Streptococcal infection is the primary precursor cause of acute nephritis, so preventing streptococcal infection is the most effective measure.
(I) General Measures
1. Exercise regularly to strengthen the body and enhance resistance.
2. Pay attention to skin hygiene, change clothes frequently and bathe often, especially in summer and autumn, to prevent insect bites and skin infections.
3. In group childcare settings or families, if scarlet fever or tonsillitis caused by streptococcal infection is detected, immediate isolation and thorough treatment are required. Uninfected individuals may receive penicillin 40–800,000 units twice daily for seven days as prophylaxis.
4. Children with recurrent tonsillitis may consider tonsillectomy. Early treatment of acute pharyngitis, otitis media, or skin infections reduces the risk of developing nephritis.
5. Monitor weather changes and promptly adjust clothing for children to avoid exposure to external pathogens.
(II) Drug Prophylaxis
1. Motherwort 100g, decocted and drunk as tea daily.
2. Heat-clearing and detoxifying formula: Honeysuckle 15g, Forsythia 15g, Balloon flower root 12g, Red peony root 15g, White rush root 15g, White peel 9g, Dandelion 9g, decocted and taken twice daily.
3. Red adzuki beans 50g, Mulberry white bark 30g, Atractylodes 12g, decocted and taken twice daily.
4. Dried calabash rind 30g, decocted and taken twice daily.
Post-illness Prevention of Progression
With proper and timely treatment, prognosis is generally favorable. However, misdiagnosis or delayed treatment may lead to chronic nephritis or nephrotic syndrome, and complications such as heart failure, hypertensive encephalopathy, or acute renal failure. Causes of disease progression include misdiagnosis, pre-existing weakness, internal retention of fluid, or excessive pathogenic heat invading internally. Possible complications include fluid rising to affect heart and lungs, heat-toxin invading heart and liver, failing heart yang, and internal closure of toxic fluid.
(I) General Measures
1. Complete bed rest for the first two weeks until gross hematuria disappears, edema resolves, and blood pressure normalizes before resuming activity. Avoid strenuous activities for three months.
2. During early stages, provide easily digestible food. Strictly limit salt intake if edema, oliguria, or hypertension occurs. Once edema subsides, urine output normalizes, and blood pressure returns to normal, switch to low-salt diet.
3. Generally, fluid intake need not be restricted in pediatric nephritis patients, except in cases of circulatory congestion, heart failure, or oliguria/anuria. When renal function is impaired, provide low-protein diet. As soon as condition improves, resume protein supply such as eggs, milk, meat, fish, to meet growth and development needs.
(II) Traditional Chinese Medicine Treatment
1. In acute phase, use Mahuang Lianqiao Chixiaodou Decoction with modifications. If edema is prominent, combine with Wupi Yin: Ephedra, Forsythia, red adzuki beans, tangerine peel, ginger peel, mulberry white bark, schisandra peel, and poria peel. If hematuria is obvious, add herbs for activating blood and resolving stasis such as great plantain, lesser plantain, white rush root, baiji, cypress leaf. If coughing and shortness of breath suggest fluid ascending, add mulberry white bark, winter melon seed, tangerine peel, suzi, apricot kernel.
2. For heat-toxin pattern, to prevent excessive fire attacking, use Wuwei Detoxifying Drink combined with Baihua She Shecao, large blue leaf, corn silk, or combined with Longdan Xiegan Wan.
3. If pallor, cold extremities approaching collapse, use Wuling San combined with Wupi Yin, or add Fangji, Sichuan pepper, cinnamon, schisandra, ginseng, or urgently decoct Dushen Tang or inject Shengmai Injection.
If mental confusion, administer Suhe Xiang Wan to open the orifices.
4. If cold-damp predominates and dampness-turbidity obstructs internally, manifesting as reduced urination or anuria, worsening edema, drowsiness, indicating impending internal closure of toxic fluid, use Wuling San combined with Fuzi Lizhong Tang. If turbid qi ascends severely, use Wen Dan Tang, or Xuanfu Dai Zhe Shi Tang, or add da huang, shanzhi, bai tou weng.
(IV) Dietary Therapy to Prevent Progression
1. 400g winter melon, 50g red adzuki beans, add appropriate water to cook into porridge. Suitable for initial stage of acute nephritis with edema and oliguria.
2. Green onion porridge: Use 60g glutinous rice, crush 5 slices of ginger, add 5 stalks of green onion with roots, simmer into porridge. Add 5ml vinegar, drink hot while covering with blanket to induce sweating. Suitable for initial stage of acute nephritis with facial edema.
3. Ginger porridge: Take 5 slices of ginger, 50g rice, cook into porridge. Add chopped green onion and vinegar just before serving, eat hot while covering to induce sweating. Suitable for initial stage of acute nephritis with facial edema, fever, no sweat, headache, nausea.
4. Red adzuki bean carp soup: Boil carp to extract broth, separately cook 50g red adzuki beans into porridge, add broth near completion (without seasoning), serve as breakfast. Suitable for generalized edema and marked oliguria in acute nephritis.
5. Coixseed and Prunella porridge: Cook coixseed and prunella seeds into porridge. Suitable for generalized edema, fever, and obvious hematuria.
(V) Single and Proven Formulas
1. Fresh Plantago major and fresh corn silk, each 60g, one dose daily, divided into two servings.
2. Fresh reed root 120g, 30g rock sugar, decocted and taken.
3. Water shield and white rush root, each 100g, 30g red adzuki beans, decocted and taken.
4. Black sesame powder: Roast black sesame into powder, mix with sugar water and drink. Suitable for generalized edema, especially severe lower limb edema.
5. Astragalus 50g, decocted and drunk as tea daily.
6. Lotus node 150g, decocted and drunk as tea. Particularly effective for obvious hematuria.
(VI) Nursing Care
1. Bed rest, keep room quiet, ensure ventilation but prevent catching cold.
2. Diet should be easy to digest; avoid raw, cold, greasy, and stimulant foods like shrimp and crab.
3. Maintain smooth bowel and bladder movements. For constipation, use Ma Ren Wan or similar to moisten intestines and promote defecation.
4. For patients with fever due to external invasion, after taking diaphoretic drugs, monitor sweating closely. After sweating, wipe dry immediately and maintain clean, dry skin.
5. Follow-up: Test urine routine 2–3 times weekly during first three months of illness. Once stable, test once weekly to monitor progress and prevent recurrence.
<Pediatric Acute Nephritis>