Acute nephritis

　　Acute nephritis is an immune disease. People first realized that the occurrence of nephritis is related to certain infections. Since the 20th century, it has been confirmed that certain types of group A beta-hemolytic streptococcus are related to the onset of acute nephritis. In recent years, it has been found that viral infections can also lead to acute nephritis, including infectious hepatitis, mumps, chickenpox, influenza, infectious mononucleosis, measles, and adenovirus, etc. In addition, there is nephritis after malaria infection.

　　Acute nephritis patients need to be vigilant about the following three major complications:

　　1. Acute congestive heart failure
　　In children with acute left heart failure, it can become the initial symptom of acute nephritis. If not identified and rescued in time, it can quickly lead to death. During acute nephritis, due to water and sodium retention, general edema and increased blood volume, pulmonary congestion is very common. Therefore, in the absence of acute heart failure, patients often have symptoms such as shortness of breath, cough, and a little wet啰音 at the base of the lung, due to respiratory tract infection, the existence of pulmonary congestion is easy to be overlooked. Conversely, there are also cases where this circulatory congestion phenomenon is mistakenly believed to be acute heart failure. Therefore, it is very important to correctly understand the pulmonary congestion caused by water and sodium retention or the concurrent acute heart failure with acute nephritis.

　　2. Hypertensive encephalopathy
　　The incidence of hypertensive encephalopathy during acute nephritis ranges from 5% to 10%. In recent years, like acute heart failure, its incidence has decreased significantly, and it is less common than acute heart failure. This may be related to timely and reasonable treatment. Common symptoms include severe headache and vomiting, followed by visual impairment, confusion, drowsiness, and may occur in paroxysmal convulsions or epilepsy-like seizures. After blood pressure control, the above symptoms improve or disappear rapidly, without sequelae.

　　3, Acute renal failure
　　During the acute phase of acute nephritis, mesangial cells and endothelial cells in the glomeruli proliferate in large numbers, leading to capillary narrowing and intravascular coagulation, further reducing the patient's urine output (oliguria or anuria). With the large retention of protein catabolic products, uremic syndrome may appear during the acute phase.

　　4, Secondary bacterial infection
　　Due to reduced systemic resistance, acute nephritis is prone to secondary infections, the most common of which are pulmonary and urinary tract infections. Once secondary infections occur, active symptomatic treatment should be given to avoid exacerbation of the original disease.

　　Acute nephritis is more common in children and males. The onset of this disease is acute, with varying degrees of severity, with mild cases presenting as subclinical type (only with abnormal urinalysis); typical cases present with acute nephritis syndrome, and severe cases may develop acute renal failure. The prognosis of this disease is generally good, and it can often be clinically cured within a few months. The typical manifestations of this disease include the following:

　　1, Hematuria, proteinuria
　　Almost all patients have glomerular源性 hematuria, about 30% of patients may have gross hematuria, which is often the initial symptom and reason for the patient to seek medical attention. It may be accompanied by mild to moderate proteinuria, and about 20% of patients have proteinuria within the scope of nephrotic syndrome. In addition to red blood cells, an increase in white blood cells and epithelial cells can be seen in the urine sediment in the early stage, and there may be granular casts and red blood cell casts, etc.

　　2, Edema
　　Edema is often the initial manifestation of the onset, with typical symptoms of morning eyelid edema or mild, non-pitting edema of the lower extremities. A few severe cases may affect the whole body.

　　3, Hypertension
　　Most patients develop transient mild to moderate hypertension, which is often related to sodium water retention, and blood pressure can gradually return to normal after diuresis. A few patients may develop severe hypertension, even hypertensive encephalopathy.

　　4, Abnormal renal function
　　In the early stage of the disease, patients may experience a decrease in glomerular filtration rate and sodium water retention, leading to a decrease in urine output, and a few patients may even have oliguria (

　　5, Congestive heart failure
　　It often occurs in the acute stage, with severe water and sodium retention and hypertension as important triggers, which requires urgent treatment.

　　To prevent acute nephritis, it is mainly necessary to prevent and treat other diseases that can cause nephritis (also known as the precursors of nephritis), especially the diseases caused by Streptococcus hemolyticus infection, such as upper respiratory tract infection, acute tonsillitis, pharyngitis, scarlet fever, erysipelas boils, and so on. According to clinical observations, patients with recurrent tonsillitis, pharyngitis, and other chronic infection foci can cause acute nephritis and transform it into chronic nephritis. Therefore, if it is confirmed that acute nephritis is caused by tonsillitis, timely tonsillectomy at an appropriate time can help cure and prevent recurrence. Other bacteria, viruses, protozoa, and so on can also cause nephritis. Therefore, the active and timely prevention and treatment of the precursors of nephritis are of great significance for preventing the occurrence of acute nephritis and preventing the transformation of acute nephritis into chronic nephritis.

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　　饮食宜忌 for acute nephritis patients
　　急性肾炎除了常规的治疗外，饮食也需要进行调理。常见的饮食要求如下：
　　1、起病3～6天，因肾小球滤过率下降，会产生一过性氮质潴留，因此需采用限制蛋白质的饮食。可多食水果、蔬菜、点心等，减少鱼、肉、蛋类的摄入，米、面等主食可不加限制。
　　2、如尿素氮超过60mg％，每日饮食中蛋白质供给量应采用牛奶、鸡蛋等高生物价优质蛋白，以减少非必需氨基酸的摄入量。
　　3、注意病人浮肿及尿量，浮肿严重者应限制摄入水分，严格记录出入液量。Currently, it is advocated that daily water intake be calculated based on the non-obvious water loss plus urine output。
　　4、急性期有持续少尿，严重氮质血症者若发生高钾血症，要避免含钾量高的食物。
　　5、充分供给各种富含维生素的食物，特别是维生素B及C的食物，饮食中应多采用水果、蔬菜。

　　除了西医治疗外，急性肾炎还可运用中医疗法。The traditional Chinese medicine (TCM) differential treatment for this disease is as follows：

　　1、Fengshui泛滥
　　Treatment method: For偏于风寒，use宣散风寒，利水渗湿；for偏于风热，use宣散风热，利水渗湿。
　　Herbal medicine: For偏于风寒，use麻桂五皮饮加减。麻桂五皮饮由麻黄汤合五皮饮加减而来，方中以麻桂、杏仁宣散风寒；桑皮降肺利水；陈皮、腹皮行气利湿；共为宣肺解表利水之剂。可加苏叶、牛膝、车前子等以加强解表利水之力。偏于风热可用越婢五皮饮加减。越婢五皮饮由越婢汤合五皮饮化裁而来，方中以麻黄、石膏、杏仁宣散风热；桑皮降肺利水；陈皮、腹皮行气利湿；茯苓渗利水湿，亦为宣肺利水之剂。可加牛膝、车前子等活血利水。

　　2. Dampness Toxin Permeation
　　Therapeutic Method: Open the lung and detoxify, promote diuresis and swelling.
　　Herbal Medicine: Use Mahuang Lianqiao Chi Xiaodou Decoction plus Huai Niuxi, Cheqianzi, and Dongguazi, etc. In this formula, Mahuang (ephedra) disperses cold and relieves the exterior, being the main drug; Lianqiao and Shengzishibi (white poplar bark) clear heat and detoxify; Xingren (apricot kernel) reduces Qi and relieves asthma; Chixiaodou clears heat and eliminates dampness, being the adjuvant drug; Jiang (ginger) and Zao (date) harmonize营 and Wei, control the bias of all the drugs; Gancao (licorice) harmonizes the middle and detoxifies, being the assistant. If damp toxicity is severe, use Wuwei Xiaodao Yin to clear heat and detoxify. Promote diuresis and swelling.

　　3. Water Dampness Soaking
　　Therapeutic Method: Invigorate the spleen and transform dampness, promote Yang and promote diuresis.
　　Herbal Medicine: Use Weiling Tang (i.e., Pingwei San combined with Wuling San) plus Huai Niuxi and Cheqianzi. Pingwei San uses Houpo (cinnamon twigs), Cangzhu (atractylodes), and Chenpi (tangerine peel) to regulate Qi and dry dampness to invigorate the spleen, making the dampness internally consumed; Wuling San uses Guizhi (cinnamon), Atractylodes, Fuling (poria), Zhuli (polyporus), and Zexie (alisma) to promote Yang and transform Qi to promote diuresis, making the dampness go away from below. The two formulas combined have a more prominent effect on invigorating the spleen and promoting diuresis, and adding Huai Niuxi and Cheqianzi can make the dampness go away quickly.

　　4. Internal Congestion of Damp-Heat
　　Therapeutic Method: Divide and eliminate dampness and heat.
　　Herbal Medicine: Use Yijiao Pei Lai Huang Wan to divide and eliminate dampness and heat from both front and back. In this formula, Fangji (stephania tetrandra) and Jiaoyan (Seselis seselis) promote diuresis and swelling; Xianlianzi (Seselis seselis) promotes lung and diuresis; Dahuang (rhubarb) clears heat and promotes defecation. The drugs work together to divide and eliminate dampness and heat from both front and back.

　　5. Excessive Heat in the Lower Jiao
　　Therapeutic Method: Clear heat and reduce fire, cool blood and stop bleeding.
　　Herbal Medicine: Xijie Herba can be used to remove Mu Tong, and add Nuzhenzi, Hanliancao, etc. In this formula, Xijie Herba and Shengdi (raw rehmannia) cool blood and stop bleeding, clear heat in the lower jiao, and are the main drugs; Huashi (talc), Danzhu Ye (linden leaf), and Zhui Zi clear the lower jiao, making dampness and heat clear, which is the adjuvant drug; Puhuang (lotus seed powder),藕节(Loujie, lotus leaf vein), and Danggui nourish blood and activate blood, which are the assistant drugs; Gancao (licorice) relieves pain and regulates the drugs. The drugs work together, treating both the symptoms and the root cause, purging the root and clearing the source, so it has a good therapeutic effect on the symptoms of dampness and heat accumulated in the lower jiao and blood flowing out of order. Adding Nuzhenzi and Hanliancao to enhance the effect of nourishing the kidney and stopping bleeding.