Exploring The Significance Of Wind Dispelling And Dampness Removing Treatment From The Correlation Between Urinary Podocytes And Active Disease Of IgA Nephropathy

Objective To observee the correlation between urinary podocyte positive and IgA nephropathy active lesions and inner disturbance of wind and damp syndrome,and to explore whether urinary podocytes can be the microscopic dialectical index of dynamically monitored the inner disturbance of wind and damp syndrome of IgAN.Through the determination of the efficacy of the use of Wind Dispelling and Dampness Removing Chinese herbs,and repeated monitoring of podocytes,in order to further clarify the significance of "inner disturbance of wind and damp syndrome" in active pathological changes of IgAN,and enrich the theoretical basis of treatments in renal active lesions.Methods Selection of Hangzhou Hospital Traditional of Chinese Medicine during January 2016-October 2018 renal biopsy smears diagnosis of primary IgA nephropathy diagnosed as renal IgA nephropathy and long-term hospitalized patients in our department outpatient follow-up,including 1 week before and after renal perforation.The podocytes were positive in 40 cases and podocytes were negative in40 cases.Collect general patient data,clinical data(including 24-hour urine protein quantitation,urinary red blood cell count,serum creatinine,serum albumin,estimated glomerular filtration rate,endogenous creatinine clearance rate,etc.),pathological data(light microscopy,Immunofluorescence,renal pathology scores,TCM syndrome differentiation,analysis of the correlation between podocytes and IgA nephropathy active disease and Inner Disturbance of wind and damp Syndrome.Patients with IgAN with or without dialectical syndrome were included in the treatment group and the control group.The treatment group was treated with Wind Dispelling and Removing Chinese herbs + Western medicine basic treatment;the control group was treated with Western medicine basic treatment for 3 months,and the urine cells were repeatedly detected after 3 months.A controlled study was conducted to analyze thesignificance of the treatment with Wind Dispelling and Removing Chinese herbs in active disease of IgA nephropathy.Results 1.Compared with negative patients,urinary podocyte-positive IgA nephropathy patients have higher serum creatinine levels,blood uric acid levels,24-hour urine protein quantitation,and microscopic red blood cell counts.Estimated glomerular filtration rate and lower endogenous creatinine clearance rate.The above differences were statistically significant(p<0.05).In the case of Oxford classification of IgA nephropathy,the positive group had higher E,S,and C ratios,and the difference was statistically significant.The cellular crescent formation rate and activity index(AI)of patients with urinary podocyte-positive IgA nephropathy were higher,and the difference was statistically significant.2.Compared with non-inner disturbance of wind and damp syndrome,patients with inner disturbance of wind and damp syndrome had higher 24-hour urine protein and urinary red blood cells,and estimated glomerular filtration rate was lower than non-rheumatic syndrome group;pathological activity index(AI)in patients with inner disturbance of wind and damp syndrome)greater than non-inner disturbance of wind and damp syndrome patients.And in the ratio of E,S,C in the Oxford classification of IgA nephropathy,the patients with rheumatic internal disturbance syndrome were higher than those without non-inner disturbance of wind and damp syndrome,and the difference was statistically significant.3.After the treatment of two different groups,the urinary podocyte conversion rate in the treatment group was higher than that in the control group.The laboratory indicators of IgA nephropathy patients treated with hurricane dehumidification,such as 24-hour urine protein quantitation,urinary red blood cells,serum creatinine,and blood uric acid levels were significantly lower than before treatment(p<0.05),but compared with the control group.There was no statistical difference(p<0.05).4.After treatment,the urinary podocyte negative in the 24 hours before treatment,the urine protein quantitation and blood uric acid level were lower than the persistent positive patients,and after treatment,the urine protein quantitation,uroscopy red blood cell level and blood uric acid were lower than Re-test patients who are stillpositive for urinary podocytes.In patients with persistently positive urinary podocytes,the incidence of tubule atrophy/interstitial fibrosis(T1)was higher in the Oxford subtype than in the negative(p<0.05).Conclusion: 1.IgA nephropathy patients with positive urinary podocytes are more active in clinical indicators and pathology.Urinary podocytes may become non-invasive markers that reflect active pathological changes of IgA nephropathy and can be dynamically monitored.2.Rheumatism syndrome is an important syndrome of IgA nephropathy.The rheumatism group is more active and more serious than the non-rheumatic group in clinical manifestations and pathology.3.Urinary podocyte excretion is closely related to active pathological changes of IgA nephropathy and rheumatic internal disturbance syndrome.Urinary podocytes can be used as a microscopic index to assist diagnosis of rheumatic internal disturbance syndrome.4.Wind Dispelling and Dampness Removing treatment has positive significance for the control of active pathological changes of IgA nephropathy.Patients who continued to test positive for urinary podocytes after treatment were more severe in both clinical and pathological manifestations.Oxford tuberculosis atrophy/interstitial fibrosis(T)may be a factor influencing the prognosis of IgA nephropathy and the efficacy of hurricane dehumidification.