TCM Acupuncture and Massage

Chapter 52 Genitourinary System Diseases (1)
Chronic nephritis

An overview of the disease

([-]) Relevant knowledge

Chronic nephritis, short for chronic glomerulonephritis, is a group of chronic glomerular diseases with different etiologies and various pathological changes.The clinical features are long course of disease, gradual progression of the disease, proteinuria, hematuria, high blood pressure, and renal impairment. Renal failure will eventually occur after 2 to 3 years or 20 to 30 years of illness.

([-]) Etiology and pathology

1. Causes
The etiology is unclear, but its pathogenesis is an autoimmune reaction process.Deficiency in the immune function of patients can reduce the body's ability to resist infection and lead to repeated microbial invasion; the body cannot produce enough antibodies to remove pathogenic substances (antigens), so that the antigens can persist in the body and form immune complexes, depositing In the kidney tissue, a chronic inflammatory process occurs.In addition, non-immune-mediated kidney damage may also play an important role in the occurrence and development of chronic nephritis. For example, the compensatory increase in serum perfusion pressure in healthy nephrons and the increase in glomerular capillary pressure can lead to glomerulosclerosis .Hypertension during the course of the disease, long-standing, can lead to narrowing and occlusion of renal arterioles, accelerating glomerulosclerosis.

2. Pathology
The pathological change of chronic nephritis is diffuse glomerulopathy in both kidneys.Due to the chronic inflammatory process, glomerular capillaries are gradually destroyed, and fibrous tissue proliferates; glomerular fibrosis and hyalinization form unstructured hyaline clusters.Due to obstruction of glomerular blood flow, corresponding renal tubular atrophy, fibrosis, interstitial fibrous tissue hyperplasia, and lymphocyte infiltration.Compensatory hypertrophy occurs in nephrons with mild lesions; hypertrophic glomeruli are sometimes seen among sclerotic glomeruli.With the gradual development of the disease, it will eventually lead to severe destruction of renal tissue, forming end-stage pyknotic kidney.

([-]) Clinical manifestations

1. Patients with prodromal symptoms have no history of acute nephritis or streptococcal infection, so it is difficult to determine the cause.

2. The onset mode is different. Some patients have no obvious symptoms at the beginning, and only proteinuria or high blood pressure are found during physical examination.Most patients have clinical symptoms such as fatigue, headache, edema, high blood pressure, and anemia after the onset of the disease. A small number of patients have acute onset, obvious edema, and large amounts of protein in the urine. Some patients are asymptomatic until vomiting, bleeding, etc. Fang sees a doctor.

3. Hypertension There are different degrees of hypertension, most of which are mild to moderate and persistent.

4. Changes in urine is an inevitable symptom of chronic nephritis. Most of the urine output is less than 1000ml/day, and a small number may appear oliguria, often accompanied by edema; those with obvious damage to renal tubular function will have increased urine output accompanied by There is nocturia, no obvious edema, and even signs of dehydration.

5. Central nervous system symptoms may include headache, dizziness, loss of appetite, fatigue, insomnia, etc., which are related to hypertension, anemia, certain metabolic and endocrine dysfunction, etc. 6. Anemia is related to the decrease of erythropoietin secreted by the kidneys, resulting in decreased differentiation, maturation and release of red blood cells. 7. Others often have cardiac insufficiency due to hypertension, arteriosclerosis, and anemia, and long-term protein loss in urine, resulting in hypoproteinemia.Some patients have edema, high blood pressure, or repeated attacks as their prominent manifestations. It is customary to divide chronic nephritis into common type, high blood pressure type and acute attack type clinically.However, these three types are not completely separated, and often overlap and transform.

([-]) Inspection

1. Urine routine urine specific gravity is low, usually below 1.020, and it is often fixed at 1.010 in the advanced stage of the disease.Urinary protein traces ranged from +++.Red blood cells and casts (granular casts, hyaline casts) are often present in the urine.In the acute attack stage, there is obvious hematuria or gross hematuria.

2. Blood tests often show mild to moderate anemia, red blood cells and hemoglobin decrease proportionally, erythrocyte sedimentation rate increases, hypoproteinemia may occur, and generally there is no obvious abnormality in serum electrolytes.

3. Renal function test: glomerular filtration rate, endogenous creatinine clearance rate decreased, blood urea nitrogen and creatinine increased.

([-]) Diagnosis

Diagnostic criteria for chronic glomerulonephritis: 1. The onset is slow, the condition is protracted, sometimes mild and sometimes severe, renal function gradually declines, anemia, retinopathy and uremia may appear in the later stage.

2. There are varying degrees of proteinuria, hematuria, edema, and hypertension, with varying degrees of severity.

3. In the course of the disease, acute attacks may be induced by respiratory tract infection and other reasons, and symptoms similar to acute nephritis may appear.There are also some cases that can have an automatic remission period.

4. According to clinical manifestations, it can be further divided into:

(1) Common type: There are various symptoms of nephritis, but no outstanding performance.

(2) Hypertensive type: In addition to general nephritis symptoms, there are prominent manifestations of hypertension.

(3) Acute attack type: Acute nephritic syndrome appears in the chronic process.

Anyone who has the above clinical manifestations and lasts for more than 1 year should consider this disease.Renal biopsy is not only helpful for diagnosis, but also can estimate prognosis and guide treatment.

([-]) Treatment

At present, there is no effective treatment for chronic nephritis. In principle, it is symptomatic treatment, including rest, eating a small amount of salt, appropriately restricting protein food, diuresis to reduce edema, lowering high blood pressure, preventing and treating heart failure, etc., and not using nephrotoxic drugs.Appropriate use of drugs that nourish and protect the kidneys.Diuresis, lowering high blood pressure, and preventing heart and brain complications are the focus of treatment.

1. General treatment Encourage patients to build confidence in overcoming the disease, prevent infection, strengthen rest, and avoid strenuous physical activity, but do appropriate and beneficial activities.

2. People with edema, hypertension or renal insufficiency should limit their sodium intake and properly control their water intake. For those with a large amount of proteinuria, patients should increase their protein intake.Those with renal insufficiency should be given high-quality protein, about 40g per day.Except for those with hyperlipidemia, there is no limit to fat, and sufficient vitamins should be given.

3. The application of diuretics. Diuretics are not necessary for mild edema. Patients with moderate or above edema can choose according to the condition. They can be used alone or in combination. The dose should be small to large, and the swelling should be gradually reduced to prevent electrolyte imbalance.

4. Antihypertensive drugs should be given appropriately depending on the condition.

5. Anticoagulant therapy and anti-oxidant application studies have shown that this type of drug has a good effect on stabilizing renal function and reducing pathological damage to the kidney.

6. Traditional Chinese medicine can be used for the treatment of traditional Chinese medicine, which can clear away heat and detoxify, reduce swelling and diuresis, and promote blood circulation and remove blood stasis.

7. Combination therapy Chronic nephritis is treated with a single drug, and the curative effect is often unsatisfactory. Combination therapy uses anticoagulant drugs, antioxidants, traditional Chinese medicine and symptomatic treatment, which can improve the curative effect.

([-]) Prognosis

The natural course of chronic nephritis patients varies greatly. Some patients are relatively stable. After 5 to 6 years, or even 20 to 30 years, they develop into the stage of renal insufficiency. A small number of patients can relieve themselves.Another part of the patient's condition develops to renal failure within 2 to 3 years due to continuous development or recurrent attacks.Generally, patients with chronic nephritis, persistent hypertension and persistent renal insufficiency have a poor prognosis.In conclusion, chronic nephritis is a progressive glomerular disease with poor prognosis.The pathological classification of renal biopsy is more reliable in judging the prognosis.

([-]) Prevention

1. Pay attention to rest and avoid overwork.Prevent catching a cold or upper respiratory tract infection.

2. If you have tonsillitis, otitis media, sinusitis, or dental caries, you should be diagnosed and treated in time.Pay attention to personal hygiene, keep the skin clean and prevent skin infection.These are the triggers that may lead to the recurrence or activity of the disease.

3.浮肿明显、大量蛋白尿而肾功能正常者可适量补充蛋白质饮食。无水肿及低蛋白血症时，每日蛋白质摄入量应限制在每公斤体重0.6克（每瓶牛奶约含6克蛋白质，每只蛋约含6克蛋白质，每50克米饭约含4克植物蛋白质）。

4. People with edema, high blood pressure and heart failure should eat a low-salt diet, and the daily salt intake should be less than 5 grams.

5. Avoid taking drugs that are nephrotoxic or easily induce renal damage, such as gentamicin, sulfa drugs, non-steroidal anti-inflammatory drugs, antipyretic and analgesic drugs such as phenacetin, etc.

6. Check the urine frequently. If there are more than 10 red blood cells per high-powered field of view in the urine, rest in bed.

7. Patients with hyperlipidemia, hyperglycemia, hypercalcemia and hyperuricemia should be given appropriate treatment in time to prevent aggravation of kidney damage.

(End of this chapter)