Chronic glomerulonephritis (chronic nephritis for short) is a group of primary glomerular diseases with different etiologies and diverse pathological changes. It is characterized clinically by proteinuria and/or hematuria and varying degrees of hypertension, edema, and/or slowly progressive renal function impairment. The disease can occur at different ages, but is predominant in middle-aged and young adults.
Major pathological subtypes and clinical symptoms.
Chronic nephritis is generally divided into the following types.
1, thylakoid proliferative nephritis.
2, IgA nephropathy.
3, membranous nephropathy.
4, thylakoid capillary glomerulonephritis.
5, focal segmental glomerulosclerosis.
6, proliferative sclerosing glomerulonephritis.
The early stage of the disease may have fatigue and weakness, back pain and other systemic symptoms. Characteristic clinical manifestations include.
(1) edema. Mostly mild to moderate edema of the eyelids and/or lower extremities, usually without body cavity effusion.
(2) Hypertension. Most often appear in renal failure, and in some cases, elevated blood pressure may be found when renal function is normal. Patients may have fundus hemorrhage, exudate, or even papilledema.
(3) Hematuria. Glomerulogenic hematuria is present, and individual cases may also show carnal hematuria.
(4) Proteinuria. 24h urine protein is often 1-3g, but there are also those who show large amount of proteinuria.
(5) Renal function impairment. Chronic progressive renal function impairment.
Diagnosis
The disease should be considered if there is abnormal urinalysis, proteinuria, hematuria or tubular urine with a history of edema and hypertension for more than 1 year. In addition to secondary nephritis, such as lupus nephritis, allergic purpura nephritis, hepatitis B-associated nephritis and hereditary nephropathy, chronic nephritis can be diagnosed clinically. Renal puncture pathology examination is of great significance in clarifying the diagnosis, guiding the treatment and judging the prognosis.
Treatment
(A) Western medicine
1., low salt, low protein diet.
Particular attention should be paid to the control of dietary protein: low salt helps edema and hypertension
The control of edema and hypertension. A high-quality, low-protein diet with 0.6-0.8g of protein per kg of body weight per day is appropriate.
2.Actively control hypertension: choose antihypertensive drugs such as benazepril, coxsartan and amlodipine under the guidance of doctors, so that blood pressure should be controlled within 130/80mmHg as much as possible.
3.Anticoagulation and platelet depolymerizing drugs: anticoagulation and platelet depolymerizing drugs are shown to have the effect of stabilizing renal function and reducing renal pathological damage. 25-50mg of dipyridamole is commonly used orally 3 times a day.
4.Prevent and actively treat infections: such as urinary tract infections and upper respiratory tract infections.
5.Prohibit nephrotoxic drugs: such as aminoglycoside antibiotics, such as gentamicin, etc., and disulfiramycin B, etc.
(B) Chinese medicine
1, identification and treatment: chronic nephritis belongs to the category of “edema”, “lumbago”, “hematuria” in Chinese medicine
It is the evidence of deficiency of the root and the symptoms. This deficiency refers to the deficiency of the lung, spleen and kidney, while the symptoms refer to external sensation, water-dampness, damp-heat, dampness and blood stasis. During the whole disease process, the waxing and waning of the positive energy and the disease evil lead to the variability of the symptoms, and individualized herbal formulas can be selected according to the corresponding symptoms. In addition, the Chinese patent medicines often used together with the Huang Quai capsule, nephritis rehabilitation tablets, Zheng Qing Feng Pain Ning tablets, etc. Our homemade Chinese medicine Blood Urine An and Yi Qi Nourishing Kidney Oral Liquid also have very good efficacy.
2.Medicinal treatment: compound astragalus porridge
It is composed of 60g of raw Astragalus, 30g of raw Coix seed, 15g of adzuki beans, 9g of hen’s internal gold (finely ground), 2 golden orange cakes and 30g of glutinous rice. First, 500ml of water, boil astragalus for 20 minutes, remove the dregs, then into the coix seeds, red beans, boil for 30 minutes, and again people chicken gold, glutinous rice, cooked into a porridge, as a daily amount, divided into two doses, chew kumquat cake 1 after eating, 1 dose daily.