Chronic Glomerulonephritis (Professor Wu Zhaolong from Shanghai Medical University)
Nephritis is an allergic disease caused by streptococcus infection. Chronic glomerulonephritis is caused by long-term acute nephritis. Some patients have a history of acute nephritis in the past, and their symptoms have disappeared for many years, mistakenly thinking that they have recovered. In fact, inflammation continues to develop slowly. After several years, the symptoms reappeared and became chronic glomerulonephritis. Some patients' renal inflammation is hidden from the beginning. Patients have no obvious manifestations of acute glomerulonephritis, but the inflammation develops slowly and becomes chronic glomerulonephritis several years later.
Chronic glomerulonephritis has edema, hypertension, proteinuria and hematuria. Due to various pathological changes, the symptoms are different. In severe cases, uremia may occur.
prescription
1. Pay attention to rest and avoid overwork. Prevent colds or upper respiratory tract infections.
2. Tonsillitis, otitis media, sinusitis and dental caries should be diagnosed and treated in time. Pay attention to personal hygiene, keep skin clean and prevent skin infection. These are all possible causes of recurrence or activity of this disease.
3. People with obvious edema, massive proteinuria and normal renal function can appropriately supplement protein's diet. When there is no edema and hypoproteinemia, the daily intake of protein should be controlled at 0.6g per kg of body weight (each bottle of milk contains about 6g of protein, each egg contains about 6g of protein, and each 50g of rice contains about 4g of plant protein).
4. People with edema, hypertension and cardiac insufficiency should eat a low-salt diet, and the daily salt intake should be less than 5g (1 yuan), about the size of a broad bean.
5. Avoid taking antipyretic and analgesic drugs containing phenacetin and other drugs harmful to renal function, such as kanamycin and gentamicin.
6. Check urine regularly. If the red blood cells in urine exceed 10, you should stay in bed.
What is chronic glomerulonephritis?
Chronic glomerulonephritis (hereinafter referred to as chronic glomerulonephritis) is considered by many people to be a very common disease in clinic. In fact, this concept is wrong. Chronic glomerulonephritis is not an independent disease, but a progressive stage before any primary or secondary glomerulonephritis enters end-stage renal failure. At this time, the pathological and clinical manifestations of different types of glomerulonephritis are gradually consistent, including proteinuria, hematuria, edema, hypertension, renal shrinkage, renal failure and irreversible renal damage. All cases of end-stage renal failure.
What is the etiology and pathogenesis of chronic glomerulonephritis?
Many people think that chronic glomerulonephritis is transformed from acute glomerulonephritis. In fact, only a few chronic glomerulonephritis are directly caused by nephritis after acute streptococcal infection, or a series of manifestations of chronic nephritis after several years of clinical recovery. Most chronic glomerulonephritis is the direct result of the delayed development of other primary glomerular diseases, such as mesangial proliferative nephritis (including IgA nephropathy), mesangial capillary nephritis, membranous nephropathy, focal segmental glomerulosclerosis and so on.
The mechanism leading to the chronic course of the disease is not only the continuation of the primary immune inflammatory injury process, but also related to the following secondary factors: ① the compensatory blood perfusion of nephron increases, and the transmembrane pressure and filtration pressure of glomerular capillary loop increase, thus causing glomerular sclerosis; ② Hypertensive injury of renal arterioles in the course of disease.
What are the modes of chronic nephritis?
There is no necessary connection between chronic nephritis and acute nephritis. According to clinical data, only 15% ~ 20% of chronic nephritis has a clear history of acute nephritis. The pathogenesis can be summarized as follows: ① Acute glomerulonephritis started, which was not completely controlled. The clinical symptoms and urinary protein lasted for more than 1 year, and then evolved into chronic nephritis. ② Previous history of acute nephritis syndrome. After several weeks or months of recovery, clinical symptoms and abnormal urine disappeared and renal function was normal. After a long interval (the elderly can reach many years), due to upper respiratory tract or other infections or overwork, nephritis symptoms such as proteinuria, edema or (and) hypertension suddenly appear. ③ No previous history of nephritis, obvious edema, massive proteinuria and other symptoms of nephrotic syndrome due to upper respiratory tract or other infections. ④ No previous history of nephritis, no recent proteinuria, progressive hypertension and/or renal insufficiency. ⑤ There was no history of nephritis in the past, and hematuria and/or proteinuria often appeared after infection or fatigue, which quickly relieved or disappeared after a short rest. Recurrent attacks, no obvious clinical symptoms.
What are the clinical manifestations of patients with chronic nephritis?
The main clinical manifestations of patients with chronic nephritis are edema, hypertension and abnormal urine, which can occur simultaneously, separately or simultaneously.
(1) Edema: Edema often occurs in eyelids, face and lower limbs, generally mild to moderate edema, and pleural effusion and ascites rarely occur when chronic nephritis does not cause uremia.
(2) Hypertension: generally moderate hypertension, with systolic blood pressure of about 20 ~ 22.7 kPa and diastolic blood pressure of about 12.7 ~ 14 kPa. Usually, blood pressure can be effectively controlled after using diuretics and beta blockers such as propranolol.
(3) Urinary system abnormality: moderate proteinuria, with a 24-hour urinary protein quantification of about 2g, often non-selective proteinuria. Gross hematuria or microscopic hematuria is also one of the urine changes of chronic nephritis. By contrast microscope examination, more than 90% of them are abnormal red blood cell hematuria, and a few are homogeneous red blood cell hematuria. In addition to proteinuria and hematuria, renal tubular urine, urine volume change, urine specific gravity and urine osmotic pressure abnormality may also occur.
Why does chronic nephritis have persistent hypertension?
Some patients with chronic nephritis have intractable hypertension. Generally, the higher the blood pressure, the longer the duration, the more serious the condition and the worse the prognosis. There may be the following reasons:
(1) After renal ischemia, the content of renin in blood increased, which aggravated arteriolar spasm and caused persistent hypertension. At the same time, due to the increase of aldosterone secretion, water and sodium retention and blood volume increase, blood pressure is further increased.
(2) When renal diseases occur, the renal parenchyma is destroyed and the anti-pressor substances secreted by renal tissue are reduced. Some people think that renal hypertension may be related to the decrease of antihypertensive substances (i.e. renal prostaglandin) formed by the kidney, so prostaglandin can be used to treat hypertension, because prostaglandin has a strong antihypertensive effect and can improve renal blood flow.
(3) Systemic arteriolar spasm and sclerosis: After renal hypertension lasts for a long time, systemic arteriolar sclerosis may occur, and the arteriolar resistance increases, leading to an increase in blood pressure.
Due to the above reasons, chronic nephritis has persistent hypertension, vasospasm and ischemia, increased renin secretion and renal parenchyma (including medulla) damage are mutually causal, resulting in a vicious circle, and chronic nephritis is intractable and persistent hypertension.
Does chronic nephritis need clinical classification?
Up to now, three meetings have been held in China to discuss, formulate and revise the clinical classification of primary glomerular diseases. 1977 beidaihe conference divided chronic nephritis into common type, nephropathy type and hypertension type. In addition to the common manifestations, nephrotic type has urinary protein > 3.5g/d (qualitative >+++), and low plasma protein and albumin < 3g/L. In addition to the common manifestations, hypertension is mainly characterized by persistent moderate or above hypertension. 1985, Nanjing conference revised this classification scheme, classified the above nephrotic syndrome as nephrotic syndrome type ⅱ, and added acute attack type.
From 065438 to 0992, the nephrology specialty group of the editorial board of Chinese Journal of Internal Medicine held a seminar on classification, treatment and curative effect standard of primary glomerular diseases in Taiping, Anhui. Most experts believe that it is difficult to accurately reflect the clinical and pathological characteristics of chronic nephritis by dividing it into "common type", "hypertension type" and "acute attack type", so they agree that chronic nephritis should not be further classified.
Why do some patients with chronic nephritis need renal biopsy?
As mentioned earlier, chronic nephritis is not an independent disease, but a syndrome of many kidney diseases with the same or similar clinical manifestations. It is suggested that patients do renal biopsy only to make clear the pathological diagnosis and contribute to the treatment and prognosis of the disease. Pathological diagnosis generally includes the following types: mesangial proliferative nephritis (including IgA nephropathy), membranous proliferative nephritis, membranous nephropathy, focal segmental glomerulosclerosis, etc. At the same time, glomerulosclerosis, renal small vessel sclerosis, renal tubular atrophy fibrosis and inflammatory cell infiltration often occur in the lesion site, and the renal volume shrinks and the renal cortex becomes thinner in the late stage.
What are the pathological types that cause chronic nephritis?
Histopathological types are not closely related to the etiology and clinical manifestations of glomerulonephritis. Clinical so-called chronic nephritis includes mesangial proliferative nephritis, membranous nephropathy, membranous proliferative nephritis, focal glomerulosclerosis and sclerosing glomerulonephritis's disease. According to domestic statistics, mesangial proliferative nephritis is the most common, followed by focal segmental glomerulosclerosis, membranous proliferative nephritis and membranous nephropathy.
How to diagnose chronic nephritis?
The typical diagnosis of chronic nephritis is not difficult, and it is more common in young men, with slow onset and prolonged course of disease. Abnormal urine test, usually proteinuria, may be accompanied by hematuria, edema and hypertension. Different degrees of renal function damage may also occur. See article 68 for diagnostic criteria.
What disease should chronic nephritis be differentiated from?
(1) Primary glomerulonephritis: The clinical manifestations of chronic nephritis and primary glomerulonephritis are very similar, but chronic nephritis is more common in young adults, with hematuria, hypertension and renal insufficiency, and poor urine protein selectivity. Primary glomerulonephritis is more common in children, without hematuria, hypertension, renal insufficiency and other manifestations, and urine protein has good selectivity. Patients with primary glomerulonephritis are very sensitive to the treatment of hormones and immunosuppressants, while patients with chronic glomerulonephritis have poor effects. Finally, renal biopsy is helpful for diagnosis.
(2) Chronic pyelonephritis: The clinical manifestations of chronic pyelonephritis can be similar to those of chronic pyelonephritis, but it is helpful to diagnose chronic pyelonephritis by asking about the history of urinary tract infection (especially women), with many white blood cells in urine, positive urine bacteria culture, and renal damage in different degrees by intravenous pyelography and radionuclide renogram.
(3) Connective tissue diseases: The incidence of renal damage in collagen diseases such as systemic lupus erythematosus and polyarteritis nodosa is very high, and its clinical manifestations can be similar to those of chronic nephritis. However, most of these diseases are accompanied by systemic and other systemic symptoms, such as fever, rash, joint pain and hepatosplenomegaly. Abnormal characteristic indicators (such as positive antinuclear antibody in blood test of lupus nephritis) can be found in laboratory examination.
(4) Hypertension: Chronic nephritis with continuously rising blood pressure should be differentiated from primary hypertension with renal damage. The onset age of the latter is often after 40 years old, and hypertension occurs before urine changes. Urinary protein is often not serious, but renal tubular function is obviously damaged. The sclerosing changes of cardiovascular, cerebrovascular and retinal vessels are often obvious.
How to distinguish chronic nephritis from chronic pyelonephritis?
It is difficult to distinguish between chronic nephritis and chronic pyelonephritis in the later stage, which can be distinguished from the following points:
(1) History: A history of urinary tract infection such as frequent urination, dysuria and low back pain is helpful for the diagnosis of chronic pyelonephritis.
(2) Repeated urine test: If the urine leukocytosis is obvious, or even there is a white blood cell cast, the urine bacterial culture is positive, which is helpful for the diagnosis of chronic pyelonephritis. Chronic nephritis is mainly characterized by repeated urine protein.
(3) In intravenous pyelography, if the kidney is found to have scar deformation, clubbed finger expansion, or asymmetric bilateral renal shadows; Radionuclide renogram examination shows that there is a great difference in bilateral renal function damage (especially on one side), which indicates chronic pyelonephritis.
(4) When chronic nephritis is complicated with infection, although the urine changes and azotemia will be improved after antibiotic treatment, the symptoms of chronic nephritis still exist, while the symptoms of chronic pyelonephritis basically disappear, which can be used for differentiation.
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 time, so it is easy to be confused with chronic nephritis complicated with hypertension. The blood pressure of malignant hypertension is higher than that of chronic nephritis, often 29/17 kpa (200/130 mmhg) or higher. However, at the early stage of the disease, the urine changes are not obvious, the amount of urine protein is small, and there is no hypoproteinemia or obvious edema. Because arteriolar sclerosis and necrosis of malignant hypertension is systemic, common retinal arterioles are highly contracted and hardened, accompanied by bleeding and exudation, papillae edema, cardiac enlargement and cardiac insufficiency, which can be used as a basis for differentiation. If chronic nephritis complicated with hypertension evolves into malignant hypertension, it is in patients with a long history of chronic nephritis that the condition suddenly deteriorates, blood pressure increases significantly, renal function deteriorates significantly, retinal hemorrhage, papilla edema, and even hypertensive encephalopathy occurs. According to these evolution laws, it is also helpful to distinguish chronic nephritis from 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 (SLE) is a systemic disease, which can be accompanied by fever, rash, arthritis and other multi-system damage. Blood cells decreased, immunoglobulin increased, lupus cells were also found, antinuclear antibodies were positive, and serum complement level decreased. Histological examination of kidney showed that immune complexes were widely deposited in various parts of glomerulus. Immunofluorescence examination often shows "full house" performance.
What should chronic nephritis patients pay attention to in life?
(1) Establish confidence in overcoming the disease: Chronic nephritis has a long course and is prone to recurrent attacks. Patients should be encouraged to enhance their confidence in overcoming diseases, closely cooperate with treatment and overcome diseases.
(2) Rest and work: Once the patient is diagnosed as chronic nephritis, at the initial stage, regardless of the severity of symptoms, rest should be the main active treatment, and regular follow-up should be conducted to observe the changes of the condition. If the condition improves, edema subsides, blood pressure returns to normal or close to normal, urine protein, red blood cells and various casts are trace, and renal function is stable, you can start to engage in light manual labor after 3 months to avoid strong manual labor and prevent respiratory and urinary tract infections. The amount of activity should be gradually increased to promote physical recovery. Anyone with hematuria, massive proteinuria, obvious edema or hypertension, or progressive renal insufficiency should stay in bed and actively treat.
(3) Diet: Patients with chronic nephritis, edema or acute hypertension should limit their salt intake, and it is advisable to take 2 ~ 4g daily. Those with high degree of edema should be controlled below 2g every day to avoid salted fish and various pickles. After the edema subsides, the amount of sodium salt will gradually increase. Except for obvious edema, the amount of drinking water should not be limited. People with low plasma protein and no azotemia should eat a high protein diet, and the daily protein should be 60 ~ 80g or higher. When azotemia occurs, the total intake of protein should be limited to below 40g per day, and high-quality protein rich in essential amino acids should be supplemented, with a total calorie of about 0. 146kJ/kg body weight. Nutrition and vitamins should be supplemented in the diet, and fruits and vegetables are not limited.
What aspects should be paid attention to in the general treatment of chronic nephritis?
At present, there is no specific treatment for chronic nephritis, and it is basically symptomatic treatment, including rest, preventing eating too much salt, appropriately limiting protein food, diuresis and reducing edema; Reduce hypertension and prevent and treat heart failure.
Be careful not to use drugs with nephrotoxicity, such as gentamicin, streptomycin and sulfanilamide. Effective diuretics and antihypertensive drugs should be given, and hormones and other drugs can be used for treatment if necessary. Appropriate use of drugs to protect the kidney, such as inosine, ATP, cytochrome C, etc. Diuresis, reducing hypertension and preventing cardiovascular and cerebral complications are the key to treatment.
How to control hypertension in patients with chronic nephritis?
In chronic nephritis, the remaining and/or diseased nephron is in a compensatory high hemodynamic state. Systemic hypertension will undoubtedly aggravate this situation and lead to progressive glomerular damage. Therefore, patients with chronic nephritis should actively control hypertension and prevent the deterioration of renal function.
In recent years, a series of research results have confirmed that most scholars have taken angiotensin converting enzyme inhibitors as first-line antihypertensive drugs. Recently, many clinical studies have confirmed that calcium antagonists, such as nifedipine and nicardipine, have positive effects on treating hypertension and delaying the deterioration of renal function. It is considered that although calcium antagonists can slightly expand into glomerular arterioles, they can obviously reduce the whole body blood pressure, thus improving the high hemodynamics and high metabolism of uninvolved or only partially involved glomeruli. In addition, calcium antagonists can reduce oxygen consumption, prevent platelet aggregation, reduce calcium ion deposition in stroma, and reduce excessive oxidation of cell membrane through cell membrane effect, thus reducing renal damage and stabilizing renal function. Clinical reports show that short-term (4 weeks) or long-term (1 ~ 2 years) treatment of nephritis patients with chronic renal insufficiency has not found any glomerular damage, but it is clearly proved that it has a very similar effect to angiotensin converting enzyme inhibitor in delaying the deterioration of renal function. Unlike angiotensin converting enzyme inhibitors, they generally have no effect on reducing urine protein. It should be pointed out that some scholars believe that calcium antagonists have an effect on renal function, and more long-term observation is needed.
Beta blockers, such as metoprolol and aminoacylpropranolol, have a good effect on renin-dependent hypertension. Beta blockers can lower renin. Although this drug reduces cardiac output, it does not affect renal blood flow and GFR, so it is also used to treat renal essential hypertension. It should be noted that some beta blockers, such as aminoacylpropranolol and naproxen, have low fat solubility and are excreted by the kidney. When renal insufficiency occurs, attention should be paid to adjusting the dosage and prolonging the medication time.
In addition, vasodilators such as hydralazine also have antihypertensive effect, and can be used together with β -blockers to reduce the stimulation of vasodilators on renin. Angiotensin system and other side effects (such as rapid heartbeat, water and sodium retention), and can improve the therapeutic effect. Hydralazine is generally 200 mg per day, but we must be alert to the possibility of this drug inducing lupus erythematosus-like syndrome.
For those with obvious edema, thiazide diuretics can be added for good renal function; For patients with poor renal function (serum creatinine > 200μ mol/L), thiazide drugs are ineffective or ineffective, and medullary loop diuretics should be used instead. When using diuretics, we should pay attention to the electrolyte disorder in the body and pay attention to the tendency to aggravate hyperlipidemia and hypercoagulability.
What is the significance of angiotensin converting enzyme inhibitor in patients with chronic nephritis?
In recent years, a large number of animal experiments and clinical observation of patients with nephritis have proved that this medicine can not only lower blood pressure, but also reduce the pressure in glomerulus, delay the deterioration of renal function, reduce urinary protein (20% ~ 40%) and alleviate glomerulosclerosis. The commonly used preparation in clinic is captopril, the general dose is 25 ~ 50m g/ time, three times a day; Enalapril without sulfhydryl has a long action time, and the usual dose is 5 ~ 10mg/ time, one day 1 time. The main mechanisms of this kind of drugs to reduce intraocular pressure, protect and stabilize renal function are as follows: ① dilate glomerular arteries, because the dilation of efferent arterioles is more obvious than that of afferent arterioles, thus reducing intraocular pressure and alleviating glomerular hyperhemodynamics; ② Angiotensin II stimulates proximal renal tubules to produce ammonium, which can reduce the level of angiotensin II and (or) increase blood potassium to reduce ammonium production, which is beneficial to reduce renal hypertrophy and avoid renal tubulointerstitial lesions induced by activating complement by bypass.
It should be noted that such preparations can cause hyperkalemia (especially renal insufficiency), and other side effects include rash, itching, fever, flu-like symptoms, decreased taste and rare granulocytopenia. Some people think that this preparation may cause acute drug-induced interstitial nephritis.
What are the effects of anticoagulant and platelet depolymerization drugs on chronic nephritis?
Recent studies have shown that anticoagulants and platelet depolymerization drugs have a good effect on stabilizing renal function and reducing renal pathological damage through long-term clinical follow-up of some types of nephritis (such as IgA nephropathy) and animal experimental nephritis model research. There is no unified plan for anticoagulation and platelet depolymerization in the treatment of chronic nephritis. Some people think that there are definite hypercoagulable states and some pathological types (such as membranous nephropathy and mesangial capillary proliferative glomerulonephritis) that are easy to cause hypercoagulable states can be used for a long time.
How to prevent and treat some factors that lead to kidney damage?
Patients with chronic nephritis should avoid upper respiratory tract infection as much as possible, so as not to aggravate or even cause rapid deterioration of renal function. Drugs with nephrotoxicity and/or easy to cause renal damage, such as gentamicin, sulfonamides and non-steroidal anti-inflammatory drugs, should be used with caution or avoided.
Patients with hyperlipidemia, hyperglycemia, hypercalcemia and hyperuricemia should be treated in time to prevent the above factors from aggravating renal 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 it is generally not recommended. However, some scholars believe that if the patient's renal function is normal or only slightly impaired, the renal volume is normal, and the urinary protein is ≥2.0g/24h, the pathological types are mild mesangial proliferative nephritis and slight pathological changes. If there are no contraindications, you can try hormones and cytotoxic drugs, and those who are ineffective will be gradually removed.
Syndrome differentiation of chronic nephritis can be divided into several types.
According to 1986, the second national academic conference on nephrology of traditional Chinese medicine discussed and revised the syndrome differentiation scheme, chronic nephritis can be divided into four syndrome types, and anyone with any three syndrome types can be classified as this type:
(1) Qi deficiency of lung and kidney: ① floating limb edema and sallow complexion; 2 weakness; 3 easy to catch a cold; ④ Lumbago; ⑤ The tongue is pale with white and wet fur, with teeth marks and thin pulse.
(2) Yang deficiency of spleen and kidney: ① obvious edema and pale complexion; (2) cold limbs; ③ The back is sour or cold, the shin hurts, the leg is soft, and the heel hurts; (4) God is tired, bored or loose stool; ⑤ Sexual dysfunction or menstrual disorder; ⑥ The tongue is tender, light and fat, with teeth marks and thin or weak pulse.
(3) Yin deficiency of liver and kidney: ① dry eyes or blurred vision; ② dizziness and tinnitus; (3) five upset and hot, dry mouth and throat; ④ Lumbago or wet dream, or menstrual disorder; ⑤ The tongue is red with little fur, and the pulse is string or thin.
(4) Deficiency of both qi and yin: ① dull complexion; (2) deficiency of qi and fatigue or easy to catch a cold; ③ Low-grade fever or fever in hands and feet in the afternoon; 4 dry mouth and throat or long-term sore throat, dark red throat; ⑤ Red tongue with little coating and thin or weak pulse.
What are the traditional Chinese medicine treatments for chronic nephritis proteinuria?
(1) Yiqi Bushen method: used for patients with lung and kidney qi deficiency and spleen and kidney qi deficiency. Radix Astragali, Radix Codonopsis and Radix Pseudostellariae can be used to tonify lung qi. Spleen can be strengthened with Radix Codonopsis, Radix Astragali, Radix Pseudostellariae, Atractylodis Rhizoma, Semen Euryales, and Semen Nelumbinis. Kidney-strengthening materials include Rosa laevigata, Lotus Root, Semen Cuscutae and Ruby.
(2) Warming and tonifying the kidney and spleen: For patients with spleen-kidney yang deficiency, commonly used prescriptions include Fuzi Lizhong Decoction and Zhenwu Decoction.
(3) Nourishing kidney yin: used for kidney yin deficiency and chronic nephritis, such as warming spleen and tonifying kidney for a long time or using hormone therapy, which can lead to kidney yin deficiency. Commonly used prescriptions are Liuwei Dihuang Decoction and Baizhi Huangtang.
(4) Tonifying both qi and yin: used for deficiency of both qi and yin. The commonly used prescription is Shenqi Dihuang Decoction. If the heart is deficient, Shengmai Powder can be used together.
(5) Yin-Yang double tonic method: For those with deficiency of both yin and yang, Guifu Dihuang decoction is commonly used, and Guilu Erxian glue can be used together.
(6) Heat-clearing and detoxicating method: It is suitable for patients with chronic nephritis complicated with infection, and can be modified with Wuwei Xiaoduyin and Yinqiao Powder.
(7) Method of promoting blood circulation and removing blood stasis: Chronic nephritis has a long course, and most patients have signs of blood stasis in different degrees. On the basis of syndrome differentiation and treatment, Saviae Miltiorrhizae Radix, Herba Lycopi, Carthami Flos, Herba Leonuri and Hirudo can be added.
(8) Dispelling wind and overcoming dampness: chronic nephritis with dampness overcoming but not rising temper can be treated by this method. Commonly used prescriptions are Qufeng Shi Sheng Decoction (Notopterygium Rhizoma 10g, Atractylodis Rhizoma 6g, Radix Saposhnikoviae 6g, Radix Astragali 15g, Pericarpium Citri Tangerinae 10g, Cimicifuga Rhizoma 10g, Bupleurum Radix 10g.
What methods does Chinese medicine have to treat renal edema?
Traditional Chinese medicine believes that the viscera most closely related to water-liquid metabolism are lung, spleen and kidney, and the dysfunction of these three viscera is the key to edema. Therefore, when treating edema, TCM generally takes dispersing lung, strengthening spleen and warming kidney as the basic principle, and the specific methods are as follows:
(1) Spreading lung and promoting diuresis: The main clinical manifestations are fever, aversion to cold, aversion to wind, headache, joint pain of limbs, cough, thin and white tongue coating and floating pulse. Edema first appears on the face and then spreads to the whole body, which is unfavorable for urination. Traditional Chinese medicine calls this edema feng shui, which is more common in acute nephritis or acute attack of chronic nephritis. Commonly used prescriptions include Yuemai Jiashu Decoction and Mahuang Forsythia Red Bean Decoction. Commonly used drugs include Herba Ephedrae, Gypsum Fibrosum, Ginger, Atractylodis Rhizoma, Radix Saposhnikoviae, Cortex Mori, Flos Lonicerae, Fructus Forsythiae, Herba Menthae, Radix Peucedani, Semen Phaseoli, Semen Plantaginis, Rhizoma Alismatis, Rhizoma Imperatae, and Herba Leonuri.
(2) Strengthening the spleen, eliminating dampness, promoting diuresis and reducing swelling: The clinical manifestations are depression and edema all over the body, especially below the waist, fatigue, short and red urine, anorexia, chest tightness, greasy fur and thready pulse. The commonly used prescription is Wuling Powder combined with Wupi Drink, and the commonly used drugs are Poria, Polyporus, Alisma orientalis, Atractylodis Rhizoma, Ramulus Cinnamomi, Cortex Mori, Pericarpium Arecae, Ginger Peel, Pericarpium Citri Tangerinae, Poria Peel, etc. Herba Ephedrae, Semen Armeniacae Amarum and Semen Lepidii are added for patients with upper body edema or even asthma; Tetrandra root, Sichuan pepper, magnolia bark, etc. are used for lower body swelling. For example, excessive damp-heat, upset and thirsty, short and red urine, constipation, yellow and greasy fur, yellow increase, Akebia Akebia, Cirsium japonicum and so on.
(3) Warming the middle warmer and strengthening the spleen, promoting qi circulation and promoting diuresis: This method is suitable for people with spleen-yang deficiency and weak constitution. The main clinical manifestations are edema of lower limbs, difficulty in recovery, chest tightness and abdominal distension, anorexia and loose stool, sallow complexion, listlessness, cold limbs, short and red urine, pale tongue with white fur and slow pulse. The commonly used prescription is Shipiyin, and the medicines are Poria, Atractylodis Rhizoma, Radix Aconiti Lateralis Preparata, Zingiberis Rhizoma, Magnolia Officinalis, Radix Aucklandiae, Pericarpium Arecae, Fructus Chaenomelis, Fructus Tsaoko, Radix Glycyrrhizae, Polyporus, Alismatis Rhizoma, Radix Codonopsis, Radix Astragali, etc. You can add.
(4) Warming kidney and promoting diuresis: it is suitable for patients with kidney yang decline. The main manifestations are high edema all over the body, especially below the waist, soreness in the waist and knees, cold limbs, listlessness, pale complexion, short and red urine, light and fat tongue, teeth marks and weak pulse. Commonly used prescriptions include Zhenwu decoction, Jinkui Shenqi pill and so on. The medicine comprises Poria, Atractylodis Rhizoma, Radix Paeoniae Alba, Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis Recens, Cortex Moutan, Alismatis Rhizoma, Rhizoma Dioscoreae, Corni Fructus, Cortex Cinnamomi, etc.
How to carry out TCM nursing for chronic nephritis?
At the same time of drug treatment, it is very important to play the role of dialectical nursing in chronic renal failure.
(1) Distinguish physique, judge deficiency and excess, and give nursing care based on syndrome differentiation: In the nursing process of chronic nephritis, it is extremely important to apply the theory of traditional Chinese medicine to check the physique and condition of patients and distinguish deficiency and excess of yin and yang. Generally speaking, edema is obvious, and deficiency is real. Strong people are stronger and hotter. People with weak constitution are deficient in cold. In addition to measuring body temperature, pulse, blood pressure and 24-hour water inflow and outflow on time, we must also observe whether there is bleeding tendency, vomiting and edema. If oliguria, lethargy and urine odor occur, most of them are dampness and turbidity accumulated in the body, and toxic pathogens are trapped in the pericardium, which is the most dangerous. You should report to the doctor in time and prepare for the rescue.
Clinically, due to yang deficiency and edema, internal water poisoning, skin irritation causes itching, so skin care should be done to prevent infection. Yin deficiency and hyperactivity of yang, numbness in water, headache, insomnia, hypertension, need to observe whether there is vomiting and convulsions. Patients with headache can acupuncture Baihui, Taiyang, Hegu and other points. People who have convulsions and vomiting should report to the doctor in time and cooperate with the doctor for rescue treatment.
(2) Observe the illness, avoid exogenous pathogens, and guide medication: carefully observe the illness, and warn patients to live carefully, avoid wind pathogens, be careful not to be tired, and pay attention to keep warm and cold. Because chronic nephritis often has an acute attack due to infection, which aggravates the original condition. The ward should be sunny, with proper temperature and good ventilation.
Clinical nursing, guiding patients to take medicine on time. Traditional Chinese medicine decoction should be taken warm. People with nausea and vomiting should take a small amount of it many times. It is effective to drop a small amount of ginger juice on the tongue before taking the medicine to prevent vomiting. Chinese medicine enema should pay attention to the moderate temperature of liquid medicine, slow injection speed and appropriate insertion depth of anal canal, generally 30cm. Only in this way can we ensure the full absorption of the liquid medicine and improve the curative effect.
(3) Adjusting diet, assisting dietotherapy and promoting rehabilitation: It is very important to choose food reasonably and correctly. Generally speaking, people with edema and hypertension should avoid salt or enter a low-salt diet. People with renal insufficiency should not eat a high-protein diet, and spicy stimulation is not appropriate. Because of the long course of disease, supplementary diet therapy is generally used as a common method. Clinically, drug therapy assisted diet therapy is of great benefit to the rehabilitation of patients.
(4) flirting, building confidence, caring and considerate: it is very necessary to adjust patients' emotions and do psychological care well. Generally speaking, first of all, we should do a good job in patients' ideological work, talk with patients with friendly language and attitude, eliminate unnecessary ideological concerns of patients, and establish optimistic mood and confidence in fighting diseases for a long time. We should do a good job in health education, care for patients in all directions, gain the trust of patients, and do our best to do a better job in TCM nursing.
What is the prognosis of chronic nephritis?
The natural course of chronic nephritis patients changes greatly, and some patients are relatively stable. It takes 5-6 years or even 20-30 years to develop renal insufficiency, and very few patients can relieve themselves. Another part of patients' condition continues to develop or has repeated acute attacks, which will develop into renal failure within 2 ~ 3 years. It is generally believed that patients with chronic nephritis with persistent hypertension and persistent renal insufficiency have poor prognosis. In short, chronic nephritis is a progressive glomerular disease with poor prognosis. Pathological classification of renal biopsy is reliable in judging prognosis. It is generally believed that minimal change nephropathy and simple mesangial proliferative nephritis have better prognosis, while membranous nephropathy progresses slowly and the prognosis is better than membranous proliferative nephritis. Most cases of the latter have renal insufficiency within several years, and the prognosis of focal segmental glomerulosclerosis is also poor. Recent studies have shown that besides glomerular lesions, the degree of renal tubular, intrarenal blood vessels and renal interstitial lesions obviously affects the prognosis. Renal tubular atrophy, renal small vessel sclerosis, infiltration of a large number of lymphocytes in renal interstitium and interstitial fibrosis have poor prognosis.
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