Membranoproliferative glomerulonephritis with mesangial capillary

　　According to the deposition site of electron-dense substances and the characteristics of basement membrane lesions, it is divided into three types: Type I: The basement membrane is thickened, and there is a double-track phenomenon due to the infiltration of mesangial cells and matrix into the space between the basement membrane and the endothelial cells. The formation of the double-track is caused by the inserted mesangium forming a pseudo-basement membrane. The mesangial proliferation in this type is the most severe, which can separate the glomeruli into lobular shapes. Electron microscopy shows the mesangial insertion phenomenon, as well as fine irregular electron-dense substances in the mesangial area and under the endothelium. Immunofluorescence examination shows IgG, IgM, and C3 granules distributed peripherally along the basement membrane, and also deposited in the mesangium. Type II: Characterized by the deposition of a large amount of large electron-dense substances in the basement membrane in a band-like manner. Immunofluorescence examination shows C3 deposition as the main component, and immunoglobulin deposition is less common. Type III: In addition to the common changes with Type I, this type has more prominent subepithelial immune complex deposition, and there are also papillary projections in the basement membrane like those seen in membranous nephropathy. Immunopathology shows C3, with or without IgG and IgM, mainly distributed in the basement membrane, and also deposited in the mesangium.

　　In addition to its clinical manifestations, mesangiocapillary glomerulonephritis can also cause other diseases. The complications of mesangiocapillary glomerulonephritis include infection, thromboembolic complications, renal failure, and disorders of protein and fat metabolism.

　　About 20% to 30% of patients with mesangiocapillary glomerulonephritis may develop the disease after upper respiratory tract infection, and its clinical manifestations and characteristics are as follows:

　　1, About 50% of patients present with overt nephrotic syndrome, about 30% present with asymptomatic proteinuria, and about 20% to 30% start with acute glomerulonephritis syndrome.

　　2, Regardless of the above syndrome or asymptomatic proteinuria, almost all have proteinuria and hematuria. Proteinuria is non-selective, and hematuria is often persistent microscopic hematuria, with about 15% presenting as episodic gross hematuria. About 80% to 90% of patients have hypertension. Severe anemia is often present at the onset, and its severity is not proportional to the degree of renal function decline. Half of the patients have renal function decline.

　　3, 30% to 50% of patients have persistent low levels of CH50 and C3, and circulating immune complexes and cold globulins may be positive.

　　Mesangiocapillary glomerulonephritis is a glomerular disease characterized by mesangial cell proliferation, expansion of mesangial matrix, thickening of the basement membrane, and the expansion of mesangial cells and matrix into the adjacent capillary wall, leading to thickening and a double-track appearance of the capillary wall under light microscopy. So, how to prevent mesangiocapillary glomerulonephritis? Below, experts introduce the preventive measures for mesangiocapillary glomerulonephritis:

　　1. Combine work and rest

　　In daily work, whether it is physical or mental labor, nephritis patients should not overwork. They should strengthen rest, otherwise it will increase abnormal metabolism and increase the burden on renal function, resulting in damage to the kidneys.

　　2. Pay attention to emotional regulation

　　Patients with chronic nephritis must establish the confidence to fight the disease, because the condition of chronic nephritis is slow and lingering, so it is necessary to maintain the determination and confidence of treatment; bad temper and excessive worry will cause liver damage, affect the secretion system to be disordered, and directly damage renal function.

　　3. Pay attention to diet

　　Unreasonable diet is often more likely to increase the renal burden on patients with chronic nephritis, causing further damage to renal function and leading to the continuous deterioration of the condition. According to the characteristics of chronic nephritis, patients should have a reasonable renal disease diet.

　　4. Regular sexual life

　　For sexual life, for patients with chronic nephritis, it should not be too frequent. Generally, no more than twice a month. If it exceeds, it is easy to lead to recurrence and aggravation of the disease.

　　5. Abstain from taking anti-inflammatory and analgesic drugs privately

　　For example, cold medicine and antibiotics, before taking anti-inflammatory and analgesic drugs, it is necessary to take them under the guidance of relevant physicians, because improper use of these drugs can directly damage renal function, leading to renal dysfunction.

　　Patients with membranoproliferative glomerulonephritis almost always have hematuria, including microscopic or gross hematuria. Proteinuria can be relatively mild, with about 30% presenting as asymptomatic proteinuria, but half of the patients have urine protein of 3.5g/24h, and more than 90% of the patients have poor proteinuria selectivity. Urine FDP and C3 may be elevated.

　　1. Through urine protein定性, urine sediment microscopy: This can preliminarily judge whether there is glomerular lesion present.

　　2. Urinalysis:The urine color is generally normal, the amount of urine protein is generally not much, and the number of white blood cells in the urine sediment increases (in the acute phase, it is often full of the field of vision, in the chronic phase, 5 per high-power field), and sometimes white blood cell casts may occur.

　　3. Urine bacterial examination:When there is a large amount of bacteria in the urine, due to the Gram staining examination of the urine sediment smear, about 90% can find bacteria. This method is simple and has a high positive rate.

　　4. Urine cell count:In recent years, the one-hour counting method has been widely used, which is considered more accurate and convenient than the 12-hour urine sediment count. The standard is that the white blood cell count greater than 300,000 per hour is positive, less than 200,000 per hour can be considered normal, and between 200,000 and 300,000 per hour should be combined with clinical judgment; the red blood cell count greater than 100,000 per hour is positive.

　　Membranoproliferative glomerulonephritis commonly manifests as nephrotic syndrome with hematuria, hypertension, and renal function damage in clinical practice. Some patients are accompanied by persistent symptoms. The pathological changes are mainly located in the glomerular basement membrane and mesangium. This disease is mainly seen in children and young adults. Then, what are the dietary requirements for patients with membranoproliferative glomerulonephritis? Below, experts introduce the dietary care for patients with membranoproliferative glomerulonephritis:

　　1. Food selection should be conducive to reducing the burden on the kidneys and eliminating or reducing clinical symptoms, mainly determined by the degree of proteinuria and the condition of azotemia, while also considering the patient's edema, hypertension, and other conditions.

　　2. Regardless of the amount of protein supply, it should be fully noted that high-quality protein should be provided adequately.

　　3. Wheat starch is a commonly used food for nephritis patients, which is made by adding water to wheat flour and making dough, then adding water repeatedly kneaded, and the starch liquid is obtained after precipitation. Wheat starch can be used to process various foods such as steamed buns, noodles, noodles, pan-fried cakes, dumplings, and wontons. Eating wheat starch foods can reduce the intake of non-high-quality protein for patients, achieving the purpose of reducing the burden on the kidneys.

　　At present, there is no effective treatment for mesangiocapillary glomerulonephritis, and several methods that can be tried are introduced:

　　1. Ye Ren gao believes that the following scheme can be used: dipyridamole 150-300mg/d plus aspirin 15mg/kg per day, taken orally in three divided doses. If ineffective, a standard course of hormones can be tried, and continue to apply for a period of time after the dose is reduced to the maintenance dose.

　　2. McEnerg applies the long-term treatment of prednisone 60mg every other day (average treatment time of 1 year), and it is said to be effective.

　　3. Balow combines the experience of many people and believes that the best choice for the treatment of this disease may be the maintenance dose of hormones (0.5mg/kg) combined with platelet aggregation inhibitors for long-term treatment.

　　4. Microcosmic Chinese medicine permeation therapy: It is a new and specific method for treating kidney diseases, based on the traditional Chinese medicine formula for treating kidney diseases, using micro-processed technology, the Chinese medicine molecules can be reduced to 1000 times, the effective components are fully released, and the biological characteristics of the active substances of the microcosmic Chinese medicine are used to activate blood circulation, remove blood stasis, and generate new tissue for the target kidney lesion tissues.