Chronic glomerulonephritis (Professor Wu Zhaolong, Shanghai Medical University) Nephritis is an allergic disease caused by streptococcal infection. Chronic glomerulonephritis is caused by acute nephritis that does not heal. Some patients have a history of acute nephritis in the past. The symptoms have disappeared for many years and they mistakenly think they have recovered. In fact, the inflammation continues slowly. After several years, the symptoms reappear and become chronic glomerulonephritis. In some patients, the renal inflammation is insidious from the beginning. The patient has no obvious symptoms of acute glomerulonephritis, but the inflammation develops slowly and turns into chronic glomerulonephritis after several years. Chronic glomerulonephritis includes edema, hypertension, proteinuria and hematuria. Due to various pathological changes, the symptoms vary. In severe cases, uremia may occur. Prescription 1. Pay attention to rest and avoid overexertion. Prevent colds or upper respiratory tract infections. 2. Tonsillitis, otitis media, sinusitis, and dental caries should be diagnosed and treated promptly. Pay attention to personal hygiene, keep your skin clean, and prevent skin infections. These are all possible triggers for recurrence or activity of the disease. 3． Those with obvious edema, large amounts of proteinuria and normal kidney function can supplement their diet with appropriate amounts of protein. In the absence of edema and hypoalbuminemia, daily protein intake should be limited to 0.6 grams per kilogram of body weight (about 6 grams of protein per bottle of milk, about 6 grams of protein per egg, and about 4 grams per 50 grams of rice). plant protein). 4. People with edema, high blood pressure and cardiac insufficiency should eat a low-salt diet. The daily salt intake should be less than 5 grams (1 qian), about the size of a broad bean. 5. Avoid taking antipyretic analgesics containing phenacetin and other drugs that damage kidney function such as kanamycin and gentamicin. 6. Check the urine frequently. If the number of red blood cells in the urine exceeds 10 per high-power field, stay in bed. What is chronic glomerulonephritis? Many people think that chronic glomerulonephritis (chronic nephritis) is a very common clinical disease. In fact, this concept is wrong. Chronic glomerulonephritis is not an independent disease. It is just the progression stage of any primary or secondary glomerulonephritis before entering end-stage renal failure. At this time, the pathology and clinical manifestations of different types of glomerulonephritis gradually become consistent, with proteinuria, hematuria, edema, and hypertension appearing. , kidney shrinkage, renal function decline, and renal damage are irreversible. About 60% of all end-stage renal failure cases are caused by chronic glomerulonephritis. What is the cause and pathogenesis of chronic glomerulonephritis? Many people believe that chronic glomerulonephritis is caused by delayed acute glomerulonephritis. In fact, only a small number of chronic nephritis are caused by post-acute streptococcal nephritis. A series of manifestations of chronic nephritis may be directly delayed or reappear several years after clinical recovery. The vast majority of chronic nephritis is the result of the direct and delayed development of other primary glomerular diseases, such as mesangial proliferative nephritis (including IgA nephropathy), mesangial capillary nephritis, membranous nephropathy, and focal segmental nephritis. Ball hardening, etc. The mechanism leading to the chronicity of the disease, in addition to the continuation of the immune-inflammatory damage process of the original disease, is also related to the following secondary factors: ① Increased compensatory blood perfusion in surviving nephrons and increased transmembrane pressure of glomerular capillary loops and increased filtration pressure, thereby causing glomerulosclerosis; ② Hypertension during the disease process causes sclerotic damage to renal arterioles. What are the ways of onset of chronic nephritis? There is no definite relationship between chronic nephritis and acute nephritis. According to clinical data, only 15% to 20% of chronic nephritis has a clear history of acute nephritis. The onset patterns can be summarized into the following five types: ① The onset of acute glomerulonephritis is not completely controlled, the clinical symptoms and urinary protein persist, and the glomerulonephritis persists for more than 1 year, and then evolves into chronic nephritis. ② There was indeed a history of acute nephritic syndrome in the past. After several weeks or months of convalescence, the clinical symptoms and urinary abnormalities disappeared, and the renal function became normal. After a long interval (up to many years in the elderly), nephritis symptoms such as proteinuria, edema, or/and hypertension suddenly appear due to upper respiratory tract or other infections or overexertion. ③ No history of nephritis in the past, but symptoms of nephrotic syndrome such as significant edema and massive proteinuria due to upper respiratory tract or other infections. ④ No history of nephritis in the past, proteinuria, progressive hypertension and/or renal insufficiency occurred in a short period of time. ⑤ There is no history of nephritis in the past. Hematuria and/or proteinuria often occur due to infection or fatigue, which are quickly relieved or disappeared after a short rest. Such attacks occur repeatedly without obvious clinical symptoms. What are the clinical manifestations of patients with chronic nephritis? The main clinical manifestations of patients with chronic nephritis include edema, hypertension, and urinary abnormalities. The three can be seen at the same time, or alone or in combination.
(1) Edema: Edema often occurs in the eyelids, face, and lower limbs. It is generally mild to moderate edema. Pleural effusion, ascites, etc. rarely occur when chronic nephritis does not cause uremia. (2) Hypertension: Generally, it is moderate hypertension, with systolic blood pressure around 20-22.7kPa and diastolic blood pressure around 12.7-14kPa. Usually, the blood pressure can be effectively improved by taking diuretics and β-blockers such as propranolol. control. (3) Urinary abnormalities: moderate proteinuria, 24-hour urinary protein quantification is about 2g, often non-selective proteinuria. Gross hematuria or microscopic hematuria is also one of the urinary changes in chronic nephritis. Using a phase contrast microscope, more than 90% of cases are deformed red blood cell hematuria, and a few are homogeneous red blood cell hematuria. In addition to proteinuria and hematuria, there may be cast urine, changes in urine volume, and abnormalities in urine specific gravity and urine osmotic pressure. Why does chronic nephritis have refractory and persistent hypertension? Some patients with chronic nephritis have refractory hypertension. Generally, the higher the blood pressure and the longer it lasts, the more serious the condition will be and the prognosis will be poor. The possible reasons are as follows: (1) The renin content in blood increases after renal ischemia, which aggravates arteriolar spasm and causes sustained hypertension. At the same time, the increased secretion of aldosterone causes water and sodium retention and increased blood volume, which further increases blood pressure. (2) In renal disease, the renal parenchyma is destroyed and the anti-pressor substances secreted by the renal tissue are reduced. Some people think that renal hypertension may be related to the reduction of anti-pressor substances (i.e. renal prostaglandins) formed by the kidneys, so it can be used Prostaglandins treat high blood pressure because prostaglandins have a strong antihypertensive effect and can improve renal blood flow. (3) Systemic arteriole spasm and sclerosis: After renal hypertension lasts for a long time, systemic arteriole sclerosis may occur, and the resistance of the arterioles increases, causing blood pressure to rise. Due to the above reasons, persistent hypertension occurs in chronic nephritis, as well as vasospasm, ischemia, increased renin secretion, and damage to the renal parenchyma (including the medulla). These factors cause a vicious circle and cause chronic nephritis to develop refractory and persistent high blood pressure. blood pressure. Does chronic nephritis require clinical classification? Regarding the clinical classification of primary glomerular diseases, so far, three meetings have been held in China to discuss, formulate and modify it. In 1977, the Beidaihe Conference classified chronic nephritis into common type, nephrotic type, and hypertensive type. In addition to the common manifestations of nephrotic type, urine protein is >3.5g/d (qualitative >+++), plasma protein is low, and albumin is <3g/L. In addition to the common manifestations of hypertensive type, the main clinical manifestations are sustained moderate or above high blood pressure. In 1985, the Nanjing Conference revised this classification scheme and classified the above-mentioned nephrotic types into nephrotic syndrome type II, and added an acute attack type. The Kidney Disease Professional Group of the Editorial Board of the Chinese Journal of Internal Medicine held a symposium on classification, treatment and efficacy standards of primary glomerular diseases in Taiping, Anhui Province in June 1992. Most experts believe that classifying chronic nephritis into "common type", "hypertensive type", "acute attack type", etc. cannot accurately reflect its clinical and pathological characteristics. Therefore, they agree that chronic nephritis will not be further clinically classified. Why do some patients with chronic nephritis require kidney biopsy? As mentioned earlier, chronic nephritis is not an independent disease. It is a syndrome of many kidney diseases with the same or similar clinical manifestations. It is recommended that patients undergo kidney biopsy for correct diagnosis and treatment. It is to clarify the pathological diagnosis, which is helpful for the treatment and prognosis of the disease. Pathological diagnosis generally includes the following: mesangial proliferative nephritis (including IgA nephropathy), membranoproliferative nephritis, membranous nephropathy, focal segmental glomerulosclerosis, etc., and there are often different degrees of glomerulosclerosis. Renal small vessel sclerosis involves renal tubular atrophy, fibrosis, and inflammatory cell infiltration in the lesion. When it develops to an advanced stage, kidney volume shrinks and the renal cortex becomes thinner. What are the pathological types that cause chronic nephritis? There is no close connection between histopathological types and the causes and clinical manifestations of glomerulonephritis. The so-called chronic nephritis clinically includes mesangial proliferative nephritis, membranous nephropathy, membranoproliferative nephritis, focal glomerulosclerosis and sclerosing glomerulonephritis in terms of pathological classification. According to domestic statistics, mesangial proliferative nephritis is the most common, followed by focal segmental glomerulosclerosis, membranoproliferative nephritis and membranous nephropathy. How to diagnose chronic nephritis? It is not difficult to diagnose typical chronic nephritis. It is more common in young men and has a slow onset and protracted disease. There are abnormal urine tests, often with proteinuria, which may be accompanied by hematuria, edema and hypertension. There may also be varying degrees of renal function damage. Please see Article 68 for diagnostic criteria.
What diseases should be distinguished from chronic nephritis? (1) Primary glomerulonephropathy: The clinical manifestations of chronic nephritis and primary glomerulonephropathy can be very similar, but chronic nephritis is more common in young adults and often has hematuria. Hypertension and decreased renal function are also more common, and urine protein selectivity is poor. Primary glomerulonephropathy is more common in children, without hematuria, hypertension, renal insufficiency, etc., and has good selectivity for urinary protein. Patients with primary glomerulonephropathy are very sensitive to treatment with hormones and immunosuppressants, while patients with chronic nephritis are less effective. Finally, a kidney biopsy can aid in diagnosis. (2) Chronic pyelonephritis: The clinical manifestations of chronic pyelonephritis can be similar to chronic nephritis, but detailed inquiries about the history of urinary tract infection (especially in women), more white blood cells in urine, white blood cell casts, and positive urine bacterial culture, Intravenous pyelography and radionuclide renography showed varying degrees of renal damage on both sides, which are beneficial to the diagnosis of chronic pyelonephritis. (3) Connective tissue diseases: Collagen diseases such as systemic lupus erythematosus and polyarteritis nodosa have a high incidence of renal damage, and their clinical manifestations can be similar to chronic nephritis, but most of these diseases are accompanied by systemic and Other systemic symptoms, such as fever, rash, joint pain, hepatosplenomegaly, and characteristic abnormality can be found in laboratory tests (such as positive antinuclear antibodies in blood tests for lupus nephritis). (4) Hypertension: Chronic nephritis with continued increase in blood pressure should be distinguished from essential hypertension with renal damage. The latter often occurs after the age of 40. Hypertension appears before urine changes. Urinary protein is often not severe but renal damage occurs. The impairment of canalicular function is obvious. The sclerotic changes of the heart, brain blood vessels and retinal blood vessels are often obvious. How to differentiate between chronic nephritis and chronic pyelonephritis? It is difficult to differentiate between chronic nephritis and chronic pyelonephritis in the later stage. It can be distinguished from the following points: (1) Medical history: There is a history of urinary tract infection, such as frequent urination, painful urination, low back pain and other symptoms. , helpful for the diagnosis of chronic pyelonephritis. (2) Repeated urine tests: If the leukocytosis in the urine is obvious, there are even white blood cell casts, and the urine bacterial culture is positive, it is helpful to diagnose chronic pyelonephritis, and chronic nephritis is mainly characterized by the repeated appearance of protein in the urine. (3) During intravenous pyelography, if the kidney is found to be scarred and deformed, showing club-like expansion, or the kidney shadow is asymmetrical on both sides; radionuclide renogram examination shows a large difference in renal function damage on both sides (especially on one side), All suggest chronic pyelonephritis. (4) When chronic nephritis is complicated by infection, although urinary changes and azotemia will improve after antibiotic treatment, the symptoms of chronic nephritis will still exist, while the symptoms of chronic pyelonephritis will basically disappear and can be differentiated. How to distinguish chronic nephritis from malignant hypertension? Malignant hypertension is more common in middle-aged people with hypertension and often causes renal insufficiency in a short period of time, so it is easily confused with chronic nephritis complicated by hypertension. The blood pressure of malignant hypertension is higher than that of chronic nephritis, often 29/17kPa (200/130mm Hg) or higher. However, in the early stages of the disease, there are many unobvious changes in urine, less protein in urine, no hypoalbuminemia, and no obvious edema. Because arteriolar sclerosis and necrosis in malignant hypertension are systemic, it is common for retinal arterioles to be highly narrowed and hardened, accompanied by bleeding and oozing, papilledema, cardiac enlargement, and cardiac insufficiency are also more obvious, all of which are Can be used as a basis for identification. If chronic nephritis is complicated by hypertension and evolves into malignant hypertension, the patient with a long-term history of chronic nephritis suddenly deteriorates, with a significant increase in blood pressure, significant deterioration of renal function, retinal hemorrhage, papilledema, and even Symptoms such as hypertensive encephalopathy occur. According to these evolution rules, it can also help to distinguish chronic nephritis and malignant hypertension. How to distinguish chronic nephritis from lupus nephritis? The clinical manifestations and renal histological changes of lupus nephritis are similar to those of chronic nephritis. However, systemic lupus erythematosus is more common in women and is a systemic disease that can be accompanied by multiple system damage symptoms such as fever, rash, arthritis, etc. Blood cells decreased, immunoglobulins increased, lupus cells could also be detected, antinuclear antibodies were positive, and serum complement levels decreased. Renal histological examination shows that immune complexes are widely deposited in various parts of the glomerulus. Immunofluorescence examination often shows a "full room" performance. What should patients with chronic nephritis pay attention to in their daily lives? (1) Build confidence in fighting the disease: Chronic nephritis has a long course and is prone to recurring attacks. Patients should be encouraged to increase their confidence in fighting the disease, closely cooperate with treatment, and defeat the disease. (2) Rest and work: Once a patient is diagnosed with chronic nephritis, in the initial stage, regardless of the severity of the symptoms, active treatment should be focused on rest, and regular follow-up visits should be made to observe changes in the condition.
If the condition improves, the edema subsides, the blood pressure returns to normal or close to normal, the urine protein, red blood cells and various casts are trace, and the kidney function is stable, you can start to do light work after 3 months, avoid strenuous physical labor, and prevent respiratory and urinary problems. occurrence of road infections. The amount of activity should be increased slowly and gradually to promote physical recovery. Anyone with hematuria, large amounts of proteinuria, obvious edema or hypertension, or patients with progressive renal dysfunction should rest in bed and receive active treatment. (3) Diet: People with acute attacks of chronic nephritis, edema or high blood pressure should limit their salt intake to 2-4g per day. People with high levels of edema should be kept below 2g per day. Salted fish and various pickles should be avoided. The amount of sodium salt should be gradually increased after the edema subsides. Fluid intake should not be restricted unless there is significant edema. People with low plasma protein but no azotemia should eat a high-protein diet, and the daily protein should be 60 to 80g or higher. When azotemia occurs, the total protein intake should be limited to less than 40g per day. Provide high-quality protein rich in essential amino acids. The total calories should be around 0.146kJ/kg body weight. Pay attention to supplement nutrients and vitamins, fruits and vegetables in the diet. No limit. What aspects should be paid attention to in the general treatment of chronic nephritis? There is currently no specific method to treat chronic nephritis. Basically, symptomatic treatment is provided, including rest, preventing excessive salt intake, appropriately limiting protein foods, diuresis to reduce edema; reducing high blood pressure, and preventing Treat heart failure, etc. Be careful not to use nephrotoxic drugs, such as gentamicin, streptomycin, sulfa drugs, etc. Effective diuretics and antihypertensive drugs should be given, and hormones and other drugs can be used if necessary. Appropriate use of nutritional drugs to protect the kidneys, such as inosine, ATP, cytochrome C, etc. Diuresis, reducing high blood pressure, and preventing heart and brain complications are the focus of treatment. How to control hypertension in patients with chronic nephritis? In chronic nephritis, the remaining and/or diseased nephrons are in a compensatory high hemodynamic state. Systemic hypertension will undoubtedly aggravate this condition and lead to progressive glomerular degeneration. Damage, therefore patients with chronic nephritis should actively control hypertension to prevent deterioration of renal function. In recent years, a series of research results have confirmed that most scholars have used angiotensin-converting enzyme inhibitors as first-line antihypertensive drugs. Recently, many clinical studies have confirmed that calcium antagonists, such as nifedipine and nicardipine, have a relatively certain effect in treating hypertension and delaying the deterioration of renal function. Studies have shown that although calcium ion antagonists have the effect of slightly dilating afferent arterioles, they can significantly reduce systemic blood pressure, so they can cause uninvolved or only partially affected glomeruli to become hyperhaemodynamic and hypermetabolic. Improved; in addition, calcium ion antagonists reduce oxygen consumption, anti-platelet aggregation, reduce calcium ion deposition in the interstitium through cell membrane effects and reduce excessive oxidation of cell membranes, thereby reducing kidney damage and stabilizing kidney function. Clinical reports indicate that short-term (4 weeks) or long-term (1 to 2 years) use of calcium antagonists in patients with nephritis with chronic renal insufficiency did not reveal any glomerular damage effects, but it was clearly demonstrated that calcium antagonists are involved in the conversion of angiotensin. Enzyme inhibitors have a very similar effect in slowing the deterioration of kidney function. Unlike angiotensin-converting enzyme inhibitors, it generally has no effect on lowering urinary protein. It should be pointed out that some scholars believe that calcium antagonists have an impact on renal function, and longer-term observation is still necessary. Beta-blockers, such as metoprolol and propranolol, have good effects on renin-dependent hypertension. Beta-blockers have the effect of reducing renin. Although this drug reduces cardiac output, it does not affect renal blood flow and GFR, so it is also used to treat renal parenchymal hypertension. It should be noted that some β-blockers, such as propranolol and propranolol, have low fat solubility and are excreted by the kidneys. Therefore, the dose should be adjusted and the medication time should be extended in patients with renal insufficiency. In addition, vasodilator drugs such as hydralazine also have antihypertensive effects. They can be used in combination with beta-blockers to reduce side effects such as stimulation of the renin-angiotensin system by vasodilator drugs (such as increased heartbeat, water and sodium retention). ), and can improve the therapeutic effect. Hydralazine is generally 200 mg daily, but one must be wary of the possibility that this drug may induce lupus-like syndrome. For those with obvious edema, if the renal function is good, thiazide diuretics can be added; for those with poor renal function (serum creatinine >200 μmol/L), thiazide drugs are ineffective or ineffective, and loop diuretics should be used instead. . When using diuretics, attention should be paid to electrolyte imbalance in the body and the tendency to aggravate hyperlipidemia and hypercoagulability.
What is the significance of angiotensin-converting enzyme inhibitors for patients with chronic nephritis? In recent years, through a large number of animal experiments and controlled clinical observations on patients with nephritis, it has been confirmed that in addition to having a certain antihypertensive effect, this drug can also reduce glomerular Internal pressure can definitely delay the deterioration of renal function, reduce urinary protein (20% to 40%) and reduce glomerulosclerosis. Commonly used clinical preparations include captopril, with a general dosage of 25 to 50 mg/time, 3 times a day; enalapril, which does not contain sulfhydryl groups, has a long acting time, and the usual dosage is 5 to 10 mg/time. Once a day. The main mechanism of this type of drug to reduce intraglomerular pressure and protect and stabilize renal function is: ① Expand glomerular arteries. Because the expansion of efferent arterioles is more significant than the expansion of afferent arterioles, the intraglomerular pressure is reduced and the renal function is relieved. Hyperglobus hemodynamics; ② Angiotensin II stimulates the production of ammonium in the proximal renal tubules, and this type of preparation can reduce the level of angiotensin II and/or increase blood potassium to reduce the production of ammonium, which is beneficial to reducing renal hypertrophy. And avoid excessive ammonium production that activates complement through the alternative pathway and induces tubulointerstitial lesions. When using this type of preparation, attention should be paid to the fact that it can cause hyperkalemia (especially in patients with renal insufficiency). Other side effects include rash, itching, fever, flu-like symptoms, loss of taste, and rare granulocytopenia. Some people believe that such preparations may cause acute drug-induced interstitial nephritis. What are the effects of anticoagulation and platelet depolymerization drugs on chronic nephritis? Recent studies have shown that long-term clinical follow-up and animal experimental nephritis model studies of anticoagulation and platelet depolymerization drugs on certain types of nephritis (such as IgA nephropathy) have the effect It has a good effect on stabilizing kidney function and reducing pathological damage to the kidneys. There is no unified plan for the application of anticoagulation and platelet deaggregation in the treatment of chronic nephritis. Some people believe that there is a clear hypercoagulable state and certain pathological types that are prone to hypercoagulable state (such as membranous nephropathy, mesangial capillary proliferative nephritis) can take a long time. time application. How to prevent and treat some factors that cause kidney damage? Patients with chronic nephritis should avoid infections of the upper respiratory tract and other parts as much as possible to avoid aggravation or even sudden deterioration of kidney function. Drugs that are nephrotoxic and/or can easily induce kidney function damage, such as gentamicin, sulfonamides, and nonsteroidal anti-inflammatory drugs, should be used with great caution or avoided. Patients with hyperlipidemia, hyperglycemia, hypercalcemia and hyperuricemia should receive appropriate treatment in a timely manner to prevent the above factors from aggravating kidney damage. Can chronic nephritis be treated with hormones and cytotoxic drugs? There is no unified view at home and abroad on whether to use hormones and/or cytotoxic drugs for chronic nephritis, and their use is generally not advocated. However, some scholars believe that if the patient's renal function is normal or only slightly damaged, the kidney volume is normal, the urine protein is ≥2.0g/24h, the pathological type is mild mesangial proliferative nephritis, minor lesions, etc., if there are no contraindications, the patient can be treated Hormones and cytotoxic drugs were tried, and those that failed were gradually removed. How many types of chronic nephritis can be divided into TCM syndrome differentiation? According to the syndrome differentiation and classification scheme discussed and revised at the Second National TCM Nephrology Academic Conference in 1986, chronic nephritis is divided into four syndrome types. Anyone with any three of them can be diagnosed as: This type: (1) Lung and kidney qi deficiency: ① Floating face, swollen limbs, and sallow complexion; ② Lack of energy and weakness; ③ Easy to catch a cold; ④ Pain in the waist and spine; ⑤ Pale tongue with white coating, teeth marks, and weak pulse. (2) Spleen and kidney yang deficiency: ① Obvious edema and pale complexion; ② Aversion to cold and cold limbs; ③ Soreness in the waist and spine or soreness in the shins, weak legs, and heel pain; ④ Mental fatigue, lack of appetite or loose stools; ⑤ Low sexual function Or menstrual disorders; ⑥ The tongue is tender, light and fat with tooth marks, and the pulse is slow and weak. (3) Liver and kidney yin deficiency: ① Dry eyes or blurred vision; ② Dizziness and tinnitus; ③ Five upsets and fever, dry mouth and throat; ④ Back pain or nocturnal emissions, or menstrual disorders; ⑤ Red tongue with less coating, stringy pulse Count or count. (4) Deficiency of both Qi and Yin: ① Pale complexion; ② Lack of energy and weakness or prone to catching a cold; ③ Low-grade fever in the afternoon or hot palms and soles; ④ Dry mouth and throat or long-term sore throat, dark red throat; ⑤ Red tongue with less coating , thin or weak pulse. What are the traditional Chinese medicine treatments for chronic nephritis and proteinuria? (1) The method of replenishing qi and strengthening the kidney: used for patients with lung and kidney qi deficiency, spleen and kidney qi deficiency. Astragalus, Codonopsis pilosula, and Radix Pseudostellariae can be used to nourish lung qi. To replenish the spleen, you can use Codonopsis pilosula, raw Astragalus membranaceus, Radix Pseudostellariae, Atractylodes macrocephala, Gorgon fruit, and lotus seed meat. Golden cherry seeds, lotus seeds, dodder seeds, and raspberries can be used to strengthen the kidneys. (2) Warming and tonifying the spleen and kidney method: used for patients with spleen and kidney yang deficiency. Commonly used prescriptions include Fuzi Lizhong Decoction, Zhenwu Decoction, etc. (3) Nourishing kidney yin method: used for those with kidney yin deficiency. Chronic nephritis, such as warming and nourishing the spleen and kidneys for too long or using hormone therapy, can lead to kidney yin depletion. Commonly used prescriptions include Liuwei Dihuang Decoction, Zhibai Dihuang Decoction, etc.
(4) Qi and Yin tonifying method: For syndromes of Qi and Yin deficiency, the commonly used prescription is Shenqi Dihuang Decoction. If there is heart Qi deficiency, Shengmai Powder can be combined with it. (5) Yin and Yang dual tonic method: For those with Yin and Yang deficiency, the commonly used prescription is Guifu Dihuang Decoction, which can be combined with Guilu Erxian Guo. (6) Heat-clearing and detoxifying method: Suitable for patients with chronic nephritis combined with infection, Wuwei disinfectant drink combined with Yinqiao powder can be used. (7) Method of activating blood circulation and removing blood stasis: Chronic nephritis has a long course, and most patients have signs of blood stasis to varying degrees. Salvia miltiorrhiza, adenophora, safflower, motherwort, leech, etc. can be added based on syndrome differentiation and treatment. (8) Method of dispelling wind and dampness: For patients with chronic nephritis who have dampness and spleen deficiency, this method can be used to treat chronic nephritis. The commonly used prescription is Qufeng Shengshi decoction (10g of Qianghuo, 6g of Astragalus root each, 6g of Fangfeng, 15g of raw astragalus, and tangerine peel). 10g, Cimicifuga 10g, Bupleurum 10g, Angelica sinensis 10g, Red peony root 15g, Chuanxiong 10g). What are the methods of traditional Chinese medicine to treat renal edema? Traditional Chinese medicine believes that the organs most closely related to water metabolism are the lungs, spleen, and kidneys. The dysfunction of these three organs is the key to causing edema. Therefore, in treating edema, traditional Chinese medicine generally uses The basic principles are to expel the lungs, strengthen the spleen, and warm the kidneys. The specific methods are as follows: (1) Expelling the lungs and diluting water: the main clinical manifestations are fever, aversion to cold, aversion to wind, headache, soreness of limbs and joints, cough, and tongue coating due to external attack of wind evil. Thin white veins floating. Swelling first appears on the face and then spreads throughout the body, making it difficult to urinate. Traditional Chinese medicine calls this kind of edema Feng Shui, and it is more common in acute nephritis or acute attacks of chronic nephritis. Commonly used prescriptions include Yuejiajiashu Decoction and Ephedra Forsythia Chixiaodou Decoction. Commonly used medicines include ephedra, gypsum, ginger, atractylodes, saposhnikovia, mulberry bark, double flower, forsythia, mint, Pediculus, adzuki bean, plantain, Alisma, Imperata root, motherwort, etc. (2) Strengthen the spleen and reduce dampness, diuretic and reduce swelling: The clinical manifestations are pitting edema all over the body, especially below the waist, weight loss, low urine volume, indigestion, chest tightness, greasy coating, and wet pulse. Commonly used prescriptions are Wuling Powder and Wupi Yin. Commonly used drugs include Poria, Polyporus, Alisma, Atractylodes, Guizhi, Morus alba, Dabupi, ginger peel, tangerine peel, Poria peel, etc. If the upper body is swollen or even wheezing, add ephedra, almonds, and Tilizi; if the lower body is swollen, add Fangji, Sichuan pepper, Magnolia officinalis, etc.; if there is excess dampness and heat, irritability and thirst, short and red urine, constipation, yellow and greasy coating, add Rhubarb, Akebia, thistle, etc. (3) Warming the body, strengthening the spleen, promoting qi and diluting water: This method is suitable for those with weak spleen yang. The main clinical manifestations are severe edema of the lower limbs, which is difficult to recover when pressed, chest tightness and abdominal distension, poor appetite and loose stools, sallow complexion, fatigue and cold limbs, small amount of urine, pale tongue with white coating, and slippery and slow pulse. Commonly used prescriptions are Shipiyin. The medicines include: Poria, Atractylodes, Aconite, Ginger, Magnolia officinalis, Acosta, Dabupi, Papaya, Caoguo, Licorice. Polyporus, Alisma, Codonopsis, Astragalus, etc. can be added. . (4) Warming the kidneys and diluting water: suitable for those with weak kidney yang. The main symptoms are high degree of edema all over the body, especially below the waist, soreness and weakness in the waist and knees, cold limbs and chills, mental fatigue, pale complexion, oliguria, pale and fat tongue with tooth marks, and a thin and weak pulse. Commonly used prescriptions include Zhenwu Decoction, Jingui Shenqi Pills, etc. Medications include Poria, Atractylodes, White Peony, Aconite, Ginger, Rehmannia, Paeonol, Alisma, Yam, Cornus, Cinnamon, etc. How to provide traditional Chinese medicine care for chronic nephritis? In addition to drug treatment, it is very important to provide syndrome differentiation and care for chronic renal failure. (1) Distinguish physical constitution, examine deficiency and excess, and provide care based on syndrome differentiation: In the nursing process of chronic nephritis, it is extremely important to use the theory of traditional Chinese medicine to examine the patient's constitution and disease nature, and to distinguish yin and yang, deficiency and excess. Generally speaking, those with obvious edema have deficiency in origin and excess in excess. Those with a strong constitution will have more fruits and more heat. People with weak constitution often suffer from deficiency and cold. In addition to measuring body temperature, pulse, blood pressure, and 24-hour fluid intake and output on a regular basis, the two must also observe whether there is bleeding tendency, vomiting, edema, etc. If there is oliguria, fatigue and drowsiness, and the smell of urine in the mouth, it is mostly due to the accumulation of dampness and turbid evil in the body, internal staining of poisonous evil, invagination of the pericardium, and transformation into Guanqi, which is the most dangerous. The doctor should be notified promptly and be prepared for rescue. Clinically, edema due to Yang deficiency and internal water poisoning can irritate the skin and cause itching. Skin care should be taken to prevent infection. Deficiency of yin and hyperactivity of yang, water not flowing into the wood, common symptoms include headache, insomnia, and high blood pressure. It is necessary to observe whether there is vomiting or convulsions. Those with headaches can acupuncture at Baihui, Taiyang, Hegu and other points. Those who have convulsions or vomiting should report to the doctor in time and cooperate with the doctor for rescue treatment. (2) Observe the condition, avoid external infections, and guide medication: The condition should be carefully observed, and the patient should be warned to live cautiously, avoid wind and evil, be careful not to overwork, and keep warm and prevent cold. Because chronic nephritis often attacks acutely due to infection, the original condition worsens. The ward should have sufficient sunlight, appropriate temperature, and good ventilation. Clinical nursing, guiding patients to take medicine on time. Traditional Chinese medicine decoction should be taken warm. Those with nausea and vomiting should take a small amount frequently.
Drop a small amount of ginger juice on the tongue before taking the medicine, which is effective in preventing vomiting. Those who use traditional Chinese medicine enema must pay attention to the moderate temperature of the medicinal solution, the injection speed should be slow, and the depth of insertion into the anal canal should be appropriate, generally 30cm is appropriate. Only in this way can the full absorption of the medicinal solution be ensured and the efficacy improved. (3) Adjust diet, supplement food therapy, and promote recovery: It is very important to choose food reasonably and correctly. Generally speaking, people with edema and high blood pressure should avoid salt or eat a low-salt diet. People with reduced kidney function should not eat high-protein diets, and spicy food is not suitable. Due to the long course of this disease, auxiliary dietary therapy is generally the method of choice. Clinically, medication supplemented with food therapy is of great benefit to patients' recovery. (4) Flirting, building confidence, caring and considerate: It is very necessary to regulate the patient's emotions and provide psychological care. Generally speaking, we should first do a good job in the patient's ideological work, talk to the patient with cordial language and a kind attitude, eliminate the patient's unnecessary ideological concerns, and establish an optimistic mood and confidence in the long-term fight against the disease. Health education should be done well, patients should be cared for in all aspects, gain the trust of patients, work diligently for patients to recover as soon as possible, and make TCM nursing work better. What is the prognosis of chronic nephritis? The natural course of chronic nephritis patients varies greatly. The condition of some patients is relatively stable. It takes 5 to 6 years, or even 20 to 30 years, to develop into renal insufficiency. A very small number of patients can relieve themselves. . Another part of the patients' condition continues to develop or has repeated acute attacks, and develops to renal failure within 2 to 3 years. It is generally believed that patients with chronic nephritis, persistent hypertension and persistent renal impairment have a poor prognosis. In short, chronic nephritis is a progressive glomerular disease with a relatively poor prognosis. The pathological classification of renal biopsy is relatively reliable in judging prognosis. It is generally believed that minimal change nephropathy and simple mesangial proliferative nephritis have a better prognosis, while membranous nephropathy progresses more slowly and has a better prognosis than membranoproliferative nephritis, which is more severe. Some cases develop renal insufficiency within a few years, and the prognosis of focal segmental glomerulosclerosis is poor. Research in recent years has shown that in addition to glomerular lesions, the degree of renal tubular, intrarenal blood vessels and renal interstitial lesions significantly affects prognosis. Renal tubular atrophy, intrarenal small vessel sclerosis, large amounts of lymphocyte infiltration in the renal interstitium, and interstitial fibrosis have a poor prognosis.