Latent glomerulonephritis

　　The understanding of Western Medicine: 1. Etiology and Pathogenesis The etiology of this disease is not yet clear, and the pathogenesis is also different. Its occurrence is often related to respiratory tract infection, acute gastroenteritis, skin infection, urinary tract infection, strenuous exercise, overwork, or trauma. 2. Pathology Since this disease is a group of primary glomerular diseases, the pathological types are diverse, mainly focal proliferative type, with不明显 basement membrane lesions, and there may be widespread IgA or IgG, lgM, C3 deposition in the glomeruli. It can manifest as minimal change nephrotic syndrome, mild mesangial proliferative glomerulonephritis, focal proliferative glomerulonephritis, focal segmental glomerulosclerosis, IgA nephropathy, and membranous nephropathy pathologic changes.

　　The understanding of Traditional Chinese Medicine: The occurrence of this disease is mainly due to internal factors, such as insufficient endowment, weakness of the internal organs; unregulated diet, damage to the spleen and stomach; internal injury of the seven emotions, stagnation of liver Qi; physical labor injures the spleen, sexual overexertion injures the kidneys, all of which are internal causes of the occurrence and development of the disease. External attack of heat evil or warm evil is the external cause of the disease, which acts on the basis of internal factors. The occurrence of proteinuria and hematuria is mainly due to the failure of the spleen to transform, the kidney to seal, and the liver to release, leading to the imbalance of Yin and Yang and the downward leakage of refined substances.

　　The prognosis of asymptomatic glomerulonephritis is good, and the course can last for decades, with no significant damage to renal function. However, a few cases of asymptomatic nephritis may suddenly worsen or even enter the stage of renal insufficiency due to a longer course of the disease or under the influence of a certain trigger (such as infection, overexertion, cold stimulation, etc.), or even without obvious triggers. The condition may become chronic and not improve, showing other symptoms of glomerulonephritis (such as hypertension, edema, and large amounts of proteinuria) and pathological changes, which are often seen in the glomerular basement membrane, mesangial proliferation, or focal glomerulosclerosis. For patients with this type of pathology, enhanced follow-up observation should be carried out to understand the condition in time and actively treat.

　　1. Medical history and symptoms

　　Most patients have no clinical symptoms and only discover abnormal urinalysis during physical examination. A few may have gross hematuria, but no edema, hypertension, and may have lower back discomfort, which may worsen after fatigue or infection and can be relieved after treatment.

　　2. Physical examination findings

　　Physical examination usually shows no positive signs.

　　3. Auxiliary examinations

　　The amount of proteinuria in 24 hours is usually below 2g, mainly composed of albumin, with the vast majority of microscopic hematuria, red blood cells showing polymorphism and diversity. Renal function is normal, rheumatoid factor and antinuclear antibody are negative, complement is normal, renal isotope, renal ultrasound, and intravenous pyelography are normal.

　　Prevention and control of infections, such as upper respiratory tract infections and urinary tract infections, are often important triggers for glomerular diseases. Repeated infections can cause kidney damage and lead to changes in renal function, so it is necessary to prevent and control them actively. Treat hypertension actively, as excessive blood pressure can damage the kidney's function of regulating blood pressure, increase glomerular pressure, and cause kidney damage. Treat the primary disease actively, control systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, and other rheumatic diseases, as well as diabetes, and combine traditional Chinese and Western medicine for the treatment of the primary disease, which is reliable in efficacy. Seek medical attention in a regular and professional hospital; when feeling unwell, you can go to a regular hospital for routine urinalysis and renal function tests, which can generally detect changes in the condition in time. After developing kidney disease, medication should be taken under the guidance of a professional doctor. In summary, the kidneys are a delicate organ in our body and require careful care to maintain their vigorous vitality as the 'essence of life'.

　　It is commonly referred to as 'asymptomatic proteinuria' when only a small amount of proteinuria is present.

　　Recurrent hematuria may occur without any abnormal findings in routine urinalysis or only with microscopic hematuria. There are no specific symptoms or signs. Under the influence of certain triggers (such as fever, pharyngitis, fatigue, or exposure to cold), hematuria may appear within a few hours or days (usually 1-2 days), and disappear or return to the original level within a short period (within 1-4 days). If microscopic hematuria persists, the red blood cells in the urine examined under a phase-contrast microscope are polymorphic, with a count greater than 10,000/ml, and no casts, which can be referred to as 'simple hematuria'.

　　The amount of proteinuria in 24 hours is usually below 2g, mainly composed of albumin, with the vast majority of microscopic hematuria, red blood cells showing polymorphism and diversity. Renal function is normal, rheumatoid factor and antinuclear antibody are negative, complement is normal, renal isotope, renal ultrasound, and intravenous pyelography are normal.

　　Dietary health care for patients with latent glomerulonephritis

　　1. For persistent trace proteinuria in latent nephritis, use White Root and Corn Silk Decoction: 30g of white root, 30g of corn silk, an appropriate amount of rock sugar, decocted as a decoction.

　　2. For recurrent microscopic hematuria in latent nephritis, use Bamboo Leaf and White Root Decoction: 10g of bitter bamboo leaves, 30g of white root, decocted as tea.

　　3. For fatigue in latent nephritis, use Lotus Seed and Job's Tears Porridge: 30g of lotus seeds, 50g of Job's Tears, and 50g of red beans cooked into porridge, then add an appropriate amount of rock sugar, and it can be eaten.

　　4. For recurrent edema in latent nephritis, use Astragalus Decoction: 60g of raw Astragalus, 60g of glutinous rice. Cut the Astragalus into slices, add an appropriate amount of water in the pot, and boil it into juice. Remove the Astragalus, then add the washed glutinous rice and cook it with high heat, and then cook it into porridge with low heat.

　　(Special reminder: The above dietary therapy for latent nephritis and dietary precautions are for reference only, as each patient with latent nephritis has different conditions. It is recommended to consult a professional doctor before adopting this dietary therapy to determine whether it is applicable)

　　Dietary principles for latent nephritis

　　Provide high-quality high-protein diet, such as milk, eggs, fish. When renal insufficiency occurs, the intake of plant protein should be controlled. In daily diet, it is necessary to ensure the intake of carbohydrates to provide enough calories to reduce the breakdown of body protein. Limit the intake of sodium, with less than 3g of sodium per day in the diet. When oliguria occurs, potassium intake should be controlled to ensure comprehensive nutrition.

　　(1) Water and salt intake: for mild edema, urine output should be greater than 1000ml/d, and excessive water restriction is not necessary. Sodium intake should be limited to less than 3g/d, including sodium-containing foods and beverages such as sausages, salted meat, canned food, etc. For patients with severe edema and oliguria, the daily water intake should be limited to 1000ml, and a salt-free diet should be adopted. Use sugar, vinegar, scallion, etc. as seasonings to increase appetite.

　　(2) Protein intake: a low-protein diet can slow the progression of renal function impairment. For patients with severe edema and hypoproteinemia, the protein intake should be 1g per kilogram per day, with more than 60% being high-quality protein, such as eggs, lean meat, fresh milk, etc. When consuming protein, there must be adequate calorie intake, with 126-147 KJ/kg per day. In addition, it is recommended to drink less alcohol and smoke less, or not smoke at all. Because alcohol and nicotine can have adverse effects on the central nervous system.

　　1. General treatment: After acute onset, bed rest should be maintained until gross hematuria disappears, edema subsides, blood pressure returns to normal, and blood creatinine returns to normal. Then, slight activity can be performed, but close follow-up is required. If the condition changes, bed rest should continue. Diet should pay attention to adequate protein, 1g/kg/d, too strict restriction or increased intake is not conducive to kidney recovery. Patients with edema and hypertension should be given low-salt (2-3g/d) or even salt-free diet; for patients with edema and oliguria, strict restriction of water intake should be performed. Some patients also need a low-potassium diet. In addition, a diet rich in vitamins should be consumed.

　　2. Etiological treatment: There is no definite conclusion on the influence of treatment of infection focus on the condition and prognosis of acute nephritis. At present, it is generally advocated that if there is an obvious infection focus and the bacterial culture is positive, antibiotics should be actively used, and penicillin or other sensitive drugs are usually selected, with a course of about 2 weeks. For patients with obvious tonsillar focus and prolonged disease for more than 2 months, with recurrent symptoms, tonsillectomy can be considered. But there is no definite conclusion on the influence of the disease course of acute nephritis.

　　Symptomatic treatment

　　1. Diuretics: After restricting water and salt intake, if edema is still severe or even due to water and sodium retention leading to heart failure, diuretics should be used. Thiazide diuretics can be selected, but for GFR

　　2. Lower blood pressure: Active and appropriate blood pressure lowering is beneficial to increase renal blood flow, improve renal function, and reduce the occurrence of cardiovascular and cerebrovascular complications. The use of diuretics can reduce volume load, thereby lowering blood pressure. Calcium channel blockers such as络活喜, α-adrenergic receptor antagonists such as prazosin can also be selected. In general, ACE inhibitors are not needed, and phen tolamine or sodium nitroprusside can be administered intravenously if necessary, which can quickly lower blood pressure and prevent the occurrence of hypertensive encephalopathy.

　　3. Reduce blood potassium: First, control the intake of high-potassium diet, use potassium-wasting diuretics such as furosemide, correct acidosis by intravenous administration of sodium bicarbonate, give glucose and insulin, oral ion exchange resins. If the above measures are ineffective, emergency hemodialysis or peritoneal dialysis should be performed.

　　4. Control heart failure: Since its occurrence is mainly due to increased volume load, diuretic antihypertensive therapy is the first choice. Sodium nitroprusside or phentolamine can be administered intravenously. Hemofiltration should be performed if necessary.