With advances in public health, pediatric mortality has declined significantly in many countries, pediatric inpatient mortality has continued to decline over the past 30 years, and the etiology of childhood deaths has shifted from infectious diseases to other chronic diseases, with a gradual increase in the proportion of deaths due to renal disease. Foreign data indicate that the number of renal replacement therapy patients in adults has more than tripled in the last 20 years, and the global incidence of ESRD ranges from 75 to 350 per million people. End-stage renal disease (ESRD).
Should pediatricians be concerned about the incidence of ESRD in adults?
ESRD is the end result of certain kidney diseases that begin with initial kidney damage, often starting in childhood and eventually progressing to renal insufficiency. Therefore, prevention of the occurrence of ESRD in adults should start with children.
What is the incidence of kidney disease in children?
At present, there are 2-3 million children suffering from different types of kidney diseases in China, and the incidence is increasing year by year.
Most of the pediatric kidney diseases can be cured, but some of them are delayed and repeated due to delayed treatment or improper treatment methods, and eventually develop into chronic renal failure. Therefore, it is especially important to give children with kidney disease timely and correct diagnosis and treatment.
First, how to early detection of pediatric kidney disease?
1, pay attention to urine observation
Red or gray color is a manifestation of hematuria, foam for a long time without disappearing may have proteinuria, cloudy urine mostly due to low water intake, but pay attention to stones, high urinary calcium, urine taste stinky and obvious, pay attention to urinary tract infection.
2.Pay attention to vulva observation
3, pay attention to the morning eyelid puffiness
4.Regular urine examination
Urine is the window of kidney, and the change of physical and chemical composition of urine is an important manifestation of kidney disease. Urine screening is an important measure for early detection of kidney disease.
Second, does the fact that everything is normal in your child guarantee that there is no kidney problem?
In a recent urine screening of 22,000 children aged 2 to 14 in primary and secondary schools and kindergartens in 21 provinces and cities, it was found that there were various types of urinary
1,901 children (8.64%) with systemic diseases. In the ongoing urine screening of children aged 3-12 years in Xiamen, the positive rate of hematuria and proteinuria was 5% to 7%. This indicates that even if a child looks healthy, he or she may have hidden kidney disease. This is why some people who have just started college or just joined the workforce suddenly find out that they are suffering from kidney failure, in fact, the hidden disease has happened long ago, just that people did not pay attention to it. For the health of children, it is beneficial to have an annual urine screening test.
Most children with abnormal urine screening are asymptomatic hematuria, which can be transient, persistent or intermittent and has complex causes, either as a manifestation of disease or in normal people; it can be a symptom of the kidney itself or secondary to systemic disorders. Asymptomatic microscopic hematuria has various etiologies and complex diagnoses, and it is socially and economically important to develop a set of efficient treatment procedures.
Third, what are the common diseases of asymptomatic hematuria or/and proteinuria?
Acute glomerulonephritis, IgAN, non-IgAN thylakoid hyperplasia, purpura kidney, lupus kidney, hepatitis B kidney, hereditary nephritis, thin basement membrane nephropathy, urinary tract infection, hirsutism, high urinary calcium, stones, tumor, drug-induced kidney injury, etc.
4.How to deal with asymptomatic microscopic hematuria?
1.Further examination to clarify the diagnosis
2.For some mild asymptomatic microscopic hematuria, it can be left untreated, but it should be followed up and observed to avoid strain and infection.
3.Most cases need active treatment. Take targeted treatment measures according to the condition.
5. Among the kidney diseases in children, nephrotic syndrome is the most serious and harmful. What should be noted in the early treatment of nephrotic syndrome?
1. Go to a regular hospital, find a specialist physician and get regular treatment.
2.Be clear about each kind of drugs you use and keep records.
3, early kidney puncture, clear pathological type, half the effort.
4.Don’t worry too much about the side effects of hormones and casually reduce or stop the medication.
5.Therapeutic treatment with Chinese medicine can improve the efficacy.
6.Don’t just pay attention to edema and seek the end.
7.Low salt diet is never salt-free.
8.Appropriate low protein diet can help reduce the elimination of urine protein.
6.What is the key to stop the progression of nephropathy and reduce renal failure?
The key to stop the progression of nephrotic syndrome to renal failure is to control refractory nephropathy. In the past half century or so, the remission rate of children with NS has increased significantly and the morbidity and mortality rate has decreased significantly. However, there are still some children who become refractory cases due to hormone resistance, dependence, frequent recurrence or relapse. Refractory nephropathy is more damaging to the kidneys due to recurrent proteinuria, not easily controlled, and long duration, and can easily develop into renal failure. Therefore, refractory nephropathy is a problem of great concern and urgent need to be solved in pediatric nephropathy clinics.
VII. What is refractory nephropathy?
1.Frequent recurrence and relapse
2.Hormone dependence
3.Hormone resistance
VIII. How to reduce the incidence of refractory nephropathy
1.Regulate the amount of medication, treatment course, and method of drug reduction
2.Define the type of pathology and choose a reasonable plan
3.Control infection
4.Regulate immune status
5.Anticoagulation therapy, thrombolysis therapy
6.Lipid-lowering treatment
7.TCM evidence-based treatment
What is the role of TCM evidence-based treatment in the treatment of kidney disease?
In the treatment of nephropathy, according to long-term clinical observation, TCM evidence-based treatment can play the role of anticoagulation to improve the remission rate; improve immunity to reduce the occurrence of infection; improve the excitability of hypothalamic-pituitary-adrenal axis to reduce recurrence; prevent and control infection; strengthen diuresis to reduce edema; and reduce the side effects of western medicine. Thus, we can achieve to reduce the incidence of recurrent and relapse of kidney disease, hormone resistance and hormone dependence.
X. What other measures can reduce the excretion of proteinuria besides hormones and immunosuppressants?
1.Low protein diet
2.Pay attention to rest and prevent exertion
3.Medication, such as ACEI, ARB, etc.
XI. What is the role of blood pressure control in stopping the progression of kidney disease?
Elevated systolic blood pressure ≥ 120 mmHg in children is a significant risk factor for progression to CRF. A lower SBP minimizes the risk of progression to ESRD, especially in those with proteinuria.