Chronic glomerulonephritis (chronic nephritis)
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Nephritis is an allergic reaction to 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?
Chronic glomerulonephritis (referred to as chronic nephritis), many people think it is a very common clinical disease. In fact, this concept is wrong. Chronic glomerulonephritis is not an independent disease. It is just the progressive 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, proteinuria, hematuria, edema, hypertension, kidney shrinkage, renal function decline, and irreversible renal damage appear. About 60% of all end-stage renal failure cases are caused by chronic glomerulonephritis.
What is the cause and pathogenesis of chronic glomerulonephritis?
Chronic glomerulonephritis is believed by many to be the result of delayed acute glomerulonephritis. In fact, only a small number of chronic nephritis are directly delayed from acute streptococcal nephritis, or a series of symptoms of chronic nephritis 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 Compensatory blood perfusion of surviving nephrons increases, glomeruli The transmembrane pressure of capillary loops increases and the filtration pressure increases, thereby causing glomerulosclerosis; ② Hypertension during the disease process causes sclerotic damage to renal arterioles.
What are the ways in which chronic nephritis begins?
There is no definite relationship between chronic nephritis and acute nephritis. According to clinical data, only 15 to 20 people with chronic nephritis have 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 abnormal urine. appear simultaneously.
(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. Diuretics and beta-blockers such as Xinde are usually used. After treatment, blood pressure can be effectively controlled.
(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% is 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 sustained 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. The prognosis is also poor. The possible causes are as follows:
(1) After renal ischemia, the blood renin content increases, 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 anti-pressor substances (i.e. renal prostaglandins) formed by the kidneys. ) is related to reduction, so prostaglandins can be used to treat hypertension, because prostaglandins have a strong antihypertensive effect and can also 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, chronic nephritis can cause persistent hypertension, vasospasm and ischemia, increased renin secretion, and damage to the renal parenchyma (including the medulla). These factors cause and effect each other, creating a vicious cycle and causing chronic nephritis. Nephritis presents with refractory sustained hypertension.
Does chronic nephritis require clinical classification?
As for the clinical classification of primary glomerular diseases, so far, three meetings have been held in China to discuss, formulate and Revise. 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 Nephrology Professional Group of the Editorial Board of the Chinese Journal of Internal Medicine held a symposium on primary glomerular disease classification, treatment and efficacy standards 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 renal biopsy?
As mentioned earlier, chronic nephritis is not an independent disease. It is a group of many patients with the same or similar clinical manifestations. For various kidney disease syndromes, it is recommended that patients undergo kidney biopsy just 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?
Diagnosis of typical chronic nephritis is not difficult. It is generally more common in young men, with 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: Chronic nephritis and primary glomerulonephropathy can have very different clinical manifestations. Similar, but chronic nephritis is more common in young adults, hematuria is common, hypertension and renal function decline are more common, and the selectivity of urinary protein is poor. Primary glomerulonephropathy is more common in children, without hematuria, hypertension, renal insufficiency, etc., and has good selectivity for proteinuria. 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 women), more white blood cells in the urine, and white blood cell tubes may be present. Type, urine bacterial culture was positive, and intravenous pyelography and radionuclide renography showed varying degrees of renal damage on both sides, all of 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 kidney damage, and their clinical manifestations can be similar to chronic nephritis, but this type of Most diseases are accompanied by systemic and other systemic symptoms, such as fever, rash, joint pain, and hepatosplenomegaly. Characteristic abnormal indicators 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, and hypertension appears before urine changes. Urinary protein is often not severe but renal tubular function impairment is more 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?
The late-stage differentiation between chronic nephritis and chronic pyelonephritis is difficult. It can be distinguished from the following points:
(1) Medical history: A history of urinary tract infection, such as frequent urination, painful urination, low back pain and other symptoms, is helpful for the diagnosis of chronic pyelonephritis.
(2) Repeated urine tests: If there is an obvious increase in leukocytes in the urine, there may even be leukocyte casts, and the urine bacterial culture is positive, it is helpful to diagnose chronic pyelonephritis, and chronic nephritis is characterized by repeated proteinuria in the urine. Lord.
(3) During intravenous pyelography, if the kidney is found to be scarred, deformed, clubbed, or asymmetrical on both sides of the kidney shadow; radionuclide renogram examination will reveal a large difference in renal function damage on both sides ( (especially on one side), all indicate chronic pyelonephritis.
(4) When chronic nephritis is combined with infection, although urine 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. , can be used for identification.
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. Therefore, it is easy to be confused with those with chronic nephritis complicated by hypertension.
The blood pressure of malignant hypertension is higher than that of chronic nephritis, often 29/17kPa (200/130mmHg) 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 strengthen their ability to fight the disease. Fight with confidence, cooperate closely 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 tract 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 to 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, Appropriate restriction of protein foods, diuresis to reduce edema; reduce high blood pressure, prevent and 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 application 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, and systemic High blood pressure will undoubtedly aggravate this condition and lead to progressive glomerular damage. Therefore, patients with chronic nephritis should actively control high blood pressure 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. It 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 rapid 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 less effective or ineffective. 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, it has been confirmed through a large number of animal experiments and controlled clinical observations on patients with nephritis that this drug can In addition to having a certain antihypertensive effect, it can also reduce intraglomerular pressure, delay the deterioration of renal function, reduce urinary protein (20-40%) and alleviate 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, you should be aware 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 granules. Decreased cells. 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 anticoagulation and platelet depolymerization drugs are effective in certain types of nephritis (such as IgA nephropathy). )'s clinical long-term follow-up and animal experimental nephritis model studies have shown that it has a good effect on stabilizing renal function and reducing renal pathological damage. 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 renal 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 be treated promptly and appropriately 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 scheme revised at the Second National TCM Nephrology Academic Conference in 1986, chronic nephritis is divided into four types Syndrome type: Anyone with any three items can be identified 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 Soreness in the waist and spine; ⑤ Pale tongue with white and moist coating, teeth marks, and weak pulse.
(2) Spleen and kidney yang deficiency: ① obvious edema, pale complexion; ② fear of cold and cold limbs; ③ soreness of waist and spine or soreness of shins, weak legs and heel pain; ④ fatigue, indigestion or Loose stools; ⑤ low sexual function or menstrual irregularity; ⑥ tender tongue, light fat with teeth marks, slow and weak pulse.
(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 little coating, stringy or thready pulse.
(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 heat in the palms and soles; ④ Dry mouth and throat or long-term sore throat, dark red throat; ⑤The tongue is reddish with less coating, and the pulse is thin or weak.
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 Erxianjiao.
(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: The course of chronic nephritis is long, and most patients have signs of blood stasis to varying degrees. On the basis of syndrome differentiation and treatment, you can choose to add salvia, adenophora, safflower, motherwort, Leeches etc.
(8) Method of dispelling wind and dampness: For patients with chronic nephritis who have dampness and poor spleen, this treatment method can be used. The commonly used prescription is Qufeng Shengshi decoction (10g of Qianghuo, 6g of each of Huangzhu, Fangfeng 6g, raw astragalus 15g, tangerine peel 10g, Cimicifuga 10g, Bupleurum 10g, Angelica sinensis 10g, red peony root 15g, Chuanxiong 10g).
What are the traditional Chinese medicine methods for treating 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 the treatment of edema, traditional Chinese medicine generally takes the basic principles of clearing the lungs, strengthening the spleen, and warming the kidneys. The specific methods are as follows:
(1) Clearing the lungs and diluting water: the main clinical manifestation is wind evil. Fever, aversion to cold, wind aversion, headache, soreness of limbs and joints, cough, thin tongue coating, white and floating pulse caused by external attack. Edema first appears on the face, 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 and fatigue, less urine, 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 history of patients with chronic nephritis varies greatly. Some patients’ condition is relatively stable. After 5 to 6 years, or even 20 to 30 years, It has only developed to the stage of renal insufficiency, and a very small number of patients can relieve it on their own. 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.