Rapidly progressive glomerulonephritis in the elderly

　　Common causes of rapidly progressive glomerulonephritis include the following four points, which patients can refer to.

　　1. Primary glomerular disease;

　　2. Related to infectious diseases;

　　3. Related to multi-system diseases;

　　4. Related to the use of drugs.

　　Patients with this disease may have persistently high blood pressure in the short term, and complications such as heart and brain diseases may occur. Renal function deteriorates rapidly, and patients with oliguria or anuria often develop uremia within a few weeks to a few months, and symptoms such as edema, nausea, vomiting, hiccups, upper gastrointestinal bleeding, and other complications may occur. Pulmonary edema, pericarditis, brain edema acidosis, hyperkalemia anemia, and other complications may occur. Most cases have an acute onset, rapid progression, and typical clinical manifestations such as oliguria or anuria, gross hematuria with a large amount of proteinuria, and progressive renal function impairment. Pathological changes such as crescent formation in more than 50% of glomeruli can be seen in renal biopsy, making diagnosis relatively easy, but attention should be paid to atypical cases.

　　The clinical signs of rapidly progressive glomerulonephritis are acute renal failure and active glomerulonephritis, which can start abruptly, but most cases are insidious in onset. At the time of initial diagnosis, azotemia is often seen, and the most prominent symptoms are weakness, fatigue, and fever. Nausea, anorexia, vomiting, joint pain, and abdominal pain are also common. Half of the patients have influenza-like symptoms before onset, and the renal function deteriorates rapidly within a few weeks or months after onset, requiring dialysis treatment.

　　There are many causes of this disease. To prevent the occurrence of the disease, everyone should pay attention to protecting the kidneys. For those who have already been diagnosed, attention should be paid to protecting the remaining renal function, such as avoiding the use of drugs that damage the kidneys, and at the same time, attention should be paid to correcting factors that reduce renal blood flow (such as hypoalbuminemia, dehydration, hypotension, etc.) and preventing infection.

　　The clinical signs of rapidly progressive glomerulonephritis are acute renal failure and active glomerulonephritis. Generally, the following examination measures need to be taken for this disease:

　　1. Urinary routine examination

　　Urine routine examination may show a large number of red blood cells or gross hematuria, common red cell casts and a small or moderate amount of protein, and an increase in urinary leukocytes is also common (>30,000/mL), which are neutrophils, monocytes, helper, and suppressor T cells. The urine specific gravity generally does not decrease.

　　2. Blood routine

　　The disease often presents with severe anemia, and sometimes there is microangiopathic hemolytic anemia, sometimes accompanied by increased white blood cells and platelets. The presence of C-reactive protein positivity suggests acute inflammation.

　　3. Immunoglobulin IgG class

　　 Antineutrophil cytoplasmic antibody (ANCA). It is found in 75% to 90% of patients with rapidly progressive glomerulonephritis associated with ANCA, with P-ANCA being more common and C-ANCA less common. Serological tests are very useful for differential diagnosis of the disease, and different etiologies can show some specific positive results, such as anti-DNA, IgA, fibronectin, hemolysis, thrombocytopenia, and increased ASO levels.

　　4. Abdominal X-ray and renal ultrasound examination

　　Ultrasound examination can detect kidney enlargement or normal size with a regular contour, but the junction between the cortex and medulla is unclear (related to kidney edema).

　　To help elderly patients with acute renal failure recover better, they can try the following diet recipes, which are very effective.

　　1. Boil Chixiao until soft and烂, add an appropriate amount of brown sugar. Take twice a day, 15-30g each time, until cured.

　　2. Boil 250g of crucian carp and 30g of Chixiao together. Take in two doses, and can be taken continuously until cured.

　　3. Boil an appropriate amount of corn silk, Dongguapi (winter melon skin), and Chixiao to make soup as tea, and take it continuously.

　　4. Boil 50g of Lizi Cao (Lychee herb) and Cheqian Cao (Plantago herb) with 500ml of water to make juice. Add 10ml of white honey when taking, take 3 times a day.

　　5. Boil 50g of corn silk and fresh white mugwort root to make tea. Take 3-5 times a day.

　　6. Boil 500g of winter melon and 30g of Chixiao with an appropriate amount of water to make soup, do not add salt or add a little salt for seasoning. Eat the melon and drink the soup, twice a day.

　　Acute renal failure belongs to Wind and Water in Western medicine, the etiology and pathogenesis are related to lung heat and Qi obstruction, and belong to Guange, the etiology and pathogenesis are related to blood and fluid mutually congealed, and the later stage is turbid evil obstruction.

　　1. Lung heat and Qi obstruction

　　Symptoms: swelling of the eyelids first, followed by the limbs or the whole body, dry mouth and thirst, dry stools, decreased urine output, and even urinary retention, floating and rapid pulse, thin yellow tongue coating, red tongue, or visible gross hematuria.

　　Herbal formula: Mahuang (Ephedra) 6-10g, Xingren (Bitter Almond) 10g, Shigao (Gypsum Fibrosum) 30g, Chenpi (Tangerine Peel) 10g, Dafupi (Big belly skin) 30g, Poria 30g, Sangpi (Mulberry bark) 15g, Chixiao (Red bean) 15g, Donggua pi (winter melon skin) 30g, Huai niuqi (Achyranthes) 10g, Cheqianzi (Plantago) 30g (decocted), Fangji (Stephania) 30g. For those with hematuria, add Daji (Prunella) 15-30g, Danpi (Mimosa Pudica) 10g, Shengdi (Rehmannia) 20g, Baimaogen (white mugwort root) 30g.

　　2. Blood and fluid mutually congealed

　　Symptoms: dizziness and headache, palpitations and shortness of breath, decreased appetite and abdominal distension, occasional nausea, fatigue, decreased urine output, or even urinary retention, deep and thin pulse, dark red tongue, thin greasy tongue coating.

　　Herbal formula: Angelica Sinensis 10g, Peony 15g, Chuanxiong 10g, Atractylodes 10g, Poria 30g, Alisma 15g, Salvia Miltiorrhiza 30g, Achyranthes 10g, Plantago 30g (decocted), Stephania 30g, Sandalwood 10g, Betel Nut 10g, Cinnamon 6g.