Kidney disease used to seem far away from us, but now it feels like it’s all around us because of its high incidence. Now I will first tell you a little bit about the current situation of kidney disease, then how to prevent it and how to manage kidney disease in the end.
Kidney disease is actually not scary at all, if managed well, this disease can be treated.
What is chronic kidney disease? In the past, we were very confused, there were many concepts, such as chronic renal insufficiency, uremia and many other concepts, which caused great difficulties in communication between the medical profession and patients. In recent years, the concept of chronic kidney disease (CKD) has been unified internationally, and it is easier for people to communicate with each other. Chronic kidney disease is defined as kidney disease if the kidney damage or decrease in kidney function, regardless of the cause, lasts for more than three months, CKD is mainly due to abnormalities in the kidney structure or hematuria in the urine, even if there is no decrease in kidney function. Also, even without these abnormalities, kidney function has declined, both of which can be diagnosed as chronic kidney disease as long as they last more than three months. For the general public, most kidney diseases are chronic kidney diseases. The medical community divides chronic kidney disease into different stages because the management is not quite the same for different stages, and the staging is also beneficial to the academic community.
First, if the kidney function is normal, but there is hematuria and proteinuria detected inside the urine, even if the kidney function is normal, this is also the first stage of kidney disease. If the kidney function decreases, it is stage 2. If CKD reaches 30 or more, it is stage 3. Above that is stage 4, which requires dialysis.
Some people ask how many stages of kidney disease I have. There is a formula if you go to the hospital to test the blood creatinine concentration. Staging is good for doctor-patient communication and disease management. If I calculate it, my CKD is stage 4, do I need dialysis? Not so, as long as we manage it well, it will not continue to develop and worsen. Even CKD stage 5 does not have to reach the point of dialysis immediately.
People say that some patients with chronic kidney disease seem to be very far away from us. The first data is a survey done in Shijingshan District, which found that the prevalence of chronic kidney disease among normal healthy adults over 40 years old is 11.3%, that is, one out of 10 people over 40 years old is a kidney disease patient. Meanwhile, a survey in Guangzhou and a survey in Tianjin also found that one in 10 adults has kidney disease.
A few days ago, another survey was done in Beijing, among people over 18 years old, one out of 10 normal people is also a patient with chronic kidney disease, which shows a very high incidence. However, unfortunately, most patients with chronic kidney disease do not know that they have chronic kidney disease, the disease awareness rate is only one in ten, that is, only one in 10 patients know that they have chronic kidney disease. If we know it, if we prevent it, it will not progress, but if we do not prevent it, it will progress invisibly, it is an invisible killer. As the age increases, the oldest, the higher the prevalence of kidney disease. In people aged 60-70, the prevalence of kidney disease is nearly 20%, higher than 70 years old. The situation in Taiwan is even more terrible. A survey was done in Hong Kong, about 20% of people have abnormal urine tests, but these people look healthy on the outside. Doctors in Taiwan have also done a survey, in CKD stage 3 or above, that is, kidney function has been incomplete, in a population, 6% of the people kidney function has been reduced. Kidney disease is a very common disease. However, the awareness rate of patients with CKD in early stage is very low, and it is the same all over the world, many people do not know they have CKD, which is the real scary thing.
Why chronic kidney disease is increasing?
One of the very important reasons is the aging of the population. The older people live, the lower the function of organs, the kidney is a very important organ, it is not difficult to understand that with the aging of the population, chronic kidney disease will become more common. Also, the increasing incidence of chronic kidney disease is related to the fact that there are more and more patients with diabetes and more patients with hypertension, and these diseases will lead to a decline in kidney function after some time, and kidney function will become worse and worse. There is also the abuse of drugs, nowadays pharmacies are everywhere, uncomfortable to buy their own drugs, which also leads to more and more people with kidney function damage. In the past, we saw that 1/4 of the patients with decreased kidney function were caused by drugs.
Also, glomerular disease caused by infection is a big problem. In addition, the rate of awareness and detection is still higher than before, and now that medical checkups are gradually becoming more popular, we have a higher chance of detecting kidney disease. The number of people with kidney disease is high, as mentioned above. But the cold is also a lot of ah, kidney disease and the cold and completely different, because the treatment of kidney disease is very expensive, if the kidney disease is not cured, the development of dialysis, an ordinary patient a year to spend 60,000 to 100,000 yuan, so dialysis in the health insurance is a major disease, this part is a special reimbursement, the state used a lot of money in this part of the treatment. If we don’t prevent it and do a good job to prevent and treat it, the burden of our country will be more and more heavy.
How to prevent kidney disease?
The top doctor treats the disease that is not yet sick, the middle doctor treats the disease that will be sick, and the bottom doctor treats the disease that is already sick. The first level of prevention is to keep those patients who do not have kidney disease from getting kidney disease, and to screen or educate the general population at risk of kidney damage, even the general population, to detect chronic kidney disease early or prevent the occurrence of chronic kidney disease. The focus of primary prevention is in the community, in the patient’s family.
We need to know how the kidneys work? The kidneys are a very important organ, on either side of the spine of the body. The kidneys have glomeruli and renal tubules. The main function of the kidneys is very simple. We compare the kidneys to a sewer that removes excess water and toxins. One of the functions of the kidneys is to remove metabolic waste from the blood, control body fluids, maintain the balance of water and electrolytes in the body, control blood pressure, promote red blood cell production, and maintain healthy bones.
To do a good job of primary prevention of kidney disease, we must first know who are prone to kidney disease. Patients with diabetes, they are very prone to develop kidney damage. Patients with hypertension and atherosclerosis, which are very common in the community. The elderly, obese people, obese people are at high risk of kidney disease. It has been found in China or western countries that the chance of kidney disease is much higher for the family members of people on dialysis than for other patients; long-term use of various drugs, such as arthritis, long-term use of painkillers, also prone to kidney damage. Therefore, our community workers should do some routine screening to find out whether these people have chronic kidney disease early.
How to detect chronic kidney disease?
One is to test and screen the high-risk group. In addition, we should pay attention to some symptoms that may appear in these patients, but unfortunately, patients with chronic kidney disease often do not have symptoms specific to kidney disease, and these symptoms can often appear in other diseases. What are the symptoms of chronic kidney disease? Fatigue, feeling tired after work, lack of energy, lack of concentration, poor appetite, poor sleep, cramps, relatively special performance is that the patient may have edema of both lower limbs, eyelid edema, dry skin, the patient did not get up at night to urinate, but now you have to get up at night to urinate, this time can indicate that your kidneys have problems. There is often foam when you urinate, this does not mean that there is a problem with the kidneys, the foam of proteinuria is often a very fine bubble end. The foam formed in urine after urination does not break for a long time, which often indicates that there is some protein inside the urine and the kidneys may have damage. Therefore, community health care workers or patients who find some symptoms like this, or people who are at high risk of kidney disease, would like to pay attention to whether they have kidney damage.
How do we know if our kidneys are damaged?
One is to have some clinical symptoms in front, and the other is to do a routine urine test, which may reveal hematuria, proteinuria, or nothing, or do a routine blood and kidney function test. There may not be any change in the urine, but the blood creatinine may be increased, which also means the kidney function is damaged. There is also an ultrasound of the kidney. So, it is very easy to find out kidney disease, urine routine, blood routine and kidney function test, as well as kidney ultrasound are effective ways to detect kidney disease.
What should we do if we find out that our kidneys are really damaged and there is hematuria, proteinuria or decreased kidney function in our urine? As health care professionals working in the community as well as patients, it is important to consider that we need to have a proper diagnostic thinking. Kidney disease is composed of many kinds, chronic kidney disease is not one disease, there are many kinds, some of them are easy to treat and some are relatively difficult to treat. Therefore, once we find that there are abnormal urine or abnormal kidney function, the first thing to look at is whether the diagnosis is accurate, whether there is an error, to determine whether you really have kidney disease. If the review reveals that people who really have kidney disease, we need to consider, what exactly is the disease that caused our kidney disease. Kidney disease is easier to diagnose than other diseases. Within the manifestations of kidney disease, it can be divided into different syndromes: such as acute glomerulonephritis syndrome, asymptomatic proteinuria and/or hematuria, nephrotic syndrome, and chronic glomerulonephritis syndrome.
In any patient with chronic kidney disease, the first thing to consider is whether it is caused by other systemic diseases. If secondary kidney disease is ruled out, only then can the disease be diagnosed as a primary kidney disease. Because the secondary ones are completely curable. Therefore, common diabetes, nephropathy, and amyloidosis-like can cause kidney disease.
In addition to glomerulonephritis, there is also tubular and interstitial renal disease, which are treatable. Including, chronic pyelonephritis, renal papillary necrosis, painkiller nephropathy, heavy metal poisoning and so on, these can be cured.
We need to know the characteristics of chronic kidney disease, kidney disease is often a disease that follows the patient for life, and often accompanied by other diseases. Especially with the gradual extension of the date of suffering from chronic kidney disease, our systemic system, including cardiovascular and cerebrovascular diseases, may appear, and many of these diseases cannot be cured, but we can completely control them from progressing. The key point is that the control of chronic kidney disease does not depend on medical personnel alone, but on the self-treatment of patients. So for chronic kidney disease to be well controlled and prevented, it is very important for patients to actively participate in the treatment arrangement instead of listening to medical staff for everything. In the treatment of chronic kidney disease, a very important feature is that drugs only play an auxiliary role, more important is our diet, lifestyle adjustments, which is crucial. Another very important thing is that chronic kidney disease is a lifelong patient, so the cure is not our goal, but the restoration of a normal life is our main goal. Now we find that many people find out they have kidney disease after medical examination, they immediately retire from the disease and immediately stop working, which is very unfavorable, they should resume normal work within their ability.
There is a big difference between chronic kidney disease and acute disease, acute disease is to say I have this disease, to get well, rest at home, and then work after the disease is well. The goal of CKD treatment is rehabilitation, not cure. Lifestyle modification of patients is the key to CKD prevention and treatment, not drugs. Health care professionals are professional mentors, not just prescribing medication, but teaching patients the proper knowledge and guiding them with the appropriate skills to change their lifestyles. Patients need to be actively involved in all decisions about their treatment, and patient self-management is the key to success or failure in disease management.
Why? Our community health care workers must realize that all chronic diseases and chronic kidney disease are the same, and our whole concept of work has to change. A patient with chronic kidney disease has a very short contact time with our health care workers in a year, maybe 10 or 15 minutes a month with the doctor, and most of the time is self-treatment at home. The only thing is that the patient must master the prevention and treatment skills, knowledge of prevention and treatment, so that the patient can self-manage, the disease can be controlled. Why is the control rate of hypertension and diabetes very low in our country including western countries? This is related to our medical model, doctors only know to prescribe drugs to patients, patients only know to take drugs, patients do not know to self-control at home. Therefore, one of our ideas is to find ways to train patients and their families to become self-care doctors. The knowledge acquired in this small area does not need to be a lot, and in this regard patients and their families should become experts in the treatment of this disease, rather than simply relying on medical personnel, because the characteristics of this disease determine that if you have to rely on medical personnel yourself, this disease cannot be controlled.