April 20 every year is the “National High Uric Acid Day”, the reason why April 20, because 420 is the normal upper limit of men’s blood uric acid levels (women need to be less than 360umol / L), if the fasting blood uric acid level of more than 420umol / L, that is, you need to be vigilant ” Hyperuricemia”. With the improvement of living standards, the incidence of “hyperuricemia” is increasing year by year, according to the “2017 China Gout Status Report White Paper” shows that the number of patients with hyperuricemia in China has reached 170 million, of which more than 80 million people suffer from gout, and it is rapidly increasing at an annual growth rate of 9.7%. Therefore, “hyperuricemia” is called following high blood pressure, high cholesterol, high blood sugar “three high” after the veritable “fourth high”. When it comes to the harm of hyperuricemia, the first thing that comes to mind is “gout”, which is a common harm of hyperuricemia. Excess urate crystals deposited in the bone joints and cartilage can be induced “gout” attack, manifested as joint swelling, redness, pain, repeated gout attacks can appear “gout stone”, resulting in joint deformation, stiffness, limited mobility. But in fact, hyperuricemia has greater harm: it can cause “atherosclerosis”, induced cardiovascular and cerebrovascular diseases; can aggravate metabolic diseases, cause insulin resistance, so that it is difficult to control blood glucose; more importantly, high uric acid can cause “uric acid nephropathy What’s more, high uric acid can cause “uric acid nephropathy”. Today, nephrologists will talk to you about the topic of “uric acid nephropathy”. How does high uric acid damage the kidneys? The kidney is an important place to remove uric acid, when the body’s blood uric acid level at a very high level, excess urate crystals will be deposited in the renal tubules and renal interstitium, the obstruction of uric acid can activate the renal local chronic inflammation, immune damage, microvascular pathology, leading to the development of chronic kidney disease. Clinically, there are three main forms of “uric acid nephropathy”: the first one is: acute uric acid nephropathy. The first one is: acute uric acid nephropathy. It is due to a large number of uric acid crystals widely blocked in the renal tubular lumen, which can directly lead to the emergence of acute renal failure, which is less common. The second form is called: uric acid stones. That is, stones formed when uric acid is deposited anywhere throughout the urinary tract, including the kidneys, ureters, and bladder. Large stones can directly obstruct the urethra, resulting in renal colic and hematuria. The third type is called “chronic urate nephropathy”, which is chronic interstitial nephritis caused by high uric acid, and can be manifested as a small amount of proteinuria and hematuria in the early stage, with impaired renal concentrating function, increased nocturia, and ultimately damage to renal function, chronic renal failure, and ultimately develop to “uremia”. “. Clinically, in fact, the most difficult is the third type of “chronic urate nephropathy”, because of its high incidence, insidious onset, and is not taken seriously, these patients can be accompanied by irreversible kidney damage, the severity of the damage, often associated with the duration and magnitude of the elevation of blood uric acid. What to do when patients with uric acid nephropathy develop renal failure? (A) The right way to open the diet and exercise Low purine healthy diet program: Need to avoid the use of food: fructose drinks, broth and gravy, animal offal, yellow wine, beer, liquor. Foods to limit: beef, lamb, pork, seafood, sweets, flavored sugar, flavored salt (soy sauce), red wine and alcoholic beverages Foods to encourage: vegetables, low-fat and skimmed milk and products, eggs. Healthy lifestyle and exercise High uric acid encourages drinking more water, you can drink soda properly to promote uric acid excretion, put the urine pH in the range of 6.2 ~ 6.9 range is most conducive to the dissolution of urate crystals and discharged from the urine. Life is recommended to quit smoking and alcohol. Encourage patients to appropriate aerobic exercise, such as walking, tai chi, brisk walking are more recommended, but need to pay attention to gradual and orderly, to avoid exertion and cold, for obese patients need to control the ideal weight through exercise and diet. (B) reasonable lowering uric acid to trace the origin of the treatment of uric acid nephropathy, patients first need to pay attention to the lowering of uric acid treatment, which is critical to reduce the frequency of gout attacks, remove hyperuricemia persistent kidney injury. It is recommended that patients go to nephrology outpatient clinic and choose appropriate uric acid-lowering drugs under the guidance of doctors to control blood uric acid in the ideal range. Clinical uric acid-lowering drugs are mainly divided into two categories: drugs that promote uric acid excretion, such as benzbromarone; drugs that inhibit uric acid production, such as febuxostat. The two types of drugs have their own advantages and disadvantages, patients with uric acid nephropathy than ordinary hyperuricemia patients with more mixed conditions, patients tend to have higher creatinine, glomerular rate filtration GFR <50ml/(min?1.73m2), or combined with renal calculi, it is generally recommended to use inhibitory uric acid production drugs. Patients with reduced renal function are also more prone to drug side effects, so further outpatient follow-up is needed to track liver and kidney function, blood routine and other indicators, and keep an eye out for uncomfortable reactions. The use of Chinese herbs to strengthen the spleen, promote dampness and tonify the kidneys can synergize with uric acid-lowering drugs to further control the blood uric acid level and reduce the dosage of uric acid-lowering western drugs. (C) Chinese medicine improves renal function and reduces gout attacks For patients with uric acid nephropathy who have already developed renal failure, in addition to the integrated treatment of chronic renal failure and active control of various risk factors that accelerate chronic renal failure, it is recommended to cooperate with Chinese medicine treatment. Chinese medicine treatment is divided into acute stage and stable stage. Acute gout: many patients like to eat fat, sweet and thick flavors, wet from the internal birth, wet from the heat, wet and hot for the disease, traditional Chinese medicine treatment when the clearing of heat and diuresis for pain as the main, while taking Chinese medicine can also be used with the hospital preparation of Jinhuang paste external application can reduce pain, reduce the use of anti-inflammatory painkillers that are detrimental to the kidneys. Chronic uric acid nephropathy: patients with dampness and phlegm stasis conjunction, phlegm stasis and dampness glue solid visible gout stone, joint stiffness, long illness, dampness and heat impregnation of the kidney, at this moment the patient's liver and kidneys are weak, easy to appear renal insufficiency, fatigue, lumbar pain, increased nocturia, eyelid swelling and other manifestations of renal deficiency. Therefore, Chinese medicine treatment of chronic uric acid nephropathy mainly starts from the disease mechanism of spleen and kidney deficiency, dampness, heat and stagnation, tonifying the kidney and draining the turbidity, and clearing away the dampness are the basic treatment rules. Chronic kidney disease combined with hyperuricemia is one of the advantageous diseases in the Department of Nephrology, Pudong Branch, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, and its treatment plan is based on the combination of Chinese and Western medicine and kidney disease of Professor Chen Yiping's experience in addition to subtractions, which has been clinically observed over the years to reduce the symptoms of lumbar soreness and fatigue of the patient, and in coordination with the uric acid-lowering medication to further control the level of blood uric acid, reduce the frequency of gouty episodes and stiffness of the joints, and improve the patient's renal function and reduce the serum creatinine. It can also improve patients' renal function, reduce serum creatinine level and increase patients' glomerular filtration rate, which will bring benefits to the majority of patients with uric acid nephropathy. The nephrology department of the branch is currently recruiting patients with blood uric acid >480umol/l, renal failure, glomerular filtration rate between 15-50ml/(min?1.73m2) for the clinical research project of Shanghai Municipal Commission of Health and Wellness, which is “Evaluation of clinical efficacy of Chinese medicine integrated program for treatment of chronic kidney disease combined with hyperuricemia”. patients with chronic kidney disease.