For people at high risk of developing chronic renal insufficiency, primary prevention, that is, prevention of chronic renal insufficiency, should be done first. For those who have already suffered from early chronic renal insufficiency, we should do a good job of secondary prevention, that is, to delay, stop or reverse the development of renal insufficiency.
1.Lifestyle adjustment.
Smoking cessation, weight control, and salt intake restriction can all be beneficial to patients with chronic renal insufficiency.
2, prevention and treatment of underlying renal disease.
Prevention and treatment of basic kidney disease includes two aspects.
First, prevention and treatment of various primary renal diseases (such as various glomerular, tubular-interstitial and renal vascular diseases).
The second is to eliminate or control the risk factors causing kidney damage (such as diabetes, hypertensive disease, autoimmune diseases, etc.), which is also one of the main measures of primary prevention.
3. Active and rational control of hypertension.
First of all, blood pressure reduction must meet the standard. For patients with glomerular filtration rate ≥15ml/min/1.73m2 chronic renal insufficiency, the target value of their blood pressure reduction is <130/80mmHg; for uremic patients, blood pressure is generally controlled below 140/90mmHg.
4, strict control of blood sugar.
The target values of blood glucose for diabetic patients are fasting level 5.0-7.0mmol/L, bedtime level 6.1-8.3mmol/L, and average glycated hemoglobin <6.5%-7.0%.
5. Control of proteinuria.
Controlling the patient’s proteinuria to below 0.3g/24h or even normal range as much as possible is one of the important links to improve the patient’s long-term prognosis.
6.Prevent and control infection.
In particular, we should strengthen the prevention and treatment of upper respiratory tract infections, hepatitis B, hepatitis C, AIDS, tuberculosis and other aspects.
7. Maintain renal perfusion, electrolyte and acid-base balance.
Avoid and promptly correct blood volume deficiency (hypotension, dehydration, etc.) or promptly correct severe renal artery stenosis or sharp reduction in local blood supply to the kidney; promptly correct metabolic acidosis (including renal tubular acidosis) and correct disorders of electrolyte metabolism such as sodium and potassium.
8. Give low-protein diet and related dietary therapy, and also prevent and treat malnutrition.
When the glomerular filtration rate is less than 60 ml/min, the application of low protein and low phosphorus diet can be started, which can be supplemented with appropriate amount of essential amino acids, which can improve the protein nutritional status of the patient, reduce hyperphosphatemia and delay the progress of renal function damage.
9, prevention and control of calcium and phosphorus metabolism disorders.
When the glomerular filtration rate <60ml/min, that should be appropriate to limit phosphorus intake (<800mg/day); when the glomerular filtration rate <30ml/min, in addition to limiting the intake of phosphorus, oral phosphorus binding agents (such as calcium carbonate, calcium acetate, etc.).
10. Correction of anemia.
When hemoglobin <110g/l or erythrocyte pressure product <33%, the cause of anemia should be examined, and if iron deficiency is present, iron supplementation therapy should be given.
11.Correct hyperuricemia and hyperlipidemia.
12.Pay attention to the prevention and treatment of cardiovascular disease and other complications.
13.Intestinal adsorbents, etc.
14.Other.
Such as avoiding the use of nephrotoxic drugs, etc.