How Do I Choose the Best Treatment for Lupus?

Lupus kidney is the most common visceral damage in systemic lupus erythematosus, and the severity of kidney disease directly affects the prognosis of SLE. There is no name for lupus nephritis in Chinese medicine. According to its clinical manifestations, the disease is attributed to edema, low back pain, sun sores, yin and yang poisoning, warm toxins, fatigue, dizziness, and palpitations. Traditional Chinese medicine believes that this disease is mostly due to inadequate endowment, deficiency of kidney essence or internal injuries of seven emotions, and yin and yang disorders; or deficiency of kidney essence, re-sensitization of evil poison, or taking poisonous fever products, causing qi and blood blockage, and operation failure. Chang, evil poison Jiujii meridian blood.

Lupus kidney

Systemic lupus erythematosus (SLE) is an autoimmune disease that invades connective tissues throughout the body. Lesions often involve multiple systems and multiple organs.

Overview of Lupus Kidney Disease

For many newly diagnosed patients with lupus kidney, many people have the question, what is lupus kidney? In fact, it is not easy to explain clearly what lupus kidney is. It is well known that lupus kidney (LN) has a great relationship with systemic lupus erythematosus (SLE).

Systemic lupus erythematosus is a typical autoimmune disease that has multiple autoantibodies in the body and invades the connective tissue of the system. The lesions often involve multiple systems and multiple organs. Many patients with systemic lupus erythematosus always associate their disease with lupus Kidney image confused. Lupus kidney is a glomerular disease that occurs in systemic lupus erythematosus after a long period of time. After understanding the concept of lupus kidney more clearly, patients with systemic lupus erythematosus are more concerned about the typical symptoms of lupus kidney, in order to roughly judge whether the disease has progressed to lupus kidney with reference to their existing symptoms. What are the symptoms of lupus kidney? The general symptoms are fever, rash, oral mucosal ulcers; damage to system organs, such as hematopoietic system, central nervous system, liver heart and multiple serositis; manifestations of kidney damage, hematuria, edema, proteinuria , Nocturia, increased hypertension, and the corresponding clinical manifestations of uremia in advanced stages.

In addition, after having a general understanding of what is lupus kidney and the symptoms of lupus kidney, it is necessary to deeply understand what is the cause of lupus kidney. The etiology of lupus kidney is unknown. Most are believed to be genetic disorders, viral infections, sunlight or ultraviolet radiation, the induction of certain drugs, and the effects of estrogen, which cause disturbances of cellular and humoral immune functions in the body. Immune disorders are the basis of the pathogenesis of lupus kidney, and the deposition of immune complexes is the main path. Therefore, lupus kidney is immune complex nephritis, and the immune complexes that cause lupus nephrogenesis are mainly DNA-anti-DNA immune complexes.

With a general understanding of what lupus kidneys are, what are the most typical symptoms of lupus kidneys, and what are the causes of lupus kidneys, you can better understand the knowledge of lupus kidneys in people who do not have lupus kidneys. Good targeted prevention, treatment of lupus kidney, and the best results in the treatment of lupus kidney from the source. Systemic lupus erythematosus (SLE) is a type of connective tissue

Lupus kidney Autoimmune diseases often involve multiple systems and multiple organs. Its clinical features are: long-term fever of unknown cause; multiple joint pain; skin damage; multiple system and multiple organ damage; has a tendency to spontaneous relief or aggravation; hormone and cytotoxic drugs are often effective; Gamma globulin increased; sedimentation accelerated; ANA could be used as a screening test.

Systemic lupus erythematosus is a common disease. Statistics from the United States show that the incidence of this disease is 50 / 100,000, accounting for about 0.7% of the population in China. The incidence of this disease is higher in females than in males, and mainly in young females. SLE who has kidney damage is lupus nephritis (LN). The incidence of lupus nephritis has been reported differently, and we believe that about 70% of the diagnosed SLE have significant renal damage. If renal biopsy is performed in SLE patients, 90% of the renal damage will be detected with light microscopy. If immunofluorescence and electron microscopy are added, almost all patients will have glomerular damage. Some patients have extrarenal manifestations, but only mild renal damage. This kind of patients have less renal failure. Other patients have renal impairment as the main external manifestations. The performance is not obvious, and it is easy to be misdiagnosed as primary glomerular disease.

Clinical manifestations of lupus kidney

Lupus kidney Renal damage manifestations: LN lesions can involve glomeruli, tubules, and renal interstitial. The clinical manifestations can be as follows:

1. Patients with hematuria and domain proteinuria are not associated with edema and hypertension, and only have mild to moderate proteinuria and domain hematuria.

2. Nephritis syndrome is often accompanied by edema or hypertension, proteinuria, and hematuria. The clinical manifestations of patients with acute onset are similar to acute nephritis and may be associated with impaired renal function. In some cases, the onset was rapid, renal function deteriorated sharply, and renal failure progressed in a short period of time. Clinically, the process of nephritis was urgent. Without active and effective treatment, the mortality rate was extremely high. In some cases, there may be no renal impairment and no significant change in urine, but it gradually develops into chronic renal failure after several years.

Causes of Lupus Kidney Formation

Lupus kidney

1, the basis of the pathogenesis of lupus kidney-immune disorders

Including lupus kidney patients with abnormal immune tolerance, B cell hyperfunction, T cell dysfunction and cytokine abnormalities.

2, the pathogenesis of lupus kidney-immune complex deposition

During the onset of lupus kidney, a variety of autoantibodies including cell nuclei, cell membranes, cytoplasm, and various tissue components will be produced. Among them, antinuclear antibody (ANA) is the most important, which plays a key role in the pathogenesis, diagnosis and condition of systemic lupus erythematosus. When systemic lupus erythematosus is complicated by renal lesions, antigen-antibody immune complexes and the original immune complexes are deposited in the glomeruli in the body of the patient, thereby causing damage to the function of the kidney, which is lupus nephritis.

Lupus kidney treatment

Lupus kidney can be divided into the following measures to treat lupus kidney according to the development of the disease.

First, the treatment of lupus kidney is based on clinical manifestations, laboratory and renal biopsy data. For mild systemic lupus erythematosus (such as only rash, low fever or joint symptoms) and abnormalities in immune serology, if the urine test is normal, and the renal biopsy shows normal or mild glomerular disease, use non-steroidal anti-inflammatory as appropriate Medicine to improve symptoms, generally do not need to use glucocorticoids or cytotoxic drugs, closely follow the condition

Lupus Kidney Lecture If the urine test is abnormal and the renal biopsy shows focal glomerular segmental mesangial hyperplasia with segmental necrosis, crescent formation and focal glomerulosclerosis, use medium and small doses of glucocorticoid ( Such as prednisone 20 40mg / d), add cytotoxic drugs or tripterygium preparation as appropriate.

2. Severe systemic lupus erythematosus (such as high fever, joint pain, weakness, or rapid involvement of the serosa, heart, lungs, liver, hematopoietic organs and other organ tissues) with acute nephritis syndrome or progressive nephritis syndrome, renal biopsy Diffuse proliferative glomerulonephritis or crescentic nephritis and progressive renal function should be treated with standard hormone therapy plus CTX shock therapy; or methylprednisolone shock therapy, 1.0g daily, static point 3 5 days is a course of treatment, followed by the maintenance of prednisone with a medium dose, which can be repeated once after 7-10 days if necessary, and generally does not exceed 3 courses. When the above method is not effective or the condition is serious, plasma exchange therapy can be considered; those who cannot use CTX can try cyclosporin A, mycophenolate, etc. With acute severe renal insufficiency, severe high blood volume, and heart failure, emergency dialysis should be performed to allow it to pass the dangerous period, creating conditions and gaining time for drug treatment.

3. Those who show asymptomatic proteinuria (urinary protein 2g / 24h) can use glucocorticoids, and add cytotoxic drugs as appropriate. Tripterygium preparation combined with prednisone also has a certain effect; those with asymptomatic hematuria can use thunder Rattan preparation (regular dose or double dose) or CTX treatment. Those with the best conditions should choose medication according to the type of kidney pathology.

4. Patients with nephrotic syndrome, but with few red blood cells in the urine and stable renal function, or renal biopsy showing membranous lupus kidney, prednisone 0.8 ~ 1.0mg / kg.d should be preferred, if the effect is not effective after 2 ~ 4 weeks When it is good, add CTX, if it is accompanied by renal dysfunction, severe hypertension, renal biopsy shows obvious glomerular hyperplasia or pathological type change, you should be given standard hormone therapy plus CTX impact therapy.

5. For those with constant proteinuria without systemic lupus erythematosus or those with azotemia and chronic renal pathology, generally do not use prednisone and cytotoxic drugs for a long time.

6. End-stage lupus kidney is treated as chronic renal failure.

Seven, general treatment: including rest, diet, diuresis, lowering blood pressure, anticoagulation and prevention and treatment of various complications, etc., should refer to the treatment of primary glomerular disease according to the patient's condition.

Eighth, TCM treatment of traditional Chinese medicine can improve the efficacy, reduce symptoms and reduce the side effects of western medicine.

Lupus kidney classification

Chinese medicine treatment starts from the overall situation and is thoroughly treated according to the etiology of lupus kidney. Generally speaking, for the treatment of lupus kidney in traditional Chinese medicine, there are five main types, namely heat-toxin-flammable type, yin deficiency and internal heat type, liver and kidney yin deficiency type, spleen and kidney yang deficiency type, and qi and yin deficiency type.

Lupus kidney fever

(1) The main symptoms of fever-tolerant lupus kidney patients are: fever persists, or thirst is hot and cold drinks are disturbed, even slang, facial symmetry erythema, bright red or subcutaneous erythema, joints Pain with edema in both lower limbs, or hematuria, turbid urine, low back pain, dry stool, red or dark purple tongue, thin yellow fur, and thin pulses. This type is more common in the acute attack of lupus kidney.

The key points of traditional Chinese medicine for the treatment of blazing lupus kidney are: clearing away heat and detoxifying, cooling blood and removing paralysis.

Lupus with kidney-yin deficiency and internal heat-type lupus

(2) The main symptoms of yin deficiency and internal heat type lupus kidney patients are: facial flushing, hair spots, tenderness or pain in the waist and knees, dizziness, low fever, dry mouth and throat, five upset fever, hot flashes, night sweats, and red stools Dry, red tongue, less moss or light peeling, pulse count. This type is more common in the subacute phase or mild active phase of lupus kidney.

The focus of traditional Chinese medicine treatment of yin deficiency and internal heat type lupus kidney is: nourishing yin and clearing heat.

Lupus kidney liver kidney yin deficiency type lupus

(3) The main symptoms of liver and kidney yin deficiency lupus nephropathy patients are: the facial erythema is not fresh, dizziness, dizziness, stunned veins, dry claw nails, irritability, soft waist, knees, or nocturnal emission. Menstruation, amenorrhea or menstruation, five upset fever, hot flashes, night sweats, insomnia and more dreams, dry mouth and throat, persistent low fever, abdominal fullness, short urine, redness or turbidity, such as fat cream, and even see tooth loss. Tongue red, little moss or light peeling, pulse string count. This disease is more common in the remission phase, chronic inflammation phase, stable phase or partial occult nephritis phase of lupus kidney.

The focus of traditional Chinese medicine on liver and kidney yin deficiency type lupus kidney is to nourish liver and kidney.

Lupus kidney spleen and kidney yang deficiency type lupus

(4) The main symptoms of spleen-kidney yang deficiency lupus kidney patients are: dark red spots on the two sides, discoloration, dizziness, chills, cold limbs, shortness of breath, lack of food, loose stools, severe pain in the limbs, and weakness of the waist and knees Or cold pain in the waist and knees, unfavorable urination, opacity over time, edema of the limbs, impotence in men, irregular menstruation in women, tooth marks on the fat side of the tongue, purple or dark tongue, or pale tongue, thin white fur The pulse is thin and weak. This type is more common in nephrotic syndrome.

The key points of traditional Chinese medicine in treating spleen-kidney yang deficiency type lupus kidney are: warming the spleen and kidney, and infiltrating the water.

Lupus with kidney qi and yin deficiency

(5) The main symptoms of qi-yin deficiency lupus nephropathy patients are: fatigue, fatigue, shortness of breath, palpitations, less lazy breath, spontaneous sweating, perspiration, dizziness, tinnitus, dry mouth and throat, five upsets, and pulse count. This type is more common in patients who are physically inactive and weaker after a standard course of hormone therapy.

The key point of traditional Chinese medicine for treating qi and yin deficiency lupus kidney is: to nourish qi and nourish yin.

Lupus kidney diet conditioning

1. Winter melon frog terrier rice porridge

Ingredients: 200 grams of winter melon (with skin), 100 grams of frog meat, 100 grams of stem rice.

Method: Cut winter melon and frog meat into pieces and simmer with simmered rice.

Diet

Efficacy: Winter melon has a sweet and cool taste, which can clear heat and quench thirst, and diuretic swelling and detoxification: frog meat has a sweet and cool taste, can clear heat and detoxify, tonic and nourish yin, and diuretic and swelling: stalk rice has a sweet taste and has spleen and stomach Effect, this dietary prescription has the effect of clearing away heat and detoxifying, swelling and dehumidification. It is suitable for patients with systemic lupus erythematosus fever toxic type, and is effective for authors of acute hair or those with secondary infection.

Diet

2. Barley mung bean lily porridge

Ingredients: 50 grams of barley (rice kernel, barley kernel), 25 grams of mung beans, 100 grams of fresh lily, and an appropriate amount of sugar.

Method: Lily simmered into petals, remove the endometrium and wash. Mung beans and barley seeds are boiled for eight hours and then put into Baihe, simmered with gentle heat, add an appropriate amount of sugar.

Efficacy: Indica rice kernel is sweet and slightly cold, enters the spleen, lungs, and kidney meridians, and has the effect of clearing heat and dampness, and the spleen eliminates edema; mung bean flavor is sweet and cool, enters the heart and stomach, and has the effect of clearing heat and detoxifying, clearing heat and dehydrating; Lily tastes slightly bitter, and has a slightly cold nature. This dietary prescription is suitable for acute recurrence of systemic lupus erythematosus, and is used in the early or combined cold.

3. Kelp lotus leaf lentils porridge

Ingredients: 50 grams of kelp, 3 lotus leaves, 50 grams of lentils.

Method: Wash the lentils, boil them and boil them for eight, add chopped kelp and chopped fresh lotus leaves, and cook together to make porridge.

Efficacy: Kelp is salty and cold, which can clear heat and water; lotus leaves have the effect of clearing heat and relieving heat and spleen; The dietary prescription is suitable for patients with early systemic lupus erythematosus with fever and fever, low fever and low urine output, and dry appetite and poor appetite.

Lupus kidney prognosis

The prognosis of lupus kidney was once pessimistic, but many authoritative scholars studying lupus kidney thought that lupus kidney was prone to recurrence. Due to the difficult prognosis of lupus kidney, about 20% of lupus kidney patients will develop uremia within 10 years, becoming one of the leading causes of death in patients with systemic lupus erythematosus. According to statistics from other scholars, 50% of patients with lupus kidney die from lupus activity itself, and another 50% die from adverse reactions such as hormone treatment. In recent years, with the early diagnosis of lupus kidney and the formulation of rigorous treatment programs such as combined glucocorticoids and cytotoxic drugs, the prognosis of lupus kidney has been greatly improved. Because of this, many lupus kidney patients have completely broken the concept of difficult prognosis for lupus kidney, and actively cooperate with doctors to make the prognosis of lupus kidney better. In addition, through clinical sampling

Lupus kidney Examination results show that another factor closely related to the prognosis of lupus kidney is infection. Infection has been tied with uremia as the leading cause of death in lupus kidneys (33% each). Patients with lupus kidney infections mainly affect the lungs (80%), followed by the brain (14%). Therefore, the prevention and treatment of infection has become an important goal and breakthrough for further improving the lupus kidney survival rate, and it is also an important way to improve the prognosis of lupus kidney. In short, for the treatment of lupus kidney and the prognosis of lupus kidney, three issues must be grasped: controlling the activity of lupus kidney, preventing recurrence, and preventing lupus kidney complications. Only by solving these three problems can we control the deterioration of lupus kidney disease, fundamentally improve the quality of life of patients with lupus kidney, and further improve the prognosis of lupus kidney.