Chronic nephritis

　　Chronic nephritis is a glomerulonephritis mainly characterized by chronic glomerular lesions of multiple etiologies, but the etiology of most patients is unknown, and it may be related to the following factors.

　　1. Infection:Infections by various bacteria, viruses, or protozoa, such as upper respiratory tract infections, asymptomatic bacteriuria, influenza, pharyngitis, and tracheobronchitis, are the most common causes of chronic nephritis.

　　2. Autoimmune diseases and vasculitis:For example, lupus erythematosus can also cause chronic nephritis due to the deposition of immune complexes. Glomerulonephritis caused by vasculitis is usually more severe and requires active treatment.

　　3. Medication:Analgesics, gold-containing compounds, certain antibiotics, and other drugs can also cause glomerular lesions.

　　4. Stress state:If sudden gastrointestinal bleeding, severe gastroenteritis, nausea, vomiting, diarrhea, hypotension, anaphylactic shock, and other conditions exceed the body's ability to cope with stress, it can lead to acute exacerbation of chronic nephritis. This mainly refers to the emergency adjustment of adrenal cortex hormone secretion by the adrenal cortex to cope with sudden stimuli. Various stress states can cause the acute exacerbation of chronic nephritis.

　　5. Genetic:Some nephritis is caused by a defect in familial hereditary collagen, leading to end-stage renal failure. Patients may also have other abnormal symptoms, such as deafness or skeletal abnormalities, and there is usually a clear history of end-stage renal failure in the family history.

　　6. Tumor:Some blood tumors or colorectal cancer, lung cancer, can cause chronic nephritis.

　　7. Others:Such as water and electrolyte disorders, acid-base balance disorders, which can cause an acute exacerbation of chronic nephritis.

　　Most people's kidney inflammation starts as an asymptomatic condition, with no obvious acute glomerulonephritis symptoms, but the inflammation develops slowly over several years and eventually becomes chronic glomerulonephritis. Complications may occur if it is not well treated.

　　1. Infection:Long-term proteinuria leads to the loss of a large amount of protein, malnutrition, immune function disorders, and various infections. Common infections include urinary tract infections, respiratory tract infections, and skin infections. Infections often trigger an acute exacerbation of chronic nephritis, leading to progressive worsening of the condition.

　　2. Anemia:In the late stage of chronic nephritis, renal parenchymal damage may occur, accompanied by various abnormalities in the blood system, such as anemia, platelet dysfunction, lymphocyte dysfunction, and coagulation mechanism disorders. Anemia is the most common complication.

　　3. Cardiac damage:Including cardiac enlargement, arrhythmia, and even heart failure, mainly related to hypertension, anemia, arteriosclerosis, and imbalance of water and electrolytes. Occasional malignant hypertension or hypertensive encephalopathy may occur.

　　Chronic nephritis can occur at any age, but it is mainly found in young and middle-aged males. The onset is different, so the clinical manifestations are also diverse. Common symptoms include:

　　1. Edema:Most patients with chronic nephritis will have varying degrees of edema. The degree of edema can be mild or severe, with mild cases showing swelling around the eye sockets and face upon waking up in the morning, or swelling in the lower limbs at the ankles in the afternoon. Severe patients may experience general edema. A small number of patients may not show edema throughout the course of the disease, making them easily overlooked.

　　2. Hypertension:For many patients with chronic nephritis, symptoms of nephritis such as hypertension may occur. Symptoms include headaches, memory decline, poor sleep, and other symptoms.

　　3. Hematuria:When the amount of bleeding is large, it can be detected by the naked eye and is called gross hematuria, which is more common in children; when the amount of bleeding is small and cannot be seen with the naked eye, it can only be found under a microscope and is called microscopic hematuria.

　　4. Proteinuria:Mostly composed of small bubbles that cannot disperse for a long time. This indicates the presence of protein in the patient's urine, and the leakage of protein is often due to glomerular lesions, which requires attention to the possibility of kidney disease. Therefore, if there is a persistent foaming situation after urination for a long time, it should be alerted, and it is necessary to seek medical attention in time for routine urine tests and 24-hour urine protein quantification.

　　Chronic nephritis is often asymptomatic and the clinical symptoms are not obvious, often when discovered, the condition is already quite serious, causing serious harm to the patients, so it is necessary to do a good job of prevention.

　　1. Strengthen physical fitness Activities such as dancing, climbing, walking, long-distance running, rowing, Tai Chi, etc., are helpful to enhance physical fitness, improve the body's resistance, and prevent post-infection immune reactive damage. This is the most important measure for preventing chronic nephritis.

　　2. Prevent infection The occurrence of nephritis is often related to upper respiratory tract infections, and to prevent the occurrence of nephritis, attention should be paid to the changes in weather temperature. Avoid going out in rainy weather, sweating in the wind, wading through rain, and wearing damp clothes, always be vigilant against the invasion of external pathogens.

　　3. Develop good living habits Irregular lifestyle, insufficient sleep, overeating, overindulgence in alcohol and sex, and overexertion can all reduce the body's resistance to external pathogens, increasing the chance of illness.

　　4. Do not take medicine arbitrarily Such nephrotoxic drugs as gentamicin tablets, aminoglycoside antibiotics such as gentamicin, kanamycin, streptomycin, and amikacin, neomycin, vancomycin, tetracycline,先锋2号, and other antibiotics all have certain nephrotoxicity and can easily cause kidney damage, so they should be used as little as possible; non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, phenylbutazone, indomethacin, and nimesulide are also very easy to cause kidney damage, and are not suitable for chronic nephritis patients.

　　Most chronic nephritis patients are asymptomatic from the beginning, and the symptoms are not obvious, making it easy to be overlooked. By the time it is discovered, the best treatment opportunity has been missed. Therefore, timely examination is particularly important.

　　1. Urinalysis:The urine specific gravity of chronic nephritis patients is low, usually below 1.020, and in the late stage of the disease, it often remains fixed at 1.010. Urinary protein is微量+~++++. The urine often contains red blood cells and casts (granular casts, transparent casts). In the acute exacerbation phase, there may be significant hematuria or gross hematuria.

　　2. Blood tests:Chronic nephritis patients often have mild to moderate normochromic anemia, with a proportional decrease in red blood cells and hemoglobin, increased erythrocyte sedimentation rate, and can have hypoproteinemia. Generally, serum electrolytes show no significant abnormalities.

　　3. Renal function examination:The glomerular filtration rate and endogenous creatinine clearance in chronic nephritis patients are reduced, blood urea nitrogen and creatinine levels are elevated, and renal function staging mostly belongs to the compensatory or decompensatory phase; phenol red excretion test and urine concentration and dilution function are both reduced.

　　The course of chronic nephritis is protracted and not easy to heal quickly. While actively treating the condition, attention should also be paid to daily diet.

　　1. Limit protein intake:For patients with chronic nephritis, it is important to control their protein intake. Proteins are converted into ammonia in the human body and when they reach the kidneys for filtration, they increase the burden on the kidneys, leading to kidney deterioration and causing serious harm to the patients. Therefore, for patients, it is necessary to strengthen the control over the intake of protein.

　　2. Reduce water intake:Patients should reduce their fluid intake, especially for patients with edema. The main factor for patients with edema to control fluid intake is to master the amount of water intake based on urine output and the degree of edema. Generally speaking, if edema is obvious, appropriate fluid intake is advisable except for the initial meal.

　　3. Control Sodium Intake:For patients with chronic nephritis, it is necessary to reasonably control the daily intake of sodium. Because patients with kidney disease generally have edema, limiting salt intake is mainly aimed at patients with edema and hypertension. Because not limiting salt can exacerbate water and sodium retention, making edema difficult to subside and causing blood pressure to rise. Therefore, patients with kidney disease should control sodium intake every day. This is also a dietary concern for chronic nephritis.

　　4. Limit Potassium Intake:Patients with hyperkalemia should avoid high-potassium foods such as seafood, mushrooms, ham, black fungus, dried fruits, corn flakes, bananas, oranges, potatoes, pickled radishes, tea, soy sauce, monosodium glutamate, and others.

　　The main purpose of the treatment for chronic nephritis should be to prevent or delay the progressive deterioration of renal function, improve or alleviate clinical symptoms, and prevent and treat complications. The conventional methods of Western medicine for the treatment of chronic nephritis include general treatment and symptomatic treatment.

　　1. General Treatment
　　Patients with edema, large amounts of proteinuria, hematuria, hypertension, and renal function damage should rest appropriately; patients with edema, hypertension, and poor renal function should pay attention to limiting salt intake and fluid intake; patients with poor renal function should not consume excessive amounts of protein.

　　2. Symptomatic Treatment
　　(1) Diuresis: For patients with chronic nephritis and edema, diuretic drugs should be used to alleviate symptoms. Commonly used diuretics include thiazide diuretics, such as hydrochlorothiazide, which can also be combined with potassium-sparing diuretics such as spironolactone or triamterene. Patients with severe edema can use potent diuretics such as furosemide.
　　(2) Hypertension: Patients with chronic nephritis and hypertension have a rapid deterioration in their condition, and it is necessary to actively control blood pressure. However, blood pressure should not be reduced too quickly or too low to prevent a rapid decrease in renal blood flow, which can exacerbate renal function damage. Commonly used drugs include thiazide diuretics or furosemide.
　　(3) Special Treatment: Glucocorticoids and cytotoxic drugs are the main drugs used in the treatment of chronic nephritis. Commonly used drugs include prednisone. Anticoagulants and antiplatelet aggregation drugs, such as heparin, dipyridamole, and aspirin, can be used in combination.