What’s going on with kidney disease
Chronic kidney injury (CKD) is a common but unfamiliar disease. It is said to be common because the incidence rate is about 10.8% in China, and there are about hundreds of millions of CKD patients in the country according to this ratio, and the trend is still growing. Such a large group of patients brings great mental pressure and economic burden not only to society, enterprises, but also to families and individuals. It is unfamiliar because many people have many misconceptions about CKD, making many originally simple conditions complicated, resulting in delayed treatment or aggravation of the condition. Some people even use inappropriate treatment measures to worsen their condition. Therefore, for every CKD patient, mastering certain knowledge about prevention and treatment related to nephritis will help you to cooperate with your physician to treat your kidney disease well!
1. What are the physiological functions of the kidneys
The kidneys are an important organ for maintaining normal physiological functions of the human body and play an extremely crucial role in maintaining the life activities of the human body. Each person has two kidneys, each kidney has about 1 million kidney units, and all the physiological functions of the kidneys are mainly performed by the kidney units. The human kidney unit has the following characteristics.
① The kidneys have a large reserve capacity, and usually as long as one side of the kidney is functioning well it can meet the normal physiological needs of the body. However, this also poses a problem in that many patients with nephritis can be asymptomatic in the early stages of renal impairment, and once clinical symptoms appear, the disease is already in an advanced stage and difficult to reverse.
② Kidney units cannot be regenerated, and one bad one is less. Generally from the age of 40 years, every decade decreases by 10%. The kidney function is gradually declining with age, so it is especially important for adult nephritis patients to have timely and reasonable treatment.
2, what is nephritis
The name of nephritis is not an independent disease, but represents a general term for a large group of diseases. It is a very good idea to have a good look at it. The former includes a variety of unexplained glomerulonephritis, which is a consequence of allergic reactions; the latter includes a number of systemic diseases, which then spread to the kidneys, such as diabetes, connective tissue diseases (lupus erythematosus, vasculitis), hepatitis B, hepatic steatosis, etc. The corresponding kidney damage can be caused. Secondary nephritis can also occur after some infections, poisoning caused by certain drugs or toxins, and allergic reactions. It is important to point out that different types of nephritis have significantly different clinical manifestations and regressions, and they also differ greatly in their treatment. Because of this, every patient with nephritis must be thoroughly examined, and only in this way can the physician help to clarify the type of nephritis in order to take effective and targeted treatment measures.
It is worth emphasizing that many patients are clinically fearful of nephrotic syndrome, which is not necessary. Nephrotic syndrome is also a common type of nephritis. No matter what kind of nephritis, as long as a large amount of protein in the blood “leak” into the urine, so that the body’s plasma protein significantly decreased, and the resulting swelling, oliguria and other phenomena, we can call this phenomenon nephrotic syndrome. Obviously, nephrotic syndrome only indicates that these nephritis patients have prominent proteinuria and significant edema, but nothing else. The actual nephrotic syndrome is not an independent disease at all, let alone an incurable disease.
The actual nerve of the person who is in a position to get a good deal more than just a few of these.
The actual nephritis patients generally show swelling, hematuria (strong tea or wash water-like color), proteinuria (increased urine foam), back pain, hypertension, increased nighttime urination, oliguria, often accompanied by gastrointestinal symptoms (nausea, vomiting), weakness, anemia, etc. in the later stages.
Generally speaking, about 75% of pediatric patients (especially children aged 2-6 years) present with nephrotic syndrome with a large amount of proteinuria as the main manifestation. These children are characterized clinically by extremely prominent proteinuria and swelling, but on renal pathological examination, the glomeruli show very mild, mostly microscopic lesion-type pathological damage, and often respond well to treatment with drugs such as tretinoin and prednisone. In other words, tretinoin and prednisone can reduce the clinical symptoms or stop the leakage of protein into the urine in children with this type of disease. Minimal lesion nephrotic syndrome often disappears in adolescence and does not cause permanent damage to the kidneys.
Adult nephritis, on the other hand, differs from childhood nephritis in that it is characterized by a different profile. In addition to unequal amounts of protein and red blood cell components in the urine, there is also swelling, hypertension, sarcoid hematuria, renal insufficiency, and other abnormalities in blood tests. The course of the disease tends to be highly fluctuating and prolonged. The clinical manifestations and the rate of progression vary greatly, which is mainly determined by the nature of the pathological damage to the kidney, and sometimes it is difficult to make a judgment from the clinical manifestations alone. The only way to clarify which type of nephritis is to have a kidney biopsy. Because of the late development of kidney biopsy and research on nephritis in China, there are many misconceptions about nephritis, and these traditional misconceptions largely affect the treatment and recovery of nephritis patients.
Eight misconceptions
1, nephritis is an incurable disease
The actual fact is that you will find a lot of people who believe that nephritis is difficult to treat or a persistent problem that can’t be cured, which is actually a misconception. The actual fact is that you will be able to get a lot more than just a few of these. The effectiveness of the treatment mainly depends on whether the treatment is timely and reasonable and whether the right medicine is prescribed, and more importantly, on the patient’s own health care measures (such as diet, rest). The reason for the misconception that nephritis is an incurable disease is that most nephritis is a chronic process with insidious symptoms that are not easily detected and ignored in the early stages. The first is that most nephritis is a chronic process and its symptoms are insidious and not easily detected at an early stage. Second, the basic pathogenesis of kidney disease is ignored. Some patients think they are cured because their symptoms are relieved after treatment and they feel well, so they neglect the maintenance treatment and follow-up. In fact, at this time, the disease is chronic and slowly progressing. When they feel unwell and go to the clinic again, the nature of the disease has changed essentially. In fact, the abnormal sensation is months to years later than the changes in urine and blood tests. Therefore, every patient with nephritis should be reviewed regularly in case of unpredictability, regardless of their condition. Early examination, correct diagnosis, long-term follow-up and serious treatment are the keys to ensure the efficacy of nephritis.
2. Avoid salt
The actual fact is that there is no scientific justification for this. The actual fact is that there is no scientific justification for this, as salt is an essential element of human tissue metabolism, and many physiological functions of the human body depend largely on the participation of such substances. Usually, if there is no obvious swelling and hypertension, 3-5 grams of salt can be supplemented daily; for severe edema or hypertension, salt intake can be reduced appropriately according to the situation. In any case, a complete ban on salt is not advisable.
3.Eating kidney to nourish the kidney
Some people think that eating animal kidneys can nourish the kidneys of the self, in fact, this is a misunderstanding. Although the protein content of animal kidney is high, it should not be eaten. Because this kind of food, in addition to cholesterol, purine content is also very high. They not only do not play a nutritional role, but will increase the burden on the kidneys, causing adverse consequences.
4, forbidden water
Many nephritis patients are reluctant to drink more water, fearing that the increased volume of urine after drinking water will increase the burden on the kidneys. In fact, the opposite is true, the body’s daily metabolic wastes are dependent on urine to bring out of the body. If you drink very little water and do not have enough urine, it will cause the accumulation of waste in the body and increase the burden on the kidneys. Only in patients with obvious swelling is it necessary to limit the amount of water drunk.
5, abuse of antibiotics
Some patients equate nephritis with general inflammatory diseases (such as enteritis, pneumonia, cystitis, etc.) and commonly use antibiotic treatment. The result is not only no obvious effect, but sometimes make the symptoms of nephritis aggravated. In fact, there is a fundamental difference between the two. Nephritis is a metaplasia caused by abnormalities in the immune system, while inflammatory diseases are caused by bacterial infections. The latter can be treated with antibiotics, while the treatment of the former is mainly to remove antigenic substances and block abnormal immune reactions, so immunosuppressants are mainly used, while antibiotics are not effective at all. On the other hand many antibiotics are more or less nephrotoxic, and if there is no indication of abuse, it can cause antibiotic kidney damage and aggravate the kidney lesions.
6, believe in prescriptions
It is a mentality of patients who have been untreated for a long time to seek medical help. The prescription for a major disease is also a psychological trust of the patient’s eagerness to cure. The so-called prescriptions generally have three cases.
(1) the accumulated experience of the previous people, some of the prescriptions have cured some cases, but the mechanism of its cure needs to be studied and confirmed by modern medical theory and methods.
② Some of them are symptomatic rather than curative.
③There are also some even fake medicines.
The reasons why patients with nephritis should not casually use prescriptions.
① it is not allopathic at all, as mentioned earlier there are dozens to hundreds of types of nephritis, different types of nephritis whose etiology, nature of lesions and severity are completely different, treatment methods are also very different, using a prescription to treat all types of kidney disease is obviously inappropriate;.
Many herbal medicines are nephrotoxic, such as powdered antibiotics, which may aggravate the kidney lesions, and most drugs are excreted through the kidneys, so abusing them will only increase the burden on the kidneys, which is harmful but not beneficial. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
7, chronic nephritis is the transformation of acute nephritis
It is widely believed that chronic nephritis is the consequence of untreated acute nephritis. In fact, there is no difference between acute and chronic nephritis. The root cause of this misconception.
One is because folk treat nephritis as a separate disease and do not differentiate from the nature of the lesion.
Second, the past understanding of nephritis is limited only to clinical experience, the lack of today’s advanced means, usually the length of time and symptoms of the onset of acute and chronic nephritis as a criterion for judgment, so far, there are still many people are still accustomed to call nephritis acute or chronic nephritis;.
Thirdly, according to the response to the initial treatment of nephritis to judge, the first treatment after the symptoms remission is acute nephritis, otherwise, it is chronic. In fact, this understanding is one-sided.
As mentioned earlier, nephritis is a general term for a large group of diseases, and there can be hundreds of them by their nature. Nowadays, it is no longer possible to distinguish between acute and chronic nephritis based on the characteristics of clinical symptoms. In other words, there is no longer a distinction between acute and chronic nephritis. This is because the majority of nephritis is characterized by clinical signs, disease course and regression, which are determined by the nature of the lesion in the kidney and are difficult to determine from clinical aspects alone. For example, there are some types of nephritis, although the clinical symptoms are very prominent, but the pathological damage to the kidney is often self-limiting, that is, after a period of self-adjustment, the renal pathological changes can be self-relief, or even self-healing; while there are some types of nephritis clinical symptoms are very insidious, or even no signs, but the pathological damage to the kidney progresses very quickly. Therefore, we should not presume to assess the nature and progression of kidney lesions from the clinical symptoms of nephritis patients alone. This may lead to unnecessary treatment of patients who could have recovered spontaneously, while some patients who need timely and durable treatment are lost. The only scientific measure to avoid this phenomenon is to make kidney biopsy, to clarify the nature of kidney lesion in time and to take targeted treatment measures.
8.Obesity is not a disease
The traditional concept equates obesity with health, and believes that obese people are in good health, while lean people may be combined with disease. Secondly, this traditional concept is wrong. All diseases are fat first” has been confirmed by a lot of research. In fact, the human body’s internal organs are limited in their ability to function, excessive obesity will increase the workload of these organs, bringing chronic damage. Diabetes and a significant portion of CKD are due to obesity. Currently, obesity is defined as the accumulation of fat in the body exceeding 20% of the ideal body weight. Obesity is diagnosed based on the patient’s body mass index. Body mass index = weight (kg) / [height (m)]2. The Chinese Obesity Research Collaborative Group, with reference to domestic epidemiological data, defines obesity as body mass index ≥ 28.0 kg/m2; waist circumference: men > 84 cm, women > 80 cm. overweight is defined as: body mass index ≥ 25.0 kg/m2. abdominal obesity is defined as: body mass index ≥ 28.0 kg/m2, visceral fat area > 120 cm2. In Europe and the United States, obesity is divided into 3 levels, I: body mass index 30.0 ~ 34.9kg/m2, II: body mass index 35.0 ~ 39.9kg/m2, III: body mass index > 40kg/m2.
Second, what tests are done for patients with nephritis
Generally speaking, for patients suspected of kidney disease, urine and kidney function should be examined promptly. These tests can initially understand the degree of kidney lesions, but if the nature of the kidney lesions still cannot be clarified, the diagnosis must be assisted by the method of kidney biopsy.
1.Urine
The simplest way to detect urine is “test paper method”. This method can only give a rough idea of the content of various components in urine, but cannot accurately determine the degree of hematuria and proteinuria. Therefore, in order to know the severity of the disease, patients with nephritis should undergo a comprehensive and accurate examination.
The current common methods are.
①Morphological analysis of urine red blood cells: This test is a special method to observe the number of red blood cells in the urine and morphological changes, which can accurately determine the degree of red blood cells in the urine and from which part of the urinary system, which is extremely important for clinical diagnosis of nephritis and observation of changes in the disease.
②Quantitative urine protein: It can accurately grasp the amount of protein leaked in the urine, which is helpful to determine the degree of lesion.
③Urine protein composition analysis: By judging the size of the molecular weight of protein urine, the degree of glomerular filtration membrane damage can be inferred indirectly.
④Urine osmolality: it can understand the concentration and dilution function of the renal interstitial tubules.
In addition, there are some tests that can measure the enzymatic changes in urine, which can also help to determine the severity of renal lesions, especially renal tubular damage.
Nevertheless, due to the wide variety of nephritis, the differences between each other in terms of clinical manifestations and blood and urine tests are not very obvious, and the various tests mentioned above are only peripheral indicators to indirectly infer the nature and extent of kidney lesions. Therefore, to accurately grasp the nature and severity of kidney lesions, only through the means of kidney biopsy can be achieved.
2.Renal biopsy
Renal biopsy is the abbreviation of kidney biopsy. Since the biopsy tissue is obtained by puncture, we often call renal biopsy as renal puncture. To date, renal biopsy is still one of the essential tools for diagnosing the nature and extent of kidney lesions and selecting the best treatment plan. The method is to take out a small strip of tissue from the kidney with a small puncture needle, and carefully study it through a series of modern scientific methods such as light microscopy, electron microscopy, immunology and molecular biology, and analyze it according to the characteristics of the lesions in the glomerulus, tubules, interstitium and small blood vessels in the kidney to identify which type of kidney disease it belongs to, its degree and regression, and to provide accurate information for treatment. With the development of modern medical technology, this technique has been commonly carried out in most hospitals.
Three, the common measures of nephritis treatment
The establishment of a treatment plan for nephritis is mainly based on the type of pathological damage to the kidney. The treatment will be different for different types of nephritis. In general, the treatment of nephritis consists of several main aspects.
① Control of the systemic symptoms caused by nephritis.
② Reduction and improvement of inflammatory damage to renal tissue.
③ Prevention or correction of comorbidities or complications.
The core of kidney disease treatment is to prevent the deterioration of kidney function rather than simply improving proteinuria or hematuria.
1.Control the systemic symptoms caused by nephritis
When nephritis attacks, it often shows swelling, weakness, hypertension, oliguria, carnitic hematuria, etc. Some patients also have symptoms of digestive tract, such as nausea, vomiting, anorexia, etc. The reason for these symptoms is mainly related to the decrease of protein concentration in the blood caused by a large loss of protein in the body through urine.
For mild edema, it can be controlled by low salt diet and water restriction or appropriate diuresis; while for severe edema, in addition to the above measures, human albumin, plasma and related substitutes can be imported to increase plasma osmolality to enhance diuretic response.
2.Control the inflammatory reaction in the kidney
Immunosuppressants can inhibit or reduce the inflammatory response in kidney tissues, improve proteinuria and hematuria, and relieve renal lesions transiently. Commonly used immunosuppressants are glucocorticoids (prednisone), some drugs that inhibit the anabolism of inflammatory cells (cyclophosphamide, azathioprine, mycophenolate and some monoclonal antibodies, etc.); some Chinese medicines (such as leigengteng) also have a strong immunosuppressive effect. It should be noted that these drugs have strong side effects or side reactions, dosage and use time should be strictly controlled, do not use blindly without purpose.
3.Reduce the workload of the kidney
When the kidney is diseased, the glomerular work pressure (glomerular perfusion pressure) rises significantly. Effectively reducing glomerular work pressure can improve proteinuria and slow down the progress of the disease. Commonly used drugs include renin-angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists. These drugs need to be used early and maintained for a long time to achieve maximum efficacy. Both converting enzyme inhibitors and angiotensin II receptor antagonists can also effectively lower systemic blood pressure, so they are especially suitable for patients with massive proteinuria and hypertension. For patients with normal blood pressure and patients with severe renal insufficiency, blood pressure and renal function should be monitored.
4. Prevention of comorbidities
Patients with nephritis are prone to comorbidities such as infections, blood clots, malignant hypertension, etc. During the treatment of nephrosis, attention should be paid to controlling blood pressure, correcting hyperlipidemia and hyperviscosity, and improving their own physical fitness.
Finally, it is worth emphasizing that medication is only a small part of the treatment process of kidney disease, the most important part of the treatment process of chronic kidney disease is to find the cause and aggravating factors of the disease (bad habits and diet), to enhance physical fitness, and to avoid some artificial factors that induce or strengthen the disease (such as abuse of antibiotics, intravenous infusions).