The Study On The Therapeutic Method Of Dampness Removing And Turbid Clearance In Tntervention Treatment Of Hypertensive Kidney Damage(Renal Failure Stage)

Objective: TO investigate the clinical characteristics of hypertensive kidney damage(renal failure stage ) in the view of Traditional Chinese Medicine and thus offer referrals for its clinical treatment. To observe the effect of Lianhuang Turbid Clearance Granules(LHTCG) in treating Renal Damage due to Primary Hypertension (Renal Failure Stage)(RDHRFS) and explore its potential mechanism. To study the effect of Lianhuang Turbid Clearance Granules(LHTCG) on renal structure and function in spontancously hypertensive rat (SHR) and explore its mechanism. Methods:1.Chronic renal failure resulted from primary hypertension, chronic nephoritis, diabetic nephropathy, and aristolochic acid nephropathy were oberserved. The special clinical charactertics of each kidney failure were investigated. The occurring probability of the syndrome of interior accumulation of dampness and turbid (SIADT) were summarized. 2.96 patients with RDHRFS were divided randomly into two groups with the ratio of 1∶1, the experiment group and the control group.Patients in the experiment group(48 cases) were administered orally with LHCTG,while those in the control group(48cases) treated with Uremic Clearance Granules(UCG).Total therapeutic course was 2 monthes for both groups , the changes of blood pressure ,urinary protein per 24 hrs,hemoglobin, renal function ,nitric oxide(NO),endothelin(ET),parathyroid hormone(PTH),N-acetyl-β-D- glucosaminidase (NAG) ,the accumulative scoring of the syndrome of dampness and turbid (SIADT) before and after the treatment were observed in the two groups,and the curative efficiency were compared. 3.29 SHRs were divided randomly into four groups: the model group ,westernmedicine control group ,the low-dosage LHTCG group and high–dosage LHTCG group. Medicine was given to each group according to the designed concentration and dosage. The therapeutic course was 12 weeks. The blood pressure , proteinuria, renal function ,angiotensinⅡ(angⅡ) and endothelin(ET) were measured, renal tissues were examined routinely by light microscoy. The levels of TGF-β1 were detected by ELISA. Results: 1.Total 209 cases were observed. Among which 42 were renal damage due to primary hypertension. 102 were due to chronic nephrotitis, 36 were due to diabetic renopathy and 29 were due to aristolochic acid nephropathy. The renal failure resulted from these four diseases showed different charactertics. A statistic analysis was done according go the ratio, occurring probability of SIADT and the symptom integral and showed that in patients with primary hypertention, the occurrence of SIADT was much higher than the other three diseases. A correlation analysis of the symptom integral and clinical index in 26 SIADT patients with primary hypertension renal failure showed a positive co-relation between SIADT and the clinical index. 2.After the treatment,the levels of blood pressure(BP), ET,PTH,NAG, serum creatinine(Scr), blood urea nitrogen(Bun) ,uric acid(UA), the accumulative scoring of the TCM syndrome of the experiment group were significantly lower than before the treatmen(tP<0.05～0.01),while levels of hemoglobin, creatinine clearance(Ccr), NO were significantly higher(P<0.05～0.01).The efficacy of LHCTG was more remarkable than that of UCG. Chi-square test confirmed the difference of the clinical efficacy was significantly between the two groups(P<0.05).3.LHTCG could significantly reduce proteinuria,lower BP, improve renal function,inhibit the excretion of angⅡand ET, alleviate renal pathological injuries,mitigate glomerulosclerosis and tubulointerstitial fibrosis, inhibit TGF-β1 expression of renal tissue. The efficacy of LHCTG was better than that of benazepril. Conclusion:1.SIADT is the main clinical presentation of primary hypertension renal failure. 2.LHTCG has a good therapeutic effect for the treatment of RDHRFS. It possesses such functions as lowering the blood pressure, improving renal function, regulating metabolic disorder of endogenous vasoactive materials, normalizing Hyperparathyroidis and improving clinical symptoms, etc.3,LHTCG had effect in protecting renal function and alleviate renal pathological injuries. The potential mechanism may be related to reducing proteinuria,lowering BP, improving renal function,inhibitting the excretion of angⅡand ET ,mitigatting glomerulosclerosis and tubulointerstitial fibrosis andinhibitting TGF-β1 expression in the renal tissue.