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TCM dialectical analysis of IgA nephropathy pathology


IgA nephropathy belongs to the traditional Chinese medicine "hematuria", "urine" category. Chinese medicine that: hot and humid blood is the disease changes, the development of the main pathological factors.

Qi deficiency-based, is the root cause of IgA nephropathy, the starting factor, but the resulting pathogenesis of hot and humid not only in the pathogenesis of the disease, but also the formation of changes in condition, deterioration of the main pathological factors. Can be described as virtual disease, due to evil.

We can see, or Feng Xie by the heat poisoning throat; or wind heat stagnation of the lungs; or damp heat accumulation in the coke intestines, conversion loss of the Secretary; or excessive meat and wine, damp heat obstruction , But always damp heat poison evil junction. Clinically common to repeated tonsil, upper respiratory tract infection, gastrointestinal infections or alcohol injury liver, hepatitis B virus infection, triggering or aggravating IgA nephropathy, in line with the mechanism of Chinese medicine hot and humid. Evil of the attack, due to Qi. Evil sporadic, or for the wind heat or heat poison, or the hot and humid. But the gas is evil, often attributed to the hot and humid, or because of water wet, you can speed out; or for the liver yang, but also easy to drop; only wet and heat each other, lingering difficult.

In the modern medicine on IgA nephropathy pathogenesis awareness, due to mucosal immune function abnormalities, resulting in abnormal blood IgA increased, these increased IgA and normal serum IgA is different from the mucous membrane of the plasma cells or secretory tissue lymphocytes Generated by the blood flow to reach the glomerular, and activation of complement, common deposition in the mesangial area. It was also found that IgA-IC did not directly stimulate the proliferation of mesangial cells, but mediated by interleukin. So we realize that the abnormal increase in blood IgA, because different from the normal serum, it can be seen as the blood of the hot and humid evil. Not only that, although the original mucosal infection caused by mucosal secretion of IgA hyperthyroidism has been eliminated, but IgA nephropathy has not only alleviated, but also showed a gradual deterioration of the tendency. This is because, as a result of the cytokine effect of serum interleukin-1 (IL-1), exogenous antigen-activated B cells produce increased lgA antibodies while also stimulating the monocyte-macrophage system to produce IL-1 , And IL-1 can act on B cells to increase the antibody. In addition, protein antigens or microbial antigens such as LPS can be activated by mucosal immune Mφ secretion of IL-1, so that in the body will form a closed cycle, IL-1 in this cycle plays an important role in mediating. This process is consistent with the characteristics of wet and dry evil.

However, the real cause of clinical manifestations, but it is caused by the evil of the evil pathology, that is, by the formation of inflammatory reaction of local renal proliferation, sclerosis and other pathological damage caused. Normal structure of the different degree of damage, the formation of the clinical manifestations are different, indicating that the severity of the dampness and heat of the evil is to determine the severity of the disease. Mesangial IgA nephropathy in addition to the inevitable changes in mesangial lesions, including increased number of mesangial cells, especially the matrix increased, often associated with varying degrees of vascular and tubulointerstitial lesions, such as crescent formation, hardening Sexual damage, interstitial inflammatory cell infiltration, tubal degeneration, atrophy, small vessel disease can occur. Here we see the damp heat caused by stasis, wet stagnation due to the impact of the disease. Clinical findings, accompanied by IgM or IgG or even complement C1q, C4 deposition of IgA nephropathy, pathological glomerulosclerosis, interstitial disease severity, more clinical manifestations of severe nephrotic syndrome, combined with hypertension, hematuria, renal function deterioration Progress is fast, is proof.

Therefore, IgA nephropathy in the kidney qi, temper, liver qi and lung qi loss, the formation of a hot and humid blood stagnation due to pathological factors, in the course of disease development, virtual is more virtual, hot and humid stasis difficult to Constantly increasing the condition, and ultimately cause the spleen and kidney decay, damp poison intrinsic kidney fatigue. In view of the above pathological mechanisms, qi and kidney, blood circulation when the treatment of IgA nephropathy Dafa.

The exact pathogenesis of IgA nephropathy is unclear, and many factors are associated with morbidity. As the glomerular mesangial and capillary ball with granular IgA and C3 deposition, and the skin is also deposited, and some cases can be detected circulating immune complex, suggesting that IgA nephropathy by the immune complex, poly-IgA and other macromolecules Drug-mediated glomerular disease, there are possible in situ autologous pathogenicity. The mechanism of immune disorder in patients can be weakened mucosal immune barrier, or for the immune complex of the body to reduce the ability to clear, IgA can also be caused by regulatory disorders. Macromolecular IgA-IC formation, activation of complement and coagulation and fibrinolysis disorders and a series of inflammatory mediators, including cytokines and other causes of glomerular damage. Some non-immune factors such as hemodynamic effects, in the development and progression of IgA nephropathy also play a role. Many of the facts also show that genetic factors in the incidence of IgA nephropathy also accounted for an important position.

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