Glomerulonefrite púrpura

　　病因可为细菌、病毒及寄生虫等感染所引起的变态反应，或为某些药物、食物等过敏，或为植物花粉、虫咬、寒冷刺激等引起。常与以下因素有关：

　1、感染：有1/3病例起病前1～4周有上呼吸道感染史,常见病原体有：病毒：柯萨奇、EB病毒、腺病毒、水痘病毒、风疹病毒、乙肝病毒等。细菌：沙门氏菌、军团菌、溶血性链球菌等。支原体、阿米巴原虫、蛔虫。

　2、Medicamentos：抗生素、磺胺、异烟肼、卡托普利等。

　3、Comida：鱼、虾蟹等.

　4、Estímulo frio：植物花粉、虫卵、蚊虫、疫苗接种，动物羽毛、油漆等。

　　紫癜性肾炎总体预后好，儿童优于成人。单纯血尿患者的预后几乎很好，而不同程度蛋白尿（1g/24h）及肾病综合征）以肾功能进行性恶化有关；有急性肾炎综合征患者，病理表现Ⅲ以上者，其预后较差，大多进展为ESRD。

　　紫癜性肾炎常出现的症状主要有以下几方面：

      1.Púrpura：为本病首发和主要临床表现, 表现发生在四肢远端、 臀部及下腹部, 多对称性分布, 稍高于皮肤表面, 可有痒感, 1～2 周后逐渐消退, 常可分批出现。从紫癜到肾脏损害间隔时间少于2Semana.

　　2.Sintomas articulares：是本病常见症状,特点为多发性、 非游走性, 多发于踝关节的关节痛。

　　3.Sintomas gastrointestinais：常可见到, 主要表现为腹痛, 腹部不适以及腹泻。常见部位为脐和下腹部。腹痛有时可表现为阵发性肠绞痛。

　　4.Other: Lymph node enlargement, liver and spleen enlargement, and nervous system involvement such as headache, convulsions, and abnormal behavior.

　　The main manifestation is abnormal urine, such as proteinuria, hematuria, and some patients have decreased renal function.

　　Prevention should pay attention to the following aspects:

　　1. Pay attention to whether there is any suspicious food or foreign body contact before the rash to avoid allergic reactions, and avoid recontact. Avoid eating seafood and other alien proteins to prevent allergic reactions and exacerbate the condition.

　　2. Pay attention to keep warm, prevent colds, and pay attention to physical exercise to enhance physical fitness and improve the body's ability to resist diseases.

　　3. After 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, pungent, and seafood should be avoided. For those with a lot of proteinuria, attention should be paid to the excessive intake of high-quality protein diet. In nursing, attention should be paid to colds. Pay attention to whether there is any suspicious food or foreign body contact before the rash to avoid allergic reactions, and avoid recontact. Avoid eating seafood and other alien proteins to prevent allergic reactions and exacerbate the condition.

　　4. Pay attention to prevent infection.

　　Common laboratory examination methods for purpura nephritis include:

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

　　2. Immunological examination: serum IgA may increase but is not specific; serum C3 and CH50Most are normal; in the active phase, blood circulation immune complexes are often increased.

　　3. In severe cases, there may be a decrease in Ccr and an increase in blood urea nitrogen and creatinine; those 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 increase.

　　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: The daily salt intake should not exceed 1 ～ 2 grams is recommended. Patients with severe edema and hypertension need to strictly limit salt intake.

　　2. Water intake: It should be strictly limited, and during the relatively hot season, the intake of water and salt can be appropriately relaxed to compensate for the water loss caused by sweating. For those with significant diuresis or vomiting and diarrhea, appropriate supplementation of salt and water is recommended.

　　3. Protein: It is recommended to supplement sufficient protein per kilogram of body weight per day 1.5 ～ 2.0 grams is recommended, generally choosing high-quality proteins with high bioavailability such as lean meat, fish, eggs, milk, etc.

　　4. Limit calorie intake: During the use of adrenal corticosteroids, children often have a significant increase in appetite, which can often lead to a dramatic increase in weight due to overeating. Children with excessive obesity may also 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 for the treatment of allergic purpura, there are no literature reports of definite efficacy for microscopic hematuria. It is recommended to closely monitor the changes in the condition and at least follow up.3-5anos.}

　　(2)Proteínuria isolada, hematuria e proteínuria ou patologia IIa grau：

　　Inibidores da conversão da enzima da angiotensina (ACEI) e (ou) antagonistas dos receptores da angiotensina (ARB) têm o efeito de reduzir a proteínuria. Tripterygium wilfordii hook F1mg/(kg·d), dividida3vezes oralmente, a dose diária não deve exceder60mg, série3meses. Mas deve-se prestar atenção aos efeitos colaterais como reações gastrointestinais, lesão hepática, supressão medular e possíveis lesões gonadais.

　　(3)Proteínuria não nefrótica ou patologia II b, IIIa grau：

　　usar tripterygium wilfordii hook F1 mg/(kg·d), dividida3vezes oralmente, a dose máxima diária não deve exceder60mg, série3～6meses. Ou tratamento combinado de hormônios com imunossupressores, como combinação de hormônios com ciclofosfamida, combinação de ciclosporina A com tacrolimus, etc.

　　(4)Síndrome nefrótica ou patologia IIIb, IV grau：Este grupo de sintomas clínicos e lesões patológicas é bastante grave, atualmente, tende a usar o tratamento combinado de hormônios com imunossupressores, entre eles, o tratamento mais eficaz é a combinação de corticosteroides com ciclofosfamida (CTX). Se os sintomas clínicos forem graves, a lesão patológica for difusa ou houver formação de corpos de espuma, pode ser usado o tratamento de choque com metilprednisona,15～30mg/(kg·d) ou1000mg/(1.73 m2·d), a dose máxima diária não deve exceder1g, administrado diariamente ou de dois em dois dias de choque,3vezes por série. A dose de CTX é de 0.75～1.0g/m2infusão intravenosa, a cada mês1vezes, usar continuamente6meses após, muda para a cada3meses de infusão intravenosa1vezes, geralmente não deve exceder8g. Quando a função renal não estiver completa, a dose de CTX deve ser reduzida pela metade.

　　Outras opções de tratamento incluem a combinação de hormônios com tacrolimus, combinação de hormônios com micofenolato de mofetila, combinação de hormônios com azatioprina, etc.

　　(5)Glomerulonefrite aguda ou patologia IV, V grau：Esses sintomas clínicos são graves e a progressão da doença é rápida, atualmente, a terapia tríplice a quádrupla é frequentemente usada, o plano comum é: tratamento de choque com metilprednisona1-2Após uma série de tratamento, tomar prednisona oral+Ciclofosfamida (ou outros inibidores imunossupressores)+Heparina+Tratamento com dipyridamol. Também há tratamento combinado com metilprednisona e urokinase de choque.+Prednisona oral+Ciclofosfamida+Warfarina+Relatórios de literatura sobre o tratamento com dipyridamol.