Radioactive nephritis

　　1. Etiology

　　Tumors of abdominal organs may lead to the disease if they receive deep radiation without any protection for the kidneys. Generally, when the kidney receives an irradiation dose exceeding 2300R (1R = 2.58×10-4C/kg) within 5 weeks, the disease can occur.

　　2. Pathogenesis

　　The pathogenesis of the acute phase is speculated to be related to vascular endothelial cell injury and necrosis caused by radiation exposure, leading to ischemia, hypertension caused by the release of renin and angiotensin II, and disseminated intravascular coagulation.

　　The onset of chronic radioactive nephritis is similar to acute, but the lesion is less severe, and the ischemic process is slower; or it may derive from the prolonged and unhealed acute phase.

　　The main complications of this disease are malignant hypertension, tubular necrosis, heart failure, and uremia.

　　1, Malignant hypertension:It refers to the appearance of papilledema (K-W fundus grading IV) with malignant hypertension, often accompanied by severe renal function impairment, and death can occur quickly if not treated actively. Malignant hypertension is a precursor to malignant hypertension.

　　2, Acute tubular necrosis:It is the most common type of acute renal failure, accounting for about 75% to 80%. It is a clinical syndrome that appears due to acute and progressive deterioration of renal function caused by various causes, such as renal ischemia and/or renal toxic damage.

　　3, Heart failure:Also known as 'cardiac failure', it refers to the inability of the heart to pump an adequate blood supply that matches the venous return and the metabolic needs of the body's tissues. It is often caused by various diseases that weaken the myocardial contraction ability, reducing the cardiac output and not meeting the body's needs, leading to a series of symptoms and signs.

　　4, Uremia:It actually refers to the inability of the human body to produce urine through the kidneys, which leads to the excretion of waste products and excessive water from the body, causing toxicity. Modern medicine believes that uremia is a series of complex syndromes produced by the derangement of internal biochemical processes in the body after renal function loss.

　　The severity of renal damage is positively correlated with the size of the radiation dose, those receiving a smaller dose of radiation have a longer incubation period, and are more likely to present with asymptomatic proteinuria or mild hypertension and renal function impairment.

　　1. Acute radiation nephritis:It usually takes 6 to 12 months after receiving radiation exposure for the onset of significant nephritis symptoms, the cause is unclear. During the incubation period, there may be mild proteinuria and hypertension, the onset is often acute, patients may experience shortness of breath, headache, loss of appetite, nausea, vomiting, and extreme fatigue, followed by edema, moderate or severe hypertension, heart failure, anemia, proteinuria (most <2g/d, but occasionally up to 4-5g/d), and may have tubular urine and microscopic hematuria, with progressive azotemia, symptoms are similar to acute nephritis syndrome, but radioactive nephritis has a slower onset than acute nephritis, there are no red blood cell casts in the urine, the prognosis of acute radioactive nephritis is poor, often leading to death from malignant hypertension and/or chronic renal failure, survivors often develop chronic radioactive nephritis, with a mortality rate as high as 50%.

　　2. Chronic radioactive nephritis:It can develop from acute radioactive nephritis or be discovered as chronic radioactive nephritis years or even a decade after receiving radioactive exposure, with early stages often lacking a clear history of acute radioactive nephritis. The clinical manifestations may resemble chronic nephritis, with asymptomatic proteinuria, some cases may develop nephrotic syndrome, with varying degrees of renal function impairment, hypertension may or may not be present, the clinical manifestations of chronic radioactive nephritis when presenting as chronic glomerulonephritis commonly include proteinuria, hyponatremia, anemia, hypertension, and a slow progression of uremia, salt loss can be a predominant manifestation, malignant hypertension may occur at any time during the course of the disease, retroperitoneal fibrosis can obstruct one or both ureters, exacerbating renal function failure and salt loss, and can coexist with radioactive enteritis, diarrhea can lead to protein and electrolyte loss.

　　3. Hypertension:After several years of radiation exposure, hypertension of unknown cause may occur without renal failure, which may be benign or progressive and malignant hypertension from the beginning, and the cause may be due to unilateral renal ischemia. The mortality of progressive and malignant hypertension is very high, mainly related to the severity of hypertension.

　　4. Simple proteinuria:Some mild cases may only have simple proteinuria, and it may take several years to slowly develop into kidney shrinkage and chronic progressive renal failure.

　　The most effective treatment is prevention, including the protection of the kidneys and the careful control and limitation of radiation doses, isolation and contact can reduce radiation damage.

　　Dietary principles

　　1. Control protein intake, generally limiting to 30 to 40 grams per day, and pay attention to providing high-quality protein in the diet, mainly referring to lean meat, eggs, and milk, etc;

　　2. Appropriate increase in carbohydrates, such as various bread or rice, to meet the basic energy needs of the body and prevent negative nitrogen balance;

　　3. Eat more foods rich in soluble fiber or polyunsaturated fatty acids, such as oatmeal, rice bran, or fish oil, to help lower blood lipids and delay the decline of renal function;

　　4. Various vitamin preparations should be supplemented, especially vitamin C, which should not be less than 300 milligrams per day.

　　5. Eat less or no plant protein, such as beans and bean products, etc;

　　6. Foods high in salt should be avoided, such as salted vegetables, pickled vegetables, preserved eggs, salted eggs, cured meat, seafood, and noodles, etc.

　　7. Try to eat less monosodium glutamate and alkalis;

　　8. The content of fat in the diet should not be excessive.

　　1. Laboratory examination:

　　1. Acute radiation nephritis:Anemia and proteinuria (most

　　2. Chronic radioactive nephritis:Common symptoms include simple proteinuria, salt-wasting hypotonic urine, and anemia; when the patient presents with chronic nephritis, there may be mild to moderate proteinuria, with a small amount of red and white blood cells in the urine sediment, and occasionally granular casts. Concentration function is poor (polyuria), and there may be hyponatremia, hypokalemia, and acidosis. Renal function damage may lead to increased blood urea nitrogen and creatinine.

　　2. Renal biopsy:

　　1. Acute radiation nephritis:Glomerular and tubular degeneration, interstitial edema and hemorrhage. As in acute nephritis type, kidney size is normal, with thickening, rupture, and glassy degeneration of the glomerular basement membrane,变性 of vascular endothelial cells, and swelling of the intima. After high-dose irradiation,纤维素样 necrosis of the renal artery and small artery walls may occur, leading to thrombosis; even some cases may show the formation of crescents. Immunofluorescence examination shows no deposition of immunoglobulins, complement, or fibrinogen, and the affected tissue is easily distinguishable from normal tissue.

　　2. Chronic radioactive nephritis:In chronic radioactive nephritis, severe vascular sclerosis can be seen in the kidneys, glomeruli shrink and there is mesangial sclerosis, tubular atrophy, interstitial fibrosis with mild inflammatory response, cysts are obviously fibrotic, and sometimes necrotic vascular lesions of malignant hypertension can be seen. Due to widespread necrosis of the arterial wall and thrombosis, glomerulosclerosis and tubular degeneration and necrosis are induced, ultimately leading to kidney atrophy. If only one kidney receives radiation, the same damage can occur in the single kidney.

　　One, radioactive nephritis food therapy

　　1. Tortoise shell drink:Yam 30 grams, tortoise shell 30 grams. First boil the tortoise shell for 2 hours, then add yam and fritillaria to cook together, remove the dregs and keep the juice. Take twice a day, in the morning and evening, for a total of 1 week.

　　2. Carp porridge:Two carp, glutinous rice 60 grams, fresh reed root 6 grams. Clean the fish, remove the internal organs and wash it, then cook it with reed root and glutinous rice to make porridge. Take twice a day, in the morning and evening, for a total of 20 days.

　　3. Euryale ferox porridge:Euryale ferox 30 grams, glutinous rice 30 grams, 10 white-barked nuts. First peel and core the white-barked nuts, then cook the nuts with Euryale ferox and glutinous rice to make porridge. Take once a day, for a course of 10 days.

　　4. Persimmon leaf sugar:Fresh persimmon leaves 1000 grams. Clean and chop the fresh persimmon leaves, add water to make a strong decoction, remove the dregs and take the juice, then concentrate it over low heat to make it thick. Add sugar to absorb the medicine juice and dry it in the sun, then crush it and store it in a bottle for use. Take 3 times a day, 15 grams each time.

　　5. Longan porridge:Longan 60 grams, glutinous rice 100 grams, a little brown sugar. ①Cut Astragalus into thin slices, wash glutinous rice clean. ②Place Astragalus in a pot, add an appropriate amount of water, boil with medium heat, then remove the dregs and take the medicine juice. ③Add glutinous rice to the pot, add the medicine juice and an appropriate amount of water, mix with high heat, then turn to low heat to cook the rice into porridge. Take twice a day, in the morning and evening.

　　6. Ginger and red date porridge:Fresh ginger 12 grams, 6 red dates, glutinous rice 90 grams. The ginger is washed and chopped, then cooked with red dates and glutinous rice to make porridge. Take twice a day, in the morning and evening, and can be taken all year round.

　　7. Black sesame Poria cocos porridge:Black sesame 6 grams, Poria cocos 20 grams, glutinous rice 60 grams. Cut Poria cocos into pieces, place it in a pot to make a decoction, then add black sesame and glutinous rice to cook porridge. Take twice a day, in the morning and evening, for a total of 15 days.

　　8. Double skin soup:Bottle gourd shell 50 grams, winter melon peel 30 grams, 5 red dates. Add the above ingredients to 400 milliliters of water, boil to 150 milliliters, remove the dregs and keep the juice. Take one dose a day.

　　9. Yam porridge:Dried yam 60 grams or fresh yam 120 grams, glutinous rice 60 grams. The yam is washed and sliced, and cooked with glutinous rice to make porridge. Take twice a day, in the morning and evening, and can be taken regularly.

　　10. Winter melon Amomum villosum soup:Winter melon 1000 grams, Amomum villosum 30 grams. The winter melon and Amomum villosum are cooked together into soup. Take one dose every other day, for a total of 20 days.

　　Two, what kind of radioactive nephritis diet is good for the body

　　1. Control the intake of protein, generally limiting it to 30 to 40 grams per day, and pay attention to providing high-quality protein in the diet, mainly referring to lean meat, eggs, and milk.

　　2. Appropriate increases in carbohydrates, such as various bread or rice, can meet the basic energy needs of the body and prevent negative nitrogen balance.

　　3. Eat more foods rich in soluble fiber or polyunsaturated fatty acids, such as oatmeal, rice bran, or fish oil, which is conducive to lowering blood lipids and delaying the decline of renal function.

　　4. Various vitamin preparations should be supplemented, especially vitamin C, which should not be less than 300 milligrams per day.

　　Third, what food should not be eaten for radiation nephritis

　　1. Eat less or not eat plant proteins, such as beans and bean products, etc.

　　2. All foods containing a lot of salt should be avoided, such as salted vegetables, pickled vegetables, salted eggs, preserved eggs, salted meat, seafood, dried noodles, etc.

　　3. Try to eat less monosodium glutamate and alkali.

　　4. The content of fat in the diet should not be too much.

　　1. General Treatment

　　Including maintaining renal function, lowering blood pressure, and symptomatic treatment. The treatment for acute radiation nephritis includes controlling hypertension, treating congestive heart failure, and treating uremia. Since the pathological damage of chronic radiation nephritis is irreversible, its treatment is mainly symptomatic treatment and supportive treatment, and routine treatment is performed for chronic renal failure. The injection of adrenaline can reduce the damage by contracting the vascular tissue of the tissue, and the tumor vascular is unresponsive to this drug, so the effect of radiotherapy is not affected by this drug. Cell proliferation inhibitors

　　It can protect the skin, but has no protective effect on the kidneys.

　　Controlling hypertension is very important, especially in the acute stage or cases of malignant hypertension, where antivascular drugs and diuretics are commonly used. Hypertension may not respond to the aforementioned treatments, and a diagnosis of unilateral or bilateral nephritis and renal ischemia is necessary when necessary (unilateral nephritis and renal ischemia often do not have increased plasma renin activity), and symptomatic treatment is required.

　　2. Other Treatments

　　For the treatment of heart failure, maintain water and electrolyte balance, ensure nutrition, and take appropriate measures when there is extrinsic compressive obstruction caused by primary tumor or fibrosis, and perform anti-infection treatment in a timely manner when urinary tract infection occurs.

　　3. Surgical Treatment

　　If there is evidence to indicate unilateral nephritis and renal ischemia, and there are symptoms of malignant hypertension, unilateral nephrectomy may be considered to eliminate malignant hypertension; there are reports that the symptoms of hypertension in patients who have undergone nephrectomy on the affected side can be cured.

　　4. Dialysis Treatment:Dialysis treatment is given during uremia.