(Disclaimer: This article is for general use only, and the following information has been processed to protect Mr. Wang’s privacy)
Abstract: The main character of this case is a 39-year-old Mr. Wang, who was diagnosed with chronic renal insufficiency and hyperuricemia after being seen outside the hospital 9 years ago due to back pain, ultrasound suggesting “polycystic kidney and kidney stones”, and a physical examination 2 years ago, which revealed elevated blood creatinine, high blood uric acid and renal insufficiency. admitted to our hospital for further treatment. After perfecting the examination, Mr. Wang was given medication, and after treatment, his blood pressure and uric acid were well controlled and his kidney function was stable.
Basic information】Male, 39 years old
Disease Type】Chronic kidney disease stage 4
Hospital】People’s Hospital of Peking University
Date of consultation】January 2022
Treatment plan】Medication (amlodipine benzoate tablets, febuxostat tablets, packaged aldehyde oxidation starch capsules, sodium bicarbonate tablets, calcium carbonate tablets, polysaccharide iron complex capsules, compound alpha-keto acid tablets, folic acid tablets)
[Treatment period] Hospitalization for 5 days, outpatient follow up
Treatment effect] Good control of blood pressure and uric acid, stable kidney function
I. Initial consultation
Mr. Wang described himself at the time of admission: 9 years ago, he visited a local hospital for lumbar pain and completed abdominal ultrasound, which indicated “polycystic kidney and kidney stone”. He was diagnosed with chronic renal insufficiency and hyperuricemia at a local hospital, and his blood creatinine fluctuated between 210-280 μmol/L. Four months ago, his blood creatinine was 350-390 μmol/L. EGFR (effective glomerular filtration rate) was 16-20ml/min, and hemoglobin was 109g/L. Mr. Wang was initially diagnosed to be in stage 4 chronic kidney disease, so he discontinued the previous medication, and there was no significant change in blood creatinine level, and now he was admitted to our hospital for further diagnosis and treatment. Physical examination: clear consciousness, normal spirit, normal urine output, no arthralgia, oral ulcers and other manifestations, blood pressure of 130/80 mmHg, no abnormalities in lung and heart examination, abdominal bulging, no edema in both lower limbs. He had hypertension for 10 years, and his mother had polycystic kidney, so there was a family history of polycystic kidney.
II. Treatment history
The diagnosis of Mr. Wang’s chronic kidney disease stage 4 was clear, and he was admitted to the hospital to perfect the tests related to secondary kidney disease, such as ANA, ANCA, blood and urine M protein, etc. The results were negative and there were no secondary factors, and the abdominal CT suggested polycystic liver and polycystic kidney. Therefore, Mr. Wang’s chronic kidney disease stage 4 was considered to be caused by polycystic kidney. We explained to Mr. Wang and his family about his condition, the severity of the disease and the next treatment plan. Because chronic kidney disease stage 4, kidney function is irreversible, the main treatment at this stage is to correct various complications, such as hypertension, hyperuricemia, anemia, etc. In addition, pre-dialysis counseling is needed in this stage, so that Mr. Wang can consider which dialysis modality to choose for treatment in the future. Try to slow down the progression of kidney disease through the treatment of all complications and comorbidities. Mr. Wang and his family understood the condition and actively cooperated with the treatment. The following complications and comorbidities are present: renal anemia, hyperuricemia, metabolic acidosis, hypocalcemia, etc.
The treatment plan is as follows.
1.Control of blood pressure: amlodipine benzoate tablets.
2.Lowering uric acid: febuxostat tablets.
3.Promote toxin excretion: encapsulated aldehyde oxidation starch capsule.
4. correction of metabolic acidosis: sodium bicarbonate tablets.
5, correction of hypocalcemia: calcium carbonate tablets.
6, correction of anemia: polysaccharide iron complex capsules.
7. high quality low protein diet combined with compounded alpha-keto acid tablets.
8, hyperhomocysteinemia: folic acid tablets.
III. Treatment effect
After 5 days of hospitalization, Mr. Wang’s condition was stable, complications were effectively controlled, and there were no obvious symptoms of uremia. Symptomatically, Mr. Wang had no uncomfortable complaints, no obvious nausea, vomiting and weakness, normal urine volume, 1500ml/day, no edema, chest tightness and breath-holding. Laboratory examination, hemoglobin fluctuated at 110-120g/L, blood uric acid was 350-420μmol/L, blood calcium was 2.10-2.30mmol/L, blood potassium was normal, blood pressure was maximum 140/85mmHg, renal function was stable, blood creatinine did not rise significantly, blood creatinine fluctuated at 330-360μmol/L, and Mr. Wang was discharged from the hospital. Mr. Wang was advised to prevent disease progression, avoid infection, exertion and application of nephrotoxic drugs, review regularly and adjust treatment.
IV. Notes
We are glad that Mr. Wang’s disease is under control. Since chronic kidney disease is irreversible, we need to advise Mr. Wang that he should take care of both life and treatment after discharge. In addition, discharge from the hospital does not mean the cessation of treatment. Attention should be paid to regular follow-up, adjusting treatment methods, controlling various complications, such as hypertension, hyperuricemia, electrolyte disorders, etc., and adjusting treatment at any time according to changes in the condition.
V. Personal insight
The incidence of chronic kidney disease is very high, and the Chinese are able to reach 10.8%, with the risk of subsequent uremia if poorly controlled. Especially after stage 3, like this case, Mr. Wang’s kidney function reserve is getting less and less, if the disease is poorly controlled, the time to enter uremia will be significantly shortened. Therefore, it is recommended that patients with chronic kidney disease, timely hospital visits, firstly to clarify the causes of chronic kidney disease, and if in the early stage of the disease, give active treatment to delay the progression of kidney disease. Review regularly to assess the kidney function and complications. According to the condition, adjust the treatment plan at any time. For chronic kidney disease, treatment is one side, self-management is also crucial, such as regular review, no missed medication, and strict attention to life will determine the effect of kidney disease treatment.