, treatment target is 130 / 80mmHg. The antihypertensive drugs that can be used include angiotensin converting enzyme inhibitors (AcEI), angiotensin II receptor antagonists (ARB), calcium channel blockers, B receptor blockers, central antihypertensive agents and diuretic Agents, etc., antihypertensive drug compatibility and general hypertension is basically the same. AcEI or ARB drugs by inhibiting the excessive activity of renin-angiotensin system, reduce systemic blood pressure and glomerular capillary pressure in the early course of the disease is particularly evident, it is preferred. Application should pay attention to the monitoring of serum creatinine and serum potassium levels to prevent acute renal failure and hyperkalemia. Autosomal dominant polycystic kidney disease is often more stubborn hypertension, more need to be combined medication. For a variety of drugs can not control the combination of refractory hypertension, careful consideration of surgical treatment.

4, common infection of urinary tract infection, other infections, including cholangitis, intestinal diverticulitis and so on. General water-soluble antibiotics through the glomerular filtration, proximal tubule secretion, fat-soluble antibiotics through the capsule wall into the cyst, so treatment. Renal cyst infection should be combined with water-soluble and fat-soluble antibiotics, water-soluble antibiotics are ampicillin, aminoglycosides, and the second and third generation cephalosporins; fat-soluble antibiotics are compound sulfamethoxazole, ciprofloxacin, chloramphenicol And metronidazole and so on. As soon as possible pathogens culture, selection of sensitive antibiotics, is expected to get a better effect. Treatment takes more than 2 weeks.

5, stones to encourage patients to drink more water, according to stone size and location, can take endoscopic stone or surgical stone.

(C) treatment of renal symptoms

1, polycystic liver to reduce the volume of liver cysts for the principle of ultrasound can be guided under the cyst aspiration and injection of hardening agent, but also the use of surgical treatment, such as laparoscopic cyst decompression and lobectomy. Cyst infection with cyst fluid drainage combined with antibiotic treatment, treatment for 2 to 3 weeks.

2, intracranial aneurysms for 18 to 35 years of age with aneurysm family history of autosomal dominant polycystic kidney disease patients, should be magnetic resonance or angiography. If no positive findings, 5 years after the review; if positive results, should be determined by angiography aneurysm size. 6mm aneurysms should be treated with interventional therapy or surgery. Aneurysm rupture bleeding, the treatment principle is to prevent rebleeding and cerebral ischemia. Can use codeine analgesic, disable aspirin. 25% of patients in the aneurysm rupture 5 ~ 14d after cerebral ischemia can occur, may be appropriate to use vasoactive drugs or calcium channel blockers. As 35% of patients may re-bleeding, mortality rate of up to 50%, the sooner the better surgical treatment, it should be within 72 hours of bleeding surgery or interventional therapy.

(4) Surgical treatment

Polycystic kidney disease gene therapy is still in the experimental stage. According to its conservative treatment can be used by surgery to remove the increased cystic disease mechanism, people have been exploring new interventions to study a new genetic and congenital kidney disease drugs [23,24]. The vasopressin V2 receptor antagonist can specifically down-regulate cyclic adenosine monophosphate (cAMP), block cAMP-activated fluid secretion and stimulate the effect of cystic epithelial cell proliferation, and therefore has the application prospect of treatment of polycystic kidney disease, is currently underway Clinical trials, and become the most anticipated class of drugs [25]. Tyrosine kinase inhibitors and PPAR-y agonists are widely used in clinical application of two types of drugs, in several autosomal dominant polycystic kidney disease animal model also showed a good therapeutic effect, also has a broad application prospects The Sirolimus (rapamycin) is an immunosuppressive agent that has been used clinically. Studies have shown that sirolimus can inhibit the occurrence and increase of renal cysts in animal models and protect renal function. Multicentre clinical trials of sirolimus in the treatment of autosomal dominant polycystic kidney disease are currently being conducted abroad [26,27]. The reference to the drug he studied also includes statins, metalloproteinase inhibitors and the like.

(5) renal replacement therapy

Kidney replacement therapy in patients with autosomal dominant polycystic kidney disease after end-stage renal disease includes peritoneal dialysis, hemodialysis, and kidney transplantation. The timing of treatment and the choice of treatment options vary from patient to patient, and non-cystic nephropathy no significant difference.

(6) Chinese medicine treatment

Chinese medicine that autosomal dominant polycystic kidney disease is caused by deposition, the early presence of qi stagnation, kidney is not solid, under the coke hot and humid; mid-term blood stasis, liver yang hyperactivity, lack of essence and blood, hot and humid bets; Zeyi is virtual stasis, liver wind within the dynamic, wet poison related to the main. Early treatment can be leech powder, Gleditsia sinensis, Liuwei Dihuang Tang Ziyin Bushen; mid-use Wuwei disinfection drink, soil Fuling Qingrejiedu, red peony, peony skin blood circulation, dandelion, car before the heat and water; Mainly.