A Research Of Relativity Between The Renal Pathological Types And TCM Syndromes In 651 Patients

ObjectivesA renal biopsy, also called a kidney biopsy, is a diagnostic test that involves collecting small pieces of tissue, usually through a needle, for examination with a microscope. The procedure is usually conducted under ultrasound guidance with germ-free technique. And the procedure is generally safe and can provide valuable information about the kidney disease. It can help in forming a diagnosis and in choosing the best course of treatment. A renal biopsy is recommended for certain people with kidney disease. It may be performed when other blood and urine tests cannot give enough information. A pathologist will look at the kidney tissue samples to check for unusual deposits, scarring, or infecting organisms that would explain a person's condition. The doctor may find a condition that can be treated and cured. If a person has progressive kidney failure, the biopsy may show how quickly the disease is advancing. So, A rental biopsy plays an important role in the diagnosis, treatment and understanding of the evolution of disease and pathogenesis research.In this report, the pathologic entities were analyzed retrospectively from August 2002 to December 2009 in Nephrology of Guangdong Hospital of Traditional Chinese Medicine, to find out the clinical types and pathologic types, and their correlation to TCM syndromes in the patients with kidney diseases.MethodsFrom August 2002 to December 2009, histological diagnosis of renal disease was made in 651 patients in Nephrology of Guangdong Hospital of Traditional Chinese Medicine, pathological diagnosis were made according to the WHO criteria for renal pathology or the modified WHO criteria of 1995, combined with clinical data, laboratory tests, immunopathogenesis and ultrastructural changes. TCM syndrome differentiation were made according to the nephritis seminars of Chinese Medical Association in Beidaihe of 1977, and Second National Conference on Traditional Chinese Medicine nephropathy in 1986.Ask for the help of covariance software of the SPSS13.0, firstly used frequency to analyze the distribution of the clinical data, pathological types and TCM syndromes. Then we used Research Question about Relationships among Variables to analyze the relationships about TCM syndromes, renal biopsy pathology and clinical data of the primary or secondary glomerular diseases.ResultsThe mean age of the whole group patients was (33.76±13.21) (range 12 to 72) years.39.6%patients were male and 60.4%female. Of the 475 patients with Primary glomerular disease (PGN) 57.1%were female; with the secondary glomerular disease (SGN), female amounted to 70.5%(P<0.01). A high incidence rate (57.3%) of this group patients occurred at the age from 20 to 39 years. While minimal change glomerulopathy (MCD), IgA nephropathy (IgAN), focal segmental glomerulonephritis (FSGN), mesangioproliferative glomerulomephritis (MsPGN) and lupus nephritis (LN) had their high incidence rate at the age of 20 to 39 years; membranous nephropathy at the age of 30 to 59 years. Hepatitis B virus associated nephritis mostly occurred at 28 to 49; nephritis of Schonlein-Henoch purpura 15 to 30; diabetic nephropathy and amyloidosis 40 to 59.Glomerular diseases accounted for 97.69%(634 patients) of the total renal patients biopsied. PGN among all the glomerular diseases accounted for 74.92%, SGN 22.82%. IgAN was the most frequent pathologic type (37.1%) of PGN, followed by MCD (25.1%), MsPGN (12.6%), MN (11.4%), FSGN (9.9%). The most frequent type of SGN was LN (62.3%), followed by hepatitis B virus associated nephritis (16.4%). Along the 6 years, there was a stead increment of patients with SGN in pathological evaluation of renal disorders. An increment of prevalence was found in IgAN (P<0.001) over 2007-2009 as compared with those during 2002-2006.The clinical manifestations of 475 cases in PGN were classified as syndrome of nephritic syndrome (NS) (43.4%), urinary abnormalities (Uab) (24.4%), chronic glomerulonephritis (CGN) (17.5%), acute nephritic syndrome (ANS) (12.0%), acute renal failure (ARF) (1.7%). IgAN was the most frequent diagnosis in those showed as Uab, while MCD, MsPGN, MN and FSGN frequently featured as In the whole group patients, the root(Ben)-deficiency and branch(Biao)-excess syndrome had a highest occurrence, which accounted for 87.8%in PGN patients and 93.1%in SGN patients. The type of qi deficiency in spleen and kidney was more common (68.6%) than other types in the root (Ben)-deficiency. The damp-heat syndrome was more common (61.8%) than other syndrome in the branch (Biao)-excess. There were 67.9%of all the patients with blood stasis syndrome. Between different pathological types of TCM syndromes was no significant difference (P> 0.05).85.5%of the electron microscope has played a determining role in the diagnosis of light microscopy. Some renal pathological types, such as hereditary nephritis, MCD, MN in early stage, were confirmed by electron microscope.ConclusionThe glomerular disease is the most common renal disease occurred in our hospital. The cases of PGN are significantly more than SGN. Along the 6 years, there was a stead increment of patients with SGN in pathological evaluation of renal disorders. In PGN, IgAN is the most frequent pathological type, followed by MCD and MsPGN. There is no significant gender difference in PGN. In SGN, LN is the most frequent pathological type. And the female are significantly more than male in LN. Adolescent is predominant in this group of patients.The root(Ben)-deficiency and branch(Biao)-excess syndrome has a highest occurrence in the whole group patients. The type of qi deficiency in spleen and kidney was the most common in the root (Ben)-deficiency, while the damp-heat syndrome in the branch (Biao)-excess. There are most patients with blood stasis syndrome. Therefore, the treatment of renal diseases should pay attention to strengthening the spleen and kidney and clearing heat and dampness, at the same time pay attention to adding blood stasis removing drugs.