A Case Report of Refractory Membranous Nephropathy Treated by the Method of Invigorating Spleen, Benefiting Qi, Activating Blood and Removing Toxicity
1.Department of Nephrology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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LU Zhenzhen, DENG Yueyi. A Case Report of Refractory Membranous Nephropathy Treated by the Method of Invigorating Spleen, Benefiting Qi, Activating Blood and Removing Toxicity[DB/OL].(2023-04-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=35868911&Fpath=home&index=0
DOI:
LU Zhenzhen, DENG Yueyi. A Case Report of Refractory Membranous Nephropathy Treated by the Method of Invigorating Spleen, Benefiting Qi, Activating Blood and Removing Toxicity[DB/OL].(2023-04-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=35868911&Fpath=home&index=0DOI:
A Case Report of Refractory Membranous Nephropathy Treated by the Method of Invigorating Spleen, Benefiting Qi, Activating Blood and Removing Toxicity
Summary of case history, In June 2014, the patient developed edema of both lower limbs without obvious inducement, which was ignored by the patient. In September 2014, edema of both lower limbs occurred again. Examination showed urinary protein 2+,and creatinine about 40 μmol/L. In order to confirm the diagnosis of the disease, renal biopsy was performed on October 5, 2014, which showed membranous nephropathy stageⅠ-Ⅱ. Prednisone combined with cyclosporine A was given, but the symptoms were not significantly relieved. In February 2015, the patient was changed the treatment of mycophenolate combined with prednisone. The examination showed that creatinine was within the normal range and the urine protein was reduced. In 2016, prednisone was discontinued and mycophenolate was reduced to 250mg bid. In April 2017, 24h urine protein was 1.3g, and the patient was changed to tacrolimus 2mg tid. The symptom was relieved, and the creatinine was maintained between 67-90 μmol/L. The dose of tacrolimus was gradually reduced, and the 24h urinary protein was 25.65mg in June 2017. The tacrolimus treatment was stopped in February 2019 due to the remission of symptoms. The patient developed edema of both lower limbs again, which gradually worsened. On April 18, 2019, the 24-hour urinary protein was 7669.38 mg, albumin was 27.8 g/L, and creatinine was 63 μmol/ L. The patient was admitted to our department for further traditional Chinese medicine treatment. Since the onset of the disease, the patient had no fever, chest tightness, shortness of breath, frequent urination, urgency and pain, gross hematuria, rash and joint pain, and no significant weight loss.,TCM diagnosis, Edema(spleen deficiency and dampness-heat syndrome),Western medicine diagnosis, Membranous nephropathy stage II; Chronic Kidney Disease stage 2; Hypertension stage 3( very high risk),Therapeutic methods, The treatment included controlling blood pressure, regulating lipid and stabilizing spots, anticoagulation and reducing fibrin, inhibiting gastric acid and protecting stomach, combined with astragalus for replenishing qi and reducing swelling, prescription of Jianpi Xiaozhong for strengthening spleen and reducing swelling injection.,Clinical outcomes, Cured without recurrence
关键词
膜性肾病健脾益气活血解毒【适合阅读专业】 肾脏病学中医学
Keywords
Membranous nephropathyInvigorating spleenBenefiting qiActivating blood and removing toxicity【Suitable majors】 NephrologyTraditional Chinese medicine
references
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Chen M , Wang H Y , Li H , et al. Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: a multicenter randomized controlled trial[J]. American Journal of the Medical Sciences, 2010, 339(3):233.
Howman A , Chapman T L , Langdon M M , et al. Immunosuppression for progressive membranous nephropathy: a UK randomised controlled trial[J]. Lancet, 2013, 381(9868): 744-751.
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