Hemolytic Nephritis

　　The etiology can be allergic reactions caused by infections with bacteria, viruses, and parasites, or allergies to certain drugs, foods, etc., or caused by plant pollen, insect bites, cold stimulation, etc. It is often related to the following factors:

　1、Infection: One-third of the cases have a history of upper respiratory tract infection 1-4 weeks before onset, common pathogens include: Viruses: Coxsackie virus, EB virus, adenovirus, chickenpox virus, rubella virus, hepatitis B virus, etc. Bacteria: Salmonella, legionella, hemolytic streptococcus, etc. Mycoplasma, amebae, ascaris.

　2、Medications: Antibiotics, sulfonamides, isoniazid, captopril, etc.

　3、Food: Fish, shrimp, crabs, etc.

　4、Cold stimulation: Plant pollen, eggs of insects, mosquitoes, vaccination, animal feathers, paint, etc.

　　Purpura nephritis has a good overall prognosis, better in children than in adults. The prognosis of patients with simple hematuria is almost very good, while patients with varying degrees of proteinuria (1g/24h) and nephrotic syndrome are related to progressive deterioration of renal function; patients with acute nephritis syndrome with pathological manifestations of grade III or above have a poor prognosis, most of them progress to ESRD.

　　The main symptoms that often occur in purpura nephritis are as follows:

      1.RashThis is the initial and main clinical manifestation of the disease, occurring in the distal extremities, buttocks, and lower abdomen, often symmetrically distributed, slightly above the skin surface, and may have an itching sensation. It may gradually regress after 1-2 weeks and often appears in batches. The interval from purpura to renal damage is less than 2 weeks.

　　2.Joint symptomsThis is a common symptom of the disease, characterized by multiple, non-migratory, and most frequently occurring joint pain in the ankles.

　　3.Gastrointestinal symptomsCommonly seen, mainly manifested as abdominal pain, discomfort in the abdomen, and diarrhea. The common sites are the navel and lower abdomen. Abdominal pain can sometimes be manifested as intermittent intestinal colic.

　　4.OtherLymph node enlargement, liver and spleen enlargement, and involvement of the nervous system such as headache, convulsions, and abnormal behavior.

　　The main manifestation is urinary abnormalities, manifested as proteinuria, hematuria, and some patients have decreased renal function.

　　The following aspects need to be paid attention to in prevention:

　　1. Pay attention to whether there is any suspicious food or foreign body contact before the rash, which may cause an allergic reaction, and avoid recontact. Avoid eating seafood and other foreign proteins to prevent recurrence of allergies and exacerbation of the condition.

　　2. Attention should be paid to keeping warm, preventing colds, and paying attention to physical exercise to enhance physical fitness and improve the body's resistance to disease.

　　3. After the onset of the disease, bed rest should be avoided to prevent overexertion, and smoking and drinking should be avoided. The diet should be rich in nutrition, easy to digest, and eat more fresh vegetables and fruits. For patients with hematuria, spicy, aromatic, and seafood should be avoided. For those with a lot of proteinuria, attention should be paid to eating a diet rich in high-quality protein. In nursing, attention should be paid to colds. Pay attention to whether there is any suspicious food or foreign body contact before the rash, which may cause an allergic reaction, and avoid recontact. Avoid eating seafood and other foreign proteins to prevent recurrence of allergies and exacerbation of the condition.

　　4. Pay attention to prevent infection.

　　Common laboratory examination methods for purpura nephritis include:

     1. Urinalysis must show varying degrees of hematuria, proteinuria, and casts.

　　2. Immunological examination: serum IgA may increase but is not specific; serum C3 and CH50 are mostly normal; circulating immune complexes are often increased during the active phase.

　　3. In severe cases, there may be a decrease in Ccr and an increase in blood urea nitrogen and creatinine; patients with nephrotic syndrome may have a decrease in serum albumin and an increase in cholesterol.

　　4. Platelet count, coagulation time, and prothrombin time are all within the normal range; early eosinophil count increases.

　　5. Renal biopsy can determine the pathological type diagnosis of the disease and differentiate it from IgA nephritis.

　   The diet of patients with purpura nephritis should pay attention to the following aspects:　

     1. Low-salt diet: It is advisable for the daily salt intake not to exceed 1 to 2 grams. For patients with severe edema and hypertension, strict salt restriction is required.

　　2. Water intake: It should be strictly limited. In the relatively hot season, the intake of water and salt can be appropriately relaxed to compensate for the water loss caused by sweating. When there is excessive diuresis or vomiting and diarrhea, appropriate supplementation of salt and water is needed.

　　3. Protein: It is advisable to supplement sufficient protein, with a daily supply of 1.5 to 2.0 grams per kilogram of body weight. Generally, high-quality proteins with high bioavailability such as lean meat, fish, eggs, and milk are selected.

　　4. Limit calorie intake: During the application of adrenal corticosteroids, children often have a significant increase in appetite, and weight gain can be dramatic due to overeating. In children, excessive obesity can sometimes cause liver enlargement and fatty liver, so it is appropriate to limit calorie intake. In addition, it is necessary to supplement sufficient calcium and vitamin D.

　　(1)Isolated hematuria or pathological Grade I:

　　Only corresponding treatment for allergic purpura is currently reported in the literature, and microscopic hematuria has not yet shown definite efficacy. Close monitoring of the condition changes is recommended, and it is suggested to follow up for at least 3-5 years.

　　(2)Isolated proteinuria, hematuria, and proteinuria or pathological stage IIa:

　　Angiotensin-converting enzyme inhibitors (ACEI) and/or angiotensin receptor blockers (ARB) have the effect of reducing proteinuria. Take 1mg/(kg·d) of tripterygium glycosides, taken three times a day, with a daily dose not exceeding 60mg, for a course of 3 months. However, attention should be paid to the side effects such as gastrointestinal reactions, liver function damage, bone marrow suppression, and possible gonadal damage.

　　(3)Non-nephrotic level proteinuria or pathological stage IIb, IIIa:

　　Take 1mg/(kg·d) of tripterygium glycosides, taken three times a day, with a maximum daily dose not exceeding 60mg, for a course of 3-6 months. Or use hormone combined with immunosuppressant therapy, such as hormone combined with cyclophosphamide, combined with cyclosporine A or tacrolimus treatment.

　　(4)Nephrotic syndrome or pathological stage IIIb, IV: The clinical symptoms and pathological injuries in this group are relatively severe, and currently, there is a tendency to use hormone combined with immunosuppressant therapy, among which the most certain efficacy is the treatment of glucocorticoids combined with cyclophosphamide (CTX). If the clinical symptoms are severe, the pathology shows diffuse lesions, or there is crescent formation, methylprednisolone pulse therapy can be selected, 15-30mg/(kg·d) or 1000mg/(1.73 m2·d), with a maximum daily dose not exceeding 1g, administered daily or every other day, with 3 treatments as a course. The CTX dose is 0.75-1.0g/m2 intravenous infusion, once a month, for 6 consecutive months, then changed to once every 3 months intravenous infusion, with a total dose generally not exceeding 8g. When renal function is impaired, the CTX dose should be halved.

　　Other treatment options include hormone combined with tacrolimus, hormone combined with mycophenolate mofetil, hormone combined with azathioprine, and other treatments.

　　(5)Rapidly progressive glomerulonephritis or pathological stage IV, V: These clinical symptoms are severe and the disease progresses rapidly. Currently, a triple to quadruple therapy is commonly used, and the common scheme is: methylprednisolone pulse therapy for 1-2 courses, followed by oral prednisone + cyclophosphamide (or other immunosuppressants) + heparin + dipyridamole treatment. There are also literature reports on the treatment of methylprednisolone combined with urokinase pulse therapy + oral prednisone + cyclophosphamide + warfarin + dipyridamole.