Refractory Nephritic Syndrome

Male, 22 years old

Chief complaint: “Recurrent Oliguria, massive leukuresis, edema of face and bilateral lower limbs for 2 years”, diagnosed with "refractory nephrotic syndrome".

History: The patient used to be treated by massive hormone therapy, cyclophosphamide, CellCept and cyclosporine A in other hospitals, but the medicines barely worked. The symptoms can be relieved a little by Dextran-40 plus Furosemide 60-100mg everyday, the total urine volume of 24 hours is around 800ml. The patient and his family were desperate.

Admission Date: 2006-5-9

Physical examination: Severe edema of eyelids and bilateral lower limbs, the skin pits when pressed, massive ascites and frothy urine, dark tongue with teeth-mark around, yellowish greasy fur, deep and slow pulse.

Lab: Moderately severe anemia (RBC: 2.95×1012/L, HGB: 88g/L, HCT: 0.26), Hypercoagulable blood (PLT: 326×109/L; FIB: 7.231g/L, APTT: 42.7g/L, APTT-R: 1.334g/L), high blood lipids level (CHOL: 11.62mmol/L, TG: 2.11mmol/L, HDL: 2.03mmol/L, LDL: 6.99mmol/L), massive leukuresis (PRO：>3.0g/L), total urinary protein for 24 hours:4610mg, Hypoproteinemia (ALB: 9.8g/L, GLB: 18.9g/L), hematuria under microscopy and hyperuricacidemia were also observed.

Diagnostic Examination: B-type ultrasonography of kidney: enlarged bilateral kidney in full shape, diffuse lesions.

Admitting Diagnosis: Refractory nephrotic syndrome

TCM: Edema (yin edema - yang deficiency of both the spleen and kidney)

The treatment plan of integrative therapy of Western Medicine and TCM was established according to patient's physical symptoms and medical history. Through the course of treatment, TCM played an important role in prevention and treatment of hormonal therapy side effects. After one year's treatment, the patient recovered well. Side effect such as infection of renal and hepatic lesion of hormone and immune suppression did not appear during the treatment. During the follow-up visit of the following year after discharge, all the lab findings are within normal ranges, no sign of relapse.

Comment: Integrative therapy of Western Medicine and TCM is the key factor to treat refractory nephrotic syndrome. In this case, Chinese herbs played very important roles not only in preventing the side-effects of hormone and guaranteeing the hormonal therapy runs smoothly, but also in preventing rebound phenomenon after reducing the amount of hormone, shortening medication period, consolidating the effect of hormone therapy, repairing the injured organs' function, and restoring the balance of yin and yang, qi and blood.

TCM treatment of difficult nephritic syndromes has its advantages. In this case, we learn that invigorating the lung and the kidney is the basic method to affect a permanent cure. And good blood circulation should be adopted consistently. Meanwhile, we should pay attention to the application of expelling wind-damp, clearing lung and eliminating phlegm. By these methods, we can prevent inflammation and coagulation, remove immune complexes, lower the lipid and decrease glomerulosclerosis and extracellular matrix deposition so as to prevent kidney damage and hasten renal injury repairs.