renal encephalopathy
Introduction
Introduction to renal encephalopathy Renal encephalopathy is caused by chronic glomeruli, chronic pyelonephritis, and renal arteries causing chronic renal failure. Renal failure caused by acute or chronic kidney disease causes a group of diseases in which severe mental disorders occur mainly due to nitrogen retention. Also known as uremic encephalopathy. Common in acute kidney failure and chronic renal failure. In the case of renal failure, the metabolic waste in the body cannot be eliminated from the urinary system, resulting in an imbalance of acid-base balance, nitrogen metabolites and urea are significantly increased. The terpenoid substrates include methyl hydrazine, bismuth succinate, dimethyl hydrazine, and creatine. Increased creatinine, causing abnormal oxygen consumption in brain, liver and kidney tissues, affecting brain metabolism and causing disorders. Some people have used the "medium molecular weight" substance theory to explain uremia. Clinical features include: urinary system and its physical symptoms and signs and biochemical changes; disturbance of consciousness is the main neuropsychological disorder; neurological function of the encephalopathy and damaging symptoms and signs. Poor prognosis, kidney transplant has a certain effect. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: epilepsy temporal lobe epilepsy
Cause
Cause of renal encephalopathy
Uremia (30%):
Uremia, blood toxic substances accumulation poisoning, is due to chronic glomerular, chronic pyelonephritis and renal arterioles caused by chronic renal failure, urea significantly increased, affecting brain metabolism, causing disorders.
Abnormal amino acid metabolism in the brain (30%):
Due to the accumulation of toxic organic acids, blood circulation disorder in the brain and increased capillary permeability in the brain, which causes changes in the properties of nerve cells and glial cells, the accumulation of organic acids hinders the removal of neurotransmitter metabolites from the choroid plexus of the brain. Blocking the conduction of glial cells, and changing the function of Na+-K+ pump, the activity of ATPase in the brain is reduced, and the brain's ability to utilize ATPase is decreased. As a result, the ATp in the brain is increased, and the activity of phosphofructosylase is inhibited. Thereby blocking the glycolysis of sugar and affecting the consumption of oxygen, the metabolic rate of the brain is reduced, the synaptic transmission is disturbed, the interaction between neurons is weakened, and the brain function is reduced.
Other factors (25%):
Metabolic waste in the body cannot be excluded from the urinary system due to renal failure, resulting in imbalance of acid-base balance. Nitrogen metabolites and terpenoid substrates including methyl hydrazine, succinate succinate, dimethyl hydrazine, creatine, creatinine, etc. High, causing abnormal oxygen consumption in brain, liver and kidney tissues, causing renal encephalopathy.
It is reported that 50% to 60% of patients may have neuropsychiatric symptoms within 1 year of renal dysfunction, and 58.8% to 82% of patients with chronic renal failure without dialysis have neurological damage. If patients with renal failure develop to the end of the period, almost all have neuropsychiatric symptoms.
Prevention
Renal encephalopathy prevention
Actively treat kidney disease and avoid the occurrence of renal encephalopathy. Control diet structure, avoid excessive intake of acidic substances, and exacerbate acidic constitution. The acid-base balance of diet is a very important part of the treatment of kidney disease and prevention of complications. For food, eat more foods rich in plant organic active base, eat less meat, and eat more vegetables. Chamagu is rich in plant organic active base, which can quickly eliminate acidosis in the body and clarify the acidity of urine, thus truly protecting the kidneys.
Complication
Renal encephalopathy complications Complications, epilepsy, temporal lobe epilepsy
In the advanced stage of encephalopathy, systemic episodes or focal episodes of epilepsy may occur, and focal epilepticus and temporal lobe epilepsy may also be seen.
Symptom
Symptoms of renal encephalopathy Common symptoms Visual impairment Eyeball tremors Drowsiness neurasthenia Syndrome Hearing loss Meningeal irritation Symptoms Unconscious coma Intelligence reduction
Brain debilitating state
Attention to the surrounding environment and sensory disturbances are the earliest and most reliable indications for uremic encephalopathy. Patients are prone to fatigue, lack of concentration, memory loss, especially near-forgetting, mental decline and so on. Patients with mild illnesses need to be discovered by intelligence check, so they are easily misdiagnosed and missed.
2. Severe psychotic symptoms
1 Depressive state: The patient can change from a debilitating state to a general inhibition and retardation of mental activity.
2 Manic state: from euphoria, agitation to high spirits, increased speech and movement, but less common in depression. 3, hallucinations and delusions: when there is confusion, there may be embarrassing, expressions irritated, snoring or excitement, distraction, memory, orientation, poor thinking, illusions and hallucinations, personality disintegration And non-reality, delusions and schizophrenia can also be seen in patients with uremic encephalopathy. Computational power and judgment are often obstacles.
3. Disorder of consciousness
Consciousness of consciousness is extremely common in uremia, especially in the late stage of uremia, which can range from lethargy to coma, and some patients may have stupor.
4. flapping tremor
Flap-like tremor is an important indicator for the diagnosis of uremic encephalopathy, but it is unique to non-uremic encephalopathy and can also be found in other metabolic encephalopathy, such as hepatic coma. Once the patient has a disturbance of consciousness. This sign is almost always present.
5. Tremor
Fine or thick tremors, especially intentional tremors of the hands and tongue, are often seen in uremic encephalopathy, and are one of the sensitive indicators for the diagnosis of this disease, often preceded by flapping tremor.
6. Myoclonus
Multifocal tendon is also very common, mainly involving the facial and limb proximal muscles, manifested as sudden, rapid, irregular, asymmetrical muscle twitching.
7. Seizures are often the late manifestations of encephalopathy. It can be a systemic episode or a focal episode, and focal epilepticus and temporal lobe epilepsy can also be seen.
8. Other
Ataxia, muscle tremors, hand and foot spasms can also be seen.
Examine
Examination of renal encephalopathy
Increased blood levels of nitrogen and decreased carbon dioxide binding. Others need to do kidney disease related tests.
Electroencephalogram (EEG) changes
The incidence of EEG changes in uremic encephalopathy is as high as 80-100%. EEG abnormalities occur early in the early stage, and change with the increase or improvement of uremia. Therefore, EEG examination is helpful for the early diagnosis of uremia patients, and the dynamic observation of EEG can understand the outcome of the disease. However, EEG changes in uremic encephalopathy are not specific, mainly diffuse slow waves, loss of normal alpha rhythm, increase in and waves, spikes in epileptic seizures, high amplitude sudden slow waves The incidence rate is 16%. Some people think that the more specific one is the waveform change of the tendon after the light stimulation. The patients with abnormal renal electroencephalogram with abnormal electroencephalogram were dialyzed. The EEG changes little after 6 months, and then gradually returned to normal. The electroencephalogram returned to normal after 6 months of kidney transplantation.
Routine testing project for kidney disease
1. Collecting urine specimens in a timely and correct manner: Urinary routine tests are convenient, sensitive, and accurate indicators for diagnosis and judgment of disease and efficacy, and must be taken seriously.
2, for patients with edema and acute nephritis should accurately record the daily intake and output. Patients with edema should be weighed once a week. For patients with ascites, the weight should be increased once a week. For patients with ascites, the abdominal circumference should be increased once a week.
3, patients with high blood pressure should be measured regularly.
4, patients with severe pleural effusion, ascites, uremic pericarditis and heart failure, often have chest tightness, suffocation, can not be supine symptoms, should promptly adjust the patient's lying position.
5, when rehydration should accurately calculate the hourly and per minute input, strictly control the drip rate to prevent heart failure and pulmonary edema.
6, for patients with diuretics, should pay close attention to the reaction after medication, alert to the occurrence of electrolyte imbalance.
7. For intramuscular injection of edema patients, deep injection should be performed. After needle extraction, the needle hole should be pressed with cotton balls for about 2-3 minutes to prevent the liquid from overflowing.
8, specific problems symptomatic treatment, observe the early performance of renal function damage, and pay attention to take measures to protect kidney function to prevent disease development and deterioration.
Diagnosis
Diagnosis and diagnosis of renal encephalopathy
Diagnostic criteria
1 on the basis of confirmed renal failure; 2 if found fatigue, weakness, less movement; 3 blood nitrogen increase and carbon dioxide binding decreased. Can be used as a basis for diagnosis.
Dialectical Treatment of Traditional Chinese Medicine: Common Syndrome and Its Dialectical Points
The clinical manifestations of this disease are diverse. According to the difference of qi and blood yin and yang, and the presence or absence of reality, the clinical can be divided into the following two types.
1. Turbidity invades and triples
(1) turbidity and poisoning on the upper focus: turbidity and phlegm, the symptoms are coughing, snoring, low breathing, or slow breathing, cold limbs, sweating, indifferent expression, confusion, and tongue Light, greasy, slippery, equivalent to light. Those who are trapped in the mind are sick, unconscious, or irritated, proverbs, tongues are strong, tongue red, yellow, veins or knots. Or heart palpitations, chest tightness, shortness of breath can not be supine, cold limbs, sweatless speech, coma, or convulsions, urinary closure, pulse fine, or ups and downs. Equivalent to heavy.
(2) turbidity and poisoning in the middle of the coke: turbidity and spleen, the symptoms of frequent vomiting, stagnation, bloating, facelessness, fatigue, fatigue, limbs, heavy stools, edema, edema, sweetness, tongue Light or light fat, thick and greasy fur, fine or fine veins. Turbid poisonous stomach, symptoms of nausea, retching or vomiting frequently, poor appetite, abdominal distension. If it is heated, it will not work, and the tongue coating will be yellow or greasy, and the pulse number or string number. If it is cold, see the stool is thin, it will be more, the tongue is light, the fur is thin, and the pulse is fine. Equivalent to light weight.
(3) turbidity invade the lower focus: liver motility, urinary edema, edema, vomiting, itchy skin, finger tremors, headache, irritability, even dizziness or arrogance, tongue twitching or contracture, tongue dry Light red or yellow dry, no pulse, fine pulse number. Deficiency of the life gate, Zheng Jian oliguria or no urine, body edema, sweating out of heart, shortness of breath, sullen, pale, limbs cold, mouth has urine and salty, pale tongue like jade, black or gray moss, The pulse is subtle. Equivalent to heavy.
2. Spleen and kidney yang
(1) spleen yang deficiency: symptoms of fatigue, lack of food, less bloating, bloating, cold, nausea and vomiting, less urine, pale tongue, white fur, slippery veins and so on. Equivalent to light weight.
(2) kidney yang deficiency: symptoms see white or stagnation, cold and tired, backache, cold knees, soft knees, foot root pain, edema below the waist, even systemic edema, nausea and vomiting, little or no urine Urine, or urination is long, the tongue is pale, the fur is white, and the pulse is fine. Equivalent to light weight.
