Physical Examination Shows High Blood Lipids, Beware Of Chronic Kidney Disease

A 15-year-old girl developed painful cramps in the lower abdomen and bloody diarrhea after eating food purchased from a street vendor. The abdominal pain did not subside after taking nonsteroidal anti-inflammatory drugs.

The diarrhea subsided on its own three days later, but the patient continued to have cramping abdominal pain and vomiting. By the eighth day of illness, the patient developed oliguria and was admitted to the pediatric department of a local hospital after unsuccessful treatment at a local clinic.

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Laboratory tests revealed symptoms of acute kidney injury (AKI), anemia, and thrombocytopenia. Next, the doctor tried to delve deeper into these key clinical features.

What are the causes of AKI?

There are three types of causes of AKI: prerenal, renal, and postrenal/obstructive.

Prerenal causes: Patients with prerenal AKI typically have a blood urea nitrogen to creatinine ratio of more than 20, but this patient had a blood urea nitrogen to creatinine ratio of 12.5.

In addition, patients with prerenal AKI typically have normal urine sediment results, but this patient had abnormal urine sediment results. Finally, patients with prerenal AKI should have an improved response to volume expansion, thereby restoring renal perfusion; however, this patient had a minimal response to volume expansion.

All of these factors suggest that the primary cause of this patient's AKI is not prerenal.

Postrenal/obstructive causes: These can be ruled out first, as there was no hydroureter, hydronephrosis, or bladder distension on ultrasound.

Renal causes:

Postinfectious glomerulonephritis: Despite the symptoms of infection in this patient, such as diarrhea, abdominal pain, and vomiting, pathogens that cause gastrointestinal infections do not usually cause postinfectious glomerulonephritis.

Immune nephropathy: No red cell casts or malformed red cells were found in the urine sediment.

Acute interstitial nephritis: Most often caused by drugs or infections, but the patient was afebrile and had only taken nonsteroidal anti-inflammatory drugs in the first 3 days of illness.

Acute tubular necrosis: No red cell casts were found in the urine sediment.

Vascular disease: Such diseases as hemolytic uremic syndrome (HUS) are caused by damage to the renal microvascular system and may be associated with anemia and thrombocytopenia in addition to obvious AKI. This patient has the above characteristics, so vascular disease is the main consideration in this case.

Taking into account the results of oliguric AKI, urinalysis and ultrasound examination, the doctor believes that vascular disease in renal etiology is the main consideration.

What is the cause of anemia?

After the administration of 2L of normal saline, the patient's hematocrit decreased to 30.9%. The mean corpuscular volume was 73.0fl, consistent with microcytic anemia.

In addition, the elevated lactate dehydrogenase level and low haptoglobin level indicate the presence of a hemolytic process.

What is the cause of thrombocytopenia?

The presence of large platelets in the patient's blood smear indicates the possibility of abnormal platelet destruction, the causes of which include drug-induced, platelet sequestration (especially splenomegaly), immune-mediated, and abnormal consumption.

The patient was not exposed to medications that could put him at risk for thrombocytopenia, and he was not found to have an enlarged spleen.

In addition, the patient had no signs or symptoms of thrombocytopenia. In addition, the patient's platelet count (53,000/mm) was higher than is typically seen in patients with immune-mediated diseases.

Consumption disorders (such as disseminated intravascular coagulation, HUS, or thrombotic thrombocytopenic purpura) are likely the primary cause.

In these disorders, the vascular endothelium is damaged, and fibrin- and platelet-rich thrombi form in the microcirculation, consuming platelets in the peripheral blood.

The protein level suggests a hemolytic process.

What causes bloody diarrhea?

The causes of bloody diarrhea can be divided into three major categories: autoimmune, anatomic, and infectious.

The spontaneous resolution of the patient's bloody diarrhea after a few days suggests that the patient is likely infected. Although the patient's stool culture was negative, the sensitivity of laboratory tests for enteric pathogens varies depending on when the specimen was collected and the type of laboratory evaluation performed.

Therefore, a negative culture result does not rule out bacterial infection.

Could the diagnosis be HUS?

The patient's symptoms included AKI, hemolytic anemia, consumptive thrombocytopenia, and infectious bloody diarrhea. Disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, systemic vasculitis, and HUS were possible diagnoses, and the doctor intended to further narrow the scope based on the patient's other clinical manifestations.

Disseminated intravascular coagulation usually occurs in patients with serious underlying diseases (such as sepsis, severe injury, or cancer), and is often accompanied by signs of bleeding, but the patient did not have the above symptoms.

Because the patient did not have purpura and neurological symptoms. In addition, the patient's short onset time reduced the possibility of systemic vasculitis.

The doctor believed that the most consistent diagnosis with the patient's clinical manifestations was HUS, which is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and AKI.

Literature shows that most cases of HUS occur after infection. The doctor speculated that the food eaten by the patient at the roadside stall contained Shiga toxin-producing Escherichia coli, which subsequently caused HUS.

So can it be confirmed that it is HUS? Re-examining the patient's clues, we found the following doubts:

Suspicion 1: Most children with HUS are younger than 5 years old.

Suspicion 2: Bloody diarrhea associated with infection with Shiga toxin-producing Escherichia coli usually begins several days after the onset of watery diarrhea, but this patient had bloody diarrhea on the first day of illness.

Let's look at the pathological results:

The patient's peripheral blood smear showed 2+ schistocytes. The Shiga toxin 1 and 2 enzyme immunoassay results of the stool specimen were negative. Histopathological examination of the renal biopsy specimen showed evidence of thrombotic microangiopathy and cortical tubular necrosis.

Immunofluorescence assay and electron microscopy showed fibrin deposition in the mesangium and capillaries; no immune complex deposits were found. The patient's AH50 assay result was less than 10% (normal range ≥46%).

Although the presence of acute glomerular thrombotic microangiopathy is consistent with HUS, the differential diagnosis of histopathological findings also includes thrombotic thrombocytopenic purpura.

To exclude thrombotic thrombocytopenic purpura, ADAMTS13 activity was measured, and the result was 64% (normal range ≥70%). In patients with thrombotic thrombocytopenic purpura, ADAMTS13 activity is usually less than 10%.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

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Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.