Glomerulonephritis

　　The etiology of nephritis is not clear in the medical community, and it is generally believed that it may be caused by a hereditary defect in the synthesis of the glomerular basement membrane. This disease has a characteristic, that is, it has a significant family history, and often several members of a family generation have hematuria. Hematuria is the most common manifestation of hereditary nephritis, and it is more common in young males.

　　10. In patients with acute glomerulonephritis, if the symptoms are not completely controlled, clinical symptoms and urinary protein may persist, and it may evolve into chronic nephritis after one year of delay.

　　9. In patients with no history of nephritis, edema and a large amount of proteinuria and other symptoms of nephrotic syndrome may occur due to upper respiratory tract infection or other infections.

　　8. In patients with a history of acute nephritis, after several weeks or months of rest, clinical symptoms and urinary abnormalities disappear, and renal function is normal. After a relatively long interval (up to several years), sudden proteinuria, edema, or (and) hypertension and other nephritis symptoms may occur due to upper respiratory tract infection or other infections or overexertion. This is also one of the causes of nephritis.

　　7. In patients with no history of nephritis, blood urine and/or proteinuria often occur after infection or fatigue, which can quickly subside or disappear after short-term rest. Such repeated attacks occur without obvious clinical symptoms.

　　Most patients with glomerulonephritis have stable clinical manifestations, but a small number of patients may develop the following complications:

　　1, Acute congestive heart failure:In children, acute left heart failure can become the initial symptom of acute nephritis, manifested as shortness of breath, cough, sputum, and blood-streaked sputum after exercise. If not treated in time, it can quickly lead to death. It is very important to correctly understand the pulmonary congestion or acute nephritis complicated with acute heart failure caused by water and sodium retention.

　　2, Hypertensive encephalopathy:The incidence of hypertensive encephalopathy in acute nephritis is less common than that of acute heart failure, which may be related to timely and reasonable treatment. The common symptoms of hypertensive encephalopathy are severe headache and vomiting, followed by visual impairment, confusion of consciousness, and can occur with paroxysmal convulsions or epilepsy-like seizures. After an increase in urine output or control of blood pressure, the above symptoms improve or disappear rapidly, and there are no sequelae.

　　3. Acute renal failure:Less than 10% of patients may develop oliguric acute renal failure.

　　4. Secondary bacterial infection:Due to reduced overall resistance, secondary infections are prone to occur, the most common being pulmonary and urinary tract infections.

　　Glomerulonephritis is a common kidney disease, which is divided into acute and chronic types. The common clinical manifestations are as follows:

　　1. Edema

　　The decrease in glomerular filtration rate leads to water and sodium retention; the loss of protein from urine causes a decrease in plasma colloid osmotic pressure, leading to water retention; an increase in renin secretion causes an increase in secondary aldosterone secretion, an increase in sodium and water reabsorption in the renal tubules, and many other factors. These are the reasons for renal edema. Mild cases may only have weight gain (hidden edema), while severe cases may have swelling all over the body, or even a large amount of fluid in the abdominal (thoracic) cavity.

　　2. Proteinuria

　　In glomerulonephritis, the permeability of the glomerular capillary wall increases, plasma albumin leaks through the basement membrane, resulting in proteinuria. Therefore, the most important characteristic of glomerulonephritis is proteinuria.

　　3. Cast urine

　　casts are formed by the coagulation and precipitation of proteins in urine, so in glomerulonephritis, there should be casts in the urine. It should be noted that the presence of only proteins without casts cannot reflect glomerular lesions. Conversely, the presence of only casts without proteins does not indicate glomerular lesions. Only when there are both proteins and casts in the urine does it indicate glomerular lesions.

　　4. Hypertension

　　The kidneys regulate water and sodium metabolism, affect the effective blood volume, and produce renin, which affects the renin-angiotensin-aldosterone system, leading to hypertension. The incidence of hypertension in chronic glomerulonephritis is 33.3%, and the incidence of uremia is 84%.

　　5. Anemia

　　Renal anemia is often caused by dilution due to water retention; when the glomeruli are severely damaged, the erythropoietin decreases, resulting in anemia. Anemia is generally normocytic and normochromic anemia.

　　6. Azotemia and uremia

　　It is the manifestation of renal insufficiency at the end stage of glomerular lesions, but not all patients with glomerulonephritis have this kind of manifestation.

　　The common preventive measures for glomerulonephritis mainly include the following aspects:

　　1. Combine work and rest

　　In daily work, whether it is physical or mental labor, patients with nephritis should not overwork and should strengthen rest. Otherwise, it will increase abnormal metabolism and also increase the burden on kidney function, eventually damaging the kidneys.

　　2. Pay attention to emotional regulation

　　Patients with chronic nephritis must establish the confidence to fight against the disease, because the condition of chronic nephritis is slow and persistent, so it is necessary to maintain the determination and confidence in treatment; irritability and excessive worry can cause liver damage, affect the secretion system's chaotic imbalance, and directly damage kidney function.

　　3, Pay attention to diet

　　Unreasonable diet is often more likely to increase the kidney burden of patients with chronic nephritis, causing further damage to kidney function, leading to the continuous deterioration and progression of the disease. According to the characteristics of chronic nephritis, patients should have reasonable kidney disease diet.

　　4, Regular sexual life should be maintained

　　For couples, for patients with chronic nephritis, it should not be too frequent. Generally speaking, it should not exceed twice a month. If it exceeds, it is easy to lead to recurrence and aggravation of the disease.

　　5, Prohibit the private and arbitrary use of anti-inflammatory analgesics

　　For example, cold medicine and antibiotics, before taking anti-inflammatory analgesics, it must be taken under the guidance of a related physician, because the inappropriate use of these drugs can directly damage kidney function, leading to renal dysfunction.

　　Glomerulonephritis can be caused by various causes, with post-streptococcal infection being more common, and the following examinations need to be done:

　　1, Microscopic examination

　　By qualitative urine protein and microscopic examination of urine sediment, it can be preliminarily judged whether there is glomerular lesions.

　　2, Urinalysis

　　The color of urine is generally normal, the amount of urine protein is generally not much, the number of white blood cells in the urine sediment increases (in the acute phase, it is often full of the field of vision, in the chronic phase, it is 5 per high-power field), and sometimes white blood cell casts may occur.

　　3, Urinary bacteria test

　　When there is a large amount of bacteria in the urine, Gram staining examination is performed on the urine sediment smear, about 90% can find bacteria. This method is simple and has a high positive rate.

　　4, Urine cell count

　　In recent years, the 1-hour counting method is often used, which is considered more accurate and convenient than the 12-hour urine sediment counting. The standard is that the number of white blood cells is greater than 300,000 per hour, which is positive, less than 200,000 per hour can be considered to be within the normal range, and between 200,000 and 300,000 per hour should be combined with clinical judgment; the number of red blood cells is greater than 100,000 per hour is positive.

　　Common dietary health care mainly focuses on the following aspects:

　　Patients should eat carbohydrate foods and starch foods such as rice, noodles, mixed grain, lotus root powder, sugarcane, yam, honey, and fresh fruits;

　　Eat more fresh green vegetables rich in vitamin C, such as cabbage, tomatoes, carrots, etc. During the recovery period, more yam, jujube, longan, lotus seeds, and silver ear with nourishing effects should be provided;

　　For patients with azotemia, provide a diet rich in high-quality protein (chicken, eggs, milk, etc.) of 0.5 grams per kilogram of body weight per day; eat more alkaline foods, which can regulate the pH value of urine to make it close to neutral, which is beneficial for treatment;

　　For patients with hematuria, it is advisable to eat vegetables such as celery, shepherd's purse, malan head, lotus root, water chestnut, horsehoof, winter melon, bitter melon, watermelon, pear, persimmon, apple, sugarcane, lotus seeds, peanuts, persimmon cake,螺蛳, clams, dried seafood, jellyfish, and mushrooms.

　　When there is oliguria or anuria, avoid eating foods high in potassium, such as fresh mushrooms, shiitake mushrooms, jujube, shellfish, beans, etc.;

　　Avoid eating foods high in salt content, such as soy sauce, monosodium glutamate, ketchup, shaosheng sauce, black vinegar, miso, etc.;

　　Avoid eating animal liver, kidney, and other foods rich in protein, try to eat less scallion, garlic, ginger, chili, and alcohol;

　　Eight, avoid eating preserved foods, such as various pickled vegetables. At the same time, try to eat less monosodium glutamate;

　　Nine, avoid eating seafood, such as fish, shrimp, eggs, and meat, which are foods that kidney disease patients cannot eat;

　　Ten, avoid eating spicy foods, such as fennel, pepper, and other foods.

　　There is no specific drug treatment for glomerulonephritis, and it is also an autoimmune disease, so the basic treatment is symptomatic treatment, the necessary links are to prevent water and sodium retention, control blood volume, so as to achieve the purpose of alleviating symptoms, preventing fatal complications (heart failure, hypertensive encephalopathy), protecting renal function, and preventing various triggering factors, promoting the repair of renal pathological tissue and function.

　　1. General Treatment

　　After the acute onset, bed rest should be taken. The dietary principles should be low salt, high vitamin, and high calorie diet. Protein intake should be maintained at 40-70g/day. Salt intake should be 2-3g/day, and at the same time, the intake of high potassium foods should be restricted.

　　2. Symptomatic Treatment

　　Diuretics, commonly used thiazide diuretics; antihypertensive, commonly used drugs thiazide diuretics, vasodilators, if necessary, can be used ganglionic blockers, or add calcium channel blockers; the treatment of hyperkalemia, mainly to limit high potassium diet and because of the use of potassium diuretics.

　　3. Treatment of Complications

　　Control heart failure, the focus of treatment should be on correcting water and sodium retention, restoring blood volume, rather than using digitalis drugs to strengthen myocardial contraction, that is, the main measures are diuretic antihypertensive; hypertensive encephalopathy, can be intravenous infusion of sodium nitroprusside and other drugs, convulsions can be used for intravenous injection of Valium; uremia, refer to 'Acute Renal Failure'.

　　4. Treatment of Infection Sites

　　Currently, it is advocated that antibiotics should be used actively when the bacterial culture of the focus is positive, and commonly used penicillin or macrolide antibiotics are used to control the focus of infection, which has the effect of preventing the spread of pathogens and lasts for about 2 weeks or until cured. There is no definite effect of tonsillectomy on the course of acute glomerulonephritis.

　　5. Anticoagulation and Thrombolysis

　　Urokinase intravenous drip, which can be supplemented with diuretics and potassium supplementation.

　　6. Dialysis Treatment

　　Dialysis treatment should be used when the following conditions occur in acute glomerulonephritis: severe water and sodium retention; acute renal failure, oliguria for more than 2 days, with hyperkalemia, acute left heart failure, and severe acidosis.