Salt-wasting nephritis

　　1. Causes of disease

　　This disease is a clinical syndrome of a rare chronic kidney disease, common causes include:

　　1. Chronic interstitial nephritis, chronic pyelonephritis.

　　2. Renal medullary cystic disease, such as polycystic kidney disease.

　　3. Renal tuberculosis, renal calcification.

　　4. Bilateral renal hypoplasia.

　　5. Obstructive nephropathy, etc.

　　2. Pathogenesis

　　Renal interstitial disease causes damage to renal tubular epithelial cells, making them less responsive to aldosterone, reducing the reabsorption of sodium chloride by the renal tubules, and a large amount of sodium chloride is excreted in the urine, thus causing hyponatremia. Its particularity is that the loss of the reabsorption function of sodium chloride in the renal tubules is much more serious than the damage to the glomerular function. In severe cases, there may be extensive damage to the renal units, and the survivors have to bear the excessive burden of solutes in the plasma, leading to osmotic diuresis, that is, the excessive loss of salt and water.

　　It is prone to complications such as hypotension and uremic acidosis. In severe cases, there may be mental confusion and other mental symptoms. In the late stage, patients may lose tolerance to salt, the tendency to lose salt may be reduced, and complications such as edema, hypertension, and heart failure may occur.

　　1. Uremia:It actually refers to the inability of the human body to produce urine through the kidneys to excrete metabolic waste products and excessive water from the body, causing harm. Modern medicine believes that uremia is a series of complex syndromes produced by the internal biochemical process disorder of the body after the loss of renal function.

　　2. Acidosis:Endocrine diseases, the accumulation of acidic substances in the blood and tissues of the body, the essence of which is the increase in hydrogen ion concentration in the blood and the decrease in pH value.

　　3. An excessive accumulation of body fluid in the interstitial space or body cavity is called edema:Only a small amount of fluid is present in a normal body cavity. If there is an accumulation of body fluids in the cavity, it is called hydrops, such as ascites (abdominal hydropericardium), pleural effusion (thoracic hydrothorax), pericardial effusion, ventricular hydrocephalus, scrotal hydrocele, and so on. The edema fluid is generally interstitial fluid. Depending on the amount of protein contained in the edema fluid, it can be divided into exudate, whose relative density is greater than 1.018, and transudate, whose relative density

　　4. In the absence of antihypertensive medication, systolic blood pressure ≥139mmHg and/or diastolic blood pressure ≥89mmHg, hypertension is classified into grades 1, 2, and 3 according to blood pressure levels.Systolic blood pressure ≥140mmHg and diastolic blood pressure

　　5. Heart failure:Also known as 'cardiac failure', it refers to the condition where the heart is unable to pump out the blood supply that matches the venous return and the metabolic needs of the body's tissues at that time.

　　The prominent clinical manifestation of this disease is hyponatremia, which can lead to circulatory failure, rapid pulse, blood pressure drop, or postural hypotension, syncope, collapse of peripheral veins, etc. Patients often have dehydration, poor skin elasticity, sunken eyes, muscle weakness, decreased appetite, nausea, vomiting, weight loss, and severe muscle spasms. If sodium salts are not supplemented in time, patients may die from uremia due to dehydration, salt loss, and a sharp decrease in glomerular filtration rate.

　　The clinical characteristics of this syndrome are:

　　1. Most are adult males, especially young adults.

　　2. Symptoms resembling Addison's disease, 50% of patients have polyuria and nocturia, skin pigmentation is bronze-colored and distributed relatively evenly, but mucosal pigmentation in the oral cheeks is less common, which is different from Addison's disease. During the acute attack, patients often feel significantly weak, have decreased appetite, nausea, vomiting, weight loss, thin pulse, low blood pressure, prone to orthostatic hypotension, fainting, and syncope. There are signs of dehydration and muscle spasms. In severe cases, there may be confusion, delirium, coma, uremia, and acidosis.

　　3. History of chronic kidney disease.

　　4. Intake of a large amount of salt (10 to 20g/d) can alleviate symptoms, 30% of patients have gastritis and a history of long-term use of large amounts of alkaline drugs.

　　5. Deoxycorticosterone treatment is ineffective, adrenal cortical function tests are normal, and urine aldosterone excretion increases.

　　The main prevention of this disease is to actively treat various primary chronic kidney diseases that cause the disease, and to actively treat the symptoms of patients who have already been diagnosed, control the progression of the disease, and prevent and delay the occurrence of complications.

　　1. Blood tests:Blood sodium and blood chloride levels are low, blood potassium levels are increased (occasionally decreased), creatinine and blood urea nitrogen levels may increase, leading to azotemia and metabolic acidosis. Blood bicarbonate and pH levels also decrease.

　　2. Urinalysis:Urine sodium levels rise, urine specific gravity is fixed, there is proteinuria, and urine aldosterone levels increase significantly, often exceeding primary hyperaldosteronism.

　　3. Others:17-ketosteroids, 17-hydroxycorticosterone, and other excretion amounts are normal or slightly increased, and there is no response to deoxycorticosterone (DOCA) treatment.

　　4. Routine ultrasound, X-ray film or CT examination.

　　5. Renal biopsy tissue pathological examination:It can clearly diagnose the primary disease.

　　Therapeutic diet for salt-wasting nephritis

　　1. Plantain Leaves Porridge

　　30 to 60 grams of plantain leaves, 1 stalk of scallion, and 50 to 100 grams of glutinous rice. Wash and chop the plantain leaves, then boil with the scallion to make a decoction and remove the residue. Add glutinous rice to cook into porridge.

　　Usage: Take 2-3 times a day, 5-7 days make up a course.

　　Traditional Chinese medicine and food efficacy: Diuretic, clearing heat, improving eyesight, and removing phlegm. Suitable for acute nephritis patients with symptoms such as anuria, hematuria, and edema. Not suitable for patients with spermatorrhea and enuresis.

　　2. Gourdbladder porridge

　　10-15 grams of dried gourdbladder powder (the older, the better), 50 grams of glutinous rice, and an appropriate amount of rock sugar. First, put the glutinous rice and rock sugar in a pot, add 500 grams of water, and cook until the rice is soft. Then add the dried gourdbladder powder and cook for a few more minutes until the porridge is thick.

　　Usage: Take twice a day, hot and immediate. 5-7 days make up a course.

　　Efficacy: Promoting diuresis and reducing edema. Suitable for edema caused by nephritis, heart disease, beriberi, and other conditions.

　　3. Winter melon red bean porridge

　　500 grams of winter melon, 30 grams of red beans. Boil the winter melon and red beans with an appropriate amount of water.

　　Usage: Add little or no salt. Eat melon and drink soup, twice a day.

　　Efficacy: Promoting diuresis, reducing edema, relieving heat toxicity, and stopping thirst. Suitable for acute nephritis with edema and oliguria. Not suitable for chronic nephritis with deficiency of the spleen and kidney and coldness.

　　4. Cabbage Job's tears porridge

　　500 grams of Chinese cabbage, 60 grams of Job's tears. First, cook the Job's tears into porridge, then add the chopped and washed Chinese cabbage, boil for two or three boils, and it is ready when the cabbage is cooked. Do not overcook.

　　Usage: Add little or no salt when eating, twice a day.

　　Efficacy: Invigorating the spleen and removing dampness, clearing heat and promoting diuresis.

　　1. Treatment

　　In addition to the treatment of the primary disease, it is mainly to supplement a large amount of sodium salt while treating the primary disease. Generally, sodium chloride can be taken orally, and a mixture of sodium chloride and sodium bicarbonate can be given in case of acidosis. When an acute crisis occurs, the patient often has nausea and vomiting, and an appropriate amount of isotonic sodium chloride solution (or 1/6mmol sodium lactate) should be administered intravenously to correct water and electrolyte imbalance. If hyponatremia is particularly severe, a hypertonic sodium chloride solution can be administered intravenously at the beginning. During treatment, the intake of sodium salt should be adjusted according to the specific condition of the patient to avoid edema or hypertension.

　　2. Prognosis

　　The prognosis of this disease depends on the condition of the primary disease and the progression of renal failure. In cases of children, timely treatment can lead to spontaneous remission after surviving to 3-4 years of age. This disease is mostly secondary, and timely treatment can even lead to a survival of 20 years. If not treated in time, death can occur rapidly.