Hepatogenic nephropathy and hepatorenal syndrome;hepatic edema, hypertension, proteinuria
The manifestations of stranguria, turbid urine and uroschesis caused by wetness-heat of lower-jiao are diseases formed from pathologic changes of the urinary system due to infection of the humane body by hepatophilic virus. More important is that hepatic disease can evoke secondary renal damage called “hepatogenic nephropathy” (肝源性腎病), as it is proved recently. These conditions may be neglected by physicians as well as patients.
It was reported that in humane immunologic glomerulonephritis, 80% belong to the immunologic complex type of nephritis, in which the most common cause is hepatitis virus antigen (especially surface antigen HbsAg) and therefore called hepatitis B nephritis (乙肝性腎炎). It is found clinically that after hepatophilic virus infection, the hepatic and renal pathologic changes can occur at the same time, or the renal lesions may occur on the basis of chronic hepatitis.
Clinical observations show that when chronic hepatitis patients of carriers of hepatitis virus have complications of nephritis, no symptoms of renal damage may be seen in the early stage. It is only some time later that variable degrees of edema, hypertension, proteinuria, hematuria (mostly hematuria under the microscope) and cylindruria would manifest. There may be changes also in renal function and in the later stage, there may even occur renal failure and “hepatorenal syndrome”(肝腎綜合征).
In the late stage of liver disease, especially in the decompensation stage sclerosis of liver, there are renal failure manifestations such as oliguria, nitremia, acidosis and electrolyte disorders and this condition is called hepatorenal syndrome. This syndrome usually occurs after gastrointestinal hemorrhage, infection, abdominal paracentesis, prolonged use of diuretics or during the postoperative period. The patient usually suffers at the same time from variable degrees of anorexia, nausea, vomiting, thirsty and psychotic or neurotic symptoms.
At present, in clinical practice, it is not rare to see chronic hepatitis patients associated with hepatomegaly, hepatic edema, hypertension and abnormal urine routine examination results. This indicates that hepatic nephritis patients of the early stage are existing widely. It is a pity that not few patients take hypotensive drugs and diuretics for long periods without knowing the effect of “chronic hepatitis” on the kidney and the importance of seeking a therapeutic method to treat the fundamental. The above mentioned treatment may relieve the symptoms of hypertension and edema to some degree, but actually the liver function is declining as time passes and the illness is in fact exacerbating.
According to statistics, in children, hepatitis B nephritis appears usually in the form of “membranous nephropathy” (膜性腎病) which commonly has no clinical symptoms and a very low incidence of renal failure. But in adults, “membrano-pratiferative nephritis” (膜增殖性腎炎) is the more common form which gives rise to the nephrotic syndrome and hematuris; its incidence of renal failure may reach 20%. So we can see that if chronic hepatitis progresses to the stage of having hypertension, edema and proteinuria manifestations, its prognosis is by no means good.
Modern medicine has proved fully the correctness of traditional Chinese medicine elucidation on the pathology and pathogenesis of chronic hepatitis. The TCM therapy of activating blood circulation and removing stasis uses TCM drugs to promote smooth microcirculation, prevent thrombosis, inhibit immunologic reactions and change capillary permeability to abolish or relieve the inflammation and damage of the various organs and tissues of the humane body caused by hepatophilic virus. It can also inhibit connective tissue metabolism, decrease glomerular fibrosis and promote absorption and malaria of fibrotic lesions. Therefore, it is very helpful in the prevention of hepatogenic nephropathy. Timely effective systemic TCM therapy may prevent or delay the occurrence of hepatogenic nephropathy and renal failure.
Introduction of cases
| Case 9
Chan (code number 488) female, age 39 years. Her first visit was on May, 1996 with the complaint of being examined as a hepatitis B virus carrier and possession of a history of proteinuria, abnormal renal function and hypertension. She was diagnosed as renal disease and hospitalized twice, but urinary system roentgenography (泌尿系造影檢查) revealed normal results. She had platelet deficiency (about 100 thousand) for a long time and had urinary system infection in February 1995. Since childhood, she had frequent soreness of loin and back, painful urination, fatigue, edema, headache, vertigo, insomnia, common cold, menstrual disorders and dysmenorrheal. The menstrual blood was bright red and large in amount, with blood clots and it usually persisted for 7-8 days. Irregular vaginal bleeding happened repeatedly, the amount of blood being variable. She presently felt tired, the left loin was painful, there was pain during urination and vaginal bleeding was taking place.
Physical examination: thin and tired looking, eye lids edematous, skin color polish yellow, paleness of conjunctiva, lips and tongue, clubbed fingers showing marked degree of anemia, hepatomegaly of 1.5 cm; percussion tenderness over hepatic and renal region, blood pressure 150/90 mmHg. The diagnosis was chronic hepatitis causing deficiency of blood and energy, wetness-heat of lower-jiao (stranguria, menorrhagia) (淋証、崩漏)and weakness of liver and kidney.
After taking 15 parcels of TCM drugs, the liver was normal, blood pressure 146/80 mmHg. Reexamination of urine routine and culture showed normal results. In the following three months, she continued TCM treatment. Irregular menstrual bleeding was corrected and the blood pressure remained at 120-140/80 mmHg. Intermittent TCM treatment continued for two more years. Her menstruation was regular and the amount decreased significantly; the menstrual phase lessened from 12 days to 4-7 days and anemia was improved. During the course of treatment, there were two episodes of relapse of hepatomegaly that reached the costal margin, but all were cured by TCM drugs. |
By WONG Kwok Hung
published on 28th August 2001
(translated by Professor ZHENG Hua En in 2003)