Common TCM Patterns in IgA Nephropathy During High-Dose Corticosteroids or Immunosuppressants

IgA nephropathy (immunoglobulin A nephropathy, IgAN) is a group of glomerulonephritides characterized by IgA deposits in the glomerular mesangium. It was first described in 1968 by French pathologists Berger and Hinglais, and is therefore also known as Berger’s disease. In traditional Chinese medicine (TCM), there is no specific disease name for IgA nephropathy. Based on its clinical symptoms and duration, it is generally classified under TCM categories such as “hematuria,” “kidney wind,” “low back pain,” “edema,” and “consumptive disease.”

TCM Pattern Differentiation and Medication Reference

|Common Symptoms

Clinical description:

Hot flashes and night sweats, irritability and insomnia, flushed cheeks and tinnitus, sore throat, dry mouth and lips, constipation, scant dark urine, a red tongue with little coating, and a thin, rapid pulse.

In plain language:

  • You may experience waves of heat and sweat after falling asleep, sometimes waking up feeling uncomfortable because your clothes or bedding are damp.
  • You may feel restless and have difficulty falling asleep, with frequent or unsettled sleep.
  • Your cheeks may become flushed and feel hot, often appearing red.
  • You may hear ringing or buzzing in your ears, even in a quiet setting.
  • Your throat may feel sore or uncomfortable, especially when swallowing or speaking.
  • Your mouth and lips may feel dry, causing discomfort when speaking or swallowing.
  • Your stools may be hard and difficult to pass, and bowel movements may feel strenuous or incomplete.
  • You may pass a small amount of urine that looks yellow or reddish and darker than usual.
  • Your tongue may appear red with very little coating, so that little or no thick coating is visible.
  • Your pulse may feel thin and fast when assessed.

|Treatment Approach

Clinical description:

Nourish yin and reduce fire.

In plain language:

  • This approach aims to nourish yin and clear deficiency heat, with the aim of easing discomfort such as dry mouth and throat, hot flashes, night sweats, irritability, or insomnia.
  • This approach aims to support yin-yang balance and ease manifestations attributed to deficiency fire, such as facial flushing, palpitations, or heat in the palms, soles, and chest.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and leaflet, and use under the guidance of a physician or pharmacist.

Zhibai Dihuang Wan
Zuogui Wan

|Common Symptoms

Clinical description:

Thirst and desire to drink, dry and sore throat, mouth ulcers, acne, constipation, scant dark urine, hematuria, a red or deep-red tongue with prickles, a thick, yellow, greasy coating, and a rapid pulse.

In plain language:

  • You may often feel thirsty and want to drink, with relief from the dryness lasting only temporarily.
  • Your throat may feel dry and sore, with noticeable discomfort when speaking or swallowing.
  • Mouth ulcers may recur and feel tender when eating or speaking.
  • Acne or pimples may develop on your skin, sometimes with localized redness and swelling.
  • Your stools may be hard and difficult to pass, with straining and less frequent bowel movements.
  • You may pass a small amount of urine that looks yellow or reddish and darker than usual.
  • There may be blood in your urine, which can appear red or blood-tinged.
  • Your tongue may look red or deep red and glossy, with prick-like spots visible on its surface.
  • Your tongue may have a thick, greasy-looking yellow coating.
  • Your pulse may feel fast when assessed.

|Treatment Approach

Clinical description:

Clear heat and resolve toxins.

In plain language:

  • This approach aims to clear internal heat, with the aim of easing manifestations such as feeling feverish or irritable, thirst, dry throat, or facial flushing.
  • This approach aims to dispel what TCM describes as pathogenic factors, with the aim of easing manifestations such as a sore, swollen throat, red and swollen sores, or skin rashes.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and leaflet, and use under the guidance of a physician or pharmacist.

References

  1. Donadio JV，Grande JP. IgA nephropathy[J]. New Engl J Med，2002，347(10)：738-748.
  2. Levy M，Berger J. Worldwide perspective of IgA nephropathy[J]. Am J Kidney Dis，1988，12(5)：340-347.
  3. Chen Huiping，Zeng Caihong，Hu Weixin，et al. Analysis of renal biopsy pathology data from 10,594 cases[J]. Chinese Journal of Nephrology, Dialysis & Transplantation，2000，9(6)：501-509.
  4. Yu XQ，Wei JL. Kidney disease in China: recent progress and prospects[J]. Chin Med J(Engl)，2009，122(17)：2048-2053.
  5. Barry M. Brenner MD. Brenner or Rector’s the kidney[M]. Saunders WB，2004.
  6. Wang Gang，Zou Yanqin，Zhou Enchao. Zou Yunxiang’s Practical TCM Nephrology[M]. Beijing: China Press of Traditional Chinese Medicine，2013.
  7. Chen Xiangmei，Chen Yiping，Li Ping，et al. A multicenter epidemiological survey of TCM syndromes in 1,016 patients with IgA nephropathy and analysis of related factors[J]. Chinese Journal of Integrated Traditional and Western Medicine，2006，26(3)：197-200.
  8. Nie Lifang，Yu Renhuan，Yu Dajun. An analysis of research on TCM syndromes in IgA nephropathy in China over the past 15 years[J]. Shanghai Journal of Traditional Chinese Medicine，2004，38(3)：59-62.
  9. Chen Yipu. Nephrology[M]. 2nd ed. Beijing: People’s Medical Publishing House，2015.
  10. Novak J，Julian BA，Mestecky J，et al. Glycosylation of IgA1 and pathogenesis of IgA nephropathy[J]. Semin Immunopathol，2012，34：365-382.
  11. Zhu Li，Zhang Hong. Pathogenesis of IgA nephropathy: advances in molecular genetic research[J]. Chinese Journal of Kidney Disease Investigation (Electronic Edition)，2014，3(2)：68-72.
  12. Zou Wanzhong. Renal Biopsy Pathology[M]. 2nd ed. Beijing: Peking University Medical Press，2009.
  13. Chen Xiangmei. Nephrology[M]. Beijing: People’s Medical Publishing House，2014.
  14. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO clinical practice guideline for glomerulonephritis[J]. Kidney Int Suppl，2012，2：139-274.
  15. Nephrology Committee of the China Association of Integrative Medicine. Practice guidelines for the Western medical diagnosis and TCM pattern differentiation of IgA nephropathy[J]. Chinese Journal of Integrated Traditional and Western Nephrology，2013，33(5)：583-585.
  16. Zhan Yongli，Yu Renhuan，Wei Cuinan，et al. TCM pattern differentiation and treatment of common accompanying patterns in chronic kidney disease[J]. Chinese Journal of Kidney Disease Investigation (Electronic Edition)，2013，2(5)：17-21.
  17. LemLey KV，Lafayette RA，Derby G，et al. Prediction of early progression in recently diagnosed IgA Nephropathy[J]. Nephrol Dial，2008，23(1)：213-222.
  18. Le Weibo，Liang Shaoshan，Liu Zhihong，et al. Long-term outcomes and risk factor analysis in 1,126 Chinese Han adults with IgA nephropathy[J]. Chinese Journal of Nephrology, Dialysis & Transplantation，2011，20(2)：101-108.
  19. Peicheng Shen. Natural History and Prognostic Factors of IgA Nephropathy Presented with Isolated Microscopic Hematuria in Chinese Patients[J]. Nephron Clin Pract，2007，106：c157-c161.
  20. Moriyama T，Tanaka K，Iwasaki C，et al. Prognosis in IgA nephropathy: 30-year analysis of 1012 patients at a single center in Japan[J]. Plos one，2014，9(3)：e91756.
  21. Shi Y，Chen W，Jalal D，et al. Clinical outcome of hyperuricemia in IgA nephropathy: Aretrospective cohort study and randomized controlled rial[J]. Kidney Blood Press Res，2012，35(3)：153-160.
  22. Tian Shoufu，Fei Mei，Chen Aiping，et al. The role of serum complement C₃ in IgA nephropathy[J]. Chinese Journal of Gerontology，2014，24：6925-6927.
  23. He Ting，Mao Haiping，Li Zhibin，et al. Clinical and pathological changes in IgA nephropathy aggravated by anemia[J]. Chinese Journal of Nephrology，2012，28(6)：460-463.
  24. Shimamoto M，Ohsawa I，Suzuki H，et al. Impact of Body Mass Index on Progression of IgA Nephropathy Among Japanese Patients[J]. J Clin Lab Anal，2015，29(5)：353-60.
  25. Lee H，Hwang JH，Paik JH，et al. Long-term prognosis of clinically early IgA nephropathy is not always favorable[J]. BMC Nephrol，2014，15：94.
  26. Cattran DC，Coppo R，Cook HT，et al. The Oxford classification of IgA nephropathy: rationale, clinicopathological, correlations and classification[J]. Kidney Int，2009，76(5)：534-545.