What is IgA nephropathy?
Discovered by French scholars in 1968, it is a pathological diagnostic term and a group of clinical syndromes.
It is the most common glomerular disease in China and worldwide.
The incidence has increased significantly in recent years, from 16.9% ten years ago to 47.0% ten years later (2001).
IgA nephropathy accounts for the first place of primary glomerular diseases, the first place of simple hematuria, the first place of nephritis syndrome, the first place of asymptomatic hematuria with proteinuria and
Clinical manifestations
Hematuria: It is the most common clinical manifestation, divided into carnal hematuria and microscopic hematuria, and IgA nephropathy accounts for 42.3% of those with the onset of simple hematuria.
Proteinuria: simple proteinuria is rare, mainly hematuria with proteinuria, a small amount of proteinuria is predominant, and IgA nephropathy accounts for 69.0% of those with the onset of asymptomatic hematuria with proteinuria.
Decline in renal function: some patients progress to renal failure after 10-20 years, accounting for 26.69% of chronic renal failure, and some patients present with renal failure at the first visit.
Hypertension: adult patients with IgA nephropathy have a high incidence of hypertension (20%), and young patients with IgA nephropathy can develop malignant hypertension.
Edema: Edema can occur in the presentation of nephrotic syndrome and is generally uncommon.
Infections: common, upper respiratory tract (pharyngitis, tonsillitis), intestinal tract, urinary tract.
Clinical typing
Occult nephritis
Chronic nephritis syndrome
Acute nephritis syndrome
Acute nephritis syndrome
Nephrotic syndrome
Malignant hypertension
Chronic Renal Failure
Morbidity characteristics
Pharyngitis synchronous hematuria: 40%-50% in the onset, with a deepening of urine color in the form of strong tea, washed flesh, soy sauce color, etc., along with cold and fever.
Inapparent onset: 30%-40% of the cases: found in young people during marriage or physical examination.
Pathogenesis
TCM.
Congenital: physical factors (lung and kidney deficiency).
Acquired: dietary habits, such as a taste for spicy food (partiality); overwork, such as long-term heavy physical and mental labor.
Western medicine: hereditary genes (familial), abnormalities of IgA molecules, cellular immune defects, etc.
Western medicine treatment
General treatment.
Control of infection.
Control of blood pressure, etc.
Evidence-based treatment recommendations for IgA nephropathy with normal renal function
1, treatment of patients with urine protein ≥ 3.5g/d: glucocorticoids can be given if the pathological type is mild.
2.Treatment of patients with urine protein 1~3.5g g/d: hormone therapy can be given, cyclophosphamide, pansentin, warfarin and cyclosporine A are not recommended.
3.Treatment of patients with urine protein in 0.5~1.0 g/d: renin angiotensin converting enzyme inhibitor (ACEI) can be given.
4. Treatment of patients with urine protein at <0.5 g/d: regular observation and follow-up.
Evidence-based treatment recommendations for IgA nephropathy in renal insufficiency
1.Patients with blood creatinine in the range of 133-250umol/L can be treated with hormones, cytotoxic drugs and azathioprine.
2. Patients with chronic kidney disease with blood creatinine >250umol/L should be treated according to the integrated chronic kidney disease protocol.
For specific types of IgA nephropathy.
Treatment of crescentic or vasculitis IgA nephropathy, especially in patients with rapidly progressing renal function, should be given intensive immunosuppressive therapy.
How to identify the evidence in Chinese medicine
Deficiency evidence.
Qi and Yin deficiency evidence
Qi deficiency of spleen and kidney
Yin deficiency of liver and kidney
Solid evidence
Wind-heat attacking the lung
Dampness and heat
Qi Stagnation and Water Stagnation
How to treat with Chinese and Western medicine
Pure hematuria needs to be treated with Chinese herbal medicine.
Hematuria with small amount of proteinuria or small amount of proteinuria needs to be treated with Chinese herbal medicine alone.
Patients who are unwilling to accept western medical treatment or western medical treatment is ineffective, need to be treated with Chinese medicine.
Patients who manifest chronic renal failure need Chinese herbal medicine treatment.
Large amount of proteinuria or moderate amount of proteinuria using hormone and withdrawal stage, need to be treated with Chinese medicine.
Renal puncture results showing acute lesions and acute renal function decline may be considered first with Western medicine alone.
How to determine the severity of the disease and long-term results
1. renal tissue: the degree of glomerulosclerosis and tubulointerstitial fibrosis are the strongest and most reliable prognostic factors? The more serious the degree of glomerulosclerosis and tubular fibrosis, the more serious the disease and the worse the prognosis.
2. Hematuria: persistent carnal hematuria suggests an acute and serious condition; persistent microscopic hematuria suggests that the kidney is in an inflammatory state, suggesting a poor long-term outcome.
3, the degree of proteinuria is an independent prognostic factor, more proteinuria, suggesting heavy disease and poor prognosis.
4, blood pressure: the higher the blood pressure, the worse the prognosis.
5, renal function: the higher the level of blood creatinine at the time of renal biopsy, the prognosis is relatively poor.
6.Family history of chronic glomerulonephritis, susceptibility to tonsillitis, salty food, etc. may increase the risk of IgA nephropathy.
How to detect the disease
1. Carnal hematuria, especially when it occurs at the same time with upper respiratory tract infection.
2.Urine examination always has red blood cells, and with the appearance of cold and diarrhea, the red blood cells also increase, and urine protein appears.
3.Urine test abnormalities coexist with pharyngitis and tonsillitis.
4.Soreness and discomfort in the lower back .
How should drugs be selected
According to the condition, choose the appropriate drugs for yourself
Lifestyle attention
Physical exercise: not strenuous physical activity, it is advisable to slow physical activity, to not feel strained.
Diet: moderate diet, do not be too salty, spicy, sour, fatty and sweet, etc.
Winter health
Winter is the main closed and hidden, the gentleman lives in the room
Winter tonic: spring and summer nourish Yang, autumn and winter nourish Yin