反流性肾病的中西医诊治现状

Current diagnosis and treatment of reflux nephropathy with integrated traditional Chinese and western medicine

反流性肾病(RN)是指由于膀胱输尿管反流(VUR)和肾内反流(IRR)伴反复尿路感染,导致肾脏形成瘢痕、萎缩、肾功能异常的一类临床综合征。RN是造成ESRD的原因之一。RN最基本的病理特点是肾脏瘢痕形成。常见的临床表现有持续或反复发作的尿路感染、蛋白尿、高血压、夜尿、多尿、腰痛、尿路结石等。治疗上主要包括西医保守治疗、外科治疗及中医治疗。西医保守治疗主要采用抗感染和综合对症治疗措施,以预防和延缓肾实质损害和肾功能减退。外科手术治疗为传统抗反流手术和内镜下注射治疗。RN中医学属"淋证"、"尿频"、"腰痛"、"遗尿"及"癃闭"等疾病范畴。基本病机为本虚标实,虚实错杂,早期以标实为主,后期以本虚为甚,需辩证施治。

Reflux nephropathy （RN） is a kind of clinical syndrome characterized by kidney scarring, atrophy, and renal dysfunction due to vesicoureteral reflux （VUR） and intrarenal reflux （IRR） with recurrent urinary tract infections. RN is one of the important causes of end-stage renal diseases （ESRD）, and its basic pathological feature is renal scarring, with common clinical manifestations of continuous or recurrent urinary tract infections, proteinuria, hypertension, nocturia, polyuria, lower back pain, urinary calculi, and so on. The treatment consists of conservative therapy, surgical therapy, and traditional Chinese medicine （TCM） therapy. In western medicine conservative therapy, mainly anti- infection and comprehensive symptomatic treatment are performed in order to prevent or delay renal parenchyma damage and kidney dysfunction, while surgical treatment includes traditional anti-reflux surgery and endoscopic injection therapy. RN in TCM refers to disease categories of ＂ gonorrhea＂, ＂frequent urination＂, ＂osphyalgia＂, ＂nocturnal enuresis＂, and ＂uroschesis＂, with a basic pathogenesis comprised of deficiency in origin and excess in superficiality, mixture of deficiency and excess, and early domination of excess in superficiality while later domination of deficiency in origin, which demands treatment with syndrome differentiation.