Thursday, September 5, 2013

How Would You Like Your Berger?

                Berger’s disease, more commonly known as IgA Nephropathy, is an autoimmune disease that injures the kidneys when IgA antibodies accumulate in the kidney tissues. IgA is the immunoglobulin that normally attaches itself to an infection in the body, inducing an immune response. With IgA Nephropathy, there is a defective form of IgA which attaches to another IgA molecule instead of an infection, forming an immune complex in the kidneys. Not knowing the difference, the body works to fight, just as it would an infection (6). This leads to inflammation and damages walls of the glomeruli (filtering units in the kidneys), inhibiting their ability to filter toxic waste through the blood and out of the body. This damage also allows for substances to spill out into the bladder. As can be expected, this is problematic, and over time leads to chronic kidney failure, requiring dialysis or a kidney transplant to sustain life (1).
                IgA Nephropathy is believed to have a genetic component to it and may remain asymptomatic for many years, only showing signs once one is entering end stage renal failure. Key symptoms that develop are hematuria, proteinuria, peripheral edema, high blood pressure, polyuria (especially at night) and pain in the lower back or below the ribs. Being that these symptoms will only become prominent in the later stages of the disease, the only way to definitively diagnose IgA Nephropathy early on is by examining a biopsy of the tissue in the kidneys to check for IgA deposits (1).
                Some ways that western medicine prevents progressive kidney damage are by limiting protein consumption, lowering high blood pressure and incorporating a fish oil supplement to slow loss of kidney function. As stated above, once a patient develops kidney failure their options are limited to dialysis or a kidney transplant. In half of transplant cases IgA deposits will reappear in the new kidney, however, it is uncommon to lose the transplanted kidney seeing as the symptoms are significantly milder and are suspected to be due to antirejection drugs.
                IgA Nephropathy is just starting to become a common disease and for that reason there is not a terrible amount of information on it. Based on my research of the symptoms and my knowledge of TCM I have come up with my own hypothesis on how to treat it. Autoimmune disorders are considered Xu conditions due to their chronic nature (2). In the case of IgA nephropathy, possibly a deep rooted Yin Xu is to blame where there is an inability to support the functions of repairing and maintaining the walls of the glomeruli; more specifically, KD Yin (the location of the deposits) and Essence Xu (the genetic nature of the disease). At this stage, I would focus on tonifying KD Yin with acupuncture points such as KD3, KD6, BL 20, BL23, SP6 and Ren4. I would consider Zou Gui Wan or Liu Wei Di Huang Wan as herbal prescriptions.
                At the later stage, I would diagnose blood stasis (IgA buildup) generating heat (inflammation). Here, I would consider points to clear heat, move blood stasis and reduce inflammation in the kidneys such as LI11, SP10, KD2, BL17, LI4, LV3 as well as open the Chong to move blood and the Ren to regulate Qi and blood. I would also change the formula to Tao Hong Si Wu Tang to move blood stagnation as well as tonify. The end stage I would diagnose as KD Yin & Yang Xu, Yang Xu prominent (peripheral edema, polyuria, proteinuria, hematuria, lower back pain). Here, I would add the points DU4, KD7, BL13, BL22, SP9 and ST28. I would prescribe You Gui Wan at this point because it warms and tonifies KD Yang, as well as incorporates herbs that tonify KD Yin.
                There is one alternative therapy out that helps with the symptoms and progression of IgA Nephropathy. Micro-Chinese Medicine Osmotherapy is a topical combination of herbs that is applied to penetrate to the kidneys to repair them. These effects take a while to appear, however, the results are longer lasting (3). The ingredients of this formula are not stated.
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