Governance experience in the one case of focal proliferative sclerosing IgA nephropathy

Patients with Zhou, male, 42 years old, newly diagnosed on January 22, 2010. The main reason: proteinuria, hematuria 1 month to diagnosis. Patients 1 month before the examination found that urinary protein, occult blood, and many times at the Peking University First Hospital, Xiyuan Hospital of review were seen hematuria, proteinuria, were not system diagnosis and treatment. Wear said: Dongzhimen Hospital, kidney renal biopsies showed 40 glomerular five global sclerosis, 4 ischemic sclerosis, two segmental glomerular sclerosis, the rest of glomerular mesangial cells and matrix light todegree of diffuse hyperplasia, focal segmental severe increase mesangial addicted complex red protein deposition, tubular epithelial vacuoles and granular degeneration, spotty atrophy, multiple foci of the renal mass-like lymph nodes and mononuclear cell infiltration with fibrosis, wall thickening of small arteries, in line with: Home stove proliferative sclerosing IgA nephropathy. Check: 24-hour urine protein excretion 1.76g; protein, occult blood; of creatinine 165.3umol / L, urea nitrogen 8.38mmol / L Blood pressure: 120/80mmHg, oral Aprovel 150mg 1, the pressure's up to 5mg day control of blood pressure. Zheng Jian: fatigue, mouth bitter stick, irritability, foamy urine, lumbar pain, stool viscosity, when the stool, no fever, cough, sputum, lower extremity edema, is satisfied that the poor sleep can red tongue, yellowish greasy, slippery pulse. Diagnosis: focal proliferative sclerosing IgA nephropathy, renal insufficiency, decompensated; hypertension in three high-risk groups. TCM diagnosis: kidney slow wind syndrome is a qi deficiency and liver stagnation and heat block the kidney by blood stasis paralysis.Governing Law: Qi stagnation, heat and dampness, Huoxuetongluo. Recipe: raw Astragalus 50g, the bupleurum 15g, turmeric 15g skullcap 15g, gardenia Health 15g, France Pinellia 10g raw barley 30g, lotus leaf 15g, earthworm 20g, silkworm 20g, raw citrus aurantium 15g, fried betel nut 30g Sophora japonica 15g, Health Burnet 30g, contact Ishido 15g, Atractylodes 20g, Treats 15g, 6 a casual 30g. 7 water, a daily, morning and evening hours service. Antihypertensive drugs to control blood pressure following the service.
29: two clinics in January, fatigue, backache relief, urinary Mo reduced, still upset, irritability, mouth bitter stick, the big can. Red tongue, yellow greasy moss, pulse string.Urine: protein, erythrocyte :10-15 / HP. Stool disappeared, still proteinuria, suggesting that reduce the blood heat; renal wear visible part of the glomerular ball, segmental sclerosis and ischemic sclerosis, renal interstitial multiple spotty fibrosis, Chinese interpreted as network interest into the plot, I strengthen Poxue Xiaozheng products.Recipe: the cases of newly diagnosed party to Huaihua, Health Burnet, plus triangular 15g, Curcuma 15g, Chuan Xiong 18, Smilax glabra 50g in order to strengthen the power of of detoxification Poxue Xiaozheng.
3 attending February 12th: The patient complaint when hypochondriac pain, lumbar pain disappeared, I no obvious discomfort, red tongue, yellow greasy moss, pulse string. 24-hour urinary protein excretion: 0.47g; creatinine: 140umol / L, urea nitrogen 7.9mmol / L,.Prompts the liver qi stagnation, not General pain. Go to the top of a lotus leaf, network Ishido, Yuan Hu 15g, Toosendan 12g Liver Qi to relieve pain.
4 attending March 1: The patient complained of sore throat, irritability, mouth bitter sticky, sticky stool, dark tongue, yellow greasy moss, pulse string. Urine: protein -, 3 - to 5 red blood cells. Show the wind poison off the pharynx into the network, the liver heat.Recipe: the bupleurum 15g, skullcap 15g, Health and gardenia 15g, gentian 10g raw barley 20g, Agastache 15g, Folium 30g, forsythia 15g of Fritillaria 15g, Shegan 15g Mint 15g, Shichangpu 15g earthworm 20g, silkworm 20g, bellflower 15g, the Chuanxiong 18g, black snake 15g, contact Ishido 15g, raw licorice 6g to detoxification LiYan, found the wind Tongluo Soothing heat and dampness.
5 clinic March 15: patients with sore throat disappeared, irritability, mouth bitter sticky stool viscosity. Dark tongue, yellow greasy moss, pulse string. 24-hour urinary protein excretion: 0.41g; the creatinine 115umol / L, urea nitrogen 6.4mmol / L,. . Recipe: top to Agastache, Fritillaria the Shegan, Folium, Fritillaria, Platycodon, the addition pinellia 10g, the Coptis 9g, the Magnolia 9g, lotus leaf 15g, Perrin 15g strengthening heat dampness.
6 attending March 29: patients with stable disease, mouth bitter sticky, no other obvious discomfort, dark tongue yellowish greasy moss, pulse strings. Urine: (-); Biochemical: (-).The cases above the white cardamom 10g continue to take medication.
Thereafter follow-up year, with no discomfort. Urinalysis, blood biochemistry were normal.
IgA nephropathy is one of the world's most common primary glomerular diseases, glomerular mesangial IgA deposition of immunoglobulin, IgA with C3 granular deposition in the mesangial area diseases. IgA nephropathy can be expressed for a variety of different forms of pathology, focal proliferative sclerosing IgAN in the IgAN in a certain proportion, and pathological changes mainly as a glomerular mesangial cell proliferation, extracellular matrix hyperplasia, severe pathological damage can varying degrees of glomerulosclerosis, tubular atrophy, interstitial fibrosis, easy hematuria, proteinuria, edema, hypertension, and renal function decline, if left untreated, can eventually lead to end-stage renal failure ( of ESRD).