One summer in 2001, Aunt Yin came from Nanhai, Guangdong to see a doctor. She told me that she had been suffering from “anemia” for more than three years and had been hospitalized in a hospital affiliated with a medical school in Hunan Province, where the doctor diagnosed her with “anemia”. Because the whole family was working in Nanhai, their income was not much, so they could not afford the cost of blood transfusion, and they had not received blood transfusion for nearly half a year. Her sister-in-law brought her to me. Her symptoms were fatigue and weakness, shortness of breath with a little activity, and a waxy complexion, but no other discomfort. The results of routine blood tests were: red blood cells 1.5×1012/L, white blood cells 3×109/L, hemoglobin 65g/L, platelets 80×109/L.
There were no obvious abnormal findings in the urine routine. Based on these two test results alone, it was easy to think of the diagnosis of anemia. However, the results of her biochemical examination were: creatinine 278umol/L, urea nitrogen 24mmol/L, high blood lipids, and no abnormalities in liver function, bilirubin and other indicators. Considering the above results, the patient had two problems: anemia and renal insufficiency (i.e. renal failure).
Among them, renal insufficiency can lead to anemia, coupled with the fact that the patient’s condition did not improve with multiple blood transfusion treatments. So her condition was judged to be renal anemia caused by renal insufficiency, and she was treated with erythropoietin according to renal anemia, and after 2 weeks, all indicators of routine blood tests returned to within the normal range, which proved that the judgment at that time was accurate. Subsequently, he has been treated according to renal insufficiency with a combination of Chinese and Western medicine, and his condition has been stable so far.
Through this case, I would like to let you clearly understand the following points.
1, no matter what kind of disease, before the cause of the disease is identified and clearly diagnosed (of course, some diseases that cannot be identified at all and cannot be diagnosed temporarily are exceptions), it is best not to blindly treat the disease, otherwise it will be counterproductive, not only detrimental to the treatment of the disease, but also may delay the treatment, aggravate the disease, and in serious cases, may lead to death. For example, the treatment of renal anemia is completely different from the treatment of common anemia. Renal failure often has varying degrees of anemia, which is a positive cellular normocytic anemia that arises mainly from.
(1) Decreased renal production of erythropoietin (EPO);
(2) Decreased iron intake;
(3) Folic acid deficiency;
(4) Shortened survival time of red blood cells in renal failure;
(5) Lack of protein in the body;
(6) Inhibition of hematopoietic function of bone marrow by uremic toxins;
(7) Blood loss during hemodialysis or frequent blood draws for laboratory tests. It may also be accompanied by a decrease in white blood cells and platelets, which may manifest as subcutaneous petechiae, nosebleeds, and excessive menstruation in women. Treatment is mainly EPO injections, folic acid and iron supplements and attention to nutrient balance. Blood transfusion therapy is generally inappropriate, unless the hemoglobin is below 50g/L and the patient’s life would be in danger without transfusion, otherwise blood transfusion therapy is not advocated. Because the red blood cells imported into the patient’s body will keep aging and dying, producing a large amount of nitrogenous waste in the short term, causing a large accumulation of toxic substances in the body, increasing the burden on the kidneys and promoting the development of renal failure.
In addition, sick, it is best to go to the hospital to see a doctor, do not be afraid of trouble, and not to save money, not to the hospital, take it upon themselves to buy drugs to eat, otherwise the consequences are unpredictable. Especially in today’s society, pharmacies can be found everywhere, the quality of pharmacy staff varies, the name of the drug is varied, we do doctors are sometimes difficult to distinguish the true from the false, not to mention the majority of patients, accidentally will eat the wrong medicine. If it is not convenient to go to the hospital, at least consult with professional personnel about the knowledge, most of the regular pharmacies are equipped with licensed pharmacists or resident pharmacists, please inform your condition before buying drugs, consult with them a couple of. Do not listen to those who are driven by monetary interests advocate “so-and-so medicine is a special medicine for a disease, the most suitable for you to take! Only they know if it is suitable, and nine times out of ten you will become a victim.
2, chronic renal failure is a relatively insidious disease, must strengthen the monitoring
In the early stages of chronic renal failure, in addition to elevated blood creatinine and urea nitrogen, often no clinical manifestations, but only the symptoms of the underlying disease, such as fatigue, nausea, vomiting, itchy skin, anemia, hypertension, hyperkalemia, etc., to the development of the disease to the residual kidney units can not adjust to the minimum requirements of the body, the symptoms of renal failure will gradually manifest. Even no performance, only when the blood test found that the blood creatinine and urea nitrogen has been very high, has lost the best time for treatment, and some have even entered the uremic phase, can only rely on dialysis or kidney transplantation treatment. However, the high cost of dialysis or kidney transplantation is not affordable for families with average income.
In May 2004, Xiao Li from Foshan, Guangdong, male, only 24 years old, just graduated from college, usually very good health, rarely sick, suddenly appeared nausea and vomiting, do not want to eat, to the hospital a check, the blood creatinine has risen to 2400 umol/L, must take dialysis treatment, but the patient has not been able to find a job, his mother has died, his father is unemployed at home, a family of 3 His mother had died, his father was unemployed, and his family of 3 depended on his sister’s monthly income of 1,200 yuan to make ends meet, so he could not afford to pay for dialysis. After many efforts, the creatinine dropped to 1500 umol/L. The patient could no longer afford to pay the hospitalization fee, and only one way left was to go home. Such examples are numerous and heartbreaking. In addition, no one has survived more than 20 years after kidney transplantation. How many people can afford to have another kidney transplant? Not many, I am afraid. Therefore, I would like to advise everyone here, regardless of your physical strength or weakness, it is necessary to have a medical checkup once a year, and do not miss the indicators of kidney function during the checkup.
3.As long as the diagnosis and treatment are timely, chronic kidney failure can be controlled
For various reasons, people can be said to “talk about kidney failure”, most people think that kidney failure is the same as a “death sentence”. In fact, it is not. Even uremia is not a terminal disease. Some patients can be treated if you can find the reversible factors of the original disease, and add to correct, uremia can be reversed. For example, various causes of hypercalcemia, lupus nephritis or hypokalemia can cause kidney damage and produce uremia, and its clinical manifestations are sometimes very similar to the uremia caused by primary chronic nephritis, but if the original disease can be detected and treated in time, the condition can be reversed. In addition, correcting certain reversible factors that aggravate renal failure can also improve renal function.
Chronic renal failure can be divided into the following stages.
1, azotemia stage, is the early stage of renal failure, blood creatinine has been elevated, but <450 umol/L, usually no obvious symptoms, there may be mild anemia, polyuria and nocturia;
2, renal failure stage, blood creatinine is significantly elevated, about 450 -707umol/L, anemia is obvious, nocturia increased, there may be nausea, vomiting, hypertension and other symptoms appear;
3.Uremia stage is the advanced stage of renal failure, blood creatinine >707umol/L, various symptoms are obvious and more serious. Azotemia stage is the key period of kidney failure treatment, based on strict control of diet, blood pressure, etc., mainly relying on a combination of Chinese and Western medicine treatment. After treatment, the development of renal failure can be delayed and creatinine in some patients may be restored to within the normal range. Even at the stage of renal failure, the combination of Chinese and Western medicine is currently advocated as the main treatment.
According to our experience, the combined treatment of Chinese and Western medicine can delay the uremic phase for 5-10 years for patients in the azotemia stage and 3-5 years for patients in the renal failure stage. After the conservative treatment with a combination of Chinese and Western medicine is ineffective, and enter the uremic phase, dialysis treatment should be performed as early as possible. Dialysis treatment can also be combined with traditional Chinese medicine treatment in order to reduce the discomfort caused by dialysis treatment and possibly the number of dialysis sessions.
In conclusion, self-monitoring and self-care are very important for all of us, and we should not ignore the disease because it is small and regret when it is not treated. You should not make the mistake of seeking medical help in a hurry. I hope the news of “so-and-so’s untimely death” will always be far away from us.