Chronic glomerulonephritis

　　The etiology of chronic glomerulonephritis is unknown. Most of the time, there is an upper respiratory tract infection or infection in other parts before onset, and a few cases of chronic nephritis may evolve from post-infectious glomerulonephritis after acute streptococcal infection, but most chronic nephritis is not derived from chronic glomerulonephritis, but directly from other primary glomerular diseases, which develop into chronic nephritis from the beginning. The disease can be divided into the following types according to its pathological type: ①Mesangial proliferative glomerulonephritis: Immunofluorescence examination can be divided into mesangial proliferative glomerulonephritis dominated by IgA deposition and non-IgA mesangial proliferative glomerulonephritis; ②Membranous nephropathy; ③Focal segmental glomerulosclerosis; ④Mesangiocapillary glomerulonephritis; ⑤Proliferative sclerotic glomerulonephritis.

　　Long-term proteinuria in chronic glomerulonephritis can lead to the loss of a large amount of protein, malnutrition, and immune function disorders, which are prone to various infections. Such as respiratory tract infections, urinary tract and skin infections, etc. Infection as a malignant stimulatory factor often induces an acute exacerbation of chronic nephritis, aggravating the condition. Although there are many antibiotics available for choice at present, if treatment is not timely or thorough, infection remains the main cause of acute exacerbation of chronic nephritis and should be given high attention.

　　Renal anemia in chronic nephritis: In the late stage, renal parenchymal damage can occur, and multiple abnormalities in the blood system may occur, such as anemia, abnormal platelet function, abnormal lymphocyte function, and coagulation mechanism disorders. Among them, anemia is the most common complication. The main reasons for anemia include: reduced erythropoiesis; increased red blood cell destruction: in renal failure, uremic toxins accumulate in the body, red blood cell metabolism is impaired, and red blood cells are prone to destruction, leading to hemolysis and anemia. Blood loss: about 25% of patients with advanced renal failure may have significant bleeding, exacerbating anemia.

　　Hypertensive chronic nephritis and renal insufficiency stage often present with serious cardiovascular complications, such as hypertension, atherosclerosis, cardiomyopathy, pericarditis, and renal insufficiency, among others. The main cause is the metabolic abnormalities in the development process of chronic nephritis renal insufficiency stage (CRF). According to statistics, the incidence of hypertension reaches 70% to 80%, and almost all patients requiring renal replacement therapy have hypertension. Among them, 3/4 of the patients can control hypertension with a low-sodium diet and dialysis, while the other 1/4 of the patients experience a rise in blood pressure after dialysis, which removes excess sodium and water from the body. In addition, hypertension in CRF patients has its inherent characteristics, manifested as the loss of the nocturnal physiological blood pressure下降 trend, and some can be divided into simple systolic hypertension.

　　The clinical manifestations of chronic glomerulonephritis are diverse, early patients may have no obvious symptoms, or may only manifest as increased urine protein, increased red blood cells in urine sediment, visible casts, sometimes accompanied by fatigue, drowsiness, lower back pain, loss of appetite, intermittent edema, mostly eyelid edema and/or lower limb pitting edema, generally without body cavity effusion, normal or slightly impaired glomerular filtration function and renal tubular concentration and dilution function, some patients may have persistent moderate to severe hypertension, may appear fundus hemorrhage, exudation, even disc edema, some patients may manifest as large amounts of proteinuria (urine protein > 3.5g/24h), even presenting as nephrotic syndrome, the condition may deteriorate abruptly after non-specific viral and bacterial infections, during acute exacerbation of chronic nephritis, large amounts of proteinuria, even gross hematuria, increased casts, worsening edema, hypertension, and renal function deterioration may occur, the condition can be restored to the original level after appropriate treatment, but some patients may therefore lead to disease progression, entering the uremic stage.

　　Chronic nephritis can have significant differences in course due to the nature of the lesion, from the first discovery of urinary abnormalities to the development of chronic renal failure, it can take several years, even decades, hypertension, infection, improper diet, application of nephrotoxic drugs, and persistent proteinuria can all accelerate the progression of chronic nephritis into chronic renal failure. Chronic nephritis is generally divided into three types in clinical practice:

　　1, Chronic nephritis-common type:It is the most common type, patients may have weakness, fatigue, lower back pain, loss of appetite, intermittent edema, generally not severe, often accompanied by mild to moderate hypertension, pale and yellowish face, narrowing of fundus arteries, with the phenomenon of arterial-venous crossing compression, moderate proteinuria (less than 3.0g/d) can be seen in urine examination, red blood cells and various casts in urine sediment, decreased creatinine clearance rate; reduced phenol red excretion, decreased urine concentration function, and increased blood creatinine and blood urea nitrogen, leading to azotemia, anemia of varying degrees, slightly lower plasma albumin, slightly higher cholesterol, this type of disease course progresses slowly, and ultimately can die due to renal failure.

　　2, Chronic nephritis-nephrotic type:It is a common type of chronic nephritis, characterized by large amounts of proteinuria (non-selective proteinuria), with daily urine protein excretion exceeding 3.5g/dl, severe edema, and decreased plasma albumin, usually below 3g/dl, hypercholesterolemia, exceeding 250mg/dl, urine sediment examination, which may show red blood cells and various casts, normal or moderately persistent blood pressure increase, normal or progressive renal function damage, increased blood creatinine and blood urea nitrogen, decreased creatinine clearance rate and phenol red excretion, anemia in patients, marked acceleration of erythrocyte sedimentation rate, and this type of nephritis can be relieved after appropriate treatment.

　　3. Chronic nephritis-hypertension type:In addition to the above general manifestations of chronic glomerulonephritis, there is an outstanding manifestation of persistent moderate to high blood pressure, and it is not very sensitive to general antihypertensive drugs. It often causes severe fundus hemorrhage or flocculent exudation, even papilledema, vision loss, and accompanied by renal damage. Urinalysis shows varying degrees of proteinuria and significant abnormalities in urinary sediment. This type has a rapid deterioration of renal function and a poor prognosis.

　　The above clinical classification is not absolute, and there is cross and transformation between types. Some patients may have the manifestations of both nephrotic type and hypertension type, which can be a mixed type.

　　Once the diagnosis of chronic glomerulonephritis is confirmed, active treatment and prevention should be carried out to prevent the progressive deterioration of renal function, and to avoid and delay the stage when the patient must receive renal replacement therapy as much as possible. Avoid factors that may worsen the condition, such as infection and fatigue. Strictly control diet and ensure adequate nutrition. Actively control and treat complications. Use Chinese medicine cautiously or avoid using nephrotoxic drugs that are likely to induce renal injury. Use traditional Chinese medicine treatment, based on the patient's condition,辨证论治, formulate herbal medicine, and use traditional Chinese medical methods to improve and delay the progression of renal failure.

　　Any abnormality in urine tests (proteinuria, hematuria, cast urine), edema, and a history of hypertension for more than one year should be considered for this disease. After excluding secondary glomerulonephritis and hereditary glomerulonephritis, chronic nephritis can be diagnosed clinically. The specific examination methods are as follows.

　　1. Urinalysis: There is often mild to moderate proteinuria, accompanied by hematuria, red blood cell casts, gross hematuria is rare, and it is mostly microscopic persistent hematuria.

　　2. Blood tests: Early changes are not obvious. In patients with renal insufficiency, normochromic, normocytic anemia can be seen, with明显accelerated erythrocyte sedimentation rate, decreased plasma albumin, mild increase in blood cholesterol, and normal serum complement C3.

　　3. Renal function tests: ① Mild to moderate decrease in内生肌酐清除率 and phenol red excretion, decreased urine concentration function; ② Serum urea nitrogen and creatinine are basically normal in the early stage of the disease. As the condition worsens, BUN and Scr gradually increase. When they are higher than the normal value, it indicates that 60% to 70% of the effective renal units have been damaged. This is of great value in the diagnosis of renal insufficiency, especially uremia.

　　4. Abdominal X-ray film: The kidneys are obviously shrunken, and the surface is not smooth.

　　5. Ultrasound: In the early stage, the kidneys are normal or shrunken, the renal cortex becomes thin or the renal structure is disordered. Ultrasound examination can help exclude congenital renal hypoplasia, polycystic kidney disease, and urinary tract obstruction diseases.

　　6. Renal biopsy: According to its pathological type, corresponding pathological changes can be seen.

　　Chronic glomerulonephritis patients should be provided with sufficient vitamins, especially vitamin C, because long-term chronic nephritis patients may have anemia, and vitamin C can increase iron absorption, so foods such as tomatoes, green leafy vegetables, fresh jujubes, watermelons, radishes, cucumbers, watermelons, tangerines, kiwis, and natural juices should be consumed.

　　For patients with poor appetite due to chronic glomerulonephritis, vitamin C preparations can be supplemented; at the same time, more foods rich in vitamin B and folic acid, such as animal internal organs and green leafy vegetables, should be supplemented, which helps to correct anemia. When hyperkalemia occurs, foods high in potassium should be avoided, and vegetables and fruits should be selected with caution. Patients with chronic glomerulonephritis should avoid sugar-containing beverages and irritant foods.

　　The treatment of chronic glomerulonephritis should aim primarily at preventing or delaying the deterioration of renal function and preventing serious complications. The following comprehensive treatment measures can be adopted.

　　1. Actively control hypertension and reduce urinary protein

　　Hypertension and urinary protein are important factors that accelerate glomerulosclerosis and promote the deterioration of renal function. Actively controlling hypertension and reducing urinary protein are two important links. Chronic nephritis often has sodium and water retention causing volume-dependent hypertension, so patients with hypertension should limit salt (NaCl

　　2. Limit the intake of protein and phosphorus in food

　　Patients with renal insufficiency and azotemia should limit the intake of protein and phosphorus, and adopt a high-quality low-protein diet or add essential amino acids or α-keto acids.

　　3. Glucocorticoids and Cytotoxic Drugs

　　Since chronic nephritis includes various diseases, the application of such drugs should be treated differently. However, if the patient's renal function is normal or only slightly impaired, the kidney volume is normal, the pathological type is relatively mild (such as mild mesangial proliferative glomerulonephritis, early membranous nephropathy, etc.), and there is a lot of urinary protein, it can be tried if there are no contraindications, and the ineffective ones should be gradually withdrawn.

　　4. Anticoagulants, Fibrinolytics, and Antithrombotic Agents

　　Such drugs can inhibit fibrin formation, platelet aggregation, and decrease complement activity, but the efficacy is not certain.

　　5. Avoid factors that may worsen kidney damage

　　Avoid factors that may worsen kidney function, such as infections, fatigue, pregnancy, and nephrotoxic drugs (such as aminoglycoside antibiotics, traditional Chinese medicines containing aristolochic acid, etc.).