Latent nephritis

　　The characteristics of hidden glomerulonephritis are hematuria, proteinuria, or both, and the specific causes are often as follows:

　　1, The main causes of diseases mainly manifested by simple hematuria (asymptomatic hematuria) include IgA nephropathy, especially in the early stage, non-IgA mesangial proliferative glomerulonephritis; focal glomerulonephritis and thin basement membrane nephropathy can also be early manifestations of kidney damage caused by allergic purpura nephritis, lupus nephritis, infective endocarditis, and thin basement membrane nephropathy.

　　2, Common causes of diseases mainly manifested by asymptomatic proteinuria (asymptomatic proteinuria) include minimal change glomerulonephritis, mesangial proliferative glomerulonephritis, membranous nephropathy, focal segmental glomerulosclerosis, and early stages of certain IgA nephropathy, amyloidosis nephropathy, diabetic nephropathy (DN), systemic lupus erythematosus (SLE), lupus nephritis (LN), and metacarpophalangeal syndrome.

　　3. The common causes of diseases mainly manifested by asymptomatic hematuria accompanied by proteinuria are various stages of early glomerular diseases (such as mild glomerular lesions, mesangial proliferative glomerulonephritis, focal proliferative glomerulonephritis, and IgA nephropathy).

　　The pathogenesis of latent glomerulonephritis is not yet clear. It is currently believed to be related to infection and immune response, and due to different etiologies, the pathogenesis is also different. Its pathological morphology also has various types, which are mostly early changes of various pathologies.

　　Latent glomerulonephritis has no obvious complications. If the clinical manifestation is hematuria accompanied by proteinuria, it is often a typical manifestation of glomerular disease and is also common in non-stationary (progressive) glomerular diseases. Due to the absence of hypertension, edema, and renal function decline, the general clinical symptoms are mild, and there are no obvious complications. In addition, asymptomatic hematuria and proteinuria can persist for a long time without change. If it is an early manifestation of a certain disease, its clinical manifestations of the primary disease will appear as the disease progresses. In this case, it is not appropriate to diagnose it as latent glomerulonephritis any longer, but should be diagnosed as the corresponding disease, such as mild glomerular lesion, mild mesangial proliferative glomerulonephritis, focal proliferative glomerulonephritis, IgA nephropathy, and early membranous nephropathy, etc.

　　Latent glomerulonephritis often has an insidious onset or may suddenly present with gross hematuria without other urinary system symptoms. Renal function is mostly normal. The main clinical manifestation is urinary abnormalities, which can be divided into the following three forms:

　　1. Asymptomatic hematuria

　　Patients are mostly young adults with no clinical symptoms or signs. Sometimes, microscopic glomerular hematuria is found during physical examination, which is persistent or recurrent. Some patients may experience transient gross hematuria after strenuous exercise, high fever, infection, alcohol consumption, etc., which quickly disappears in a short period. During the episode of hematuria, lumbar pain may occur. Due to the recurrent episodes, it is also called benign recurrent hematuria. This type is more common in IgA nephropathy and can also be seen in non-IgA mesangial proliferative glomerulonephritis, focal segmental glomerulonephritis, and thin basement membrane nephropathy.

　　2. Asymptomatic hematuria and proteinuria

　　Patients of this type have episodic hematuria, while proteinuria persists. During the episode of hematuria, proteinuria also worsens. After the hematuria subsides, proteinuria decreases accordingly, making the condition more severe than simple hematuria. Due to the absence of hypertension, edema, and renal function decline, patients often fail to seek timely medical attention, leading to early misdiagnosis. This type is more common in mesangial proliferative glomerulonephritis, focal glomerulosclerosis, and IgA nephropathy.

　　3. Asymptomatic proteinuria

　　This condition commonly occurs in young males, presenting with persistent proteinuria (although urine protein levels fluctuate with each test, they are always positive). The quantitative urine protein is usually below 2g/d, mainly composed of albumin. Urine sediment is normal, without edema, hypertension, and other clinical manifestations. Renal function is normal, and blood biochemical tests are often normal. The disease can last for many years with a good prognosis. There are no clear pathological changes in histology; it may also be the early manifestation of different types of glomerular diseases, such as membranous nephropathy, mesangial proliferative glomerulonephritis, minimal change nephrotic syndrome, focal segmental glomerulosclerosis, and even early manifestations of certain IgA nephropathy.

　　In daily life, one should pay attention to rest and avoid fatigue, prohibit the use of nephrotoxic drugs, and remove recurrent infection foci if possible, such as in patients with recurrent acute tonsillitis, tonsillectomy can be considered. In case of acute infection, inflammation should be controlled in time to avoid exacerbating hematuria and proteinuria. In daily life, tea can be used as a drink, which can not only prevent and improve nephritis but also regulate the body's physiological balance, anti-inflammatory and antibacterial, enhance human immunity, and greatly reduce a series of complications caused by nephritis.

　　The main clinical examination methods for hidden nephritis are urine examination and other auxiliary examinations, as follows:

　　First, urine examination

　　1. Asymptomatic hematuria: Under the microscope, persistent glomerular hematuria and (or) recurrent gross hematuria can be seen, with 0.5ml of blood or more than 5×10^9/L red blood cells per 100ml of urine, which is persistent or recurrent. Some patients may have transient gross hematuria after infection with fever or intense exercise, which quickly disappears. Sometimes routine urinalysis, blood routine, renal function, blood uric acid, blood glucose, and other tests are normal. The morphology of renal glomerular red blood cells often changes abnormally, and various deformed red blood cells (such as strawberry-shaped, lotus-shaped, etc.) can be seen under phase-contrast microscopy.

　　2. Asymptomatic proteinuria: Urinalysis protein is positive, and the urine contains no leukocytes and red blood cells. The 24-hour urine protein excretion is usually below 2g, mainly composed of albumin. Urine sediment is normal, renal function is normal, and blood biochemical tests usually show no abnormalities. Routine blood tests, erythrocyte sedimentation rate, platelets, coagulation time, and blood culture are all normal. Urinary bacterial culture and urinary tuberculosis and cytological examination are negative. Liver and kidney function (including creatinine clearance rate, urine specific gravity, and concentration test) are normal. Blood antistreptolysin O, rheumatoid factor, antinuclear antibody, cold globulin are negative, and complement is normal. Some IgA nephropathy patients have elevated blood IgA levels, while other immunoglobulins are normal.

　　Second, other auxiliary examinations

　　All examinations, including radionuclide renal imaging, kidney ultrasound, cystoscopy, and intravenous pyelography, are normal.

　　Patients with hidden nephritis should eat a light diet, pay attention to food hygiene, and rationally match their diet. They should eat foods rich in vitamins, trace elements, and high-quality low-protein foods, and avoid eating foods high in salt, potassium, animal protein, and high-fat meats. Patients can also improve their symptoms very well through the following Panax notoginseng chicken soup食疗 method.

　　Formula and preparation:500 grams of chicken meat, 4 grams of Panax notoginseng powder. Wash the chicken clean, and grind the Panax notoginseng into powder. Boil the water with high heat, add the chicken and boil for 3-5 minutes, then remove the chicken and transfer it to a stewing bowl, and simmer over low heat until the chicken is tender. Add the Panax notoginseng powder and a moderate amount of scallions, salt, and monosodium glutamate for seasoning, and it is ready to eat.

　　Effects:The hen has a warm nature and sweet taste, and can warm the middle, invigorate the spleen, and benefit the kidney and essence. Panax notoginseng has a warm nature and sweet taste, and can stop bleeding, remove blood stasis, reduce swelling, and relieve pain, making it an excellent hemostatic medicine. Modern pharmacological studies have shown that Panax notoginseng can shorten the blood coagulation time and cause vasoconstriction. This formula has the effects of invigorating the spleen and kidney, benefiting the Qi and blood, and stopping bleeding and removing blood stasis.

　　Indications and contraindications:This formula is suitable for asymptomatic nephritis with hematuria as the main symptom. It is not suitable for patients with common cold and fever or those without blood stasis.

　　At present, there is no special treatment for asymptomatic nephritis, and the main treatment is general preventive treatment to protect kidney function.

　　First, general treatment

　　1. Diet and rest: Limit the intake of protein in the diet to avoid further damage to the kidneys caused by high protein filtration. Engage in lighter work, reduce work intensity, and avoid fatigue.

　　2. Treatment of the primary lesion: For patients with upper respiratory tract infection and suppurative lesions (such as tonsillitis), active use of antibiotics to control infection, treat acute and chronic inflammatory lesions, and block antigen-antibody immune reactions should be carried out. For recurrent tonsillitis, surgery should be scheduled, and dental caries should also be treated in a timely manner.

　　3. Prohibit the use of nephrotoxic drugs: such as aminoglycosides (gentamicin, kanamycin, streptomycin) and traditional Chinese medicine (aristolochic acid, Guanmutong, etc.).

　　Second, drug treatment

　　1. ACEI: has the effect of reducing urinary protein, which is achieved by reducing the intraglomerular pressure of the kidney, reducing urinary protein, and at the same time, it is helpful to improve the permeability of the glomerulus. It can be used for both simple proteinuria and proteinuria with hematuria. It is particularly suitable for patients with mild hypertension, and different preparations can be selected according to the patient's blood pressure. Most scholars advocate starting with a low dose to avoid kidney damage caused by hypotension, and to reduce or discontinue the dose in time once the blood pressure is found to be lower than normal.

　　2. Antithrombotic drugs: commonly used in patients with simple hematuria. Commonly used drugs include dipyridamole (Panax notoginseng); aspirin may cause allergy, and large doses may also cause interstitial kidney damage, so it should be used with caution; traditional Chinese medicine such as Baoshenkang, Shenshenkang, and Liushuiyangwan have the effects of promoting blood circulation and removing blood stasis, and protecting the kidneys, and are commonly used in clinical practice. Adrenal cortical hormones and cytotoxic drugs, in general, it is not necessary to use adrenal cortical hormones and cytotoxic drugs in the early stage, and it can be tried with tripterygium glycosides, and traditional Chinese medicine can also be used.

　　The prognosis of this disease is good. More than 50% of patients can recover spontaneously after 5 years of onset. Only a few patients have increased blood pressure and decreased glomerular filtration rate.