Liver-derived renal damage

　　1, Glomerulonephritis caused by hepatitis B virus.Hepatitis B virus is abbreviated as HBV. It is a dsDNA virus belonging to the family Hepadnaviridae. According to current knowledge, HBV is only susceptible to humans and chimpanzees, causing the disease of hepatitis B virus infection.

　　2, Glomerulonephritis caused by the disorder of immunity, physiology, and metabolism in the body during liver cirrhosis, mainly with IgA nephritis as the main type.Cirrhosis is a common chronic progressive liver disease, characterized by diffuse liver damage formed by one or more etiologies acting for a long time or repeatedly. Pathologically, there are widespread liver cell necrosis, nodular regeneration of residual liver cells, proliferation of connective tissue, and formation of fibrous septa, leading to destruction of the lobular structure and formation of false lobules. The liver gradually deforms, becomes hard, and develops into cirrhosis.

　　12, Renal functional acute renal failure caused by renal hypoperfusion in severe liver insufficiency, known as hepatorenal syndrome.

　　It may be complicated with hepatic encephalopathy, coma, infection, hemorrhage, hypotension, and liver failure, among others.

　　1, Hepatic encephalopathy, also known as hepatic coma, is a comprehensive syndrome of central nervous system dysfunction caused by severe liver disease, based on metabolic disorders. The main clinical manifestations are disturbance of consciousness, abnormal behavior, and coma. There are acute and chronic encephalopathies.

　　2, Hypotension is a general term for systemic arterial blood pressure below normal. Generally speaking, when the blood pressure of the adult brachial artery measured by routine measurement is below 90/60 mmHg (12.0/0.8 kPa), it can be called hypotension.

　　6, Liver failure is a clinical syndrome characterized by widespread and severe damage to liver cells, with severe紊乱 in metabolic function, abbreviated as liver failure.

　　Medical history and symptoms

　　1, Hepatitis B virus-related nephritis is more common in children and males, and patients with hepatitis B or carriers of hepatitis B virus may present with asymptomatic proteinuria or nephrotic syndrome, and a few patients may have gross hematuria.

　　2, Nodular glomerulonephritis secondary to liver cirrhosis has a history of liver cirrhosis, and patients may show abnormal urine tests (such as microscopic hematuria), hypertension, and renal insufficiency, among others. A few patients may not have clinical manifestations, and renal function deterioration is relatively slow.

　　3. Hepatorenal syndrome is common in the decompensated stage of liver dysfunction, most patients have certain triggers, such as excessive diuresis, large-volume abdominal fluid drainage, gastrointestinal bleeding, and the use of certain nephrotoxic drugs; usually oliguria occurs at the same time or after severe liver dysfunction, and renal function can deteriorate progressively over several days, weeks, or months, often accompanied by nausea, vomiting, mental apathy, and drowsiness; in severe cases, there may be hepatic encephalopathy and coma, infection, bleeding, hypotension, and liver failure, which are the main causes of death in patients.

　　Actively treat various liver diseases and prevent the progression of diseases.

　　1. The ideal weight loss method is a balanced diet combined with regular exercise.

　　2. Keep away from various possible blood-contaminated utensils Avoid unnecessary blood transfusions, injections, ear piercing, tattooing, and sharing toothbrushes, razors with others, as well as reducing contact with possible blood-contaminated utensils, because hepatitis B and C are mainly transmitted through blood and body fluids. Therefore, eating together with carriers of hepatitis B and C will not be infected.

　　3. Balanced diet In order to achieve rapid weight loss, one only eats fruit for three meals a day and does not eat other foods, or it is a 'low-sugar diet' - a combination of high protein and low carbohydrate diet. Unbalanced diet increases the burden on the liver. The liver is responsible for converting the food eaten into the body's energy source. For the liver, converting non-carbohydrates into energy is more laborious than converting carbohydrates into energy. The balanced diet energy source combination should be 55-65% from carbohydrate energy (such as rice, noodles), 11-15% from protein energy (such as meat, beans), and 20-30% from fat energy, of which unsaturated fat accounts for 85% (such as vegetable oil).

　　4. Pay attention to dietary hygiene. Do not drink raw water, nor eat seafood raw, as clams, oysters, and shellfish are prone to infection by hepatitis A virus. If you are going to travel to areas with a high risk of hepatitis A infection, such as Mainland China, Southeast Asia, Central and South America, Africa, etc., it is best to get vaccinated against hepatitis A before departure.

　　5. Do not drink alcohol Drinking alcohol increases the risk of fatty liver and alcoholic liver disease. People with liver disease should completely quit alcohol.

　　6. Quit smoking Smoking is related to liver cancer.

　　7. Do not take medicine arbitrarily. All the drugs taken must be detoxified by the liver. In addition to prescribed drugs, avoid taking other drugs on your own, as taking multiple drugs is likely to produce drug interactions, affecting the liver's ability to metabolize drugs. When people with liver disease seek medical treatment, they should inform the doctor of all the drugs they are currently taking as a reference for the doctor's prescription.

　　8. Pay attention to sleep time. The normal sleep time for adults should be 8 hours. It is normal to go to bed around 11 p.m., and to enter the deep sleep state from 1 to 3 a.m. This is the best time to nourish the liver blood. Conversely, the blood will not be nourished enough. Therefore, we appeal to avoid staying up late as much as possible. If it is inevitable to become a member of the late-night group, one should take in more adequate nutrition to protect oneself and minimize the harm to the body caused by staying up late.

　　1. Positive serum HBV antigen, positive HBV antigen in renal biopsy are evidence for diagnosing nephritis associated with hepatitis B virus.

　　2. In liver cirrhosis-induced glomerulonephritis, urinary changes become obvious with the aggravation of proliferative lesions, with proteinuria, casturia, and microscopic hematuria; gross hematuria is less common than in primary IgA nephropathy, most patients have positive blood circulation immune complexes, elevated blood immunoglobulins, especially elevated IgA, and a few patients have decreased blood C3.

　　3. In patients with liver-kidney syndrome, urine protein is negative or trace, urine sediment is normal or contains a small amount of red, white blood cells, and casts; thrombocytopenia, anemia, and abnormal liver function; Ccr significantly decreased, blood urea nitrogen and creatinine increased.

　　4. Ultrasound examination may show changes in cirrhosis, but the kidneys usually show no changes.

　　Therapeutic diet for liver源性 kidney damage:

　　1. Gourdbladder decoction: 60g fresh gourdbladder, or 30g dried product, decocted and drink the decoction.

　　2. Watermelon rind, winter melon rind each 15g, 12g trichosanthes, decocted in water. Take twice a day, with the effect of clearing heat, removing dampness, and promoting diuresis.

　　3. Wu Dou decoction: equal amounts of mung bean, adzuki bean, black bean, soybean, and dolichos (15g each). Boil in water, eat the beans and drink the soup. Take one dose a day.

　　4. Mushroom as a dish, or boiled juice for drinking.

　　5. 100g yam, 50g Astragalus, decocted in water, take twice a day.

　　6. Pork pancreas corn silk decoction: 1 pork pancreas (cleaned), 30g corn silk, decocted in water, take twice a day.

　　First, the treatment of liver源性 kidney damage in Western medicine

　　1. Nephritis associated with hepatitis B virus:See the treatment of primary glomerulonephritis, but glucocorticoids may promote the replication of HBV, and the efficacy is not certain, so they should be used with caution; antiviral treatment, such as interferon and traditional Chinese medicine, may have certain efficacy.

　　2. Liver cirrhosis-induced glomerulonephritis:Generally, no special treatment is needed, mainly to protect the liver and prevent further damage to liver function; a few patients with acute deterioration of renal function or presenting with nephrotic syndrome, their diagnostic and treatment principles are the same as IgA nephropathy.

　　3. Liver-kidney syndrome:The key lies in the treatment of liver disease and its complications; avoid excessive diuresis and large amounts of abdominal fluid drainage, be cautious when using nephrotoxic drugs, correct electrolyte imbalance; on the basis of improving liver function, appropriate expansion and diuresis, intravenous infusion of small doses of dopamine (such as 20mg dopamine added to 250ml of low molecular dextran for intravenous infusion, 15-20D/min), prostaglandins, or phentolamine, etc., may improve renal hemodynamics; moderate abdominal fluid drainage or filtration and concentration of abdominal fluid for reinfusion can reduce intraperitoneal pressure, which is beneficial to improve renal blood circulation; dialysis indications are the same as chronic renal insufficiency. Surgical treatment is necessary when indicated.

　　Second, the treatment of liver源性 kidney damage in traditional Chinese medicine

　　1. Liver depression and Qi stasis, internal obstruction of dampness and water:Evidence of oliguria or anuria, nausea and vomiting, dullness and distension of the abdomen, rumbling sound in the abdomen, edema of the lower extremities or the whole body, headache and irritability, severe cases may have convulsions and coma, greasy tongue coating, strong and robust pulse. Treatment should be to soothe the liver and relieve depression, invigorate the spleen and drain dampness. The formula chosen is Chaihu Shugan San combined with Weiling Tang with modifications: Bupleurum, White Peony, Chuanxiong, Processed Cyperus, Bupleurum, Magnolia, Poria, Alisma, Amomum, and Plantago.

　　2, Yang deficiency of the spleen and kidney, water and dampness泛滥:Symptoms include ashen or pale complexion, aversion to cold and cold limbs, fatigue and loose stools, abdominal distension like a drum, or accompanied by limb edema, stuffy chest and poor appetite, nausea and vomiting, short and scanty urine, white and slippery tongue coating, deep and thin or soft and thin pulse. Treatment should be to strengthen the spleen and warm the kidney, transform Qi and promote diuresis. The formula chosen is附子理中汤combined with五苓散with modifications: 附子、党参、白术、干姜、肉桂、泽泻、茯苓、车前子、大腹皮. If there is severe vomiting, add半夏、吴萸to warm the stomach and stop vomiting.

　　3, Yin deficiency of the liver and kidney, mutual binding of dampness and heat:Symptoms include abdominal distension and fullness, even blue veins exposed, restlessness and bitter taste in the mouth, thirst without desire to drink, short and red urine, thin and hot stools, red tongue with yellow and greasy coating, wiry and rapid pulse. Treatment should be to nourish the liver and kidney, clear heat and remove dampness. The formula chosen is一贯煎combined with茵陈蒿汤with modifications: 北沙参、麦冬、生地、枸杞、泽泻、猪苓、茯苓、茵陈、生大黄、栀子、滑石. If the tongue is deep red and lacks moisture, add玄参、石斛to clear heat and generate fluid; If there is nosebleed and gum bleeding, add仙鹤草、鲜茅根to cool the blood and stop bleeding.

　　4, Turbidity and toxicity congestion, stomach Qi rising:Symptoms include poor appetite, abdominal fullness, nausea and vomiting, constipation or diarrhea, short and涩urine, yellow and greasy tongue coating or thick and greasy white coating, thready and rapid pulse. Treatment should be to reinforce the healthy Qi and reduce turbidity, harmonize the stomach and stop vomiting. The formula chosen is黄连温胆汤combined with温脾汤with modifications: 人参、附子、生大黄、黄连、姜半夏、生姜、茯苓、竹茹. If there is turbidity and toxicity congestion, diarrhea, white and thick greasy coating, vomiting of clear fluid, the raw大黄is changed to prepared大黄, remove黄连, and add肉桂、吴萸to enhance the warming and stopping vomiting effect.

　　5, Invasion of the heart and liver by evil, blood heat and wind stirring:Symptoms include headache and dizziness, or confusion and delirium, following clothes and touching the bed, trembling of the lips, tongue, and fingers, and even spasms and convulsions of the limbs, bleeding gums and nosebleeds, red tongue with thin coating, wiry and thin pulse. Treatment should be to cool the blood and clear heat, and stop the wind and spasm. The formula chosen is犀角地黄汤 combined with羚羊钩藤汤with modifications: 牛角、生地、丹皮、钩藤、菊花、赤白芍、竹茹、茯神、甘草、羚羊角、地龙. If there is a large amount of vomiting of blood and stools, it is necessary to配合输血、输液及其他止血方法抢救；If there is loss of Qi with blood and sweating, and the pulse is fine and thready, an emergency dose of独参汤is used to support the Yuan and save the Qi; When the disease reaches the Yin deficiency of the liver and kidney, the liver wind stirs, and symptoms such as halitosis, confusion, and spasms appear, 紫雪丹or安宫牛黄丸are used in combination to calm the spasms and stop the wind, and to calm the liver and open the orifices.