Section I. Acute glomerulonephritis
I. Clinical manifestations
(a) Clinical symptoms The onset of the disease is relatively rapid, and there are mostly antecedent infections, such as upper respiratory tract or skin infections, 1~3 weeks before the onset of the disease. About 90% of the patients have edema, typically manifested as morning eyelid swelling, which may gradually spread to other parts of the body in severe cases; about 2/3 of the patients have hypertension, often transient moderate hypertension, and severe cases may develop hypertensive encephalopathy or heart failure. Most patients have oliguria, which recovers after 1 to 2 weeks. Only a small percentage of patients develop to anuria. Wei Lianbo, Department of Nephrology, Zhujiang Hospital, Southern Medical University
(II) Physical examination Most patients have edema, and in severe cases, ascites and pleural fluid may be present.
II. Examination
(I) Urine examination Almost all patients have microscopic hematuria, often accompanied by erythrocyte tubular pattern, and about 40% of patients have carnal hematuria; proteinuria is often mild or moderate, mostly non-selective proteinuria;
(ii) Hematological examination
1. Blood count: Mild orthochromic, orthocytic anemia, often due to water and sodium retention and hemodilution; leukocyte count is elevated in the presence of infection; hematocrit is often increased, usually 30-60 mm/h;
2, bacteriological and serological tests pharyngeal or skin pathogenic bacteria culture, about 20%-30% positive, after the use of antibiotics, the positive rate decreases; anti-streptococcal hemolysin “O” antibody positive rate of 50%-80%, often in 2-3 weeks after the streptococcal infection, 3-5 weeks to reach a peak and then gradually decline, 50% within 6 months Within 6 months, 50% of the antibodies will be normalized, and within 12 months, 75% of the antibodies will be normalized, and a few patients will continue for a longer period of time.
Most patients have a decrease in serum total complement activity (CH50) and C3 levels in the early stages of acute nephritis, which return to normal within 6-8 weeks.
4.Renal ultrasound examination with normal or enlarged size of both kidneys.
5. Renal tissue biopsy shows diffuse intracapillary proliferative glomerulonephritis.
Diagnostic criteria
(i) History of antecedent infection, such as respiratory or skin infection, for 1 to 3 weeks prior to onset.
(ii) The presence of typical clinical symptoms such as hematuria, proteinuria, edema and hypertension within a short period of time can be diagnosed as acute nephritis syndrome.
(iii) Positive culture of hemolytic streptococci, positive serological tests, and decreased serum complement contribute to the establishment of the diagnosis.
(iv) Continuous observation of urine changes and changes in serum complement levels is required in those with atypical clinical symptoms.
(v) The establishment of diagnosis depends on kidney biopsy.
I. Traditional Chinese medicine treatment
1. Damp-heat infiltration type
Main symptoms: ulceration of skin sores or abscesses, fever and vicious wind, swelling of the face, swelling of the whole body, urine with little color, bitterness and constipation of the mouth, red tongue, yellowish greasy coating, and slippery pulse.
Treatment: Clearing heat and detoxifying toxins, resolving dampness and subduing swelling.
Herbs: Ephedra, forsythia, red bean soup combined with Five Flavors Disinfectant Drink
Ephedra 5g, almond 9g, ginger bark 5g, sorrel 10g, forsythia 10g, adzuki bean 30g, silver flower 20g, wild chrysanthemum 12g, dandelion 12g, aster 12g, purple-backed asparagus 12g, white foxglove 30g.
Addition and subtraction: for skin erosion, add bitter ginseng, Tu Fu Ling to clear heat and permeate dampness; for redness and pus overflow, add saponaria, flea horn to clear heat and drain pus; for swelling, add zedoary, psyllium to diuretic and reduce swelling.
2.Water-damp impregnation type
Main symptoms: swelling of the limbs extending to the whole body, no fingers when pressed, short and cloudy urine, heavy and sleepy body, stuffy chest, dullness, generalized evil, white and greasy moss, sunken and slow pulse.
Treatment: Dampness and diuresis, promoting Yang and eliminating swelling.
Remedy: Wu Ling San combined with Wu Pi Drink. Zege 12g, Poria 12g, Poria 12g, Atractylodes macrocephala 10g, Cinnamomum 6g, Poria bark 9g, Dagashi 15g, Chenpi 9g, Ginger bark 9g.
Addition and subtraction: If the upper half of the body is very swollen, add Ephedra 6g, Almond 10g, Scapularia 6g to promote the lung and water; the lower half of the body is swollen, minus Mulberry Bark, add Sichuan Pepper 10g, Fangji 10g to disperse dampness, water and swelling.
3.Yin deficiency damp-heat type
Main symptoms: blood in urine or flesh-washing water-like urine, frequent urination, burning sensation, mostly without painful urination, often accompanied by irritable heat and thirst, lumbar soreness and leg weakness, or see swelling, red tongue with little coating, thin pulse.
Treatment: Nourish Yin, cool the blood, clear heat and dampness.
Remedy: Xiao thistle drink. Radix Rehmanniae 30g, Xiao Thistle 15g, Slippery Rock 15g, Plantago ovata 15g, Pu Huang 9g, Lotus Root 9g, Radix Rehmanniae 15g, White Fescue 30g, Motherwort 15g.
Addition and subtraction: If the heart is troubled and less sleepy, add Huang Lian 6g, light bamboo leaf 6g to clear the heart and calm the mind; if the yin deficiency is very strong, add Yuan Shen 12g, Lady’s Maidenhair 12g; if the blood in urine is obvious, add Dry Lotus Grass 15g, Xian He Cao 15g; if edema is present, add Ze Di 15g, Pig Ling 12g.
Second, Western medicine treatment
Treatment is mainly based on symptomatic treatment and rest. At the same time, prevent various complications, such as acute renal failure, heart failure, hypertensive encephalopathy, etc. Those with acute infection foci should use antibiotics.
1.Control of infection Available penicillin (800,000 U, intramuscular injection, 2 times/day) or macrolide antibiotics (such as erythromycin 0.25g, 4 times/day) for 10-14 days.
2. Symptomatic treatment If edema does not subside even after restricting water and sodium intake, diuretics should be used. Hydrochlorothiazide 25mg, 2~3 times/day or fosfomycin (tachyphylaxis) 20~40mg, 1~2 times/day can be used. In severe cases, tachyphylaxis can be used for intravenous infusion. If the increase in blood pressure cannot be controlled by diuretic treatment, calcium antagonist antihypertensive drugs such as Bexincom 30mg, 1 time/day or ACEI type antihypertensive drugs can be used.
3, rest and nutrition PSGN patients should pay more attention to rest until the hematuria disappears, edema subsides, and blood pressure returns to normal. Also eat a diet that is easy to digest and rich in vitamins. Patients with edema and hypertension should appropriately limit the intake of water and salt. In case of renal insufficiency, protein intake should be restricted.
4.Dialysis treatment Patients with oliguric acute renal failure, severe and difficult to correct hyperkalemia and heart failure should be treated with dialysis.
[Efficacy criteria]
I. Cure Clinical symptoms disappear, urine red blood cells and urine protein turn negative, blood sedimentation and complement are normal.
Improvement Clinical symptoms basically disappear, but there is still persistent microscopic hematuria or mild proteinuria, and renal function is normal.
III. Not cured Clinical symptoms persist with significant hematuria and proteinuria.