[Diagnosis]
I. Clinical manifestations
1. Clinical symptoms The clinical manifestations of this disease vary widely, with varying severity of symptoms, and there can be a fairly long period of asymptomatic urinary abnormalities. In the early stage, there may be physical fatigue, lumbar and knee pain, and poor memory, etc. Edema is sometimes absent. As the disease progresses, nocturia may gradually increase. Most patients have hypertension, and some patients have hypertension as the prominent manifestation. Kidney function may be reduced to different degrees. Wei Lianbo, Department of Nephrology, Zhujiang Hospital, Southern Medical University
2. Physical examination Chronic disease appearance, some patients have edema.
II. Examination
1.Urinary routine It may show varying degrees of proteinuria and/or hematuria, and there may be red blood cell tube type.
2.Blood routine Most patients have normal hemoglobin or mild anemia. White blood cells and platelets are mostly normal.
3.Renal function Most patients can have a long period of stable renal function. As the disease progresses, the late stage may show decreased urinary concentration function, elevated blood creatinine and decreased creatinine clearance.
4.B-type ultrasound The kidney size is normal in the early stage, but bilateral symmetrical shrinkage and cortical thinning may appear in the late stage.
Diagnostic criteria
The diagnosis can be considered if the disease develops slowly and other secondary glomerular and/or tubulointerstitial diseases can be excluded, and there are clinical abnormalities in urine routine and different degrees of renal function decreases. If there are no contraindications, renal biopsy is of great value in confirming the diagnosis, guiding treatment and assessing prognosis.
[Treatment]
I. Traditional Chinese medicine treatment.
1. Spleen and kidney deficiency without edema type
Main symptoms: soreness and weakness of the waist and knees, dizziness, fatigue, laziness, lack of breath and speech, lack of color, poor appetite and loose stools, pale tongue with white fur and weak pulse.
Treatment: Strengthening the spleen and tonifying the kidney.
Radix et Rhizoma Ginseng and Rhizoma Atractylodis Macrocephalae plus or minus. Radix Codonopsis Pilosulae 15g, Rhizoma Atractylodis Macrocephalae 15g, Atractylodes Macrocephalae 10g, Poria 20g, Semen Coicis 15g, Astragalus Membranaceus 30g, lotus flesh 15g, Gorgon fruit 20g, Golden cherry 20g, Radix et Rhizoma Glycyrrhiza Glabra 6g.
Addition and subtraction: Add 15g of Eucommia globulus if the back is sore, 10g of Chen Pi and 30g of Abdominal Bark if the abdomen is distended.
2.Spleen and kidney Yang deficiency edema type
Main symptoms: edema of the limbs and even the whole body, soreness of the waist and coldness of the limbs, pale face, loose stools, scanty urine, light fat tongue, white and greasy moss, sunken and thin pulse.
Treatment: Warming the kidney and promoting hydration.
Formula: Zhen Wu Tang with reduction. Radix et Rhizoma Pseudostellariae 6g, Poria 9g, Radix Paeoniae 9g, Ginger 9g, Atractylodes Macrocephala 6g.
Addition and subtraction: add 3g of cinnamon in case of kidney yang deficiency; add 15g of dahurian bark and 15g of psyllium in case of edema to enhance the effect of diuresis; add 30g of astragalus and 15g of codonopsis in case of spleen deficiency to strengthen the spleen and benefit the qi. For evidence of blood stasis, add 10g of leech and 20g of motherwort to activate blood circulation and resolve blood stasis. For abdominal distension, add 12g of betel nut and 10g of mucuna pruriens.
3.Yin deficiency of liver and kidney, dampness and heat within
Main symptoms: dizziness and tinnitus, lumbar soreness and leg weakness, dry mouth and throat, insomnia, yellow urine or astringent pain, or blood in urine, or mild swelling of the limbs, red tongue with little coating, thin pulse.
Treatment: Nourishing the liver and kidney, clearing heat and relieving dampness.
Radix Rehmanniae Pubescens, plus reduction.
Zhi Mu 10g, Cornelian 10g, Sheng Di 15g, Ze Di 10g, Shan Yao 10g, Fu Ling 40g, Dan Pi 12g, Xie Cao Root 30g, Zea Mays 30g.
Addition and subtraction: dizziness and tinnitus heavy add wolfberry 15g, chrysanthemum 12g, hooked vine (after the next) 15g, nourishing yin and submerging yang; blood in the urine plus small thistle 20g each, white foxglove 30g; urinary astringency and pain adverse plus q Cun 10g, Qu Mai 10g to clear damp heat; heartburn and insomnia plus light bamboo leaf 10g, gardenia 10g to clear heat and eliminate annoyance.
4, Qi and Yin deficiency type
Main symptoms: sore back and seminal emission, slight or no swelling of the limbs, palpitation and shortness of breath, lack of color, fatigue or dry throat and mouth, lack of color, red tongue with little coating, thin pulse or hematuria.
Treatment: Tonifying Qi and nourishing Yin
Formula: Ginseng and Astragalus Dihuang Tang with reduction.
Radix et Rhizoma Ginseng 12g, Radix Astragali 20g, Radix Astragali 10g, Cortex Eucommiae 10g, Rhizoma Polygonati 10g, Poria 20g, Dampi 10g, Zeligia 10g.
Addition and subtraction: for sore throat, add Mai Dong, Sha Shen, Red Peony to nourish Yin and invigorate Blood; for heavy swelling of limbs, add Poria, Che Qian Zi to promote water retention and reduce swelling.
5.Void of the ligament blocking type
Main symptoms: lumbar pain fixed or stabbing pain, dark gray face, dry skin, or petechiae, petechiae, decreased urine output, swollen limbs, purple tongue or petechiae, astringent and sunken pulse or fine count.
Treatment: Promote positive and expel evil, dispel blood stasis and promote circulation.
Radicals: Peach-Hong Siwu Tang with Addition and Reduction. Peach kernel 15g, safflower 10g, angelica 10g, Chuanxiong 10g, red peony 15g, motherwort 30g, salvia 20g, poria 15g, astragalus 20g, leech 10g.
6.Agreement formula: proteinuria as the main manifestation belongs to TCM Qi deficiency and blood stasis with proteinuria formula.
7. For proteinuria mainly manifested by Qi deficiency and blood stasis in TCM, use Renkang Pill 6g, taken orally 3 times a day.
8. Torch flower root tablets 5 tablets, orally, 3 times a day, or Lei Gong Gong Fu Polysaccharide tablets 20mg, orally, 3 times a day.
II. Western medical treatment
1, diet therapy High quality low protein diet (0.6~0.8/kg per day), while controlling the intake of phosphorus in the diet. When eating a low-protein diet, the intake of carbohydrates should be increased appropriately to meet the calories required for the physiological metabolism of the body and to prevent negative nitrogen balance.
2. Essential amino acids Essential amino acids or a-keto acids (0.1-0.2g/kg.d.) can be used after 2 weeks on a low protein diet.
For those on a very low protein diet, the intake of a-keto acid or essential amino acids should be increased appropriately (8~12g/d).
3.Control of hypertension Mostly use angiotensin-converting enzyme inhibitors (such as mercaptomethoproline 12.5~50mg/time, once every 8 hours) or calcium antagonists (such as Bysentone 30mg/time, once a day). As for other antihypertensive drugs such as ß-blockers, a-blockers, vasodilators and diuretics, they can also be used. In case of poor renal function, thiazide diuretics are ineffective or poorer and should be replaced with tab diuretics.
4, symptomatic treatment Prevention of infection, prevention of water-electrolyte and acid-base balance disorders, avoidance of nephrotoxic drugs is important to protect renal function and prevent progressive development of chronic renal disease and rapid deterioration of renal function.
5. ACEI or ARB antihypertensive drugs can be used to reduce proteinuria.
[Efficacy criteria]
1.Cure Clinical symptoms disappear, hematuria and proteinuria are negative, and renal function is normal;
2.Good Clinical symptoms basically disappeared, hematuria and proteinuria persisted, and renal function was normal.
3.Unhealed Clinical symptoms are obvious, hematuria and proteinuria persist, and renal function is normal or abnormal.