uremic pneumonia in the elderly
Introduction
Introduction to uremia pneumonia in the elderly The most common pulmonary complication of chronic renal failure is uremic pneumonia, also known as uremia lung, or uremia pulmonary edema. It is pulmonary edema and non-infectious pneumonia caused by uremia. It is the main pathology of pulmonary edema. Performance of the clinical syndrome. basic knowledge The proportion of the disease: the incidence rate of the elderly over 60 years old is about 0.04%-0.05% Susceptible people: the elderly Mode of infection: non-infectious Complications: pleural effusion, pulmonary edema, acute left heart failure in the elderly
Cause
The cause of uremia pneumonia in the elderly
(1) Causes of the disease
The lung is in a very important position in the whole body. On the one hand, the lung directly communicates with the external environment and is connected with the external environment. Therefore, the lung is affected by external pathogenic factors and affected by internal environmental changes. Can cause changes in the respiratory system. In chronic renal failure, many infections, toxins, immunity and other factors can have adverse effects on the lungs. These factors include the direct effects of bacteria, fungi, viruses, etc. on the lungs. May have an indirect effect on the lungs, such as pulmonary edema caused by sodium water retention, that is, uremic pneumonia, pulmonary edema caused by sodium and water retention in chronic renal failure, can directly cause lung function damage, and other chronic renal failure Various toxins can directly cause lung damage, and the pathological process that damages the kidney can also cause changes in the lungs, such as scleroderma, Wegener's granulomatosis, sarcoidosis, and lung-kidney syndrome.
In recent years, according to foreign scholars, the common causes of uremia are diabetic nephropathy, hypertensive nephropathy, glomerulonephritis, polycystic kidney disease, etc., and most of the patients with diabetic nephropathy and hypertensive nephropathy are elderly people. Combined with coronary heart disease, it is more prone to uremic pneumonia, that is, uremic pulmonary edema, and patients with polycystic kidney disease usually have clinical symptoms around 60 years old, so most of these patients are elderly.
(two) pathogenesis
The pathological manifestations of uremic pneumonia are diffuse rubber-like changes, or hard edema, accompanied by an increase in lung weight, which is typical of pulmonary edema, alveolar telangiectasia, congestion, and alveolar thickening. Alveolar septal edema, fibrous alveolar exudate rich in protein in the alveoli, jelly-like, easy to coagulate, hemorrhagic and fibrotic pulmonary edema in severe cases, alveolar wall cells shed, macrophage and monocyte infiltration, Sometimes transparent membrane formation can occur, recurrent uremia pulmonary edema causes pulmonary interstitial fibrosis and alveolar hemosiderin deposition, about 20% with fibrinous pleurisy.
Uremic pulmonary edema is different from other pulmonary edema. It is generally thought to be related to the increase of blood urea nitrogen and serum creatinine. There is a uremic toxin in the blood of uremia patients, which is a small molecular steroid. Substance, which causes an increase in alveolar capillary permeability, causing protein-containing fluids to spill over into the alveoli and interstitial lungs, causing pulmonary edema, and sodium retention is another cause of uremia pulmonary edema, and senile uremia Patients are often associated with left heart failure, which plays an important role in the development and development of uremia pulmonary edema. Plasma osmotic pressure is reduced, such as massive proteinuria, malnutrition, anemia, leading to fluid leakage. Quality, causing pulmonary interstitial edema, increased free radicals in the body, and the patient's systemic antioxidant capacity decreased, can not quickly and effectively eliminate these superoxide anions, resulting in the removal of foreign bodies while exacerbating tissue damage.
Prevention
Elderly uremic pneumonia prevention
Prevention of uremic pneumonia should first prevent uremia, clinical prevention is for healthy people and asymptomatic patients, first for patients with diabetes, hypertension, polycystic kidney disease, systemic lupus erythematosus, urinary tract obstruction First- and second-level preventive measures should be taken to conduct health consultation on these patients, that is, to advise individuals, change their behavioral lifestyle, reduce risk factors, prevent the occurrence and development of diseases, including:
1 Conduct a general health check on high-risk groups, regularly review urine routine and renal function, and detect diseases early.
2 Eliminate risk factors for exacerbation of chronic renal failure such as infection, heart failure, dehydration or improper treatment.
3 adhere to the etiology of chronic renal failure, such as chronic nephritis, lupus nephritis, purpuric nephritis, IgA nephropathy, hypertensive nephropathy, diabetic nephropathy, etc. need to adhere to long-term treatment.
4 diet therapy: the application of low protein, low phosphorus diet, the ability of the kidney to discharge metabolites in chronic renal failure, the accumulation of toxins in the body, these toxins are basically protein metabolites, so protein intake should be limited, but Multi-restricted protein intake can cause malnutrition, resulting in hypoproteinemia, so for patients with chronic renal failure to be nutritional therapy, it is best to use high-priced protein, such as eggs, milk, fish, lean meat, etc., eat less plants Protein (such as soy products), to ensure adequate calories, and to add vitamin C and vitamin B.
5 Disable or use drugs that are harmful to kidney function.
6 If you find that the amount of urine is reduced, edema is aggravated, nocturia is increased, etc., you should go to the hospital in time.
7 for patients who have been identified as uremia, breathing difficulties, cough, can not be supine, blood in the sputum, consider uremic pulmonary edema, go straight to the hospital for treatment, so as not to delay the disease.
Complication
Elderly uremic pneumonia complications Complications, pleural effusion, pulmonary edema, acute left heart failure in the elderly
Can be complicated by pleural effusion, difficulty breathing, pulmonary edema, left heart failure and so on.
Symptom
Symptoms of uremia pneumonia in the elderly Common symptoms After hemoptysis, qi sputum with bloodshot sputum, dyspnea, pleural effusion, pulmonary interstitial fibrosis, renal failure, hydronephrosis, kidney water accumulation
Symptom
The typical symptoms are cough, cough, blood in the sputum, difficulty in breathing, supine at night, and shortness of breath after activity, while early uremia pneumonia patients have no obvious symptoms, systemic symptoms caused by uremia, symptoms of some patients Atypical, pulmonary edema is very obvious, but breathing difficulties and cough, the symptoms of cough are very light, so it is easy to be ignored, such as the development of pulmonary interstitial fibrosis, there may be obvious breathing difficulties, about half of patients can be concurrent Pleural effusion, mostly fibrinous exudate, a small amount of blood.
2. Signs
Early uremic pneumonia patients can have no obvious signs, typical signs can appear in the late stage, respiratory promotion, lip cyanosis, both lungs can be heard and wet voice, a small number of patients can smell dry voice.
Examine
Examination of uremia pneumonia in the elderly
Laboratory tests: all tests for chronic renal failure may occur, such as advanced pulmonary interstitial fibrosis, blood gas analysis may show hypoxemia and metabolic acidosis, pathogen examination is often negative, pleural effusion routine Check for exudate.
Imaging
The performance on the chest X-ray varies with the severity of the disease and the duration of the disease. It is divided into 4 phases:
(1) Pulmonary congestion: The lung texture is enhanced, the hilar shadow is enlarged, and the middle and lower lung fields are ground-glass-like.
(2) Pulmonary interstitial edema: The outer diameter of the bronchial and vascular sections around the hilar is thickened and the edges are blurred, which is called cuff sign, and Kerley B and A lines may appear.
(3) Alveolar edema: diffuse flaky shadows and fusion into large shadows.
(4) Pulmonary interstitial fibrosis: Most cord-like and reticular shadows in the lung field.
(5) Others: There may be signs of pleural effusion, pericardial effusion, pleural thickening, and pulmonary calcification.
2. Pulmonary function test
The lung capacity is reduced and the diffuse function is reduced.
Diagnosis
Diagnosis and diagnosis of uremia pneumonia in the elderly
diagnosis
Clinically, in patients with a clear diagnosis of chronic renal failure, such as coughing, coughing, bloody or hemoptysis in the sputum, difficulty in breathing, etc., when there is a wet squeak and pleural effusion in the bottom of the lung, If other factors (pneumonia, Goodpasture syndrome, cardiogenic pulmonary edema, etc.) can be excluded, the possibility of uremia pneumonia should be considered.
Differential diagnosis
Clinically, it must be differentiated from bacterial pneumonia, bronchial pneumonia, and bronchitis.
