Asymptomatic IgA nephropathy with abnormal urinalysis refers to IgA nephropathy without clinical manifestations such as edema and hypertension, normal renal function, and only manifests as renal hematuria and/or proteinuria. Due to the absence of clinical symptoms or mild symptoms, doctors and patients did not pay enough attention to it in the past. With the development of renal tissue biopsy technology and the improvement of patients’ health awareness, asymptomatic IgA nephropathy is gradually gaining attention because more and more studies have shown that asymptomatic IgA nephropathy is not a mild pathological change or necessarily a benign lesion, and there is a possibility of renal failure in the subsequent course of the disease.
Some reports show that the natural course of IgA nephropathy: at the time of renal puncture if renal function is normal, GFR decreases 1-3 ml/min per year; in patients with nephrotic syndrome, GFR decreases 9 ml/min per year; in patients with Scr >3 mg/dl, GFR has to decrease 20 ml/min per year.(1)(2) In case of occult glomerulonephritis: 44% of patients present progression of disease, 23% of patients are in clinical remission; 30% of patients progress to ESRD after 20 years; another 30% of patients show a decrease in renal function. (3) Since asymptomatic IgA nephropathy with abnormal urinalysis can also lead to renal failure if left to develop, early intervention and treatment is necessary. Chinese medicine has its own characteristics in the treatment of IgA nephropathy, which are not only related to the different understanding of the pathogenesis and changes of the disease, but also related to the geographical characteristics, diet and living habits of the patients, because different geographical environment, genetic background and living habits can lead to different information collected by the four consultations of Chinese medicine, and the identification and prescription of the disease.
The information collected by the four consultations of TCM doctors may be different, and the diagnosis and prescription may also be different. Therefore, the treatment of IgA nephropathy in Chinese medicine is very diverse, and the benevolent will see the wisdom of the wise.
The pathogenesis of IgA nephropathy is still unclear and involves two major factors: immunity and genetics. The incidence of IgA nephropathy is significantly correlated with race and geographic distribution, and familial IgA nephropathy has been reported; its development is associated with HLA; HLA class I antigens are distributed in all nucleated cells. Their antigenic specificity lies in the specific amino acid sequence of the peptide chain antigenic determinant cluster. These antigens can be altered by foreign substances such as a virus or a chemical, and when these gene products are altered, they become autoimmune and become targets for immune exclusion. It is clear that the essence of the target function is to “recognize the self” in order to ensure the integrity of the body. However, the double-edged sword of 118 is also one of the causes of IgA nephropathy.
I believe that Chinese medicine treatment of IgA nephropathy, regardless of whether the clinical symptoms are obvious, should grasp three points, the first prevention of problems before they occur: adjust the balance of the body’s yin and yang qi and blood, enhance resistance, prevent the occurrence of various infections, to avoid the occurrence of worse immune response, aggravating the disease. Secondly to actively control and treat infections when they are present. Thirdly to prevent and control the aggravation of renal pathological changes and prevent the occurrence of renal fibrosis.
Treatment of patients with IgA nephropathy when infections occur.
Upper respiratory tract infection: manifested as sore throat, runny nose, cough, sputum, or fever and headache, increased hematuria, proteinuria, or hematuria with the naked eye.
The TCM etiology of sore throat and runny nose as the main cause: wind-heat external attack. The method of draining wind and clearing heat and relieving pharynx is given with Yin Qiao San plus reduction: Jin Yin Hua, Lian Qiao, Thornbush, Burdock, Tempeh, Peppermint, Pan Lan Gen, Bamboo Leaf, Bai Mao Gen, Angelica dahurica, etc.
Chinese patent medicine: Yin Qiao Jie Po Po granules, Lian Hua Qing Fei capsule, etc.
Cough, sputum and fever are the main causes of TCM: wind-heat offending the lung. Use the method of clearing heat and promoting the lung, with Ma Heng Shi Gan Tang plus Di Bai San and Er Chen Tang with addition and subtraction:roasted ephedra, almonds, raw gypsum, raw licorice, mulberry peel, ground bone bark, dandelion, Chen Pi, Semen Parsley, Poria, Scutellaria, etc.
Chinese patent medicine: mahjang shigang oral liquid + Lianhua Qingxian granules.
Urinary tract infection: frequent, urgent, hot and painful urination, red urine, or fever, lumbar pain and edema. The cause of TCM is damp-heat invasion, downward transmission of bladder, unfavorable water channels, heat knots in the lower jiao, which can lead to edema and blood and proteinuria in urine. The treatment is to clear damp-heat by adding and subtracting Bazheng San plus Xiao Thistle Drink: Q Cun, Qu Mai, Shi Wei, Lanxian Cao, Liu Yi San, Ze Di, Che Qian Cao, Han Zhi Lian, Dandelion, Bamboo Leaf, Xiao Thistle, Pu Huang Char, Sheng Di, Lotus Root, etc.
Chinese patent medicines: Bazheng San (granules), Sanjin Tablets, Hot Lin Qing, Blood and urine, Huang Quai Capsules, etc.
Intestinal infection: diarrhea, abdominal pain, nausea, loss of appetite, or fever, increased hematuria and proteinuria. In Chinese medicine, the cause is damp-heat invasion, the large intestine is not properly transmitted and transformed, the stomach is not harmonized and lowered, resulting in diarrhea and discharge. The treatment is Baitou Weng Tang or Ge Ge Gen Scutellaria Huanglian Tang plus San Ren Tang with addition and subtraction: Baitou Weng, Huanglian, Qin Pi, Cao Xi, Cardamom, Almond, Ginger, Semen, Plantain, Bamboo Leaf, Bamboo Roo, Horsetail, etc.
Adjustment of the physique of patients with IgA nephropathy to prevent problems before they occur.
Qi and yin deficiency: Qi and yin deficiency in the body, or excessive exertion, resulting in Qi and yin deficiency: weakness and tiredness, lumbago and weakness, susceptibility to colds, spontaneous sweating and/or night sweating, hematuria and/or proteinuria.
Treatment can be done with Ginseng and Radix Rehmanniae Tang with addition and subtraction as appropriate: Astragalus, Radix Codonopsis (prince’s ginseng), Radix Rehmanniae, Cornu Cervi Pantotrichum, Poria, Dampi, Zedoary, Fructus Lycii, Panax quinquefolium, etc.
119 liver and kidney yin, deficiency fire: vegetative liver and kidney yin deficiency, or fatigue injury, yin deficiency will produce internal heat: weakness, lumbar acidity, dry mouth at night, spontaneous sweating and or night sweats, insomnia and susceptibility to insomnia, or heat in the heart of the hands and feet, heart trouble. Blood in urine if heat injures the kidney complex.
Treatment can be given by adding or subtracting: salt cypress, salt Zhi Mu, rehmannia, tortoise board, (pig spinal cord), huai niu knee, mulberry, wolfberry, danpi, small thistle, lotus root, chasteberry, dry lotus grass, etc.
Spleen and kidney Qi deficiency
The clinical manifestations are: weakness and shortness of breath, abdominal distension and loose stools, fatigue, weakness of the back and legs, and swelling of the lower limbs. Proteinuria and hematuria may occur. Treatment may include the following additions and subtractions: Guei Spleen Tang, Wu Zi Yan Zong Wan, Tonic Zhong Yi Qi Tang, Shui Lu Er Xian Dan, etc.
Astragalus, Radix Codonopsis, Radix Angelicae Sinensis, Rhizoma Atractylodis Macrocephalae, Poria, Fructus Lycii, Semen Cuscutae, Raspberry, Fructus Schisandrae, Fructus Gorgonii, Semen Plantago.
How to prevent renal fibrosis in patients with IgA nephropathy?
(Personal experience)
The kidney fibrosis of IgA nephropathy is a chronic process, in the process of Chinese medicine treatment, constantly adjust the balance of yin and yang qi and blood, so that the body is in good condition at all times, to be able to resist the attack of external evil, in the event of infection, to control the development of the disease as soon as possible, in order to reduce the immune response to aggravate the kidney damage, so the treatment should pay attention to clearing heat and detoxification, cool blood to stop bleeding; in the remission and chronic development stage to pay attention to the supplementation plus In the remission stage and chronic development stage, attention should be paid to tonifying plus activating blood circulation and removing blood stasis.
Because in the pathological changes of the disease, the blood clotting system is activated, which accelerates the renal pathological process, which is consistent with the theory of Chinese medicine that long-term disease enters the ligament. At the same time, some patients with IgA nephropathy also have lipid metabolism disorder, and some drugs to activate blood circulation and remove blood stasis are helpful to improve lipid metabolism disorder. In long-term clinical observation, I found that patients with lipid metabolism disorder and glucose metabolism disorder are also prone to infections. According to Chinese medicine, where evil is present, its qi must be deficient. Only by fully mobilizing the positive factors of the body can we resist external evil and mobilize a positive immune response to make the condition progress in a good direction. It is also the best way to prevent kidney fibrosis.