Introduction: Chronic kidney injury (CKD) is a common but unfamiliar disease. It is common because the incidence rate is about 10.8% in China, and there are hundreds of millions of CKD patients in the country, and the trend is growing. Such a large group of patients brings great mental pressure and economic burden not only to society, enterprises, but also to families and individuals. It is unfamiliar because many people have many misconceptions about CKD, which makes many simple conditions complicated, resulting in delayed treatment or aggravation of the condition. Some people even have their condition worsened due to inappropriate treatment measures. Therefore, it is important for every CKD patient to acquire certain knowledge about prevention and treatment of nephritis, which will help you to cooperate with your physician to treat your kidney disease well!
What are the physiological functions of the kidneys?
Kidney is an important organ to maintain the normal physiological function of human body and plays an extremely crucial role in maintaining the life activities of human body. Each person has two kidneys, and each kidney has about 1 million kidney units, and all the physiological functions of the kidneys are mainly performed by the kidney units. The human kidney unit has the following characteristics.
① The kidneys have a large reserve capacity, and usually as long as one side of the kidney is functioning well it can meet the normal physiological needs of the body. However, this also brings a problem, that is, many patients with nephritis can be asymptomatic in the early stages of renal impairment, and once clinical symptoms appear, the disease has entered an advanced stage and is difficult to reverse;
② Kidney units cannot be regenerated, and one bad one is less. Generally, it decreases by 10% every ten years after the age of 40. As the kidney function gradually decreases with age, it is especially important for adult patients with nephritis to receive timely and reasonable treatment.
What is nephritis?
Nephritis is not a separate disease name, but rather represents a general term for a large group of diseases. It can be divided into dozens, or even hundreds, of different types. The former includes glomerulonephritis of unknown origin, which is a consequence of allergic reactions; the latter includes some systemic diseases that first spread to the kidneys, such as diabetes, connective tissue diseases (lupus erythematosus, vasculitis), hepatitis B, hepatic steatosis, etc. The corresponding kidney damage can be caused. Secondary nephritis can also occur after some infections, poisoning caused by certain drugs or toxins, and allergic reactions. It is important to point out that different types of nephritis have significantly different clinical manifestations and regressions, and they also differ greatly in their treatment. Because of this, every patient with nephritis must be thoroughly examined, and only in this way can the physician help to clarify the type of nephritis in order to take effective and targeted treatment measures.
It is worth emphasizing that many patients are clinically fearful of nephrotic syndrome, which is not necessary. Nephrotic syndrome is also a common type of nephritis. No matter what kind of nephritis, as long as a large amount of protein in the blood “leak” into the urine, so that the body’s plasma protein significantly decreased, and the resulting swelling, oliguria and other phenomena, we can call this phenomenon nephrotic syndrome. Obviously, nephrotic syndrome only indicates that these nephritis patients have prominent proteinuria and significant edema, but nothing else. Therefore, nephrotic syndrome is not a separate disease at all, let alone an incurable one.
The common clinical symptoms of nephritis
Patients with nephritis generally present with swelling, hematuria (strong tea-colored or flesh-washing color), proteinuria (increased urine foam), back pain, hypertension, increased nocturnal urination, oliguria, and in later stages, often accompanied by gastrointestinal symptoms (nausea, vomiting), weakness, anemia, etc.
In general, about 75% of pediatric patients (especially children aged 2-6 years) present with nephrotic syndrome with a large amount of proteinuria as the main manifestation. These children are characterized clinically by extremely prominent proteinuria and swelling, but on renal pathology examination, the glomeruli show very mild, mostly microscopic lesion-type pathological damage, often responding well to treatment with drugs such as tretinoin and prednisone. In other words, tretinoin and prednisone can reduce the clinical symptoms or stop the leakage of protein into the urine in children with this type of disease. Minimal lesion nephrotic syndrome often disappears in adolescence and does not cause permanent damage to the kidneys.
Adult nephritis, on the other hand, differs from childhood nephritis in that it is characterized by a different profile. In addition to unequal amounts of protein and red blood cell components in the urine, there is also swelling, hypertension, sarcoid hematuria, renal insufficiency, and other abnormalities in blood tests. The course of the disease tends to be highly fluctuating and prolonged. The clinical manifestations and the rate of progression vary greatly, which is mainly determined by the nature of the pathological damage to the kidney, and sometimes it is difficult to make a judgment from the clinical manifestations alone. The only way to clarify which type of nephritis is to have a kidney biopsy. Because of the late development of kidney biopsy and research on nephritis in China, there are many misconceptions about nephritis, and these traditional misconceptions largely affect the treatment and recovery of nephritis patients.
Eight misconceptions
One of the misconceptions: nephritis is an incurable disease
The actual fact that many people think that nephritis is difficult to treat or a stubborn disease that cannot be cured is actually a misconception. The majority of nephritis is not only treatable, but also curable or remittable. The effectiveness of the treatment depends mainly on whether the treatment is timely and reasonable and whether the right medicine is prescribed, and more importantly, on the patient’s own health care measures (such as diet and rest). The reason for the misconception that nephritis is an incurable disease is that most nephritis is a chronic process with insidious symptoms that are not easily detected and ignored in the early stages. The first is that most nephritis is a chronic process and its symptoms are insidious and not easily detected at an early stage. Second, the basic pathogenesis of kidney disease is ignored. Some patients think they are cured because their symptoms are relieved after treatment and they feel well, so they neglect the maintenance treatment and follow-up. In fact, at this time, the disease is chronic and slowly progressing. When they feel unwell and go to the clinic again, the nature of the disease has changed essentially. In fact, the abnormal sensation is months to years later than the changes in urine and blood tests. Therefore, every patient with nephritis should be reviewed regularly in case of unpredictability, regardless of their condition. Early examination, correct diagnosis, long-term follow-up and careful treatment are the keys to ensure the efficacy of nephritis.
The second misconception: avoid salt
The folklore says that nephritis patients should avoid salt for 100 days, in fact, this is not any scientific reason. The actual fact is that salt is an essential element of human tissue metabolism, and many physiological functions of the human body depend largely on the participation of such substances. Usually, if there is no obvious swelling and hypertension, 3-5 grams of salt can be supplemented daily; for those with severe edema or hypertension, salt intake can be reduced according to the situation. In any case, a complete ban on salt is not advisable.
Myth No. 3: Eat kidneys to nourish the kidneys
Some people think that eating animal kidneys can nourish the kidneys of the self, in fact, this is a misunderstanding. Although animal kidneys are high in protein, they should not be eaten. Because this kind of food is high in purine content in addition to cholesterol. They not only do not play a nutritional role, but will increase the burden on the kidneys, causing adverse consequences.
The fourth misconception: water ban
Many nephritis patients are reluctant to drink more water, fearing that the increased volume of urine after drinking water will increase the burden on the kidneys. In fact, the opposite is true, the body’s daily metabolic wastes are dependent on urine to bring out of the body. If you drink very little water and do not have enough urine, it will cause the accumulation of waste in the body and increase the burden on the kidneys. Only in patients with obvious swelling is it necessary to limit the amount of water drunk.
Myth No. 5: Misuse of antibiotics
Some patients equate nephritis with general inflammatory diseases (such as enteritis, pneumonia, cystitis, etc.) and commonly use antibiotic treatment. The result is not only no obvious effect, but sometimes make the symptoms of nephritis worse. In fact, there is a fundamental difference between the two. Nephritis is a metaplasia caused by abnormalities in the immune system, while inflammatory diseases are caused by bacterial infections. The latter can be treated with antibiotics, while the treatment of the former is mainly to remove antigenic substances and block abnormal immune reactions, so immunosuppressants are mainly used, while antibiotics are not effective at all. On the other hand many antibiotics are more or less nephrotoxic, and if abused without indications, they can cause antibiotic kidney damage and aggravate kidney lesions.
Myth No. 6: Believe in prescriptions
It is a mentality of patients who have not been cured for a long time to seek medical help. The prescription for a major disease is also a psychological trust for patients who are eager to be cured. The so-called prescriptions are generally three kinds of cases.
(1) Some prescriptions have been handed down from the accumulated experience of previous people, and some of them have cured some cases, but the mechanism of its cure needs to be studied and confirmed by modern medical theories and methods.
(2) Some of them are symptomatic rather than curative.
(3) Some of them are even fake medicines.
The reason why nephritis patients can’t just use prescriptions: one is that it’s not allopathic at all, as mentioned earlier there are dozens to hundreds of types of nephritis, different types of nephritis whose causes, nature and severity of lesions are completely different, the treatment methods are also very different, using a prescription to treat all types of kidney disease is obviously inappropriate; secondly, many herbs are nephrotoxic, such as powdered antibiotics, casual abuse is likely to aggravate the kidney lesions. And most drugs are excreted through the kidneys, abuse of drugs will only add to the burden on the kidneys, there are hundreds of harm rather than good. Therefore, for kidney patients, we should wait until the nature and extent of the lesion is clear before considering treatment.
The seventh misconception: chronic nephritis is the transformation of acute nephritis
It is a common belief that chronic nephritis is a consequence of untreated acute nephritis. In fact, there is no difference between acute and chronic nephritis. The reason for this misconception: one is because folk treat nephritis as an independent disease, not from the nature of the lesion to distinguish; two is the past understanding of nephritis is limited to clinical experience, the lack of today’s advanced means, usually to the length of time and symptoms as acute and chronic nephritis judgment criteria, so far, there are still many people are accustomed to nephritis called acute or The first thing you need to do is to get a good idea of what you are getting into. In fact, this understanding is one-sided. As mentioned earlier, nephritis is a general term for a large group of diseases, and there can be hundreds of them according to their nature. Nowadays, it is no longer possible to distinguish between acute and chronic nephritis based on the characteristics of clinical symptoms. In other words, there is no longer a distinction between acute and chronic nephritis. This is because the majority of nephritis is characterized by clinical signs, disease course and regression, which are determined by the nature of the lesion in the kidney and are difficult to determine from clinical aspects alone. For example, there are some types of nephritis, although the clinical symptoms are very prominent, but the pathological damage to the kidney is often self-limiting, that is, after a period of self-adjustment, the renal pathological changes can be self-relief, or even self-healing; while there are some types of nephritis clinical symptoms are very insidious, or even no signs, but the pathological damage to the kidney progresses very quickly. Therefore, we should not presume to assess the nature and progression of kidney lesions from the clinical symptoms of nephritis patients alone. This may lead to unnecessary treatment of patients who could have recovered spontaneously, while some patients who need timely and durable treatment are lost. The only scientific measure to avoid this phenomenon is to make kidney biopsy, to clarify the nature of kidney lesions in time and take targeted treatment measures.
Myth No. 8: obesity is not a disease
The traditional concept will be obese and health equivalent, think obese person body good, and lean person may be combined with disease. Secondly, this traditional concept is a big mistake. “100 diseases fat for the first” has been a lot of research to confirm. In fact, the human body’s internal organs are limited in their ability to function, excessive obesity will increase the workload of these organs, bringing chronic damage. Diabetes and a significant portion of CKD are due to obesity. Obesity is currently defined as the accumulation of fat in the body exceeding 20% of the ideal body weight or more. Obesity is diagnosed based on the patient’s body mass index. Body mass index = weight (kg) / [height (m)]2. The Chinese Obesity Research Collaborative Group, with reference to domestic epidemiological data, defines obesity as body mass index ≥ 28.0 kg/m2; waist circumference: men > 84 cm, women > 80 cm. The standard for overweight is: body mass index ≥ 25.0 kg/m2. In Europe and the United States, obesity is divided into three levels: Level I: body mass index 30.0 to 34.9 kg/m2, Level II: body mass index 35.0 to 39.9 kg/m2, Level III: body mass index > 40 kg/m2.