The kidneys are one of the most important organs in the human body, one on each side, located on both sides of the spine at the waist, the kidneys are attached to the upper part of the posterior abdominal wall, shaped like a fava bean, the size, shape and weight of the two kidneys are approximately the same, their size is about 11 x 6 x 3 cm2 and their weight is 100-150 grams. The most basic structure that makes up the structure and function of the kidney is the renal unit (including the glomerulus and tubules), and each kidney has about 1 million kidney units, the number is fixed and will not be regenerated after birth, and one less will be destroyed. Its basic physiological function is not only to excrete metabolic waste and regulate fluid and acid-base balance in the body, but also to secrete certain important hormones (such as erythropoietin), the result of which is to maintain the stability of the internal environment of the body, so that metabolism can be carried out normally.
Uremia (end-stage renal disease): refers to various causes of kidney damage and failure, the residual kidney function is less than 10% of normal, resulting in the accumulation of metabolic waste in the body, metabolic toxins involved in all organs of the body, resulting in systemic dysfunction, water-electrolyte, acid-base balance disorders, a series of systemic clinical symptoms. Nearly 20-30% of patients with kidney disease are first discovered due to dizziness, weakness, nausea, vomiting, gum bleeding and other common symptoms when they go to the hospital.
When it comes to uremia, countless people are afraid of it, and some even think that having uremia is a death sentence. In fact, uremia is not an incurable disease, relying on dialysis and drug treatment alone can survive for more than a decade, or even decades, some people work in the morning dialysis afternoon, and some people have a kidney transplant, can live like a normal person. It can be said that the treatment of uremia has made great progress in the past 40 years. Although uremia is no longer a terminal disease, there are still many problems (such as long-term dialysis complications, etc.) to be further studied and solved, and its harm to society, patients and their families is still great. Because of the high cost of treatment, many families become poor or return to poverty due to the disease. According to statistics, the treatment cost of end-stage renal disease in the United States reached $17 billion in 2002, accounting for 6.7% of the total medical costs; the treatment cost of uremic patients in China is about RMB 80,000 to 100,000 yuan per person per year, and the annual cost of dialysis in Shanghai is as high as RMB 250 million yuan for about 3,000 new dialysis patients. Even if some patients are fortunate enough to have a kidney transplant, the cost of taking anti-rejection drugs to maintain the normal function of the transplanted kidney after successful surgery will be 50,000 to 60,000 yuan per year, instead of everything being fine after the surgery. This shows how much the cost of uremia treatment affects society and families.
Uremia is not so much a sudden occurrence as it is a sudden discovery. Uremia is actually a slow process that accumulates in the body over time as kidney function gradually declines until it fails and the toxins produced by the body due to metabolism cannot be excreted normally through the kidneys. About 500 million people worldwide have chronic kidney disease of varying degrees, and the prevalence of chronic kidney disease in people over 40 years of age in China is as high as 8% to 9%, while the awareness rate is less than 1%. About 20-30% of patients are diagnosed with uremia on their first visit to the doctor. There are many reasons for this phenomenon, mainly in the following areas.
1, insidious onset of kidney disease, the lack of specificity of clinical manifestations: many patients have no knowledge of kidney disease, the early symptoms of kidney disease are easy to ignore, even if a little discomfort think that rest for a period of time will heal itself. There are also some patients, due to economic constraints, do not enter the hospital as a last resort. Whether it is inadvertent neglect or limited by economic conditions, the condition deteriorates unknowingly, so when the patient has to see a doctor has reached the uremic phase.
2, the kidney function compensatory capacity is very strong: a glomerulus can completely replace the work of 3-4 glomeruli, kidney function damage in the early stage, the patient can not have any discomfort, only when the double kidney function damage of 70-80% or more, the patient will have more obvious discomfort, before that the patient often does not have obvious clinical symptoms and signs, so its early consultation rate is only 20% -30%.
3, patients do not have regular follow-up: some kidney disease, even if clinically cured, its pathological process is still developing. For example, some people have had acute nephritis when they were young, and then well, not re-examined, and so a dozen years or decades later again to see the doctor is already uremic, or even forget that there was a history of acute nephritis.
4, there is a disease to seek medical attention. Chronic kidney disease has different causes, pathological types and stages, and complex clinical manifestations, so it is not uncommon for people to be misdiagnosed. Some patients are misdiagnosed with primary hypertension due to dizziness, headache and high blood pressure; some are diagnosed with fundus hemorrhage due to sudden blindness; some are misdiagnosed with gastritis or gastroenteritis due to poor appetite, nausea, vomiting or diarrhea; and some are misdiagnosed with iron deficiency anemia or reocclusion anemia due to anemia. The diagnosis of chronic kidney disease, the primary cause, is overlooked. Some patients have been turned around to seek medical help, and some of them can temporarily improve, but their kidney function deteriorates progressively, and finally they are found to be uremic.
Is it very difficult to diagnose kidney disease? No, kidney disease is easy to detect and diagnose as long as attention is paid to it.
The most crucial thing is to stay alert and aware of kidney disease, and don’t forget to do urine examination (urine routine) during annual physical examination or when the following symptoms appear.
(1) the presence of foam in the urine.
(2) hematuria or darkening of urine
(3) Increased nocturia.
(4) frequent, urgent, painful urination and back pain.
(5) swelling of the eyelids, face or lower limbs.
(6) dizziness, headache, insomnia, forgetfulness, back pain, fatigue, dry mouth, and heel pain, etc.
(7) elevated blood pressure.
(8) bleeding spots or allergic purpura on the body.
(9) History of diabetes mellitus.
(10) History of nephritis.
If the kidney is found to have problems, do not take it lightly, must see a nephrologist as soon as possible to clarify the diagnosis of the original disease, if necessary, should be performed kidney puncture biopsy, because it has positive clinical significance for the diagnosis, treatment and estimation of prognosis of kidney disease. Once the diagnosis is clear, we should insist on long-term treatment, regular review and medication on time. In addition, even if the disease is found, you should not be too anxious, worrying a lot, seeking medical advice everywhere, changing doctors frequently, listening to all kinds of advertisements, folk remedies and secret recipes. I do not know that the treatment of chronic kidney disease with a clear diagnosis is a chapter to find, any expert treatment of the diagnosis and treatment of the disease have a process of understanding, and the efficacy of the stage from quantitative to qualitative change, running around will only make the disease worse. In addition, many drugs such as aminoglycoside antibiotics, painkillers, herbal medicines containing aristolochic acid have nephrotoxicity, and even some commonly used antihypertensive drugs (such as ACEI and ARB preparations such as Kepone) have strong nephrotoxicity under certain conditions, and must be treated under the guidance of a regular specialist, and must not be used indiscriminately. For chronic kidney disease, current treatments mainly stay at the level of relieving symptoms, protecting the kidneys and delaying kidney function damage. The causes and triggers that may cause chronic kidney disease, such as exertion, smoking, cold, tonsillitis, diabetes, hypertension, hyperlipidemia, drug intoxication, etc., should be actively prevented and controlled. Once there is an increase in foam in urine, change in urine color, frequent urination, increased nocturia, edema, hypertension, anemia, etc., you should go to the hospital for urine examination, ultrasound and kidney function test if necessary.
The course of a patient with uremia usually goes through 4 periods, namely, the period of declining renal storage capacity, azotemia, renal failure and uremic phase. Many patients can be asymptomatic in the first 2 phases, only having abnormal urine tests. Therefore, urine examination is very important at any time. Patients with clearly diagnosed chronic kidney disease should be treated promptly, avoid nephrotoxic drugs, try to control blood pressure, blood sugar or lower blood lipids, etc., to delay renal failure and prevent uremia and its cardiovascular and other complications. For patients with kidney disease, in addition to adhering to the correct treatment, diet is also particularly important. Generally speaking, salt should be appropriately restricted for those with obvious generalized swelling or hypertension, while for those without obvious swelling and normal blood pressure, salt restriction is not necessary. Non-dialysis patients with renal impairment should limit protein intake according to the degree of renal impairment, with a daily protein intake of 0.5-0.8g/Kg body weight. Acidosis, hyperkalemia and uremic symptoms are the main causes. Once drug therapy is ineffective, the glomerular filtration rate should be treated with dialysis when it drops below 10%, because the later the dialysis is performed, the more complications there are, the worse the patient’s prognosis, the lower the quality of life and the shorter the survival time. For patients already on dialysis, a high-protein diet with a daily protein intake of 1.2 g/Kg body weight is advocated because dialysis partially solves the problem of excretion of metabolic wastes, plus the fact that dialysis itself loses some nutrients. It should be noted that residual renal function should be preserved as much as possible, anemia should be corrected as much as possible, and the weight between dialysis should not exceed 3 Kg.