Systemic lupus erythematosus (SLE) is a common disease. Statistics show that the incidence of this disease is 50/10 million, accounting for about 0.7 of the population in our country. The incidence of this disease is higher in women than in men, and mainly in young women. SLE if there is kidney damage, that is lupus nephritis (LN). The incidence of lupus nephritis has been reported differently, and we believe that approximately 70% of the diagnosed SLE have significant renal impairment. If renal biopsy is performed in SLE patients, the renal damage is up to 90%, and almost all of the patients have glomerular damage if they are examined by immunofluorescence and electron microscopy.
Some patients were dominated by extra renal manifestations, but only have mild renal impairment, the patients with renal failure were less; some patients with renal damage as the main manifestation, such as nephrotic syndrome, renal performance is not obvious, easily misdiagnosed as primary glomerular disease.
Lupus nephritis is the most common visceral damage in systemic lupus erythematosus, and the severity of kidney disease directly affects the prognosis of SLE.
There is no known case of lupus nephritis in Chinese medicine. According to the clinical manifestations of this disease, edema, lumbago, Angelica in sun sores, Yin Yang poison, Wen asthenia, dizziness palpitation etc. Chinese medicine believes that this disease is due to congenital deficiency of kidney essence deficiency or impassioned internal injuries, the imbalance of yin and yang deficiency of kidney essence; or, complex sense of toxin, or take the goods caused by toxic heat, blood block, running sluggish, long protracted meridians caused by toxin.
Clinical manifestations of lupus nephritis
More than 90% of SLE were seen in women, mainly in young and middle-aged women. Kidney involvement rates are generally high in men under 30 years of age. Clinical renal involvement is seen in 2/3 lupus patients. Most kidney damage occurs after rash, arthritis, and other systemic involvement, but about 1/4 of patients with renal symptoms as the first manifestation. The clinical manifestations of renal and extrarenal organ involvement is not parallel, some patients with renal manifestations and renal involvement; some patients have obvious nephrotic syndrome or renal damage, but no obvious systemic involvement.
Systemic manifestations of lupus nephritis
The systemic manifestations of lupus nephritis are most common in unexplained fever, arthritis, and mucocutaneous lesions. With the involvement of the system of liver, heart, central nervous system and hematopoietic organs, more than 1/3 patients with multiple serosa (pleural and pericardial membrane) and so on.
(One) general symptoms: most patients show general weakness, weight loss, 90% of patients have fever, and some can exceed 39 degrees.
(Two) skin and mucous membrane lesions: most patients have skin lesions at the skin exposure, and about half of the patients have facial erythema or alopecia. Some patients with urticaria, discoid erythema, palms, fingers, nails, Zhou Hongban, purpura and so on. Some patients have mouth ulcers. Among them, hair loss is the main index of SLE activity.
(Three) joints and muscles: 90% of patients suffer from joint pain and are common in small joints of the limbs. About 30% of the patients had myalgia. Long term irregular use of steroids can cause aseptic osteonecrosis of the femoral head in some patients.
(Four) cardiovascular: pericarditis may occur in some patients, usually transient and mild, and a small number of patients may have myocarditis. About 1/4 of patients can have Raynaud's phenomenon.
(Five) the lung and pleura: some patients may have pleurisy or lupus pneumonia. But the clinical common infection of SLE complicated with pneumonia, not lupus pneumonia, should be paid attention to
(Six) blood system: red blood cell: 50% to 75% patients with positive pigment anemia; the white blood cell: 60% patients of white blood cell number <4.5 * 109/L, especially the lymph decreased obviously; blood platelet: generally decreased slightly, few can seriously reduce. About 50% of the patients had lymph node enlargement.
(Seven) gastrointestinal tract: there may be abdominal pain, which may be related to vasculitis caused by abdominal visceral lesions. The liver, splenomegaly was seen in 30%, 20% of the patients. A small number of patients may have ascites.
(Eight) nervous system: the clinical manifestations are complex and varied. Often show mental abnormalities, such as depression, confusion, etc., and pay attention to the hormone induced mental abnormalities identified. The most notable is epilepsy (15% ~ 50%), occasionally migraine, peripheral neuritis and so on.