June 29, 2022

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Relation: Serum creatinine/renal failure/renal atrophy and uremia?

Relation: Serum creatinine/renal failure/renal atrophy and uremia?

 

Relation: Serum creatinine/renal failure/renal atrophy and uremia? Nephrologists need to understand the concepts of blood creatinine, renal failure, renal atrophy and uremia.

Relation: Serum creatinine/renal failure/renal atrophy and uremia?
In the process of examining and diagnosing diseases, patients with kidney disease often encounter test results and diagnostic names such as “serum creatinine”, “renal failure”, “renal atrophy” and “uremia”. We all know that there must be a connection between them, but it is not clear what the relationship is?

Someone asked:

  • Increased blood creatinine is kidney failure?
  • Kidney failure will cause kidney atrophy?
  • Patients with renal failure will eventually end up with uremia?
  • Excessive blood creatinine will lead to kidney failure and uremia?
  • Renal atrophy exists in all patients with uremia?
  • Patients with renal atrophy are renal failure or uremia?

Are these statements correct? To clarify these problems or questions, nephrologists need to understand the concepts of blood creatinine, renal failure, renal atrophy and uremia.


Blood creatinine

According to the results of fasting blood test, blood creatinine is divided into exogenous and endogenous. Exogenous creatinine is the final creatinine produced after meat food is metabolized in the body, and endogenous creatinine It is a metabolite of muscle tissue in the body.

Generally speaking, when people consume a relatively balanced amount of meat every day, and do not exercise vigorously, the blood creatinine test results are relatively stable. To a certain extent, it can reflect the degree of impaired renal function of the patient. That is, the blood creatinine is high, indicating that the kidney function has been impaired; but if the blood creatinine is not high (in the normal range), it does not mean that the kidney function is normal.

Among them, there are many reasons or incentives for high blood creatinine, and it is necessary to distinguish whether it is acute or chronic, and whether it is prerenal, postrenal or renal. Among them, it is necessary to distinguish whether it is renal glomerulus or renal tubulointerstitium or renal blood vessel.

Finally, it needs to be added that the acute increase in serum creatinine can be completely cured, and it will be difficult to develop into renal failure and uremia in the future, let alone become renal atrophy; chronic increase in serum creatinine can only be controlled or delayed The condition may continue to develop in the future, or progress to chronic renal failure and uremia, and renal atrophy may occur.


Kidney failure

Renal failure caused by various reasons is called renal failure, which can be divided into acute renal failure (or acute kidney injury) and chronic renal failure (or chronic renal insufficiency). Partial renal failure is classified as chronic renal insufficiency combined with acute kidney injury. Regardless of the type of kidney failure, patients will have elevated serum creatinine, some are rapid in the short term, and some are slowly elevated for a longer period of time.

Patients with renal failure may have no obvious abnormalities, and may also have manifestations such as nausea and vomiting, abdominal distension, poor appetite, backache and fatigue, low back pain, edema, and oliguria and anuria. Mild renal failure can be cured quickly, and severe renal failure requires renal replacement (dialysis and kidney transplantation) treatment. Acute renal failure with high edema and reduced urine output can show enlarged kidneys; severe chronic renal insufficiency can show kidney atrophy.

Whether it is acute renal failure or chronic renal failure, if the treatment is not in place, it may progress to uremia, which may eventually lead to kidney atrophy.


Kidney atrophy

Renal atrophy refers to the loss of nephron function or insufficient blood supply to the kidneys caused by various reasons, resulting in a pathological anatomical phenomenon in which the size of the kidney decreases and the physiological function of the kidney decreases. Diseases such as stenosis and kidney dysplasia.

Renal atrophy can only occur on one side (one kidney on the left or right side), or atrophy of both kidneys can occur at the same time. It’s just that the kidneys are a little smaller than ordinary people, so the conclusion that kidney atrophy is not always possible. Because the size of the kidney is also related to factors such as age, gender, height, fatness and thinness, and region, it is necessary for the doctor to make a conclusion on whether it is renal atrophy after a comprehensive analysis of the specific situation.

In patients with renal atrophy, the internal structure of the kidney is often disturbed, the capsule is abnormal (such as the capsule is not smooth), and the renal blood flow decreases. Patients who are clearly atrophy of both kidneys usually suffer from renal failure, with increased serum creatinine and/or decreased glomerular filtration rate, which can be diagnosed as renal failure, and may eventually develop into uremia.

In patients with unilateral renal atrophy, blood creatinine or glomerular filtration rate can be completely normal. If the contralateral kidney can be protected, it will not progress to renal failure and uremia.


Uremia

Uremia is the advanced stage of acute or chronic renal failure, and patients are usually in stage 5 of chronic kidney disease. When the uremic stage of chronic renal failure is developed, the patient’s kidneys cannot perform normal functions and will have a series of abnormal manifestations, such as symptoms and signs related to water and electrolyte disorders, endocrine dysfunction, metabolic end products and large retention of toxins, etc. .

Therefore, the diagnosis of uremia must also be chronic renal failure (not acute renal failure), the patient’s serum creatinine must also be elevated (and very high), and often manifested as atrophy of both kidneys (must not be one of the kidneys) Shrinking).


Through the explanation of the above four concepts, the nephrologist may be able to understand the relationship between them. Finally, to summarize, patients with kidney disease with excessive blood creatinine can be diagnosed as patients with renal failure, renal failure and uremia patients with increased blood creatinine, and patients with chronic renal failure or uremia in the late stage will have kidney atrophy and kidney atrophy. It has often developed into chronic renal failure, and chronic renal failure has developed to a severe stage, which is uremia, and patients with uremia have a significant increase in blood creatinine, etc.

 

(sourcechinanet, reference only)


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