1.Do all patients with kidney disease need to take hormones?
Not all patients with kidney disease need to take hormones, only patients who show nephrotic syndrome, or rapid decline in kidney function and systemic inflammation may need to use hormones, whether to use hormones must listen to the professional doctor’s opinion.
There are many side effects of hormones, including changes in appearance, such as full-moon face, hypertension and stress peptic ulcers in some patients. In addition, hormones can cause diabetes, but also can cause mental abnormalities, need to be careful.
2. Do hypoglycemic drugs and antihypertensive drugs hurt the kidneys?
Commonly used antihypertensive drugs generally do not hurt the kidneys, and glucose-lowering drugs have not been reported to hurt the kidneys, but blood pressure and blood sugar are too low for the kidneys. Metformin in renal insufficiency will occur when taking lactic acidosis, to be used with caution.
3, why is it necessary to take cyclophosphamide, primaquine and other immunosuppressive drugs for kidney disease?
There are indications for the use of these drugs in the treatment of nephropathy, commonly due to membranous nephropathy, vasculitis, lupus nephritis, the pathogenesis of these diseases is related to the activation of immune B cells, often requiring the use of cyclophosphamide or primaquine immunosuppression. Cyclophosphamide has significant side effects, but this drug has several benefits.
The first benefit is that it is effective, the second benefit is that the effect is longer lasting and less likely to recur, and the third is that it is very inexpensive. Therefore, for these reasons, we recommend the use of cyclophosphamide. The common side effects of this drug are hair loss
These side effects are temporary and can be recovered after stopping the drug, so this drug can still be used. The side effects of primaquine are relatively few, but patients with renal
The use of patients with renal insufficiency should be noted that this drug can easily lead to relatively heavy infections, and attention should be paid to monitoring the patient’s blood routine, CD4 cells and other indicators in the process of use.
In the vast majority of patients with kidney disease, hormones and immunosuppressants do not need to be taken for the rest of their lives, and are generally taken for 1 to 5 years, and can be gradually withdrawn when the disease is stable. Only a few, such as lupus nephritis patients may need to take hormones and immunosuppressants for a long time to prevent relapse.
4.How to take medication for kidney disease patients?
For patients with kidney disease, hormones are generally taken once in the morning, or in divided doses if they have lupus nephritis, are running a fever, or are diabetic. Cyclophosphamide is usually taken in two doses in the morning and afternoon. Drink more water when taking this medicine and do not take it before going to bed. The more expensive drugs such as primidone, cyclosporine and tacrolimus should be taken twice a day on an empty stomach, 12 hours apart.
What if I miss a dose? If it is a hormone, it is okay to make up for it on the same day, but if you miss a dose of other drugs, you have to take one less dose, such as cyclosporine and tacrolimus, do not take them at the same time, the dose is doubled and kidney damage may occur.
Does a negative urine protein mean that the kidney disease is cured?
We often have such cases, patients found that the urine protein has turned negative, and then stop the drug on their own, once the drug is stopped, it will be repeated, especially in nephrotic syndrome, glomerular microscopic lesions are easy to have this problem. It is important to maintain the treatment for a period of time after the urine protein turns negative, at least half a year, to consolidate the efficacy, and then slowly reduce the drug later. If the maintenance time is not enough, the disease is very easy to relapse.
We suggest that patients with chronic kidney disease should have a review once every one to three months according to their condition and the use of medication, or once every one to two weeks if they have recently added medication. The items to be reviewed include blood routine, kidney function, liver function, electrolytes, urinalysis, 24h urine protein quantification, etc. In case of lupus nephritis and vasculitis, some immune-related activity indicators such as complement, blood sedimentation, C-reactive protein, etc. should also be monitored.
There is no edema on the body and creatinine is normal, is the kidney disease under control?
In patients with edema, if the edema gradually subsides, it can only indicate that the disease may be improving, which may be a sign that the kidney disease is under control, but the edema subsides is not the same as the kidney disease is cured; the creatinine is normal, which can only indicate that the kidney disease is improving, not the same as it is cured, there is a difference between improving and cured, and it needs to be consolidated for a period of time.
If patients reduce their own medication or say suddenly stop, the danger is great.
The first danger is the relapse of the disease, for example, suddenly stop using hormones, and within a week, or within one to two weeks, proteinuria appears again, which is a relapse of the disease.
The second more serious danger is that patients may develop nephrotic syndrome and very serious comorbidities, such as thromboembolism and pulmonary embolism. Some time ago, we had a patient who was in a hypercoagulable state of nephrotic syndrome, and he should have been on anticoagulants, but when he went to Beijing to see a doctor, he stopped the anticoagulants, and then he was hospitalized and had a very serious pulmonary embolism.
The third very serious risk is the possibility of adrenocortical insufficiency. These patients who have been using hormones for a long time have potential adrenocortical insufficiency in their bodies, and if they suddenly stop using hormones, they may induce adrenal crisis, which may manifest as hypotension, high fever, and general discomfort.
In general, sudden discontinuation of hormones may result in three main types of consequences: the first type of consequences is relapse of the disease; the second type is the occurrence of nephrotic comorbidities, such as pulmonary embolism; and the third type of consequences may cause adrenal crisis.
Do patients with chronic kidney disease need to strictly control their diet?
Whether to control the diet depends on the patient’s condition. If the patient’s kidney function is normal and there are no obvious symptoms, then just controlling salt is enough, other diets do not need to be controlled, of course, do not overeat. If the patient urinates
Normal, no little urine, then how much water to drink every day does not need to be limited, thirsty should drink, of course, do not drink too much. However, if the patient has edema, decreased urine output, or has one of the three conditions of heart failure, water should be appropriately restricted.
Patients with kidney disease must strictly limit salt and have a low salt diet, with an intake of no more than 6 grams per day. Especially in the north, salt intake is relatively high, with a daily salt intake of 10 grams, 12 grams or even 20 grams. I recommend cooking with less than half of the salt, stir-fry without MSG, put salt when the dish is almost cooked, and usually do not eat salted vegetables, which are more practical ways to limit salt.
Kidney disease patients with normal kidney function do not need to limit protein intake, but do not eat too much, do not overeat. If the creatinine clearance rate is lower than 50 ml/min, or patients with chronic kidney disease entering stage III, to low
Protein diet, daily supplement the necessary protein through the intake of high-quality protein, such as animal protein, referring to animal lean meat, eggs, dairy products, the amount should be less than less than 0.6 grams / kg body weight / day, the proportion of more than 60%.
Can kidney disease patients eat soy products? This is a question asked by many people. If there is no hyperuricemia is possible to eat soy products, because soy protein is high-quality protein; but if there is hyperuricemia, then soy products should be limited, but tofu is allowed to eat, tofu processing process its nucleic acid composition is destroyed, will not increase too much purine load.
A big meal once in a while is likely to worsen the disease. A big meal such as a hot pot, the intake of uric acid may be greatly increased, may occur hyperuricemia, increasing the burden on the kidneys; more salt intake, eat a lot of meat also increases the burden on the kidneys, so for patients with chronic kidney disease, we oppose big meals and binge eating.