Refractory nephrotic syndrome refers to primary nephrotic syndrome with any of the following characteristics:
1. Those who are ineffective in the standard course of treatment are called hormone-ineffective nephropathy.
2. Remission after standard course of prednisone but frequent relapse (3 relapses within one year or more than 2 relapses within half a year) is called frequent relapsing nephrotic syndrome , accounts for about 30-50% of primary nephrotic syndrome, and is currently the most difficult disease to treat and has a poor prognosis in clinical nephropathy. From the perspective of pathological types, it is common in membranous nephropathy, membranous proliferative nephritis, mesangial Proliferative nephritis, focal segmental glomerulosclerosis, and some IGA nephropathy. In the past, most of the studies were limited to the application of glucocorticoids and immunosuppressants, and often failed to achieve satisfactory results. At present, it is believed that its various complications can affect its curative effect, and severe cases can be fatal, so it should be taken very seriously!
The following is an analysis of the treatment of refractory nephrotic syndrome by traditional Chinese medicine from a case Advantages:
【Patient Information】
The patient, female, is 16 years old.
Chief complaint: edema with proteinuria recurred for more than 14 years. The patient developed edema of the face and both lower extremities 14 years ago without any obvious inducement. He went to a local hospital and was diagnosed with nephrotic syndrome after relevant examination. In the past 14 years, the patient’s condition has relapsed, and he has taken hormone therapy for many times, but the effect is not satisfactory. In order to seek systemic treatment of traditional Chinese medicine, he went to our outpatient clinic for treatment, and he still took methylprednisolone 28mg for treatment.
【Syndrome of first visit】
First visit on August 9, 2017.
Symptoms: swollen face and eyelids, shortness of breath, fatigue, chest tightness, loss of appetite, backache, a lot of foamy urine, no obvious dry mouth, bitter mouth, sleep fair, stool Thin soup, pale and fat tongue, white and greasy fur, weak and slow pulse.
Physical examination: BP: 96/78mmHg; percussion pain in both kidneys (+); edema in both lower extremities.
Urinalysis on August 5, 2017: LEU (+), PRO (++++), BLD (++++++);
24h urine protein quantification: 8.26g/24h; plasma albumin: 20.2g/L.
Blood lipids: plasma total cholesterol (T-CHO) 9.0mmol/L, triglyceride (TC) 4.24mmol/L, low-density lipoprotein cholesterol (LDI-C) 6.2mmol/L.
Kidney function:
Cr: 89μmol/L, UA: 427μmol/L.
Western medicine diagnosis: refractory nephrotic syndrome.
【Syndrome Differentiation and Treatment】
Chinese Medicine Diagnosis: edema, syndrome differentiation is spleen deficiency and excessive dampness.
Therapeutic method: Tonify qi and invigorate the spleen, eliminate dampness and relieve diarrhea.
Prescription: Shenling Baizhu San and Huangqi Wuling San addition and subtraction: Codonopsis 20g, Yun Fuling 15g, Atractylodes macrocephala 15g, white lentils 15g, yam 30g, lotus seeds 15g, amomum 15g, fried Coix seed 30g, licorice 5g, Eucommia 15g, Eucommia 15g, Divine Comedy 30g, astragalus 30g, tangerine peel 15g, burnt hawthorn 30g, big belly skin 15g, stone reed 15g, motherwort 15g, plantain seed 15g, achyranthes bidentata 15g , Danshen 15g, Erigeron 15g.
【Follow-up】
Second visit on August 24, 2017:
After taking the medicine for 15 doses, the patient’s edema obviously subsided compared with before, backache was relieved, dry mouth, frequent urination, a small amount of foamy urine, poor sleep and easy to wake up, pale red tongue, yellow greasy fur, deep and slow pulse.
Physical examination: BP: 96/66mmHg.
Recheck urine routine: PRO (++), BLD (++).
Traditional Chinese Medicine Syndrome Differentiation: Intrinsic Dampness and Heat.
Treatment method: Unblock Qi, clear dampness and heat.
Prescription: Sanren decoction combined with Wulingsan addition and subtraction: bitter almond 15g, cardamom 15g, melon seeds 15g, fried coix seed 30g, fried magnolia 15g, French half Summer 15g, talcum powder 15g, light bamboo leaves 15g, Poria cocos 15g, Atractylodes macrocephala 15g, perilla leaves 15g, licorice 5g, Chuanxiong 15g, Jiaohawthorn 30g, Polyporus 15g, Dabupi 15g, Shiwei 15g, Motherwort 15g, Plantago Achyranthes 15g, Achyranthes bidentata 15g, Salvia miltiorrhiza 15g, Erigeron breviscapitalis 15g.
Third visit on September 8, 2017:
After taking 15 doses of medicine, the edema obviously subsided and the backache was relieved obviously , Nake, Mianke, no dry mouth, occasional nocturia, bruised lips, red tongue, yellow greasy fur, stringy and slippery pulse.
Physical examination: BP: 106/60mmHg.
Recheck urine routine: RBC+, BLD+.
Traditional Chinese medicine syndrome differentiation: internal accumulation of spleen deficiency and dampness.
Therapeutic method: Clear away dampness and heat, transform qi and promote water flow.
Prescription: Sanren Decoction combined with Wuling Powder Addition and subtraction: Poria 15g, Polyporus 15g, Dabupi 15g, Atractylodes macrocephala 15g, Guizhi 10g, Shiwei 15g, Motherwort 15g, Coix seed 30g, Plantain 15g, Imperata 15g, Eucommia ulmoides 15g, Licorice 5g, Bitter almond 15g , cardamom 15g, melon seeds 15g, fried Magnolia officinalis 15g, talcum powder 15g, light bamboo leaves 15g, perilla leaves 15g, Chuanxiong 15g, breviscapine 15g, burnt hawthorn 15g.
Fourth consultation on September 23, 2017:
After taking 15 doses of medicine, the patient’s edema disappeared, he had no backache and low back pain, he was in good spirits, he had no chest tightness, loss of appetite, and thirst Drinking, short red urine, dry stool, red tongue with yellow greasy coating, deep and rapid pulse.
Recheck urine routine: normal; 24h urine protein quantification: 0.1g/24h; plasma Albumin: 40.8g/L; blood lipids: total cholesterol 5.01mmol/L, triglyceride 1.2mmol/L, low-density lipoprotein cholesterol 1.05mmol/L.
Chinese Medicine Syndrome differentiation: Damp-heat accumulation.
Treatment method: Unblock Qi, clear damp-heat.
Prescription: Sanren Addition and subtraction of soup: 15g bitter almond, 15g cardamom, 15g melon seeds, 30g fried coix seed, 15g fried magnolia bark, 15g French pinellia, 15g talcum powder, 15g light bamboo leaf, 15g poria cocos, 15g Atractylodes macrocephala, 15g perilla leaf , Licorice 5g, Pueraria 15g, Notopterygium 10g, Ligusticum chuanxiong 15g, Stir-fried Divine Comedy 30g, Jiao Hawthorn 15g, Erigeron breviscapus 15g, Rosa laevigata 15g, Gorgon fruit 10g, Liuyuexue formula granules 6 bags, Stir-fried Anemarrhena 15g, Stir-fried barberry 10g. A total of 15 doses, one dose per day, decocted in water. After treatment, the patient’s health recovered well, and he continued to take our prescription to consolidate the curative effect.
【Note】
Difficult Remedial nephrotic syndrome (refractory nephritic syndrome, RNS) refers to hormone resistance, dependence and frequent relapse (more than 3 relapses within 1 year or more than 2 episodes within half a year) and intolerable side effects of hormones, making it difficult to continue medication nephrotic syndrome. Its clinical manifestations include massive proteinuria, hypoproteinemia, edema and hyperlipidemia.
Refractory nephrotic syndrome is a lingering condition that is protracted and may lead to renal failure and eventually develop into uremia. At present, the treatment of refractory nephrotic syndrome by western medicine mainly adopts the combined application of glucocorticoid and cytotoxic drugs on the basis of symptomatic treatment such as diuresis, swelling reduction, urinary protein reduction, and lipid lowering.
Glucocorticoid is a common drug for the clinical treatment of refractory nephrotic syndrome, and its therapeutic effect has been generally recognized by the medical community. Modern pharmacology shows that glucocorticoids can further inhibit the secretion of antidiuretic hormone, thereby controlling the inflammatory response produced by the patient’s body, controlling the permeability of the glomerular basement membrane, etc., and then significantly exerting the effect of diuresis and elimination of urinary protein.
In this case, the patient took methylprednisolone for a long time. Methylprednisolone is a moderate-effect glucocorticoid drug, which can effectively inhibit the secretion of aldosterone and antidiuretic hormone, and has anti-inflammatory effects Significant, but patients who take hormones for a long time will have adverse reactions such as bone marrow suppression, infection, developmental disorders, osteoporosis, and abnormal glucose metabolism.
Traditional Chinese medicine has unique advantages in treating refractory nephrotic syndrome:
< p data-track="85">(1) It can achieve the effect of treating both symptoms and root causes;
(2) Improve the patient’s physical fitness and further improve the quality of life of the patient;
(3) Reduce the side effects of western medicine, reduce recurrence, and improve hormone sensitivity;
(4) Can better Improve the clinical symptoms of patients.
Traditional Chinese medicine believes that diseases belong to the categories of “edema”, “asthenia” and “lumbar pain” in traditional Chinese medicine. All diseases are caused by deficiency of the spleen and kidney, and the deficiency of the spleen and kidney causes water to flow indiscriminately, overflowing the skin and making the body swollen.”
For children, Chinese medicine has “the body of pure yang It is said that hormones are medicines to help yang and generate heat. Long-term use can easily damage true yin and suppress true yang, leading to deficiency of both qi and yin, the same source of liver and kidney, loss of kidney water, and water not containing wood. Yin, kidney yin loss.
Therefore, on the basis of Western medicine treatment, it is often used to invigorate Qi and invigorate the spleen, warm the kidney and promote water, soothe the liver and relieve the lung, and clear away dampness and heat. Treatment of viscera, or promoting water and dampness, treating both symptoms and root causes,It can increase the short-term remission rate, reduce the long-term recurrence rate, and improve the prognosis.
In my opinion, the main pathogenesis of this disease is deficiency in origin and excess in excess. Deficiency in origin is mainly manifested in the three viscera of the lung, spleen and kidney, and deficiency in the superficiality is manifested in three aspects of wind evil, damp turbidity, and blood stasis. Therefore, the root cause of the recurrent outbreak of the disease is the deficiency of righteousness, which cannot resist exogenous pathogens. Just as the “Neijing” says: “The righteousness is in the interior, and the evil cannot be done.” “When the evil gathers, its energy must be empty.”
In terms of treatment, in the treatment of edema, the focus is on regulating the spleen and kidney. While diuretic and swelling, it is necessary to pay attention to the care of righteousness and enhance the patient’s physical fitness.
The newly diagnosed patient has severe edema, and the syndrome is spleen deficiency and excessive dampness. reduce. Reuse Atractylodes macrocephala and Poria to invigorate the spleen and eliminate dampness; Chinese yam tonify the spleen and qi; astragalus to invigorate qi and promote water; compatible with Eucommia ulmoides, Huai Achyranthes bidentata and other medicines to invigorate the liver and kidney; add psyllium seed, white lentils, stone reed, big belly skin, etc. Drugs that ooze water and dampness; mix with amomum to regulate Qi and regulate waterways; add qi-regulating drugs such as tangerine peel, motherwort, salvia and other blood-activating drugs, licorice to invigorate the spleen and harmonize the middle, and reconcile all drugs. The whole party plays the merits of invigorating Qi and invigorating the spleen, expelling dampness and stopping diarrhea altogether.
The edema of the patient in the second diagnosis obviously subsided, and the symptoms of dry mouth were obvious, and the syndrome was identified as damp-heat accumulation. Governing method: Unblock Qi, clear away dampness and heat, add and subtract Sanren Decoction combined with Wuling Powder. On the basis of exuding water and dampness, it also nourishes yin and clears away heat.
The symptoms of dry mouth of the patients in the third examination disappeared, and the spleen and kidney were continued to be adjusted, and the water and dampness were treated with infiltration and drainage. The symptoms of the patients with the fourth diagnosis disappeared, and the body recovered well. There was no recurrence during the treatment process.
Since then, I have been taking traditional Chinese medicine for conditioning to consolidate the curative effect, and achieved a satisfactory curative effect for the patient. Treating refractory nephrotic syndrome with western medicine alone has a lot of side effects and is prone to relapse, so it is difficult to achieve an ideal therapeutic effect. Combined treatment with traditional Chinese medicine can not only reduce the recurrence of the disease but also reduce the side effects of hormones, so as to achieve good curative effect. https://wj.qq.com/s2/11237665/5301/
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