With the aging of society, the elderly population in China is increasing and the incidence of kidney disease in the elderly is on the rise. The kidneys of the elderly change morphologically and functionally as they age. Nephrotic syndrome of the elderly (NSIE) is reported to account for about 33%-60% of nephropathies in the elderly . Therefore, its diagnosis and treatment have been paid more and more attention. For this reason, the reporter interviewed Professor Li Wei, an expert in nephrology from Shandong Provincial Hospital, and asked her to talk about the prevention and treatment of nephropathy.
A. Prevention of chronic kidney disease starts from daily life
Professor Li Wei pointed out that chronic kidney disease refers to chronic kidney structural and functional disorders (history of kidney injury > 3 months) caused by various reasons, including normal and abnormal glomerular filtration rate (GFR), pathological injury, abnormal blood or urine composition, abnormal imaging, or unexplained decrease in GFR (GFR < 60 ml/min) for more than 3 months. Chronic kidney disease is a common disease that poses a serious risk to human health and life. Its high prevalence, high mortality rate and low awareness rate have made it a public health and medical problem that cannot be ignored. Its serious consequences are end-stage renal disease (uremia). Therefore, the prevention and treatment of this disease is especially important and should start from daily life.
A regular life and a reasonable diet are very beneficial for the prevention and control of any disease. Do not consume excessive high protein foods. Protein intake is digested and absorbed to produce a series of metabolites excreted by the kidneys. Excessive protein intake can increase the excretory burden on the kidneys, leaving the kidneys in a high metabolic state, especially the elderly and those who have kidney disease should avoid a high protein diet, eat digestible, vitamin-rich foods, pay attention to food safety, eat more fresh fruits and natural foods.
Infections often cause or aggravate chronic kidney disease as a cause. In general, we should pay attention to appropriate exercise to enhance the body’s resistance; at the same time, we should avoid strain and cold to prevent infection. Such as upper respiratory tract infection, influenza, pharyngitis, tracheobronchitis, urinary tract infection and asymptomatic bacteriuria, etc., may become the trigger for the onset of chronic kidney disease or aggravate the symptoms.
Because of its special structure and function, the kidney is the most drug-sensitive organ in the body. Common nephrotoxic drugs include aminoglycosides (gentamicin, kanamycin, etc.), cephalosporins, vancomycin, sulfonamides, non-steroidal anti-inflammatory drugs, contrast agents and herbal medicines containing aristolochic acid (such as Guanmu Tong, Guang Fangji and Qing Mu Xiang; Chinese patent medicines such as Gentian Diarrhea Liver Pill and Guanxin Suhe Wan). These drugs may lead to acute and chronic kidney damage, and it is not yet possible to determine the susceptible population for nephrotoxicity of the above drugs, but patients with existing chronic diseases such as kidney disease, hypertension and diabetes should pay special attention when using the above drugs.
Blood pressure is an independent risk factor that causes and aggravates kidney injury. Active prevention of hypertension and making blood pressure reach the standard are important measures to avoid kidney injury and delay the progression of kidney disease. For elderly people, blood pressure should be controlled at 140/90mmHg, for kidney disease and diabetic patients, blood pressure should be controlled at 130/80mmHg or less, and for those who have more than 1 gram of proteinuria per day, blood pressure should be controlled at 125/75mmHg. Attention should be paid to keep blood pressure stable during treatment to avoid blood pressure falling too fast or too low to aggravate the lack of blood supply to heart, brain and kidney.
Professor Li said that as early as the Yellow Emperor’s Classic of Internal Medicine, “calmness and emptiness, the true energy from the, the spirit of internal control, the disease is safe from”, which shows the importance of spiritual regimentation for the prevention and treatment of disease. Patients with chronic kidney disease should treat the disease correctly, keep a cheerful mood, emotional stability, proactively cooperate with the doctor’s treatment, emotional conditioning, in order to recover health as soon as possible.
Second, the prevention of nephrotic syndrome in the elderly Chinese medicine has advantages
Professor Li Wei said “Nephrotic syndrome is a common kidney disease, it is a group of syndromes with a large amount of proteinuria, hypoproteinemia, edema and hyperlipidemia as the main clinical manifestations.” Nephrotic syndrome in the elderly is a deficiency of the lungs, spleen and kidneys, especially in the spleen and kidneys, while the symptoms are wind, dampness, heat, toxicity and stasis. Clinical deficiency is often mixed with reality, and the disease is difficult to heal. Treatment is based on the following aspects.
1. Combination of evidence and disease identification. The basic law of treating geriatric nephrotic syndrome is to strengthen the spleen and nourish the kidneys to cure the root, because the deficiency of both spleen and kidneys is the basis of geriatric nephrotic syndrome, so nourishing the spleen and kidneys is the method to cure the root. Commonly used to strengthen the spleen and kidney drugs such as astragalus, ginseng, atractylodes, atractylodes, yam, coix seeds, wolfberry, etc.. In case of edema, add Poria, Poria, Dong Gua Pi, Chen Pi, etc. to promote water retention and reduce swelling. Appetite loss, add grain buds, malt, etc. Activate blood circulation and eliminate blood stasis throughout.
2.The correct and reasonable use of Chinese medicine to enhance the therapeutic effect and reduce the adverse drug reactions. When applying hormones and cytotoxic drugs, adverse reactions such as infection, osteoporosis, bone marrow suppression, liver function damage, etc. are likely to occur. The occurrence of these adverse reactions can be greatly reduced by giving TCM evidence-based treatment to address the symptoms of these adverse reactions. In the first stage of hormone use, the symptoms of yin deficiency and fire often appear, so it is appropriate to use the method of nourishing yin and lowering fire; in the reduction stage of treatment, it is often transformed from yin deficiency to qi deficiency and yang deficiency, so it is appropriate to tonify temperature and yang; in the maintenance stage, to prevent relapse, it is appropriate to strengthen the kidney and strengthen the spleen.
3.Prevent the disease before it happens, prevent the disease from changing, and prevent the disease from returning. Nephrotic syndrome in the elderly is often triggered by a cold, prevention and control of seasonal evil, reduce the interference of external evil, to maintain the stability of the internal environment is the key to prevent the recurrence of the disease. We can apply Yu Ping Feng San to improve the immunity of the body with Huang Qi and Bai Zhu. During the recovery period, the patient’s qi and blood have not yet recovered and their ability to resist disease is reduced, so it is easy to feel external evil and induce aggravation of the disease. Paste formula has its unique advantages in regulating disease and preventing recurrence. It is one of the effective methods to prevent this disease.
Prevention of kidney deficiency from the perspective of “treating the disease before it occurs
Kidney deficiency is a syndrome in Chinese medicine, broadly speaking, it refers to the overall low function of the body, and can occur in a variety of diseases, including not only kidney diseases in Western medicine, but also systemic diseases, or no substantial disease at all, only low function. Common symptoms include soreness and weakness of the waist and knees, dizziness, memory loss, impotence and spermatorrhea, reduced sexual function, frequent urination, fear of cold, premature graying or hair loss, reduced menstrual flow in women and other symptoms of premature aging. To prevent kidney deficiency, we should have the concept of “treating the disease before it happens” and pay attention to several aspects, including balanced diet, regular life, combining work and rest, reducing mental stress and releasing bad emotions.
The Yellow Emperor’s Classic of Internal Medicine believes that “kidney color black”, because the color of the five elements of black is water, and the five organs of the kidney is also water, all black food has the function of kidney, such as black beans, black rice, black sesame, black fungus, etc.. In addition, Chinese wolfberry, yam, walnuts are the famous kidney remedy, can be taken for a long time.
In Chinese medicine, “Yang out of Yin is awake, Yang into Yin is sleep”, the natural and human yang energy is upward and outward during the day, and vice versa at night. If you don’t sleep at night, the human body must overcome the double resistance of nature and human yang qi inward and downward, so that the human body’s yang qi goes upward and outward, which is an energy-consuming process that consumes the body’s essence, that is, the body’s kidney essence, which inevitably leads to faster aging. Adjusting work and rest is the most direct and simple way to replenish the kidneys.
Sitting for a long time hurts the kidneys, so it is recommended to exercise for an hour every day to get the body moving. You can also try the method of adjusting the breath of the “intention to keep the Dantian, Qi sinking Dantian”. First, calm down and put your mind on the Dantian, the area under the umbilicus where the kidney energy is located. When you inhale deeply, you can naturally feel the breath rising from the sacral area to the top of the head along the back of the body, and when you exhale, the breath sinks from the top to the Dantian, a breathing process is a cycle of gas along the front and back of the body, and let the breath be as deep, long, thin and even as possible. In addition, in Chinese medicine, emotions and internal organs of the one-to-one correspondence, “fear hurts the kidneys”, should prevent excessive fear of kidney injury.
There are two kinds of kidney deficiency, namely kidney yin deficiency and kidney yang deficiency. If there are cold signs in the kidney deficiency symptoms, such as fear of cold, cold hands and feet is Yang deficiency; if at the same time there are signs of heat such as dry mouth, hot hands and feet, it may be Yin deficiency internal heat. Kidney yin deficiency can be treated with Chinese herbal medicines such as raw earth, xuan ginseng, chasteberry, mulberry, dendrobium, etc. You can also use Liu Wei Di Huang Wan, Zuo Gui Wan. For kidney yang deficiency, you can also use some Chinese herbs, such as cinnamon, deer antler, Epimedium, Xianmao, Bacopa monniera, Eucommia, Sequoia, Cistanches, locking the yang, bone marrow, walnuts and other herbs, and you can also use the Right Return Pill and other drugs. Chinese medicine reminds us that we need to pay attention to the fact that kidney supplementation for premature aging must be the right medicine, not indiscriminate use of drugs, so as not to affect health.
The poultice is suitable for the old and weak, long-standing illness, chronic pain and sub-healthy state, and can also play a very good role for people who are afraid of cold. As long as according to the individual symptoms, physique, age, past medical history and other factors, determine its Yin deficiency, Yang deficiency, Qi deficiency, blood deficiency bias, discriminatory application of cream tonic, can receive very good results.
Third, dialectical treatment to prevent and treat renal insufficiency
Prof. Li Wei pointed out that the treatment of chronic renal insufficiency in Western medicine is based on the consensus of integrated treatment, mainly on changing lifestyle, low protein diet, giving essential amino acids or α-keto acids, controlling hypertension, reducing proteinuria, correcting metabolic acidosis, maintaining water-electrolyte balance, correcting hyperlipidemia, improving abnormal lipid metabolism, anticoagulation and improving microcirculation as treatment methods. Chinese medicine treatment of chronic renal insufficiency is still based on evidence-based treatment, and is based on support and detoxification. And there are two main features: first, to make full use of the existing functions of the body to eliminate toxins, so that the body into a virtuous cycle; second, the maximum possible to restore the function of damaged tissues and organs.
1.Discriminative use of medicine, effective control of reversible risk factors
TCM believes that the reversible factors are.
① External evil;
②Toxic internal growth;
(3) Blood stasis blocking the ligaments;
(iv) internal disturbance by wind evil, etc.
For these different types of symptoms, TCM practitioners can apply herbal tonics, and also adopt measures such as special prescriptions, special medicines, internal administration, external cleansing, enema, intravenous administration, etc., which are not only more effective, but also have the advantage of treating both the symptoms and the root cause.
2. Combination of disease identification and evidence identification, taking into account deficiency and reality
CRF more spleen and kidney deficiency, but easy to produce turbid toxicity, so must be supplemented with moderation, not dull supplementation, stagnant supplementation, should be the reference to the kidney’s qi-transformation function and the evil hostage situation, the combination of disease and evidence, the application of supplementation. Chinese medicine practitioners can better select and use the medicine flexibly according to the patient’s condition of deficiency and actuality, with a view to combining the disease, taking into account the symptoms and the root cause, combining the use of tonic and diarrhea, attacking and supplementing at the same time.
3. Combined internal and external treatment, with precise curative effect
Chronic renal failure involves multiple systems throughout the body and it is difficult to rely on one simple medicine or one method. Therefore, it is necessary to adopt comprehensive therapy, such as combining internal and external treatment, oral and enema, Chinese medicine bath (skin dialysis), Chinese medicine enema (colon dialysis), etc., which can increase the excretion of toxins from the skin and intestines and facilitate the relief of the disease.
Chinese medicine starts from a holistic approach, treats with evidence, integrates regulation, benefits the kidney and drains turbidity, protects the spleen and stomach, and maintains positive energy. Through the organic combination of multi-path and multi-therapy, together with western medicine, we actively lower blood pressure, sugar, lipids, maintain water-electrolyte and acid-base balance, thus protecting residual kidney function and delaying the time of patients entering dialysis. Utilizing the advantages of TCM evidence-based treatment, we adopt a variety of TCM characteristic treatment measures, combining Chinese and Western medicine and complementing each other’s advantages, which have remarkable effects on patients with kidney disease.