The Clinical Investigation Of Risk Factors And Traditional Chinese Medicine Syndrome Elements In Acute Kidney Injury Patients On Chronic Kidney Disease

Object:To analyze the influencing factors and TCM syndromes of acute kidney injury on the basis of chronic kidney disease(A/C),to explore the pathogenesis and syndromes of A/C in traditional Chinese medicine,and to provide guidance for the prevention and treatment of the disease.Methods:The data of A/C patients admitted in our hospital from Dec 2013 to Nov 2016 were collected.The clinical data were collected including the symptoms and signs,laboratory tests,renal function,treatment and prognosis.Using traditional Chinese medicine syndrome differentiation method,we summarize A/C in traditional Chinese medicine syndromes,and explore the characteristics and pathogenesis of A/C in Chinese medicine,providing evidence for the prevention and treatment of A/C in Chinese medicine.Results:(1)General information:In this study,a total of 66 cases were collected,including 34 males(51.52%),32 females(48.48%),with a male/female ratio at 1.063:1.The youngest patient in this study was 18 years old,and the oldest patient was 84 years old.Among them,there were 22 cases(33.33%)of patients under 40 years old,13 cases(19.70%)between 40 to 60 years old,and 31 cases(46.97%)over 60 years old.Infection is the most common cause leading to AKI in CKD patients with a total of 23 cases(34.85%).Fifteen cases(22.73%)were caused by progression of primary disease,10 cases(15.15%)caused by low blood volume,6(9.09%)cases by malignant hypertension,4 cases(6.06%)by taking nephrotoxic drugs,water and electrolyte disorders respectively and 2 cases(3.03%)by urinary tract obstruction and tumor respectively.Primary disease:Primary disease is listed as follows:primary chronic glomerulonephritis in 26 cases(39.39%),primary nephrotic syndrome in 22 cases(33.33%),ANCA-associated vasculitis in 8 cases(12.12%),diabetic nephropathy,lupus nephropathy in 4 cases(6.06%)respectively and hypertension Renal injury in 2 cases(3.03%).A total of 36 patients(54.54%)were treated with emergency dialysis.A total of 26 cases(39.39%)fully recovered,22 cases(33.33%)were partially recovered and 18 cases(27,27%)di not recover.(2)prognosis of patients with A/C:Basic renal function in A/C patients was significantly associated with prognosis.(p<0.05)A/C patients caused by malignant Hypertension,lupus nephritis and ANCA-associated small vasculitis had poor recovery.A/C patients caused by nephrotic syndrome had good recovery.Patients' basic test results(concerning CKD clinical stage,blood urea nitrogen,serum creatinine,glomerular filtration rate)and basic renal function in patients with A/C was significantly associated with the prognosis after treatment;A/C patients' basic hemoglobin,blood Albumin,carbon dioxide binding rate were also associated with the prognosis.(P<0.05)Patients with Stage 3-4 CKD could be free of dialysis after treatment.(3)A/C patients with TCM syndrome characteristics:In this study,A/C patients with origin-deficiency syndromes of spleen and kidney qi deficiency syndrome accounted for 34 cases(51.51%),followed by Deficiency of Qi and Yin,liver and kidney yin deficiency in 10 cases,spleen and kidney yang deficiency in 6 cases and deficiency of both yin and yang in 4 cases.damp pathogen syndrome is the most common in evil-excess syndromes,accounting for 24 cases,followed by 16 cases of damp-heat syndrome,15 cases of syndrome of blood stasis,8 cases of heat-toxin and 3 cases of endogenous wind syndrome.The distribution difference of evil-excess syndromes in origin-deficiency syndromes:spleen and kidney Qi deficiency consist of damp pathogen syndrome in 14 cases,10 cases of blood stasis syndrome,damp-heat syndrome in 8 cases,and 2 cases of heat-toxin syndrome.TCM syndrome deficiency for the qi and yin deficiency,the evil-excess syndromes for the damp pathogen syndrome,damp-heat syndrome in traditional Chinese medicine were statistically significantly associated with prognosis of A/C patients(P<0.05).Conclusion:(1)Infection is the most common cause of A/C.(2)Lupus nephritis and ANCA-associated vasculitis predisposed A/C patients to a rather poor prognosis.Basic renal function,hemoglobin,serum albumin and carbon dioxide combining rate were all significant associated with prognosis in A/C patients.(3)A/C patients caused by nephrotic syndrome had good recovery.Patients with Stage 3-4 CKD could be free of dialysis after treatment.(4)The pathogenesis of A/C is characterized by ben deficiency and biao sthenia.The root-deficiency syndromes of spleen and kidney qi deficiency syndrome.Qi and Yin Deficiency,liver and kidney yin deficiency are more common.Wet turbidity,damp-heat syndrome and blood stasis are the common factor in evil-excess syndromes.A/C patients with damp-heat syndrome and heat-toxin syndrome had poor prognosis.