Analysis Of Clinical Characteristics Of 604 Patients With Simple Renal Cysts And The Study Of Its Traditional Chinese Medicine Syndromes

ObjectivesTo know the clinical features and the distribution of TCM syndromes of patients with simple renal cysts (SRCs) in Guangdong Province. To further explore the correlation rules between SRCs and hypertension, or renal function, or TCM syndromes. To more deeply understand the clinical value of SRCs. To normalize the treatment according to TCM syndrome differentiation of SRCs and take full advantage of TCM treating in SRCs, then protect the renal function.MethodsAnalyze the clinical data of the collected patients with SRCs by the meyhod of retrospective study. Contrast the clinical indicators among different cyst characteristics. Contrast the clinical indicators and cyst characteristics among different blood pressure level and among different renal function level. Analyze the SRCs patients being complicated hypertension, or decreased renal function by using logistic regression analysis. Discriminate the TCM syndromes by referring the standards of TCM syndromes of chronic glomerulonephritis and considering our clinical experience, patients’symptoms, tongue examination, pulse examination and prescriptions. Analyze the correlation between TCM syndromes and cyst characteristics, and the correlation between TCM syndromes and clinical indicators.Results1. General information:604 cases were collected totally. The sex ratio is 1.46:1(men vs. women). Patients over 50y are accounted for 64.24%. There is no statistical difference between men and women in average age, and their age compositions are consistent. There are 218 cases complicated with hypertension(36.1%), and 175 cases complicated with prehypertension(29.0%). 193 cases complicated with urinary calculi (32.0%), and 239 cases complicated with hyperuricemia(39.6%). The cases complicated with decreased renal function are 334(55.3%) and there are 117 CKD3-5 patients.2. Clinical characteristics of SRCs:The age and blood pressure of patients with large cysts (D≥20mm) are significantly higher than those with small cysts (D<20mm). The age, blood pressure, uric acid and serum creatinine of patients with multiple cysts (N≥2) or bilateral cysts are significantly higher than those with single cyst.3. Correlative study on SRCs patients complicated with hypertension:There are statistical differences among different blood pressure groups in age, BMI, eGFR, uric acid, cholesterol, triglycerides, hemoglobin, prevalence of diabetes, prevalence of glomerulonephritis or nephrotic syndrome, cyst size, cyst number and cyst location. Hypertensive group patients are of older age, higher BMI, lower eGFR, higher level of uric acid, cholesterol and triglycerides, higher prevalence rate of diabetes and glomerulonephritis or nephrotic syndrome, bigger cyst and higher prevalence rate of multiple cysts or bilateral cysts. The logistic regression analysis revealed that age≥50y, large cysts, multiple cysts are the risk factors for SRCs patients being complicated with prehypertension. And the risk factors for SRCs patients being complicated with hypertension include these following:age≥50y, overweight, hyperuricemia, decreased renal function, diabetes,large cysts and bilateral cysts.4. Correlative study on SRCs patients complicated with decreased renal function:There are statistically differences between two renal function groups (eGFR<90 vs. eGFR≥90) in age, sex, BMI,blood pressure,uric acid, cholesterol,triglycerides,prevalence of glomerulonephritis or nephrotic syndrome, cyst number and cyst location. The logistic regression analysis revealed that male,age≥50y, hyperuricemia, hypertension, urinary calculi and glomerulonephritis or nephrotic syndrome are the risk factors for SRCs patients being complicated with decreased renal function.5. Distributions of TCM diagnoses and TCM syndromes:Low back pain(N=120,19.9%),stranguria(N=134,22.2%)and other diagnoses(N=l47,24.3%)are the most common TCM diagnoses of SRCs,and the cases diagnosed hematuria are50(8.3%).Deficiency of Qi and Yin,combined with damp-heat and blood stasis6.Correlative study between TCM syndromes and cyst characteristics: The differences-between the prevalence rate of large cyst and small cyst, between the prevalence rate of multiple cysts and single cyst, between the prevalence rate of unilateral cyst and bilateral cysts-are statistically different among the SRCs TCM syndromes. The asdthenic splenonephro-Yang and dampness and blood stasis are in higher prevalence rate of large cysts, multiple cysts and bilateral cysts.5.Distributions of TCM diagnoses and TCM syndromes:Low back pain(N=120,19.9%),stranguria(N=134,22.2%)and other diagnoses(N=l47,24.3%)are the most common TCM diagnoses of SRCs,and th7. Correlative study between TCM syndromes and clinical indicators:There are statistical differences among deficiency syndrome groups in age, eGFR, uric acid, blood pressure, hemoglobin, prevalence of glomerulonephritis or nephrotic syndrome, prevalence of urinary calculi and prevalence of urinary infection. Asdthenic splenonephro-Yang group patients are of older age, lower eGFR, higher level of uric acid, higher level of blood pressure, lower hemoglobin, higher prevalence rate of glomerulonephritis or nephrotic syndrome. Deficiency of Qi and Yin group patients are of higher prevalence rate of urinary calculi and urinary infection. There are statistical differences among excessive syndrome groups in age, eGFR, uric acid, blood pressure, cholesterol, hemoglobin, BMI, prevalence of glomerulonephritis or nephrotic syndrome, prevalence of urinary calculi and prevalence of urinary infection. Dampness and blood stasis group patients are of older age, lower eGFR, higher level of uric acid, higher level of blood pressure, higher prevalence rate of glomerulonephritis or nephrotic syndrome. Damp-heat and blood stasis group patients are of higher prevalence rate of urinary calculi and urinary infection.ConelusionLarge cysts and bilateral cysts are the risk factors for SRCs patients being complicated with hypertension. To control the development of simple renal cysts may be beneficial to preventing and treating hypertension. Deficiency of Qi and Yin combined with damp-heat and blood stasis is the most common TCM syndrome of SRCs. Asdthenic splenonephro-Yang combined with Dampness and blood stasis syndrome patients are susceptible to large cysts, multiple cysts and bilateral cysts. Some clinical indicators such as age, blood pressure, renal function, uric acid, etc., are significantly different among different TCM syndrome groups. These above can be the references for treating SRCs according to syndrome differentiation.