Introduction
Chronic kidney disease, the onset of chronic kidney disease, early symptoms of chronic kidney disease, prevention and treatment of chronic kidney disease, prognosis of chronic kidney disease
Definition of chronic kidney disease
Clinically, the diagnosis is glomerulonephritis, occult nephritis, pyelonephritis, allergic purpura nephritis, lupus erythematosus nephritis, ventilated kidney, iga nephropathy, nephrotic syndrome, membranous nephropathy, nephrotic syndrome, diabetic nephropathy, hypertensive nephropathy , polycystic kidney disease, etc., when the onset of these kidney diseases is difficult to heal, the time is more than three months, the patient's urine and related blood indicators are abnormal, renal pathology, imaging findings are abnormal, or the kidney's glomerulus is effective The filtration rate is less than 60%, which can be collectively referred to as "chronic kidney disease". If chronic kidney disease fails to be treated promptly and effectively, and the disease progresses, the patient with chronic kidney disease will develop chronic renal insufficiency and renal failure, eventually forming uremia.
Incidence characteristics
The characteristics of chronic kidney disease include “three highs” and “three lows”: high incidence rate, high prevalence of cardiovascular disease and high mortality rate; low awareness rate of chronic kidney disease in the whole society, low prevention rate, concomitant The awareness rate of heart and blood is low. According to the survey, the prevalence of chronic kidney disease in Chinese people over 40 years old is more than 10%, and the awareness rate is less than 5%. In China, the majority of patients with chronic kidney disease occur in glomerulonephritis, accounting for 40%. With the changes in dietary structure and living habits of our population, other secondary chronic kidney diseases are increasing. Coupled with the limited medical level in China, the situation of prevention and treatment of chronic kidney disease in China is facing severe challenges.
Early symptoms
Familiar with the symptoms that may occur in the early stage of chronic kidney disease can play a warning role in the occurrence of chronic kidney disease, and facilitate the early diagnosis and treatment of patients with chronic kidney disease, effectively curbing the deterioration of the disease. Usually, when there is a lot of foam in the urine and there is an increase in blood or nocturia in the urine, that is, urine routine examination of urine protein and red blood cells in the urine may be an early warning signal for early occurrence of chronic kidney disease. The symptoms of early chronic kidney disease are not obvious. For example, patients with chronic nephritis have no obvious symptoms. Therefore, when there is abnormal urine, it is recommended to seek medical attention for diagnosis. Once the patient feels that he has obvious symptoms such as obvious fatigue and anemia before he goes to the doctor, the condition of chronic kidney disease may have passed the early stage, which will bring more difficulty to the later treatment of chronic kidney disease.
Digestive system: The symptoms manifested by the digestive system are generally the most obvious, such as nausea, vomiting, glossitis, diarrhea, mouth odor and oral mucosal ulceration, and even major bleeding in the digestive tract.
Mental, nervous system: The most common symptoms of the mind and nervous system are fatigue, numbness of the limbs, memory loss, mental dysfunction, dizziness, headache, insomnia, burning of hands and feet, slang, muscle twitching, convulsions, coma, etc.
Cardiovascular system: Hypertension is the most prone to cardiovascular disease, arrhythmia, heart failure, myocardial damage, pericarditis, hardening of the arteries, and vascular calcium.
Hematopoietic system: The most prominent symptom of the hematopoietic system is anemia. If there is a tendency to hemorrhage in the late stage of renal failure, there are common nasal discharges and ecchymoses, but also hematemesis, blood in the stool, hemoptysis, hematuria, intracranial hemorrhage, and menorrhagia.
Respiratory system: When you have acidosis, you can breathe deeply. In the advanced stage, you may have uremic bronchitis, pneumonia, and pleurisy.
Skin: The skin of patients with chronic renal failure may be dull, dry, and desquamate. Urea cream, rash, pigmentation, etc. often occur.
Dehydration or edema: due to loss of renal tubular concentration function and high concentration of urea caused by osmotic diuretic, obvious polyuria, plus vomiting, diarrhea, drinking less, etc., often occur dehydration. Into the oliguria period, it is easy to cause excessive water, edema, hypertension, heart failure, water intoxication and dilutionHyponatremia.
Metabolic disorders: impaired glucose tolerance, elevated blood levels of glucagon, growth hormone parathyroid hormone, adrenocortical hormone, gastrin, etc. There may also be abnormalities in fat metabolism and hyperlipidemia.
Preventive treatment
Once suffering from chronic kidney disease, it is difficult to cure. However, it is not that suffering from chronic kidney disease, uremia is inevitable. Early intervention in the control of chronic kidney disease prevented it from progressing completely. Therefore, prevention and treatment of chronic kidney disease is the key to physical rehabilitation of patients with chronic kidney disease.
The prevention and treatment of chronic kidney disease mainly includes the following three points:
First of all, in view of the characteristics of chronic kidney disease, the low awareness rate, it is necessary to mobilize all the people in the society to pay attention to chronic kidney disease. Everyone should actively prevent and treat chronic kidney disease.
Second, we must strengthen early prevention and control work to prevent the occurrence of chronic kidney disease. This requires timely and effective treatment of existing kidney diseases (such as chronic nephritis) and its risk factors (such as proteinuria, hypertension), as well as diseases that may cause secondary damage to the kidneys (such as diabetes, Ventilation, high blood pressure, etc. and risk factors (such as smoking, hyperlipidemia, etc.) for timely and effective treatment and control, two aspects work together to prevent the occurrence and deterioration of chronic kidney disease.
Finally, delay or even reverse the progression of chronic kidney disease. Specifically, it is necessary to not only timely and effective treatment of existing chronic kidney disease risk factors such as hypertension, proteinuria, hematuria, anemia, etc., but also serious complications of various systems in the middle and late stage of chronic kidney disease. The disease, especially the prevention of cardiovascular and cerebrovascular complications, thus reducing the mortality rate of renal failure and uremia, and achieving the goal of improving the long-term survival rate of patients with chronic kidney disease. From the clinical practice of prevention and treatment of chronic kidney disease, the combination of Chinese and Western medicine has the most significant effect. On the basis of the above prevention and treatment of chronic kidney disease, Western medicine is applied to the symptomatic treatment of complications and nephropathy symptoms, and combined with traditional Chinese medicine to perform functional repair of the kidneys of patients with chronic kidney disease, so that it can achieve true effective treatment of chronic kidney disease. It is expected to delay or even reverse the deterioration of chronic kidney disease.
Prognosis of various chronic kidney diseases
What is the prognosis of chronic nephritis?
The causes of chronic nephritis are complicated, the course of disease is long, the severity of the disease development is disparate, the speed is different, and there is a progressive tendency. The natural course of patients with chronic nephritis varies greatly. Some patients have stable conditions. After 5 to 6 years, or even 20-30 years, they develop renal insufficiency, and very few patients can relieve themselves. In another part of the patient's condition, the condition continues to develop or recurrent episodes, and renal failure develops within 2 to 3 years. It is generally believed that persistent hypertension and persistent renal dysfunction in chronic nephritis have a poor prognosis. In short, chronic nephritis is a progressive glomerular disease with a poor prognosis. Therefore, chronic nephritis must be treated early and reviewed regularly.
The pathological classification of renal biopsy is reliable for the prognosis. It is generally considered that the prognosis of minimally pathological nephropathy and mesangial proliferative nephritis is better, the progression of membranous nephropathy is slower, and the prognosis is better than that of membrane proliferative nephritis. Some cases have renal insufficiency within a few years, and the prognosis of focal segmental glomerulosclerosis is also poor. Recent studies have shown that in addition to glomerular lesions, the extent of renal tubules, intrarenal blood vessels, and renal interstitial lesions significantly affect prognosis. Renal tubular atrophy, intrarenal small blood vessel sclerosis, renal interstitial massive lymphocytic infiltration and interstitial fibrosis have a poor prognosis.
Clinical observation: 1 The history of hemolytic streptococcal infection before the onset is better than the history of no streptococcal infection. 2 patients with only proteinuria or hematuria, or only hematuria, and no other clinical symptoms, the prognosis is better. 3 chronic nephritis hypertension prognosis is relatively poor. If you use antihypertensive drugs, blood pressure can be reduced to normal or slightly higher, the prognosis is relatively better. The blood pressure exceeds 22.7/14.7 kPa (170/110 mm Hg), and the prognosis is poor if the general antihypertensive drug is not effective. 4 patients with persistent hematuria, renal function deteriorated faster. 5 renal dysfunction, the prognosis of patients with azotemia is poor.
Prognosis of interstitial nephritis
The prognosis of chronic interstitial nephritis varies with the etiology and degree of renal impairment. Chronic interstitial nephritis can be cured when the cause can be completely eliminated. If the stage of chronic renal insufficiency has been developed, chronic renal failure is often formed with a poor prognosis.
Prognosis of nephrotic syndrome
The prognosis of nephrotic syndrome varies greatly depending on the etiology, the type of pathology, and whether or not it is reasonably treated. In estimating the prognosis of renal syndrome, the following factors can be used as a reference:
(1) Age: Among children with primary nephrotic syndrome, minimal lesions accounted for 80%, and in the 2-6 age group, 85% of minimally pathological nephropathy gradually decreased with age. Only 20% of adults older than 30 years old. Because of the good prognosis of this type of nephrotic syndrome, 54% of children with nephrotic syndrome can be completely relieved, and only 21% of adults can be completely relieved. But in children, the younger the age of onset, the higher the mortality rate. Some people have different views on this. There is a statistic in the United Kingdom that about 15% of children with nephrotic syndrome continue to have symptoms after adulthood.
(2) hematuria: nephrotic syndrome type 1 is not obvious in hematuria, pathologically mostly microscopic disease or mild mesangial proliferative nephritis, the prognosis is good. The obvious hematuria is a type II nephrotic syndrome with a poor prognosis.
(3) proteinuria: selective proteinuria showed mild lesions, good prognosis, and poor prognosis of non-selective proteinuria. If there is severe proteinuria in the early stage, renal failure occurs earlier and the prognosis is poor.
(4) Hypertension and azotemia: common in nephrotic syndrome type II, not sensitive to hormone therapy, poor prognosis.
(5) serum cholesterol: elevated serum cholesterol is more common in small lesions, the incidence of other diseases is lower, and secondary nephrotic syndrome caused by systemic lupus erythematosus, serum cholesterol is normal, it can be considered elevated serum cholesterol The prognosis is better. However, children with serum cholesterol higher than 20.8mmol / L, the mortality rate is high.
(6) Time to start treatment: early diagnosis, early treatment, and a relatively good prognosis. The prognosis of patients with corticosteroids starting more than 6 months after onset of adult nephrotic syndrome is poor. Some 68 cases of nephrotic syndrome were reported. None of the patients who started the hormonal therapy for more than 6 months had a remission, and those who had a course of less than 6 months started hormone therapy, and 15% had complete or partial remission.
(7) Time of edema: There are statistics showing that adult nephrotic syndrome has the highest number of end-stage renal failure in the third to fourth years after the first edema.
(8) Response to hormones: Patients with nephrotic syndrome who have a poor response to corticosteroid treatment at the outset indicate poor treatment and poor prognosis.
IGA nephropathy prognosis
The prognosis of this disease is general, a few people can be relieved, most of the disease progresses slowly, and some eventually develop renal failure. Factors associated with prognosis are:
(1) Men, and those with a higher onset age (greater than 40 years old) have a poor prognosis.
(B) with high blood pressure, especially difficult to control high blood pressure, the prognosis is poor.
(C) renal biopsy pathological examination showed diffuse, proliferative glomerular damage, especially with crescent formation; focal segmental glomerular sclerosis, poor prognosis.
Prognosis of polycystic kidney disease
Individuals with polycystic kidney disease have large differences, and the duration of the disease is closely related to the presence or absence of comorbidities. If the patient has more comorbidities and progressive uremia, the prognosis is poor; while some patients have renal dysfunction, but there is no comorbidity, the course of the disease is slow, and the prognosis is relatively good. Therefore, the clinical treatment of polycystic kidney disease can be the key to determine the prognosis. The younger the clinical symptoms of the disease, the worse the prognosis. It usually lasts for about 10 years after symptoms appear. If you do not do dialysis therapy and kidney transplantation, the average age of death is about 50 years old. The main causes of death of this disease are renal failure, heart failure, intracranial hemorrhage and pulmonary infection.
Prognosis of membranous nephropathy
The disease is a relatively benign disease that develops slowly. According to reports from around the world, the 10-year survival rate is around 80%. Factors affecting the prognosis of this disease are generally recognized as a large number of proteinuria and renal dysfunction, and other factors have different results.
(1) Age: The prognosis of children is good, and the 10-year survival rate can reach more than 90%. Most of the proteinuria will be spontaneously relieved within 5 years after diagnosis, and about 25% in adults, usually more than 3 years after onset. It will happen.
(2) Gender: Kincaid-Smith reported that the disease is a positive benign disease in women. The 5-, 10-, and 15-year survival rates are 99%, but if the woman's pregnancy is pregnant, it will aggravate the development of the disease.
(3) The degree of proteinuria: It has been recognized that the degree of proteinuria affects the prognosis. Patients with nephrotic syndrome at the onset renal biopsy have a survival rate of 76% and 60% at 10 and 15 years, respectively, and 10 years without nephrotic syndrome. The 15-year survival rate was 98%. In addition, according to the degree and duration of proteinuria, a rough estimate: 1 proteinuria ≥ 8g / d for more than 6 months, the incidence of poor prognosis is 66%; 2 proteinuria ≥ 6g / d for more than 9 months The incidence of poor prognosis was 55%.
Daily care
1. No drinking
The fusel oil and nitrous limbs in alcoholic alcohol can cause degeneration and carcinogenesis of kidney tissue. Therefore, patients with kidney disease should drink alcohol to prevent liver and kidney damage.
2, no smoking
What are the precautions for patients with chronic nephritis? Tobacco contains a variety of harmful substances, which can impair liver and kidney function and inhibit nephron repair. Therefore, patients with kidney disease must decide to quit smoking.
3, prohibiting anger
Traditional Chinese medicine is anger and liver injury, liver qi stagnation does not stretch, leading to detoxification, detoxification function into the kidneys, aggravating the burden on the kidneys, easy to accumulate, so angry as the enemy of kidney disease.
4, pay attention to rest
What are the precautions for patients with chronic nephritis, the kidney is an important metabolic organ of the human body, renal dysfunction, nutritional disorders in patients with kidney disease, so fatigue and weakness, need more rest.
6 scraping treatment of chronic kidney disease
1. Evenly apply safflower oil on the back liver, life gate, Sanjiao Yu and Shenshu, and scrape with a flat scraping method to scrape the bleeding point.
2. Use the thumb to rub the sputum, water, and the middle pole in the abdomen to a degree of local acid swelling.
3. Apply safflower oil evenly on the lower limbs of Yinlingquan, Sanyinjiao, and Taixi, and use a diagonal scraping method to scrape the bleeding point.
7 health care methods
First, control the intake of water and salt in the diet.
1, water, sodium intake: sodium intake should be less than 3 grams / day, severe edema should be less than 2 grams / day; water intake can be calculated according to the previous day's total urine volume +500ml.
2, protein intake: control protein intake, can also achieve low phosphorus purposes, generally 0.6 g / kg body weight per day, half of which is high-quality protein (animal protein rich in essential amino acids), such as eggs, lean meat, Milk and so on.
3, energy intake: daily intake of energy 30 ~ 35kcal / kg, of which fat supply is less than 30%, the rest in addition to protein, provided by sugar.
4, to supplement a variety of vitamins and trace elements: such as vitamins A, B, C, D, E, P and trace elements Cn, Zn, Fe and so on. Fresh vegetables, fruits, cacti, nuts, beef, etc. can be given.
Second, patients should pay more attention to rest.
For patients with chronic nephritis, in daily life and work, you should take more rest and not overwork, which will have a positive effect on the treatment of chronic nephritis.
Third, the patient should exercise properly.
For patients with chronic nephritis, in daily life, you should take more rest and exercise, but the amount of exercise should be moderate, so that it can help the treatment of chronic nephritis, and it is easy to enhance the health care method of patients with chronic kidney nephritis!
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