Chronic Nephritis Chronic glomerulonephritis, also known as chronic nephritis, is a group of diseases originating from the glomeruli of the kidneys. The onset is slow, and the clinical manifestations can be mild or severe, fluctuating over time, with a duration of more than three months. Main symptoms may include edema, hypertension, proteinuria, hematuria, and the presence of renal tubular casts, among which one or several manifestations (such as hematuria or proteinuria) may be present. Sometimes it may be accompanied by nephrotic syndrome or severe hypertension.

Chronic glomerulonephritis, abbreviated as chronic nephritis, is a group of diseases originating from the glomeruli of the kidneys. It has a slow onset, and clinical manifestations can vary in severity, with the condition sometimes being mild and at other times severe. The disease can persist for more than three months. The main symptoms may include edema, high blood pressure, proteinuria, hematuria, and urinary casts, with one or several of these manifestations present (such as hematuria or proteinuria). In some cases, it may be accompanied by nephrotic syndrome or severe hypertension.

As the disease progresses, there may be renal function impairment, anemia, electrolyte and mineral metabolism disorders, among other conditions. During the course of the disease, acute exacerbations of nephritis may occur, often triggered by infections such as respiratory tract infections. During these exacerbations, symptoms resembling acute nephritis may appear, and some cases may resolve spontaneously while others may experience worsening of the condition.

Chronic nephritis can be classified based on clinical manifestations into nephritic syndrome, nephrotic syndrome, asymptomatic hematuria and/or proteinuria, and chronic renal insufficiency. Some patients may experience acute attacks or concurrent tubulointerstitial and renal vascular diseases.

Based on pathological features, chronic nephritis can be further classified into minimal change disease of the glomeruli, including minimal change glomerulopathy, focal segmental glomerulosclerosis, focal segmental glomerulonephritis, diffuse glomerulonephritis, including membranous nephropathy and proliferative glomerulonephritis.

Membranous nephropathy

Proliferative glomerulonephritis

Proliferative glomerulonephritis can be further divided into:

Mesangial proliferative glomerulonephritis (e.g., IgA nephropathy);

Mesangiocapillary glomerulonephritis;

Mesangial capillary glomerulonephritis, including membranoproliferative glomerulonephritis type I and type III;

Dense deposit disease, also known as membranoproliferative glomerulonephritis type II;

Crescentic glomerulonephritis.

Currently recognized factors that can cause glomerulonephritis include the following:

Infections

Viral infections, the most common in China being hepatitis B virus infection leading to nephritis, causing membranous lesions in adults and proliferative lesions in children. In addition, hepatitis C virus, human immunodeficiency virus (HIV), and others can also trigger glomerulonephritis.

Post-streptococcal glomerulonephritis. In response to the infection, the body produces additional antibodies, which ultimately deposit in the glomeruli, causing inflammation. Children are more susceptible to post-streptococcal glomerulonephritis.

Bacterial endocarditis can also lead to glomerulonephritis.

Immune diseases

Systemic lupus erythematosus;

Goodpasture syndrome;

Vasculitis, most commonly associated with anti-neutrophil cytoplasmic antibodies (ANCA)-associated small vessel vasculitis.

Other autoimmune diseases, such as rheumatoid arthritis, ankylosing spondylitis, can also lead to secondary glomerulonephritis.

Metabolic factors

Obesity;

Hypertension;

Diabetic nephropathy.

Genetic factors

Genetic factors, such as polycystic kidney disease, Alport syndrome, and others.

Tumor-related diseases

Glomerulonephritis is also associated with certain tumor-related diseases, such as multiple myeloma, chronic lymphocytic leukemia, and solid tumors like lung cancer and stomach cancer.

In addition, it is important to note that the onset of some kidney diseases has a genetic background, and apart from typical hereditary nephritis, some kidney diseases are also influenced by genetic factors.

Most patients with chronic glomerulonephritis have an insidious onset, and clinical manifestations are diverse. Early on, abnormalities may only be indicated through urine and related tests without any noticeable symptoms. As the disease slowly progresses and worsens, patients may exhibit:

Fatigue, tiredness;

Lumbago;

Loss of appetite;

Edema, which may appear in the face, hands, feet, and abdomen;

Hypertension;

Hematuria, visible to the naked eye as cola-colored or pinkish urine, or detected as microscopic hematuria;

Proteinuria, characterized by increased foamy urine;

Anemia, which becomes more prevalent and severe as renal function gradually deteriorates.

Several traditional Chinese medicine components have shown definite therapeutic effects against chronic kidney diseases, and their usage has been confirmed as safe through long-term and large-scale clinical observations:

Tripterygium wilfordii preparations: Compounds such as triptolide extracted from Tripterygium wilfordii have shown significant effects in reducing proteinuria in patients with nephritis and protecting podocytes, making them suitable for conditions such as IgA nephropathy and membranous nephropathy.

Rhubarb preparations: They have effects in delaying the progression of renal function and inhibiting mesangial cell proliferation. Refined extracts of rhubarb acid have metabolic regulatory effects such as blood glucose control, especially suitable for metabolic-related renal damage such as diabetic nephropathy.

Cordyceps preparations: Cordyceps sinensis promotes repair of renal (particularly tubulointerstitial) damage and inhibits renal interstitial fibrosis. Apart from natural cordyceps, there are also various artificially cultivated cordyceps effective component preparations that can have therapeutic effects.

In addition, it is important to note that some drugs containing aristolochic acid (such as aristolochia and asarum) have been proven to have the risk of damaging the kidneys, leading to elevated creatinine levels and even renal failure, and have been prohibited. It is recommended to avoid using "folk remedies" or drugs with unclear ingredients to prevent accidental ingestion of drugs containing aristolochic acid, exacerbating kidney damage.

Low-sodium diet: It is recommended to consume less than 6g/day. This can be achieved by avoiding products with added salt, including convenience foods, fast food, and consuming less salted pickled vegetables such as pickled mustard greens and salted vegetables, as well as high-sodium condiments like table salt and oyster sauce, reducing the daily sodium intake.

Control of protein intake: Generally, it should be 30-40g per day, with a focus on high-quality proteins such as eggs, milk, fish, lean meat, and other animal proteins. For patients with normal renal function and significant proteinuria, the protein intake can be appropriately increased to 1.0g/kg per day. For those strictly adhering to a high-quality low-protein diet and with economic conditions allowing, complex amino acid preparations can be taken to supplement essential amino acids, reduce the burden on the kidneys, and improve protein metabolism.

Limitation of phosphorus intake: Avoid or reduce consumption of high-phosphorus foods such as animal offal, nuts, dried vegetables, and other high-phosphorus foods.

Weight control.

If diabetic, pay attention to controlling blood glucose levels.

Quit smoking.

Avoid improper use of nephrotoxic drugs, such as aminoglycoside antibiotics (e.g., cephalosporins, vancomycin), contrast agents, nonsteroidal anti-inflammatory drugs (e.g., indomethacin, diclofenac, and ibuprofen), and traditional Chinese medicines containing aristolochic acid.

The following points should be noted:

Maintain good emotional well-being: Maintaining good emotional well-being not only greatly improves quality of life but also has a positive impact on treatment and prognosis of the disease.

Regular lifestyle: Once the condition is stable or improving, a regular daily routine is beneficial for the body's recovery. Regular exercise, weight control, and avoiding colds are important.

Dietary hygiene: A light and balanced diet, avoiding overeating, drinking plenty of water, avoiding leftovers, and not consuming raw or cold dishes.

For most cases of chronic glomerulonephritis, there are no specific causes or prevention measures. The main focus is on maintaining good personal health, engaging in regular exercise to enhance immunity, strict blood glucose control, smoking cessation, weight reduction, and avoiding the use of non-steroidal anti-inflammatory drugs such as ibuprofen.