Scientific Life: Hello, Dr. Yang! Can you give our readers a general introduction to membranous nephropathy? Is the incidence related to age and gender? Dr. Yang: Membranous nephropathy is a pathological diagnosis characterized by diffuse immune complex deposition under the epithelial cells of the glomerular basement membrane with diffuse thickening of the basement membrane. The main manifestation of membranous nephropathy may be a nephrotic syndrome – a large amount of proteinuria, edema, hypoproteinemia and so on. Western medicine is not ideal for the treatment of membranous nephropathy, but the treatment of this disease has been discussed in Chinese medicine, and the results are still good. The incidence of this disease is predominantly in adults, with the age group of 40 to 50 years old. About 10%-20% of patients will go into remission on their own; about 40%-60% will continue to progress and progress to uremia in 10-15 years, and this part of the population needs treatment. Western medicine treatment is generally based on the proteinuria situation to choose different hormones and immunosuppressants and other programs of treatment. In recent years, we have seen more and more patients with membranous nephropathy, partly because of the increasing incidence and kidney penetration rate, and partly because Chinese medicine has certain advantages in treating membranous nephropathy, which can effectively compensate and solve some shortcomings and side effects in the process of Western medicine treatment. Scientific Life: What are the causes of membranous nephropathy? Dr. Yang: Membranous nephropathy is divided into primary and secondary, and excluding secondary is primary membranous nephropathy. Membranous nephropathy is a common pathological type of primary nephrotic syndrome in adults. Secondary membranous nephropathy where the etiology in order: 1, autoimmune diseases, such as common lupus nephritis, rheumatoid arthritis, Grave’s disease, mixed connective tissue disease, desiccation syndrome, psoriasis, etc.; 2, infections, such as common viral hepatitis B, followed by hepatitis C, syphilis, etc.; 3, tumors, such as digestive system, respiratory system, hematological system tumors, etc.; 4, drugs, such as common gold agents, mercury, D-penicillamine, etc. The incidence of primary membranous nephropathy in children is low and mostly secondary to membranous nephropathy, most commonly in hepatitis B virus-associated nephritis. Scientific Life: What are the discomfort symptoms of membranous nephropathy? Can it be self-detected? Dr. Yang: The initial symptoms of secondary membranous nephropathy are weakness, back pain and fatigue, dizziness and neck discomfort in patients with hypertension, proteinuria as the main symptom in blood test reports, followed by swelling of eyelids and lower limbs, which is somewhat different from edema in heart failure. Blood tests may show low protein and fluctuations in blood lipids. Patients themselves do not think they are patients with membranous nephropathy by virtue of these symptoms, and further punctures must be performed to confirm the specific disease. For patients with chronic diseases, we recommend them to have their urine routine checked every 2 weeks-1 month; for healthy people, we recommend them to have their urine routine checked every 6 months or a year, which is good for early detection of the disease. Scientific Life: Is it correct to say that “30% of membranous nephropathy heals spontaneously, 30% of proteinuria but normal kidney function, 30% of kidney failure, and 10% of complications or even fatal”? And what is the possibility of recurrence for each of them? Dr. Yang: This statement is basically correct: 10%-20% of people with membrane nephropathy will resolve on their own as the primary disease is controlled and improved, and their immune system is improved. There are also some people with proteinuria for a long time, I think this is also due to the fact that the amount of protein in his proteinuria is not much, for example, 1~2 grams, in such a case, he can have proteinuria for a long time and the kidney function is roughly normal. However, there is still a situation where a large amount of proteinuria (more than 6 grams) or even a dozen grams in his proteinuria, or with some infections, high blood pressure, abnormal blood sugar, etc., can make him progress to uremia within 10-15 years. There are also complications such as infections, blood clots, tumors, etc., which can lead to other diseases. Scientific Life: Dr. Yang, how does TCM treat membranous nephropathy? Dr. Yang: A clear diagnosis is the most important thing. To carry out the treatment of membranous nephropathy, other disease causes such as tumor, hepatitis B, infection, lupus, etc. should be ruled out first, and then western medicine immune agents and/or hormone treatment should be carried out according to its degree of proteinuria. However, along with western medical treatment, if the treatment is unsatisfactory, or if there are more side effects or complications, such as persistent proteinuria, then we recommend the patient to undergo Chinese medical treatment. At present, from the clinical large-scale double-blind controlled and other trials, we found that Chinese medicine has good effect on some patients with persistent proteinuria, mental depression, edema and discomfort, poor sleep, and strong hormone side effects, which can effectively control their proteinuria, protect their kidney function, and effectively improve their quality of life, etc. Meanwhile, the treatment of membranous nephropathy should not be required to be fast. In terms of TCM treatment, I think membranous nephropathy is generally treated in early, middle and late stages. For early stage membranous nephritis, TCM is based on clearing heat and detoxification, benefiting Qi and activating Blood; for middle and late stage membranous nephritis, it is based on strengthening the spleen and tonifying the kidney, benefiting Qi and activating Blood. It is usually necessary to follow up once in 1~2 weeks. Generally, do not change the prescription frequently if the evidence is accurate, and the condition usually improves in three months to a year. Scientific Life: Dr. Yang, some patients have taken herbal medicines indiscriminately or by mistake, resulting in herbal kidney, does this indicate the drawbacks of Chinese medicine in treating diseases? Is it that Chinese medicine has many side effects? Dr. Yang: As far as our hospital is concerned, our principle of treating kidney disease is to treat the disease that TCM is good at on the basis of clear diagnosis, not to treat kidney disease with TCM blindly and single-mindedly. So we can’t think which is more suitable for treatment and more advantageous for Chinese and Western medicine, but we have to see which treatment can better treat the disease, for example, in treating proteinuria, hematuria and chronic renal insufficiency, Chinese medicine has very good efficacy, so Chinese and Western medicine still have to actively cooperate to bring the gospel to patients. In the past, we thought that Chinese medicine had no side effects, in fact, this preaching now seems to be wrong. The earliest reported side effect is herbal nephropathy. In fact, the “Compendium of Materia Medica” has already divided herbal medicines into upper, middle and lower grades, and it is a misconception to think that herbal medicines have no side effects. Coupled with the cultivation of herbal medicines, the use of pesticides, excessive heavy metals and mold, we need to pay attention to not taking herbal medicines indiscriminately. Scientific Life: In the view of TCM, how do patients with membranous nephropathy usually take care of themselves? Is it possible to exercise? Dr. Yang: Half of the responsibility of kidney patients lies with patients and half with doctors. Patients must pay attention to their living habits, otherwise any effective treatment will be doubly effective. Patients with secondary membranous nephropathy should avoid spicy stimulation, seafood should also be eaten sparingly, or usually light. For patients with poor kidney function, roughly speaking, a glass of milk a day an egg protein amount. When you are sick, you should actively seek medical attention. Patients with membranous nephropathy have a large amount of proteinuria and the blood viscosity will be high, so proper exercise, such as walking and slow walking, is helpful for the treatment and physical recovery of membranous nephropathy.