| Acute kidney injury is a common clinical syndrome; it’s emergency and critical and relates to adverse prognosis. The treatment for AKI emphasises on the removal of the causes and controling the risk factors. It still in reseach that treating AKI with Traditional Chinese medicine. We observate the characteristics and syndrome of70cases of acute kidney injury, and observe the effect of the method of "harmonizing Shaoyang, dredging and promoting the Sanjiao" in treating AKI.Research1. The syndrome analysis of acute kidney injuryObjective:To observe the risk factors and syndromes which are closely related to the experience of AKI and the adverse prognosis of AKI.Methods:Patients, all accord with the AKIN definition and classification for AKI, are from Guang’anmen Hospital, China Academy of Chinese Medical Science from November2011to January2013. We collect the general data, clinical features, auxiliary examination, TCM symptoms, therapies, and clinical and renal outcomes after90days.Results:1. Basic materials65patients and70cases were collected in this research, male28cases (60.0%) and female42cases (40.0%). The average age is61.66±19.81. The number of AKI in the elders (older than65years) is36cases, which accounts for51.4%of all cases. Patients in department of nephrology accounted for39cases (55.7%). AKI occurred in department of internal medicine is63cases (90.0%), and7cases (10.0%) in department of surgical.2. Underlying diseases51cases (72.9%) suffering from cardiovascular disease, accounts for the largest share. Followed by41cases (58.6%) of chronic kidney disease (CKD) patients.3. Acquirement of AKIThere are35cases (50%) of hospital-acquired AKI, equal to the number of community-acquired AKI.4. Classification of AKIThe number of AKI on first stage is24(34.4%), second stage is12(17.1%), and third stage is34(48.6%).5. Causes of AKI49cases (70.0%) of AKI are induced by two causes or more. The number of prerenal AKI is38(54.3%), postrenal AKI is7(10.0%), the intrinsic AKI is25(35.7%), and AKI associated with nonspecific diagnosis is47(67.1%).6. Complications of AKIAfter the experience of AKI, the most common complications are infection (27cases,38.6%), cardiovascular disease (22cases,31.4%), and endocrine and metabolic disease (18cases,25.7%) during the period of in hospital.7. TCM syndromeThe nature of AKI is mainly deficiency origin and excess in superficiality. The deficiency syndromes are mainly Yin deficiency syndrome (69cases,98.57%) and Qi deficiency syndrome (67cases,95.71%). The excess syndromes are mainly damp-heat syndrome and turbidity-toxin syndrome, which can be found in all cases. The disease location is mainly in kidney (70cases,100%) and spleen (67cases,98.71%).8. Clinical and renal outcomesWithin90days follow-up,38cases (54.3%) survive,19cases (27.1%) died, and13cases (18.6%) lost to follow-up.Within90days follow-up,26cases (37.1%) completely recovered renal function,5cases (7.1%) partly recovered renal function,23cases (32.9%) need maintenance dialysis or died, and16cases (22.9%) lost to follow-up.9. Correlation analysis of TCM syndrome and the experience and prognosis of AKIThere is a positive correlation between the classification of AKI and damp-heat syndrome, turbidity-toxin syndrome and the scores of excess syndromes (P<0.05). Yang deficiency syndrome (OR=2.895) and symptom of heart system (OR=4.919) are independent risk factors for the recurrence of AKI.Qi deficiency syndrome (OR=2.850) and symptom of heart system (OR=3.085) are independent risk factors for mortality. There is a positive correlation between maintenance dialysis and Qi deficiency syndrome (P=0.031).10. Risk factors for experience of AKIAKI often develops in elderly patients, as well as patients from internal department, especially department of nephrology. Adjusted the influence of the causes of AKI and other underlying diseases, the underlying disease of respiratory system is an independent risk factor for AKI in the elders (OR=4.344). The use of drug with nephrotoxicity (OR=13.315) and patients without nephrological intervention (OR=6.819) are independent risk factors for HA-AKI. Hemoglobin level (OR=0.943) is independent risk factor for the recurrence of AKI.11. Risk factors for adverse prognosis of AKIThe underlying disease of nervous system (RR=3.265), patients without nephrological intervention (RR=3.568). and MODS (RR=5.548) are independent risk factors for mortality of AKI patients within90days. There is a positive correlation between maintenance dialysis and improper fluid management (P=0.001) and diabetes mellitus (P=0.003).Conclusion:1. The deficiency of Qi and Yin in spleen and kidney, disturbance of dampness, heat and toxicity is one of the key points of TCM pathogenesis of AKI.2. Patients tend to recur AKI are usually with Yang deficiency syndrome, and the disease location is mainly in heart system. Patients with obvious Qi deficiency syndrome or symptoms involved in heart system have a high mortality. Patients need maintenance dialysis have obvious Qi deficiency syndrome.Research2. The observation of "harmonizing Shaoyang, dredging and promoting the Sanjiao" in treating AKIObjective:To explore the clinical curative effect of "harmonizing Shaoyang, dredging and promoting the Sanjiao" in treating acute kidney injury.Methods:By method of small sample randomized controlled clinical trials, we included in25inpatients with AKI from Department of nephrology, who can be diagnosed as AKI and TCM syndrome diagnosis were dampness, heat and toxicity diffuses the Sanjiao. Divide these patients into treatment group (12cases) and control group (13cases) randomly. Control group was given modern medical treatment, and treatment group was given decoction by the method of "harmonizing Shaoyang, dredging and promoting the Sanjiao In addition" in addition. The treatment course was28days. The evaluation of renal function is by the reduction of SCr and the need of maintain dialysis. To compare the renal function, we observate clinical outcomes and the change of TCM symptoms within90days. Application the SPSS version18.0establish database and analyzed, when p<0.05difference was considered to have statistical meaning.Results:1. As for the clinical outcomes and the recovery of renal function, there is no statistical difference between treatment group and control group (P=0.740).2. The levels of SCr of both groups reduced obviously after treatment, but there is no statistical difference between treatment group and control group (P=0.624).7. Symptoms of both groups were improved after treatment, and treatment group has a better the curative effect in improving damp-heat syndrome. Comparative differences between groups is statistically significant (P=0.049). Conclusion:The method of "harmonizing Shaoyang, dredging and promoting the Sanjiao" is effective in improving damp-heat syndrome of AKI patients. But it’s necessary to prolong treatment course appropriately in order to delay the progress kidney disease and to reduce chronic pathological change. |
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