Hepatitis B-related nephritis

　　What are the causes of hepatitis B-related glomerulonephritis?

　　The relationship between hepatitis B virus and nephritis in terms of pathogenesis is not yet fully understood and may be related to the deposition of hepatitis B virus antigen-antibody complexes in the glomerulus causing immune injury, direct infection of kidney cells by the hepatitis B virus, and autoimmune pathogenesis caused by hepatitis B virus infection. Due to the incomplete anti-HBe response in children and adolescents, it may be the main reason why hepatitis B glomerulonephritis favors them. The known causes are as follows:1, HBV circulating immune complex deposition:

　　So-called circulating immune complexes refer to the combination of HBV antigens (HBsAg, HBeAg, HBcAg) and corresponding antibodies, such as the combination of HBsAg and anti-HBs, forming an 'antigen-antibody complex' that circulates in the blood. When this circulating immune complex settles and remains on the glomerulus or renal tubules, it accumulates there, eventually causing renal lesions. Experts have found HBV immune complexes in kidney tissue, proving that HBV circulating immune complexes can damage the kidneys.2, HBV directly infects kidney cells:

　　HBV's hepatotropism is not very strict. In addition to the liver, HBV can also infect other sites, such as the kidney, pancreas, skin, bile duct epithelium, bone marrow, and peripheral mononuclear cells. After HBV enters the human body, it directly invades the liver along one path and the kidney along another path, replicates in the kidney, causing renal lesions, and leading to nephritis. Experts have found HBV DNA in kidney tissue, which is the best proof. Some scholars have found that within 6 months of the onset of HBV-related nephropathy, 87.5% of patients have HBV DNA in their renal tubular epithelial cells, and the detection rate of HBV DNA in kidney tissue of patients with worsening renal damage is significantly increased.3, HBV infection leads to immune dysfunction in the human body:

　　What complications can hepatitis B-related glomerulonephritis easily lead to?

　　21. Hepatitis B glomerulonephritis is clinically manifested as nephrotic syndrome or non-proteinuria, often accompanied by microscopic hematuria, and some may start with nephrotic syndrome. Membranous nephritis rarely has hypertension or renal insufficiency; while membranoproliferative glomerulonephritis, about 40% of people have hypertension, and 20% have renal insufficiency. Patients often have no obvious history of hepatitis exposure or clinical symptoms of hepatitis. The diagnosis is based on three aspects:

　　20. 1. The serum hepatitis B virus antigen is positive.

　　19. 2. Hepatitis B virus was found in renal tissue sections.

　　18. 3. Patients with glomerulonephritis can exclude secondary glomerular diseases such as lupus nephritis.

　　15. One, mental and psychological care

　　14. As described in traditional Chinese medicine, it is important to understand and encourage patients to express their concerns. Encourage patients to broaden their minds, relax their thoughts, avoid negative pessimism, and do not "get stuck in a dead end". Learn to cultivate one's spirit and build confidence in overcoming the disease, so that the body can recover sooner.

　　13. Two, life care

　　12. Promote physical and mental rest: For patients with renal hypertension, blood pressure should be measured regularly, and bed rest time should be increased according to the changes in blood pressure.

　　11. Reasonable diet: In terms of diet, specific dietary guidance should be given to patients according to the condition of each disease. For example, when renal insufficiency occurs, high-calorie intake (mainly sugar) and high-quality low-protein diet should be consumed, fluid intake should be limited, and fluid balance should be maintained.

　　10. Pay attention to oral care: Brush your teeth in the morning and evening and after meals to keep the mouth clean, remove halitosis, reduce nausea, and prevent the growth of bacteria and fungi.

　　9. Strengthen skin care: Good skin care for chronic renal failure patients is an important measure to prevent skin infection, bedsores, and related complications. Due to the deposition of uremic frost, which stimulates the skin, patients often have itching and discomfort, which affects sleep. It is also easy to get infected after scratching the skin, so it is necessary to frequently wash with warm water to keep the skin clean, avoid using soap and alcohol, change clothes and bedding frequently. For patients with severe edema, it is even more important to protect the skin, change positions frequently, massage the areas under pressure, and prevent bedsores.

　　Three, observation of condition and efficacy routine tests are convenient

　　1. Collect and send urine samples for testing in a timely and correct manner: Urinalysis is a convenient, sensitive, and accurate indicator for diagnosis and judgment of the condition and efficacy, and it must be paid attention to.

　　2. Accurate recording of the daily 24-hour intake and output is required for patients with edema and chronic renal failure. Edematous patients should have their weight measured once a week, and abdominal fluid patients should have their abdominal circumference measured once a week.

　　3. Blood pressure should be measured regularly for patients with hypertension.

　　4. Patients with severe pleural effusion, ascites, nephrotic pericarditis, and heart failure often experience chest tightness, shortness of breath, and inability to lie flat. It is necessary to adjust the patient's position promptly.

　　5. When replenishing fluids, the amount of fluid administered per hour and per minute should be calculated accurately, and the drip rate should be strictly controlled to prevent heart failure and pulmonary edema.

　　6. For patients using diuretics, close attention should be paid to the reactions after taking the medication and be vigilant about the occurrence of electrolyte imbalance.

　　7. When administering intramuscular injections to edematous patients, deep injection should be preferred. After removing the needle, apply a cotton ball to the needle hole for about 2-3 minutes to prevent the overflow of medication.

　　8. Treat specific problems symptomatically, observe for early signs of renal function damage, and take protective measures for renal function to prevent the progression and deterioration of the disease.

　　Fourth, prevention and care of complications

　　1. Prevent abrupt changes in blood pressure, prevent hypertensive encephalopathy and acute pulmonary edema, acute renal insufficiency, and other conditions.

　　2. Prevent infection: strengthen environmental and personal hygiene protection measures, keep the indoor environment clean and well-ventilated, and perform daily ultraviolet disinfection, etc.

　　3. Prevent heart damage, regularly check the patient's heart rate, rhythm, and breathing, and provide corresponding care if abnormalities are found.

　　4. Prevent renal function damage.

　　Fifth, health education

　　1. Enhance self-health awareness, prevent infection, and avoid various stress factors.

　　2. Strengthen physical exercise to improve the body's resistance.

　　3. Take medication as prescribed by the doctor, regularly check urine, and seek medical attention immediately if symptoms appear.

　　4. Pay attention to water intake and adhere to a reasonable diet in daily life.

　　5. Childbearing women should pay attention to contraception.

　　6. Regular outpatient follow-up.

　　Urine routine examination, blood pressure, liver function, renal function.

　　Currently, there is no unified diagnostic standard for HBV-related nephritis internationally. Referring to the opinions of the 1989 Beijing Symposium, it is recommended that China try the following three criteria for the diagnosis of HBV-related nephritis: ① Positive serum HBV antigen; ② Membranous nephropathy or membranous proliferative nephritis, excluding secondary glomerular diseases such as lupus nephritis; ③ Finding HBV antigen in renal tissue sections. The third point is the most basic condition, and the absence of this cannot be diagnosed.

　　1. Be cautious with medication：Especially avoid using drugs that are harmful to the liver and kidneys. Additionally, do not blindly use immune-enhancing drugs.

　　2. Strictly prohibit alcohol consumption：The intermediate metabolites of alcohol have a clear hepatotoxicity and increase the burden on the kidneys. All beverages containing alcohol, including wine, should not be consumed. After drinking, alcohol is quickly absorbed in the gastrointestinal tract, with approximately 90% or more of the alcohol content (ethanol) metabolized in the liver. Ethanol has a direct stimulating and toxic effect on liver cells, causing liver cell变性 and necrosis, and acute renal tissue lesions. Therefore, for patients with hepatitis B nephritis, abstinence from alcohol is a basic requirement for self-care.

　　3. 注意饮食：Many patients with hepatitis B nephritis have digestive system diseases and poor digestive absorption abilities. It is important to pay attention to strengthening nutrition while controlling the intake of fat and sugar, avoid eating moldy food, and eat more foods rich in protein and immune-enhancing substances, such as fish, meat, eggs, milk, soy products, fungi, and fresh fruits and vegetables.

　　4. Reasonable作息：Hepatitis B nephritis patients must ensure that they receive adequate rest every day, but they should not rest excessively. Within their abilities, they can engage in some moderate activities. Due to significant individual differences, the specific amount of activity needs to be flexibly controlled by themselves, without any specific quantity requirements. Generally, it is advisable to avoid obvious fatigue after the activity. The activities should be relatively relaxed, such as walking and Tai Chi. It should be noted that heavy physical labor should be absolutely avoided.

　　5. No staying up late either:In addition to ensuring 7-8 hours of sleep every night, it is best to take a half-hour nap at noon.

　　6. Adjust emotions:Treat diseases correctly, maintain a pleasant mood, and build confidence in overcoming diseases. Avoid negative emotions such as depression and anger. Excessive excitement and anger can worsen the condition, so it is especially important to prevent anger, and one should be broad-minded and calm in dealing with matters and people. Only by maintaining a happy mood can it be conducive to the recovery of hepatitis B nephritis.

　　7. Prevent colds and infections:Hepatitis B nephritis patients are in an immunological imbalance when they are sick. If they catch a cold or have a fever, it will worsen the damage to the liver and kidneys. In addition, hepatitis B nephritis patients have low body immunity, and they are prone to be infected by various pathogenic factors during the illness or after recovery, causing colds, bronchitis, urinary tract infections, etc., which may lead to recurrence or exacerbation of the condition. Therefore, it is especially important to prevent colds, change clothes in response to temperature changes, and be extra careful in all aspects of diet, rest, and personal hygiene.

　　1. As of now, there is no effective treatment for hepatitis B nephritis. Immunosuppressants are beneficial for various types of glomerulonephritis, but they may delay the body's ability to clear hepatitis B virus, so most people do not advocate hormone therapy. Interferons have antiviral effects by binding to cell surface receptors, activating certain enzymes to block the reproduction and replication of the virus, but they cannot enter host cells to directly kill the virus. Arabinosyladenine can inhibit DNA polymerase and nucleotide reductase, thereby inhibiting the replication of the virus. If interferon therapy is combined, better effects can be achieved. In addition, traditional Chinese medicine with properties of clearing heat and dampness, activating blood circulation to resolve blood stasis, and invigorating the spleen and benefiting the Qi, also has certain efficacy in regulating the body's immune function and inhibiting and killing hepatitis B virus.

　　2. Hepatitis B nephritis patients should be isolated during the active phase of hepatitis B. Patients should enhance their self-confidence, overcome anxious and sad emotions, and allow the body to gradually enhance its resistance to fight against the disease.