Characteristics Of The Syndrome Elements Of Diabetic Nephropathy And The Mechanism Of Action Of The Hurricane And Collaterals

In recent years,more and more scholars have recognized the effectiveness of "wind drugs" in the treatment of diabetic kidney disease,but only at the level of clinical experience.We are the first that put foward the Qufeng Tongluo method of diabetic kidney disease,and the theory hypothesis that diabetic kidney disease caused by pathogenic wind.We consider that the micro abdominal mass formation is the basic pathogenesis of diabetic kidney disease.Pathogenic wind is an important pathological factor that determine the development of the disease as the static blood,heat,phlegm-dampness and qi depression.Long-term diabetes can lead the deficiency of renal collaterals.When careless living,the pathogenic wind can attack patients,and stay in the renal collaterals because of the weak healthy qi.The excess heat and liver-kidney yin deficiency can genesis pathogenic wind.Besides,the micro abdominal mass can make the collaterals without blood and the blood deficiency can also induce the pathogenic wind.All these pathogenic wind stay in the renal collaterals.The duration when the pathogenic wind generates is the equivalent of early stage of diabetic kidney disease.The pothogenic wind accumulates as time goes and breaks out when it become strong enough.The blast of the pathogenic can lead mass of urinal protein.The time when pathogenic wind breaks out equals the clinic stage of diabetic kidney disease.However,the clinical manifestations of pathogenic wind in diabetic kidney disease are still unclear.In order to study the syndrome features of the pathogenic wind of diabetic didney disease,we conducted the following series of studies:ObjectivesStudy one:The pathogenic wind plays an important role in the development and formation of multiple kidney diseases.The treatment targeting pathogenic wind is widely used in renal diseases.But the expert consensus or diagnostic criteria about the clinical manifestation of pathogenic wind in renal diseases havn't formed yet,which brings obstacles to the syndrome study of pathogenic wind in diabetic kidney disease.Therefore,we conducted this study to make the clinical manifestations of pathogenic wind in chronic kidney disease,which can provide a reference for the syndrome study of pathogenic wind in diabetic kidney disease.Study two:It was found that wind-medicines are effectiveness not only in nephroitis,but also in treating diabetic kidney disease from clinical practice.In recent years,some experts raised the idea of treating diabetic kidney disease from the point of pathogenic wind.However,it is still not clear that which type of diabetic kidney disease patients are suitable for treatment targeting pathogenic wind.The clinical manifestations of pathogenic wind in diabetic kidney disease are also unknown.In order to clarify the clinical manifestations of pathogenic wind in diabetic kidney disease,we conducted this syndrome study among DKD patients based on the clinical manifestations of pathogenic wind in chronic kidney disease.Study three:The pathogenic wind plays an important role in the development of diabetic kidney disease and we observed that the treatment of Qufeng Tongluo method has the effect of reducing the urine protein in diabetic kidney disease.But the machanism is unclear.While results of study two showed that pathogenic wind has a positive correlation with 24-hour urinary protein,and urinary protein production has a close relationship with podocyte injury.Therefore,from the perspective of podocyte injury,this experiment is conducted to explore the mechanism of Qufeng Tongluo method treating diabetic nephropathy.MethodsStudy one:Developed Delphi was used in this study.Instead of traditional first blank survey,literature research was used to form the item pool of clinical manifestations of pathogenic wind in renal diseases.Based on this item pool,expert surveys were conducted for twice and then items were cut properly.The items that were agreed generally by experts formed the consensus for pathogenic wind determination in chronic kidney disease.Study two:Cross-sectional survey was used in this study.The questionnaire was made based on the consensus for pathogenic wind determination in chronic kidney disease which was formed in study one.A questionnaire survey was conducted among the patients who met the inclusion criteria.The information of BMI,duration of diabetes,duration of diabetic nephropathy,24-hour urinary protein,urinary microalbumin,albumin,glycosylated hemoglobin and creatinine were recorded.The correlation between pathogenic wind and physical and chemical inspections was analyzed and clinical manifestations of pathogenic wind in diabetic kidney disease were sorted out.Based on previous clinical data,correlations between common syndromes of diabetic kidney disease and 24-hour urinary protein were analyzed.Study three:Thirty-two GK rats were randomly divided into model group,sham operation group,Yiqi Huoxue group and Qufeng Tongluo group.The diabetic nephropathy model was built by high-fat high-sugar feeding plus single nephrectomy.The Yiqi Huoxue group and the Qufeng Tongluo group were interviewed with Yiqi Huoxue granules and Qufeng Tongluo granules respectively,while the model group and sham operation group were given purified water.The change of 24-hour urinary protein,blood glucose,serum creatinine,alanine aminotransferase and aspartate transaminase were observed after 8-week interview.Meanwhile,The expression of podocyte marker proteins such as nephrin,desmin,podocin and podocalyxin in glomeruli were detected with immunohistochemistry.ResultsStudy one:The item pool formed by literature research contains 15 items.In more than 10 out of 33 articles,acute stage with cold symptoms or recurrent induced by cold,lots of foam in the urine and facial edema was considered to be the clinical manifestations of pathogenic wind in renal diseases.After two rounds of expert survey,item was deleted properly by research group,based on statistic results and expert suggestions.Besides,normalize the average of each item's score to get the weight of items.In the end,the consensus for pathogenic wind determination in chronic kidney disease was formed.The consensus contains items showed as follow:acute stage with cold symptoms or recurrent induced by cold(0.13),lots of foam in the urine(0.11),facial edema(0.11),pain in the waist and knee(0.09),arthralgia(0.09),dizziness and tinnitus(0.10),with skin rash(0.08),itchy skin(0.10),aggravation because of eating seafood(0.09)and the condition changes quickly(0.10).Study two:A total of 111 patients were included in this survey,including 81 males and 30 females,with an average age of 59.23±3.15 years old.The results showed that the average time from the diagnosis of diabetes to the occurrence of diabetic kidney disease was 12.25±6.80 years,while the average time from the diagnosis of diabetic nephropathy to the abnormal increase of creatinine was only 2.11±3.28 years.The descriptive analysis of the items shows that itchy skin,lots of foam in the urine,pain in the waist and knee,facial edema and dizziness and tinnitus were happened in more than 50%of the investigated patients.The correlation analysis demonstrated that the score of pathogenic wind in the clinical stage was higher than that in the early stage.Among patients in the clinical stage of diabetic kidney disease,there is a positive linear relationship between syndrome scores of pathogenic wind and 24-hour urinary protein,but not with glycosylated hemoglobin,urinary microalbumin,body mass index,duration of diabetes,duration of diabetic nephropathy and creatinine.The 24-hour urinary protein and qi deficiency syndrome,blood deficiency syndrome,yin deficiency syndrome,yang deficiency syndrome,blood stasis syndrome,phlegm-dampness syndrome and dampness turbidity syndrome did not show significant correlation.Study three:Compared with the model group,Yiqi Huoxue group(P=0.000<0.01)and Quafeng Tongluo group(P=0.000<0.01)can significantly reduce urinary protein.In terms of serum creatinine,Both Yiqi Huoxue group and Qufeng Tongluo group were lower than model group,but only Yiqi Huoxue group(P=0.043<0.05)was statistically different from the model group,while there was no significant difference between Qufeng Tongluo group and model group.For blood glucose and liver function,there was no significant difference among the all groups.In terms of podocyte protection,there was no significant difference in the expression of desmin protein among the all groups,but the expression level of nephrin was higher in the Yiqi Huoxue group(P=0.044<0.05)and the Qufeng Tongluo group(P=0.008<0.01)than that in the model group.In the regulation of podocin and podocalyxin,although the expression levels of Yiqi Huoxue group and Qufeng Tongluo group were higher than those of the model group,only the difference between Qufeng Tongluo group and model group(podocin:P=0.006<0.01;podocalyxin:P=0.021<0.05)statistical significance.Conclusions1.Pathogenic wind in chronic kidney disease manifests as acute stage with cold symptoms or recurrent induced by cold,lots of foam in the urine,facial edema,pain in the waist and knee,arthralgia,dizziness and tinnitus,with skin rash,itchy skin,aggravation because of eating seafood and the condition changes quickly.2.Pathogenic wind plays an importand role in the formation and development of diabetic kidney disease.The pathogenic wind in diabetic kidney disease manifested as itchy skin,lots of foam in the urine,pain in the waist and knee,facial edema and dizziness and tinnitus.Among the patients in the clinical stage of diabetic kidney disease,pathogenic wind is obvious compared with those in early stage and has a positive correlation with 24-hour urinary protein.3.Both Qufeng Tongluo method and Yiqi Huoxue method can relieve the podocyte injury and thus reduce the urinary protein.Besides,The Qufeng Tongluo method is better than the Yiqi Huoxue method in protecting the podocytes,but it has weaker effect than the Yiqi Huoxue method in protecting the renal function.