Study Of Relationship Between Traditional Chinese Medicine Syndrome Differentiation-Type And Primary Nephrotic Syndrome Complicated With Acute Renal Failure

Objective:To explore characteristics of TCM Syndrome Differentiation(TCM-SD) for primary nephrotic syndrome(PNS) complicated with acute renal failure(ARF) patients.And then,to explore internal linkages and relationship between TCM-SD and renal pathology, biochemical index of these patients.By doing this,it may provide reliable basis for making TCD differentiation objectively and treating exactly.Method:Select 80 patients of PNS complicated with ARF(PNS-ARF) and 80 patients of PNS non-complicated with ARF(Non-PNS-ARF),then,to make TCM-SD,to collect renal pathology and biochemical index,ect.Then,analyzing internal linkages and relationship between TCM-SD and renal pathology,biochemical index of PNS-ARF patients and comparing with characteristics of TCM-SD, renal pathology and biochemical index between PNS-ARF patients and Non-PNS-ARF patients.Results:1.The incidence rate of TCM-SD in PNS-ARF patients from high to low was Syndrome of endoretention of damp heat (EDH 39%), Syndrome of Yang deficiency of spleen and Kidney (YSK 25%),Syndrome of moisture soaking(MS 16%), Syndrome of Qi deficiency of spleen and kidney (QSK 11%),Syndrome of siltation of water cross-resistance(SWCR 9%). The incidence rate of TCM-SD in Non-PNS-ARF patients from high to low was Syndrome of Qi deficiency of spleen and kidney (QSK 32%), Syndrome of Yang deficiency of spleen and Kidney (YSK 23%),Syndrome of endoretention of damp heat (EDH 18%),Syndrome of siltation of water cross-resistance(SWCR 18%),Syndrome of moisture soaking(MS 9%).2.The serum creatinine concentration of EDH,YSK,MS,QSK,SWCR in PNS-ARF patients was 302.42±217.83umol/L,265.69±140.11umol/L,443.62±367.94umol/L,203.83±89.42umol/L,190.00+64.65umol/L.There was a significant difference between PNS-ARF and Non-PNS-ARF patients(P=0.001).In PNS-ARF patients,the serum creatinine concentration of QSK was significantly lower than other types,while the serum creatinine concentration of MS was significantly higher than other types.3.The serum albumin concentration of EDH,YSK,MS,QSK,SWCR in PNS-ARF patients was 18.63±5.47g/L,17.15±4.57g/L,16.12±4.05g/L,13.16±2.31g/L,17.75±1.89g/L. There was a significant difference between PNS-ARF and Non-PNS-ARF patients(P=0.03). concentration of QSK of PNS-ARF patients was significantly lower than Non-PNS-ARF control group,but concentration of EDH of PNS-ARF patients was significantly higher than Non-PNS-ARF control group.They.existed significant differences(P<0.05).other types vs Non-PNS-ARF control group(P>0.05).The serum albumin concentration of QSK was significantly lower than EDH,they had significant difference (P<0.05). 4.The urinary protein concentration of EDH,YSK,MS,QSK,SWCR in PNS-ARF patients was 4.09±2.01 g/d,5.36±1.62g/d,4.87+2.44g/d,4.17±2.61g/d,4.97±1.81g/d.There was not significant difference between PNS-ARF and Non-PNS-ARF patients(P=0.82),there also was not significant difference between each other in PNS-ARF patients.5.The serum total cholesterol concentration of EDH,YSK,MS,QSK,SWCR in PNS-ARF patients was 10.62±3.23mmol/L,10.94+3.27mmol/L,8.53+1.97mmol/L,11.29+2.32mmol/L 17.97+5.25mmol/L.There was not significant difference between PNS-ARF and Non-PNS-ARF patients(P=0.08).In PNS-ARF patients, QSK and YSK did not meet the normal distribution and was given to exclude. Concentration of SWCR of PNS-ARF patients was significantly higher than EDH,MS(P=0.00).6.The incidence rate of renal pathological type in PNS-ARF patients from high to low was mesangial proliferative glomerulonephritis(MPGN 43%),minimal change nephrosis (MCD 27%),focal segmental glomerulosclerosis(FSGS 13%),membranous nephropathy (MN 9%),Mesangiocapillary glomerulonephritis (MCGN 8%).The incidence rate of renal pathological type in Non-PNS-ARF patients from high to low is mesangial proliferative glomerulonephritis(MPGN 32%),minimal change nephrosis(MCD 27%), membranous nephr-opathy(MN 18%),focal segmental glomerulo-sclerosis(FSGS 13%),Mesangi-ocapillary glomerulonephritis (MCGN 10%).7.In the renal pathological type distribution of PNS-ARF patients, there was significant differences between MPGN and other pathological types(P<0.05).There also was significant difference between YSK,EDH and other three types,while YSK vs EDH(P>0.05).8.About renal interstitial edema, inflammatory cell infiltration and inflammatory cell infiltration,PNS-ARF patients are much severity than Non-PNS-ARF patients (P<0.01).In the comparison of PNS-ARF patients with various TCM syndrome types in renal interstitial lesions, there was significant difference between YSK, EDH and QSK,MS,SWCR (P<0.05),but QSK,MS,SWCR Comparison between the three was not significant difference(P>0.05).Conclusion:1.PNS-ARF patients' main TCM-SD was Syndrome of endoretention of damp heat(EDH) and Syndrome of Yang deficiency of spleen and Kidney (YSK).They occured the ARF because water,blood clot and humid heat can not be eliminated from the body, resulting in serum creatinine and blood urea nitrogen increased.But just in terms of serum creatinine level, most of the lower levels of serum creatinine were QSK patients, while MS patients' levels of creatinine were higher. Non-PNS-ARF patients' main TCM-SD was Syndrome of Qi deficiency of spleen and kidney (QSK) and Syndrome of Yang deficiency of spleen and Kidney (YSK).2.The serum albumin concentration of PNS-ARF patients was significantly lower than Non-PNS-ARF control group,it clued that when the severe hypoalbuminemia of PNS patients,we should pay attention to prevent the occurrence of ARF,but there was not significant difference between PNS-ARF and Non-PNS-ARF patients in serum total cholesterol concentration.For PNS-ARF patients, spleen and kidney function weakless and gasification deficiency were the key pathogenesy of QSK patients,so the serum albumin concentration of QSK was significantly lower than EDH,serum ALB level can be used as a index to discriminate them.Otherwise,concentration of SWCR of PNS-ARF patients was significantly higher than other types,it tip that SWCR patients were more prone to hyperlipidemia.3.According to 24h urinary protein concentration of the distribution,there was not significant difference between PNS-ARF and Non-PNS-ARF patients and there also was not significant difference between each other in PNS-ARF patients.4.PNS-ARF,Non-PNS-ARF patients' main renal pathological types are mesangial proliferative glomerulonephritis(MPGN) and minimal change nephrosis(MCD).In PNS-ARF patients with pathological types,MPGN patients were more easy to occur the Syndrome of endoretention of damp heat (EDH) and the Syndrome of Yang deficiency of spleen and Kidney (YSK).5.PNS-ARF patients' renal interstitial edema and degeneration level were higher than the Non-PNS-ARF patients,it tip that it was an important factor leading to acute renal failure.EDH and YSK patients' intrinsic renal interstitial edema were much more serious, they easily lead to ARF.