kidney disease
Introduction
Introduction to kidney disease Kidney disease, various kidney syndromes. There is a dynamic balance between the internal environment and the external environment between the human body. If a variety of pathogenic factors inside and outside the body damage the balance of the human body, resulting in dysfunction of viscera and blood, disease and kidney, it will cause kidney disease. Chronic Kidney Disease (CKD) Definition: Chronic kidney structural and dysfunction caused by various causes (history of renal damage greater than 3 months), including normal and abnormal pathological damage of renal GFR, abnormal blood or urine components, and imaging Check for abnormalities, or unexplained GFR drop (<60ml/min·1.73m2) for more than 3 months, which is CKD. Diseases causing chronic kidney disease include various primary, secondary glomerulonephritis, tubular damage, and renal vascular lesions. According to GFR, chronic kidney disease can be divided into five stages. Early detection and early intervention can significantly reduce the complications of CKD patients and significantly improve the survival rate. For the treatment of CKD, including the treatment of primary disease, various risk factors Treatment and delay in the progression of slow renal insufficiency, when CKD patients progress to 5, renal replacement therapy should be promptly performed. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: uremia acute renal failure
Cause
Cause of kidney disease
1. Research from the perspective of hemorheology
It can be shown that patients have a significant increase in plasma viscosity, whole blood viscosity, fibrin content, and platelet aggregation, which are important causes of renal cell ischemia or necrosis.
2. The cause of the disease at the time of infection
Infections such as pharyngitis and tonsillitis can cause this disease, and a cold is the most common infection that causes and aggravates the disease.
3. Bad external environmental factors
Such as cold, damp, etc. will cause the body's own immune function and disease resistance reduced.
4, overworked
Causes the body's immunity to decrease, which will cause the disease in the long run.
5, long-term urine
Not only is it easy to cause bladder damage, but the urine stays in the bladder for a long time. It is also very easy to cause bacterial growth. Once it returns to the ureter and kidney, the toxic substances will cause kidney infection, which will lead to urinary tract infection, this disease and even uremia.
6, indiscriminate use of drugs
Kidney disease caused by indiscriminate use of drugs is not uncommon. Many cold medicines, anti-inflammatory painkillers, diet pills and Chinese herbal medicines have kidney toxicity. These medicines are very common and widely used. People who do not have medical knowledge are often prone to danger when they self-medicate. Obese people are prone to chronic diseases such as high blood pressure and diabetes. If these chronic diseases are not well controlled, they will easily damage the kidneys in the long run and cause this disease indirectly.
7, too much salt
The main component of the salt is sodium chloride. Sodium is a mineral nutrient necessary for the human body. Chlorine has a certain effect on the production of gastric acid and maintaining the osmotic pressure of human blood. However, the sodium in the salt is too high in the human body to cause water accumulation in the body and produce edema. Increased blood volume and small arterial tension lead to an increase in blood pressure, so people with high salt levels have a high incidence of hypertension. Hypertension is extremely easy to develop with this disease.
8, other diseases
It can cause damage to the glomerular capillary filtration membrane, leading to this disease syndrome. The 2/3 adult and most children with this disease syndrome are primary, including primary glomerular disease, acute glomerulonephritis and acute nephritis. Pathological diagnosis mainly includes: minimal pathological disease, membranous glomerulonephritis, mesangial capillary proliferative nephritis (membrane proliferative nephritis) and focal segmental glomerulosclerosis. Secondary causes of this disease syndrome are: infection, drugs (mercury, organic gold, penicillamine and heroin, etc.), toxins and allergies, tumors (lung, stomach, colon, breast solid tumors and lymphomas, etc.), systems Lupus erythematosus, allergic purpura amyloidosis and diabetes. One third of adults with this disease syndrome and 10% of children can be caused by secondary factors.
9, body fluids are in an acidic environment for a long time
It is an alkaline mineral, and trace elements are neutralized, which accelerates the formation of various diseases. Acidic constitution easily causes renal dysfunction.
Prevention
Kidney disease prevention
The kidney has a strong compensatory function. When the kidney disease is early or not too severe, the patient has little feeling. Even if some patients have backache, edema, poor appetite and other discomforts, they are mostly attributed to fatigue, sub-health, etc. It is rare to think that there may be a problem with the kidneys. When there is a symptom of renal insufficiency such as hypertension or anemia, the renal function has been basically lost, and it has progressed to the mid-term or uremia stage. Therefore, regular physical examination is particularly important.
1. Annual medical examination
Adults should check their urine routine and kidney function once a year. If the urine routinely checks for urinary protein and elevated serum creatinine, they should be taken seriously. Look for a specialist to do further examination. High-risk groups of chronic kidney disease, such as the elderly over 60 years old, family members of patients with chronic kidney disease, patients with metabolic diseases such as diabetes, gout, hyperuricemia, hypertension, systemic lupus erythematosus, hepatitis, tumor, systemic infection , urinary calculi, urinary tract infection, urinary tract obstruction, history of acute renal failure, renal unit reduction (unilateral kidney or partial nephrectomy), with or without symptoms, should go to the hospital every six months to one year A urine routine, kidney function and kidney B ultrasound.
2, enhance physical fitness
Participate in aerobic exercise, exercise properly, exercise more sweat in the sun, help eliminate excess acid in the body, and prevent the disease.
3, maintain a good mood
Do not have excessive psychological pressure. Excessive pressure can lead to the deposition of acidic substances and affect the normal metabolism. Proper adjustment of mood and self-stress can maintain a weak alkaline constitution, thus preventing the occurrence of this disease.
4, life should be regular
People with irregular living habits, such as singing karaoke, playing mahjong, and not returning home at night, will have aggravated physical acidification. Easy to suffer from diabetes. Good habits should be developed to maintain a weak alkaline constitution and keep the disease away from you.
Complication
Nephrotic complications Complications uremia acute renal failure
infection:
As a large number of immunoglobulins are lost from the urine, plasma proteins are reduced, affecting antibody formation. The application of adrenocortical hormone and cytotoxic drugs can reduce the body's resistance and cause infections such as skin infections, primary peritonitis, respiratory infections, urinary tract infections, and even sepsis.
Coronary heart disease:
Patients with nephrotic syndrome often have hyperlipidemia and hypercoagulable state, which is prone to coronary heart disease. It has been reported that the incidence of myocardial infarction in patients with nephrotic syndrome is 8 times higher than that of normal people. Coronary heart disease has become the third cause of death in nephrotic syndrome (second only to infection and renal failure).
Thrombosis:
Patients with nephrotic syndrome are prone to thrombosis, especially membranous nephropathy can reach 25% to 40%. The causes of thrombosis include edema, less patient activity, venous stasis, hyperlipidemia, increased blood viscosity, increased fibrinogen content, increased v, VII, VIII, and x factors, and the use of adrenocortical hormones. High coagulation state, etc.
Acute renal failure:
Patients with nephrotic syndrome are often in low blood volume and hypercoagulable state due to massive proteinuria, hypoproteinemia, and hyperlipidemia. Vomiting, diarrhea, the use of antihypertensive drugs and diuretics a lot of diuretic, can significantly reduce the blood perfusion of the kidney, which in turn reduces the glomerular filtration rate, leading to acute renal failure. In addition, renal interstitial edema during nephrotic syndrome, protein concentration to form tubular occlusion of renal tubules and other factors, can also induce acute renal failure.
Electrolytes and metabolic disorders:
Repeated use of diuretics or long-term unreasonable salt ban can cause hyponatremia secondary to patients with nephrotic syndrome, using adrenocortical hormone and a large number of diuretics to cause a large amount of urination, if not timely potassium, prone to hypokalemia .
Symptom
Symptoms of nephropathy Common symptoms Edema, urinary protein, fatigue, kidney pain, kidney fire, urinary palm, black facial edema, kidney failure, abdominal pain
Nephritis:
The main manifestations of nephritis: fatigue, waist pain, anorexia, gross hematuria, edema, hypertension, renal dysfunction, decreased urine output (some patients with oliguria), congestive heart failure, etc., the clinical manifestations of specific diseases, please refer to the corresponding diseases Entry.
Interstitial nephritis:
Generally there are polyuria, polydipsia, nausea, nocturia, gross hematuria, muscle weakness, soft palate, joint pain and other manifestations. According to the clinical manifestations of this disease, it can be attributed to the Chinese medicine "leaf syndrome", "urine blood", "thirst quenching", "squatting", "small labor" and other areas of evidence. Interstitial nephritis has acute and chronic points, and clinical manifestations vary.
1, acute interstitial nephritis performance
Acute interstitial nephritis has different clinical manifestations and no specificity due to its different causes. Mainly characterized by oliguria or non-oliguric acute renal insufficiency, may be associated with fatigue, weakness, fever and joint pain and other non-specific manifestations. Loss of renal tubular function may occur with low specific gravity and low osmotic urinary pressure, renal tubular proteinuria, and water, electrolyte and acid-base balance disorders, and some patients present with Fanconi syndrome.
2, chronic interstitial nephritis performance
Chronic interstitial nephritis is often occult, chronic or acute onset, due to chronic inflammation of the renal interstitial, mainly fibrotic tissue hyperplasia, tubular atrophy, it often has its common clinical manifestations.
Chronic reflux nephropathy :
The clinical manifestations of this disease vary. The number of urinary tract infections, the severity of the symptoms and the degree of reflux and the degree of renal scarring, only a case of infection history can also have severe reflux. The first urinary tract infection in a child, regardless of age, sex and severity of symptoms, should be checked. Children often develop symptoms under the age of 4, with recurrent urinary tract. Most of the medical patients are young and middle-aged women, mostly due to unilateral renal atrophy, renal failure, urinary symptoms, high blood pressure, etc.
The most common clinical manifestations of this disease are urinary tract infections and flank pains when urinating. The incidence of urinary tract infections is 63% to 88%; the incidence of proteinuria is 34, 5% to 54, 7%, which may also be the first symptom of RN, often appearing after several years of severe scar formation, suggesting that VUR has Lead to glomerular lesions, indicating poor prognosis. Renal function continues to worsen even after VUR disappears. In addition, the disease also has latent characteristics, often found in pregnancy due to urinary tract infections, proteinuria, hypertension, pre-eclampsia or renal failure. Individual patients occasionally undergo imaging studies for other reasons, and were found to have a single or double kidney scar or atrophy or to consider the diagnosis of asymptomatic bacteriuria. Some cases can be asymptomatic for a long time, until the renal insufficiency enters the uremia stage.
Cystic nephropathy :
The kidney size and shape are normal or slightly larger when the disease is young. The number and size of cysts gradually increase and increase with age. In most cases, the kidney volume increases to a considerable extent until 40 to 50 years old, and the symptoms are mainly Lateral kidney enlargement, pain in the kidney area, hematuria and hypertension.
1. Kidney enlargement: The renal lesions on both sides are asymmetrical, and the size is different. In the late stage, the two kidneys can occupy the entire abdominal cavity. There are many cysts on the surface of the kidney, which makes the kidney shape irregular, uneven, and hard.
2, kidney pain: for its important symptoms, often for the back of the back pressure or dull pain, but also severe pain, sometimes abdominal pain, pain can be due to physical activity, walking time is too long, sedentary and so on, can be relieved after bed rest, Intrarenal hemorrhage, stone movement or infection is also the cause of sudden severe pain.
3, hematuria: about half of the patients with microscopic hematuria, may have paroxysmal gross hematuria, this is caused by rupture of the cyst wall blood clots, blood clots can cause colic through the ureter, hematuria often accompanied by white blood cell urine and proteinuria, The amount of urinary protein is small, generally not more than 1,0g / d, pyuria in the kidney infection, hematuria increased, low back pain with fever.
4, high blood pressure: a common manifestation of ADPKD, before the serum creatinine is not increased, about half of the high blood pressure, which is related to the cyst compression of surrounding tissues, activation of the renin-angiotensin-aldosterone system, in the past 10 years, Graham PC, Torre V and Chapman AB have confirmed the normal tissues in the kidney of the disease. The cysts are adjacent to the interstitial and cystic epithelial cells, and the renin pigment is increased, and the renin secretion is increased. These are closely related to the growth of cysts and the occurrence of hypertension, in other words, Hypertensive cysts grow faster and can directly affect the prognosis.
5, renal insufficiency: this disease will occur sooner or later, renal insufficiency, individual cases in the adolescent period, kidney failure, generally before the age of 40, there is very little renal dysfunction, about half of the 70 years old still maintain renal function, but high blood pressure The process of developing kidney failure has been greatly shortened, and some patients still maintain kidney function at the age of 80.
6, polycystic liver disease: middle-aged patients with ADPKD, about half have polycystic liver disease, about 70% after 60 years old, it is generally considered that its development is slow, and more cystic kidney is about 10 years later, its cyst is caused by the labyrinth Expanded, in addition, pancreas and ovary can also occur cysts, colonic diverticulum rate is higher.
7, cerebral artery aneurysm: 10% to 40% of this hemangioma, often due to rupture of hemangioma, further examination of cerebral hemorrhage was found, in addition, thoracic aortic aneurysm and heart valve disease (such as valvular insufficiency and Prolapse is also more common.
Adult polycystic kidney disease usually develops in early adulthood, often with hematuria, hypertension or renal insufficiency. Abdominal palpation can reveal large polycystic kidney disease, renal function is mostly progressive, hypertension, obstruction or Pyelonephritis is an important cause of accelerated renal dysfunction. Autosomal recessive (infant) polycystic kidney disease occurs in infancy, clinically rare, mostly in infancy, and very few people with mild disease can live to adulthood.
The degree of anemia in this disease is often lighter than that of uremia caused by other causes. The reason is that the cyst of the kidney can generally produce erythropoietin.
Elderly nephrotic syndrome :
The disease is often caused by infection (tonsitis, pharyngitis or general upper respiratory tract infection), or suffering from cold, fatigue, onset, acute onset, sometimes insidious onset, the main performance:
1, edema: systemic, physical, concave edema, early more common in the ankle, morning eyelids, facial edema, with the development of the disease, edema can go to the whole body and chest, abdominal cavity and scrotum effusion, and even Pericardial effusion, heart failure can occur in elderly patients with severe edema.
2, a large number of proteinuria: urine protein > 3, 5g / 24h, severe cases up to a dozen grams, with selective or non-selective proteinuria.
3, hypoproteinemia: plasma total protein decreased, mainly plasma albumin decreased, mostly in 10 ~ 30g / L (1 ~ 3g / dl), occasionally reduced to 5, 8g / L (0, 58g / dl) .
4, hyperlipidemia: most patients with blood cholesterol, phospholipids and triglycerides can be elevated, these 4 points, a large number of proteinuria and hypoproteinemia as a necessary condition for diagnosis.
Diabetic nephropathy :
1, proteinuria early diabetic nephropathy without clinical proteinuria, only by radioimmunoassay can detect microalbuminuria. The only early manifestation of clinical diabetic nephropathy is proteinuria, which gradually evolves from intermittent to persistent.
2, edema clinical diabetic nephropathy generally no edema early, a small number of patients may have mild edema before plasma protein reduction. If a large amount of proteinuria, plasma protein is low, edema is aggravated, and the disease progresses to late stage.
3, hypertension in the type 1 diabetes mellitus patients with diabetes, the prevalence of hypertension is not increased compared with normal people, type 2 diabetes patients with high blood pressure, but if there is proteinuria, the proportion of hypertension is also elevated, in the presence of kidney disease The patient is accompanied by high blood pressure in the syndrome. This hypertension is mostly moderate and a few are severe.
4, renal failure Diabetic nephropathy progress is very different. Some patients with mild proteinuria can last for many years, but the kidney function is normal, some patients have few urinary protein, can rapidly develop nephrotic syndrome, kidney function gradually deteriorates, and finally uremia.
5, anemia patients with significant azotemia, may have mild anemia.
6, other organ complications manifested in cardiovascular disease such as heart failure, myocardial infarction. Neuropathy such as peripheral neuropathy. A neurogenic bladder can occur when the autonomic nerve is involved. Retinopathy, almost 100% of diabetic nephropathy with retinopathy, but severe retinopathy does not necessarily have significant renal lesions. When diabetic nephropathy progresses, retinopathy often accelerates to worsen.
Examine
Kidney disease examination
1, urine test
Urine routine tests are convenient, sensitive, and accurate indicators for diagnosis and judgment of disease and efficacy, and must be taken seriously.
2, urine volume and abdominal circumference examination
For patients with edema and acute nephritis, the urine volume should be accurately recorded 24 hours a day. 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, blood pressure measurement
Patients with hypertension should be measured regularly for blood pressure.
4. Merger certificate monitoring
Patients with severe pleural effusion, ascites, uremic pericarditis and heart failure often have chest tightness, belching, and symptoms of supine, and should adjust the patient's lying position in time.
5, fluid replacement
The hourly and minute input should be accurately calculated, and the drip rate should be strictly controlled to prevent heart failure and pulmonary edema.
6, diuretics
Pay close attention to the reaction after medication, and be alert to the occurrence of electrolyte imbalance.
7, edema injection observation
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 to 3 minutes to prevent the liquid from overflowing.
8, symptomatic observation
Specific problems symptomatic treatment, observe the early damage performance of renal function, and pay attention to take measures to protect kidney function to prevent disease development and deterioration.
Diagnosis
Diagnostic diagnosis of nephropathy
Can be diagnosed according to the cause, clinical manifestations and related examinations.
