March 10, 2016 is the 11th World Kidney Day, and this year’s theme is “Prevention of chronic kidney disease should start with children”. Why should the prevention of kidney disease start with children?
I. What is chronic kidney disease (CKD)
If there is evidence of kidney damage (kidney pathology, blood, urine, imaging abnormalities) for ≥3 months, or glomerular filtration rate (GFR) <60ml/min/ duration ≥3 months, it is called CKD, and routine urine test is the most sensitive, most economical and least invasive test to detect kidney disease. Its significance for the diagnosis of early kidney disease is even greater than that of blood tests. Abnormal urinalysis includes proteinuria, hematuria, tubular urine, etc.
Second, early detection is the key to treat CKD
Since early kidney disease often does not have any symptoms, it is often ignored. But when physical discomfort occurs, kidney disease often reaches the middle and late stage. In advanced kidney disease, even if actively treated, the quality of life may be much worse than before. Therefore, early detection, regular checkups, understanding the risk factors of CKD and trying to avoid them are the keys to prevent CKD. Early intervention is the key to treat kidney disease.
3. What are the risk factors of CKD?
1. Autoimmune factors: autoimmune reactions induced by the deposition of immune complexes formed by various infections in the kidney; autoimmune reactions induced by environmental pollution that changes the tissue characteristics of the kidney; autoimmune diseases such as systemic lupus erythematosus, small vasculitis, rheumatoid arthritis, etc. involving the kidney. Among them, the first two are the causes of glomerulonephritis that we often talk about.
2, diabetes: diabetic nephropathy is the early occurrence of diabetes, and is also the most common and problematic complication. In Europe and the United States, diabetes has become the most common cause of CKD, and the incidence of diabetes in China is close to 10%, so perhaps in the near future, diabetes will also become the main cause of end-stage renal disease in China.
3. Hypertension: CKD leads to hypertension and hypertension also causes CKD. Moreover, whether primary or secondary, persistent hypertension is the culprit of deteriorating kidney function, so blood pressure control is the main treatment for CKD and is used throughout.
4. Drugs: Many drugs such as heavy metals, antimicrobials, sulfonamides and contrast agents can damage the kidneys, and many Chinese medicines also cause kidney damage. In cases of drug-related kidney damage, the factors of Chinese medicines account for about half or even more. Generally speaking, western medicine tends to lead to renal tubular damage and Chinese medicine tends to lead to interstitial kidney damage, the latter has more insidious symptoms and may be heavier.
5.Other factors: polycystic kidney, urinary tract obstruction, urethral malformation, urinary tract infection, allergy, viral infection such as hepatitis B, etc., can lead to CKD.
6. Life factors: high salt diet, low water intake, long-term urine holding, long-term alcohol consumption, etc., are all good factors for kidney injury.
What are the causative factors of CKD in children?
According to statistics, the top three causes of CKD in children are
1. congenital kidney and urinary tract malformations, accounting for 48%~59%, including urethral malformation, polycystic kidney, horseshoe kidney, congenital renal agenesis, etc. Urinary system ultrasound or CT examination can be detected early.
2, hypertensive nephropathy, accounting for 10~19%. Do not think that hypertension is only a disease of adults, certain secondary hypertension such as primary aldosteronism often begins in childhood, in addition to overnutrition resulting in obesity may also appear in childhood hypertension.
3, glomerulonephritis, accounting for 5 to 14% of chronic glomerulonephritis in many children is induced by repeated respiratory infections. This condition may also develop in childhood or wait until adulthood, and many adults with chronic nephritis have a history of recurrent respiratory infections in childhood. Therefore, recurrent respiratory infections, especially tonsillitis, must be taken seriously and treated better.
Prevention of CKD should start from children
Both childhood CKD and adult CKD have a high incidence rate, but the awareness and prevention rates are very low. The purpose of World Kidney Day is to arouse people’s attention to CDK and raise the level of awareness of CKD.
Acute kidney injury (AKI) in children due to various factors is also common, but often overlooked. For example, many children with severe infectious diarrhea actually end up dying not from the infection, but from AKI caused by diarrhea.
CKD in children not only causes painful disease in children, but also leads to higher mortality rate in children and affects their growth and development as well as their life as adults, so it should be taken more seriously by the society at large. Early detection and treatment can prevent greater tragedies, which is the real meaning of this year’s World Kidney Day with children as the theme.