chronic kidney failure Chronic renal failure (CRF) refers to the progressive outcome of various chronic kidney diseases, characterized mainly by the decline in renal function, retention of metabolic waste products, and imbalance in the body's internal environment.

Chronic renal failure (CRF) is the outcome of the continuous progression of various chronic kidney diseases, characterized by declining renal function, retention of metabolic waste products, and imbalance in the body's internal environment.

The triggering factors for the acute exacerbation of chronic renal failure include the following:

- Insufficient blood volume (such as hypotension, massive hemorrhage, shock, dehydration, etc.)

- Improper use of nephrotoxic drugs, such as aminoglycoside antibiotics, polymyxins, vancomycin, contrast agents, non-steroidal anti-inflammatory drugs (such as indomethacin, diclofenac, and ibuprofen), etc.

- Acute decrease in local renal blood supply

- Recurrence or exacerbation of primary diseases causing renal damage (such as IgA nephropathy, nephrotic syndrome, etc.)

- Poorly controlled severe hypertension

- Urinary tract obstruction

- Others: various infections, dysfunction of extrarenal organs (such as heart failure, liver failure), etc.

The triggering factors for the progressive development of chronic renal failure include the following:

- High blood sugar, hypertension

- Proteinuria, hypoalbuminemia

- Anemia, hyperlipidemia, hyperhomocysteinemia

- Obesity, smoking, malnutrition, advanced age, etc.

- Disturbances in water metabolism: Early manifestations include polyuria, increased nocturia, which gradually progress to a decrease in glomerular filtration rate, leading to oliguria or even anuria.

- Electrolyte imbalances: Early dysfunction in renal tubular reabsorption can lead to hypokalemia, while reduced excretion of electrolytes in later stages may result in hyperkalemia, hyperphosphatemia, and hypocalcemia, leading to seizures. Hyperkalemia can cause cardiac arrhythmias.

- Metabolic acidosis: Patients often present with poor appetite, nausea, vomiting, fatigue, delayed reactions, deep and rapid breathing, and even coma.

- Gastrointestinal symptoms: Digestive system symptoms are typically the earliest to appear, common symptoms include anorexia, nausea, vomiting, and halitosis. Advanced stages may manifest as gastrointestinal ulcers, hematemesis, and melena.

- Neurological symptoms: Early manifestations include fatigue, headaches, insomnia, low spirits, decreased memory, limb pain, while advanced stages may lead to seizures, and even confusion, coma.

- Hematological symptoms: Reduced red blood cell production leading to anemia, abnormal platelet function resulting in prolonged bleeding or easy bruising. Impaired immune system function leading to increased susceptibility to infections.

- Cardiovascular symptoms: Commonly observed cardiovascular-related diseases include hypertension, atherosclerosis, pericarditis, and in severe cases, heart failure, which is the most common cause of death in uremic patients. Symptoms include elevated blood pressure, arrhythmias, dyspnea, and orthopnea.

- Respiratory symptoms: Patients may experience dyspnea, hyperventilation, and related conditions such as pleurisy, pulmonary infections, etc.

- Other symptoms: Mineral and bone metabolism disorders (renal osteodystrophy) typically manifest as bone pain, muscle weakness, and in severe cases, may lead to fractures. Some patients may experience pruritus.

Chronic renal failure falls within the scope of traditional Chinese medicine categories such as "drowning toxicity", "deficiency fatigue", and "guan ge".

Herbal therapy:

1. Spleen-kidney Qi deficiency pattern

Symptoms: Fatigue, shortness of breath, reduced appetite, lassitude, lumbago, weak knees, abdominal distention, loose stools, tastelessness in the mouth, pale tongue with tooth marks, and deep, thready pulse.

Treatment: Tonify Qi, invigorate the spleen, and strengthen the kidneys.

Prescription: Modified Liu Jun Zi Tang.

2. Spleen-kidney Yang deficiency pattern

Symptoms: Cold limbs, fatigue, shortness of breath, reduced appetite, lassitude, lumbago, weak knees, cold and painful lumbar region, abdominal distention, loose stools, nocturia, pale tongue with tooth marks, and deep, weak pulse.

Treatment: Warm and tonify the spleen and kidneys, invigorate Yang Qi.

Prescription: Modified Ji Sheng Shen Qi Wan.

3. Spleen-kidney Qi-yin deficiency pattern

Symptoms: Fatigue, lumbago, weak knees, dry mouth and throat, restlessness, nocturia, pale tongue, and thin, thready pulse.

Treatment: Tonify Qi and nourish Yin.

Prescription: Modified Shen Qi Di Huang Tang.

4. Liver-kidney Yin deficiency pattern

Symptoms: Dizziness, headache, lumbago, weak knees, dry mouth and throat, restlessness, dry stools, scanty, dark urine, pale red tongue with scanty coating, and deep, thready or wiry pulse.

Treatment: Nourish and tonify the liver and kidneys.

Prescription: Modified Liu Wei Di Huang Wan.

5. Yin-Yang deficiency pattern

Symptoms: Cold limbs, restlessness, dry mouth and throat, lumbago, weak knees, nocturia, dry stools, pale tongue with tooth marks, and deep, thready pulse.

Treatment: Tonify both Yin and Yang.

Prescription: Modified Jin Gui Shen Qi Wan.

Topical therapy:

Using herbal medicine soaked in water and placed in a cloth bag, the herbal bag is applied as a hot compress to the bilateral kidney shu points and Guan Yuan point, 1-2 times a day. A treatment course lasts for 3 months, with the aim of promoting circulation, warming Yang, and promoting diuresis.

Acupuncture therapy:

Acupoints such as Zhongwan, Qihai, Zusanli, Sanyinjiao, Shenshu, Sanjiaoshu, and Xinyu are selected to tonify Qi. Acupoints such as Guanyuan, Zhongji, Yinlian, Shenshu, and Sanjiaoshu are selected to promote urination. Acupoints such as Dazhui, Mingmen, Shenshu, Pishu, Zhongwan, Zhongji, Zusanli, and Sanyinjiao are selected for tonifying the spleen and kidneys.

Medicated bath therapy:

Medicated baths serve as an auxiliary method for treating chronic renal failure. After the herbal medicine is packed into a bag, it is placed in a steam bath apparatus and steamed for 30-45 minutes per session, aiming to induce sweating without causing fatigue. This therapy is performed three times a week to further eliminate toxins, and assist in correcting hypertension and azotemia.

Colon irrigation therapy:

Colon irrigation therapy can be divided into machine irrigation and manual catheter irrigation, with the principle of promoting blood circulation, removing turbidity, and facilitating the excretion of more toxins from the intestines.

- Blood pressure control: Patients' blood pressure should generally be maintained around 130/80 mmHg. Patients should adhere to a low-salt diet, with recommended daily salt intake less than 5g. They should consume fewer high-salt pickled vegetables (such as mustard tubers, salted vegetables, etc.) and condiments with high salt content (such as table salt, oyster sauce, etc.).

- Blood sugar control: Patients should consume less sugary drinks and fruits (such as milk tea, bottled drinks, durians, etc.).

- Limiting protein intake: Adequate protein intake can alleviate symptoms and related complications, and delay disease progression. On the basis of a low-protein diet of 0.6g/(kg·d), essential amino acids or α-keto acids should be supplemented appropriately, while ensuring sufficient calorie intake. The low-protein diet should mainly consist of high biological value proteins, such as eggs, milk, fish, lean meat, etc.

- Limiting potassium intake: Patients should avoid or reduce consumption of high-potassium foods and fruits (such as yams, potatoes, bananas, etc.). They should try to avoid consuming vegetable soups, and vegetables should be soaked for a period before processing.

- Limiting phosphorus intake: Patients should avoid or reduce consumption of high-phosphorus foods such as animal offal, nuts, dried vegetables, etc.

- Improving lifestyle: Quitting smoking, limiting alcohol consumption, engaging in aerobic exercise, and controlling weight (BMI 22-24), etc.