The Curative Effect Observation And Prognosis Analysis Of Tonifying Kidney And Clearing Away Damp-heat Method In Treating Glomerulonephritis Proteinuria

Objective:To observe the curative effect and prognostic influence of tonifying kidney and clearing away damp-heat method in glomerulonephritis proteinuria.MethodsrUse the retrospective cohort study.99 patients with chronic disease who are followed upon 9 months were reviewed from 2010.05-2015.12 in Nephrology of Jiangsu Provincal Hospital of TCM,including 89 cases with renal biopsy data. Patients were treated by Chinese herb in tonifying kidney and clearing away damp-heat method. Tripterygium wilfordii glycosides were added when 24 hours’total urine protein is more than 1.0g or not be effective after 3 months’treat with Chinese herb alone. Urine protein, blood pressure, renal function, blood fat and blood uric acid were observed before or after therapy. Estimate the curative effect of proteinuria in different urine protein classification and diverse renal pathology types. By using the Cox proportional hazard model, analyse the prognostic influence of tonifying kidney and clearing away damp-heat method in glomerulonephritis proteinuria.Result:① Total effective rate:the total effective rate of treatment after 3,6 and 9 months is 81.8%,86.9% and 90.9%; ② Effect on urine protein:the urine protein began to decrease after 3 months’therapy and reach the minimum at 9 months. There is significant difference in PRO and UTP among different treatment course (P< 0.05);③ Effect on different urine protein classification:the patients with a lower initial UTP level has a noticeable trend in decrease of urine protein after treatment (P<0.05);④ Effect on different renal pathology types:patients with IgAN, FSGS and MN have a decrease trend in UTP after treatment. The UTP decrease after 9 months’therapy in patients with IgAN and FSGS have statistic significance (P<0.05).There is no significant difference between pretherapy and post-treatment (P>0.05);⑤ Change of renal function and other indicators:There is no significant difference between pretherapy and post-treatment in Bun, Scr, eGFR, MAP, Hb, Alb, TC, TG, LDL-C and UA (P>0.05);⑥ Prognostic influence:independent risk factors for prognostic influence in IgAN include high blood pressure (HR:1.7, P=0.013), the initial UTP>2.5g/d (HR:3.6, P=0.000), decrease rate of UTP after 3 months’therapy<30%(HR:1.9, P=0.000), eGFR<60ml/min/1.73m2 (HR: 4.3, P=0.018), hyperuricemia (HR:3.2, P=0.023); independent risk factors for prognostic influence in MN include high blood pressure (HR:3.5, P=0.003), the initial UTP>2.5g/d (HR: 6.8, P=0.000), decrease rate of UTP after 3 months’therapy<30%(HR:2.7, P=0.000)Conclusion:① Tonifying kidney and clearing away damp-heat method do good to decrease urine protein. The total effective rate reach 90.9% after 9 months’ therapy, among which patients’ renal function remain stable. ② This method decrease urine protein better in those have a lower initial urine protein level. ③ Using this method could alleviate glomerulonephritis proteinuria, especially in IgAN and FSGS. ④ Independent risk factors for prognostic influence in chronic nephrities include a high initial urine protein level and a low rate of descend of UTP after 3 months’ therapy. Tonifying kidney and clearing away damp-heat method is effective to decrease the urine protein, and thus, delay the progression of chronic nephritis.