In addition to the many details that are not easily detected in daily life, chronic kidney disease is also characterized by the fact that it is easily triggered by many other conditions and potentially numerous risk factors. In this issue, we will crush together.
The first ambush: synergistic evil with hypertension, with endless consequences
Hypertension is prone to cause chronic kidney disease. The blood vessels of the kidneys are like a rubber band, it needs a little elasticity. After the patient’s blood pressure rises, the blood vessels of the kidneys will be under more pressure. If the blood pressure continues to be high, this “rubber band” will be pulled very tight; long-term, the blood vessels will harden, and eventually lead to the kidneys also harden. If the patient is obese, a large amount of fat will be tightly wrapped around the kidneys, resulting in fat accumulation, it will cause poor circulation in the kidneys, which can lead to glomerulosclerosis in the early stage and kidney failure and atrophy in the later stage, leading to uremia.
Case: Old Gao is over 50 years old, is the leader of the village. 10 years ago his body has become blessed: 1.70 meters tall, he weighs 110 kg. As he grew older, his blood pressure also gradually increased. At first Lao Gao did not take it seriously, then he always felt a little dizzy, and irregularly took some antihypertensive drugs. Last year, the township organized a physical examination of village cadres, Lao Gao was found to be suffering from renal insufficiency and uremia.
Response: What awaits Lao Gao is dialysis or kidney transplant.
The second ambush: the wickedness with diabetes
A serious complication of diabetes is diabetic nephropathy. Among the uremic dialysis patients, diabetic nephropathy occupies a large proportion, which shows the prevalence of its damage to the kidneys. Diabetic glomerulosclerosis is a kind of glomerular lesion with mainly vascular damage, early stage is mostly asymptomatic, blood pressure can be normal or high, urinary microalbumin excretion >200 micrograms/minute, this stage is called occult nephropathy (or early nephropathy), if you can actively control hypertension and hyperglycemia, the lesion can be expected to improve; if poor control, with the progress of the disease can develop into clinical diabetic nephropathy.
Case: Wang Danyang, who has always been obese, went to the hospital for examination because of foam in urine, fatigue and weakness, and edema in both lower extremities, and was found to have elevated blood sugar and protein in urine; ultrasound found that the kidneys were also damaged. The doctor said that Wang had type 2 diabetes and diabetic nephropathy stage III.
Response: Thankfully, Wang’s condition was discovered early, and after weight loss and diet control, combined with medication, Wang’s blood sugar is now more stable and her proteinuria has disappeared.
The third ambush: attacking with hyperlipidemia, adding to the problem
Patients with hyperlipidemia are often complicated by chronic kidney disease, which causes morphological changes in kidney damage, resulting in increased fat content, weight and volume of the kidney; histological examination reveals that patients often have significant fat deposits in the basement membrane of the renal tubules and glomeruli, and the glomeruli also become hypertrophic, leading to focal segmental glomerulosclerosis.
Case: Wang Bo, who just passed middle age, was running a small business in the countryside. He was obese but did not have any discomfort, so he did not take it seriously. But not long ago, Wang Bo went to the hospital for blood test due to dizziness and was found to have hyperlipidemia and protein and sugar in his urine. He felt very strange because he had always been healthy and had never suffered from nephritis. He was busy consulting with his doctor, who read his labs and found that his blood lipids were very high, so he suspected that he had chronic kidney disease. After a kidney puncture, the doctor’s diagnosis was confirmed to be correct.
Response: Wang Bo is lucky because his disease has not yet reached the stage of uremia. After a period of treatment, Wang Bo basically returned to normal.
Fourth ambush: secret meeting with hyperuricemia, falling down the well
Gout very easily triggers hyperuricemia, leading to substantial renal lesions and uric acid stone formation, a small amount of proteinuria, and can be accompanied by mild swelling, moderate benign hypertension, increased nocturia and other symptoms; followed by decreased glomerular filtration rate and elevated urea nitrogen. The disease often develops slowly and leads to life-threatening renal insufficiency.
Case: Half a month ago, Lao Shi went to the hospital because of foamy urine and joint pain. After examination, Lao Shi was found to have hyperuricemia kidney damage, commonly known as gout nephropathy. The main reason for this disease in Lao Shi was that he did not diet, liked to eat animal offal, and over-eat meat and alcohol, and did not like to exercise.
Response: After allopathic treatment and dietary modifications after admission, Lao Shi’s condition was much better. If Lao Shi can insist on controlling his diet, his disease will further improve.
The fifth ambush: drug-related kidney damage surfaced, harming people
Drug-related kidney damage is due to different kinds of drugs on the kidney parenchyma damage, especially tubular interstitial damage, such as aminoglycosides, analgesics caused by kidney damage and some Chinese medicine caused by aristolochic acid nephropathy.
Case: Mr. Pan suffers from gouty arthritis. When the pain in his joints attacked, he used to take allopurinol and colchicine, in addition to analgesics such as anti-inflammatory pain and ibuprofen to relieve the pain. In the past year, he had recurring attacks of gout and took analgesics every day to prevent pain. Not long ago, his family said that he looked ugly, and at the same time, Master Pan himself often felt weak and had a dry mouth, and also experienced weight loss, increased nocturia and hematuria, occasionally accompanied by urinary urgency and pus.
After a series of biochemical tests, he was found to be suffering from not only anemia but also renal insufficiency, and the ultrasound results showed that his kidneys were shrinking, with thinning cortex and poor surface finish. The doctor said that Master Pan was suffering from “analgesic kidney damage”.
Response: Patients like Mr. Pan should resolutely avoid abusing painkillers; when you must take painkillers, pay attention to drinking more water to increase the amount of urine and improve the solubility of the drug to avoid precipitation of crystals and damage to kidney tissue. Long-term analgesic users should have regular comprehensive urinary system examination, and once symptoms such as increased nocturia, mild anemia and elevated blood pressure appear, they should go to the hospital as early as possible to prevent the occurrence of analgesic nephropathy.
The sixth ambush: with occult nephritis extremely disguised, difficult to see the face
Occult nephritis is a manifestation of chronic glomerulonephritis. Its salient feature is that patients do not have any clinical conscious symptoms, only abnormal urine routine tests, such as positive urine protein test, positive urine occult blood test, persistent or recurrent microscopic hematuria, and a large number of abnormal red blood cells visible on phase contrast microscopy. If kidney puncture examination is performed, pathological changes in the histological structure of the kidney can be found.
The disease is mostly seen in adolescents, with the age of onset mostly between 10 and 30 years old, and is rare above 40 years old, with more males than females. The onset is insidious and often lacks glomerulonephritis features such as edema and hypertension. Bilateral nonspecific lumbar soreness may be the only symptom in the medical history. Mainly, urinalysis is abnormal, and many patients are found by chance from routine urinalysis, or first confirmed by urinalysis done for cold or fever or during physical examination.
Case: Ms. Zhang was over 50 years old and her unit physical examination revealed renal insufficiency with mild anemia. Ms. Zhang was healthy in the past and never suffered from acute or chronic nephritis, hypertension, diabetes, lupus erythematosus and other diseases, but Ms. Zhang had been suffering from back pain for many years. Why did Ms. Zhang cause uremia? It turns out that Ms. Zhang suffers from occult nephritis.
Seven, response: physical examination + self-examination
First of all, it is necessary to do regular routine urine examination. Many units have annual routine physical examinations for their employees, and there are indeed patients with proteinuria or microscopic hematuria detected during routine physical examinations, followed by further examinations to confirm the diagnosis of nephritis. However, there are many units that do not do routine urine examinations. This is not correct. All units should have annual routine physical examinations, and all annual routine physical examinations should include routine urinalysis so that patients with occult nephritis can be detected and treated in a timely manner.
Secondly, a simple and easy way is: if there are many splashes of foam after urination, like beer or laundry detergent water, and the foam does not dissipate for a long time, it may be a sign of proteinuria; if the color of urine is like meat wash or tea water color, it is carnal hematuria. You should go to the hospital for examination and, if necessary, a kidney puncture to confirm the diagnosis. Especially if there are kidney disease patients in the family, it is essential to raise awareness. The sixth ambush: drug-related kidney damage surfaced, harming people.