December 8, 2021

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Still need dialysis if creatinine of chronic renal insufficiency not too high?

Still need dialysis if creatinine of chronic renal insufficiency not too high?

 

Still need dialysis if creatinine of chronic renal insufficiency not too high?  The creatinine of chronic renal insufficiency is not too high, other indicators are well controlled, can I not need dialysis?

Still need dialysis if creatinine of chronic renal insufficiency not too high?
In most cases, the progress of chronic renal insufficiency is relatively slow.

In patients with chronic renal insufficiency, whose blood creatinine is not too high, their blood creatinine is generally around 200μmol/L, or above 120μmol/L, or 150μmol/L to 200μmol/L, or 250μmol/L, etc. In the compensatory or decompensated phase of chronic renal insufficiency, it has not reached the renal failure and uremia phases.

Moreover, the patient’s urine protein and blood pressure are all well controlled. After treatment, the patient’s 24-hour urine protein quantitative is less than 1.0g and blood pressure control is basically up to the standard. Others such as hemoglobin, blood potassium, blood phosphorus and carbon dioxide binding Indicators such as force are in the normal range.


In our patients, we often encounter kidney diseases like the above. Nephrologists will have questions: The creatinine of patients with chronic renal insufficiency is not too high, and other indicators are well controlled. Can dialysis be unnecessary in the future?

To answer this question, first figure out what chronic renal insufficiency is. Chronic renal insufficiency is also called chronic renal failure. It is a disease in which various acute and chronic kidney diseases develop to a certain stage and the glomerular filtration rate decreases. The patient’s renal parenchyma (glomerulus, renal tubules, and renal interstitium, etc.) ) Has been severely damaged. Clinically, it is mainly manifested by decreased renal function, retention of metabolic waste, and imbalance of the body’s environment, which may or may not have obvious abnormal feelings.

The causes of chronic renal insufficiency mainly include primary glomerular disease (IgA nephropathy, non-IgA mesangial proliferative nephritis, membranous nephropathy, minimal changes, focal segmental glomerulosclerosis and mesangial proliferative nephritis), Diabetic nephropathy, hypertensive kidney damage, polycystic kidney disease, infection-related nephritis (such as chronic pyelonephritis and hepatitis B virus-related nephritis), and immune disease kidney damage, drug-induced kidney damage (such as antipyretic analgesic nephropathy), etc. .

In most cases, the progress of chronic renal insufficiency is relatively slow. However, when the patient’s blood pressure is poorly controlled or the urine protein is always high, the patient’s condition develops relatively quickly. In some special cases, such as infections (cold, tonsillitis, trachea and bronchitis, pneumonia, enteritis and urinary tract infections, etc.), insufficient effective circulating blood volume (fever, excessive sweating, gastrointestinal bleeding and excessive diuresis, etc.) , And the use of nephrotoxic drugs (aminoglycoside antibiotics, antipyretic analgesics, contrast media and Chinese medicine containing aristolochic acid), the patient’s condition will get worse, and the blood creatinine will rise rapidly.

By correcting these aggravating factors in time, the patient’s renal function can be restored to its original level, otherwise the progress of renal failure will be accelerated, and the condition of chronic renal insufficiency will take another step, and the time between uremia and the need for dialysis will be closer. step.

Irreversible rapid progress in patients with chronic renal insufficiency may occur, but it is not very common.

Patients with chronic renal insufficiency whose blood creatinine is not too high, and indicators such as urine protein and blood pressure are well controlled, and the glomerular filtration rate (GFR) is still above 45ml/min. Acute aggravating factors and reversible factors can also be timely Correction and treatment. The progress of this part of chronic kidney disease patients will be very slow, and they can hardly see the progress of the disease for a long time.

If the patient’s current age is over 40 or 50 years old, and after another 20 to 30 years of very slow development, there is still hope that the life expectancy will not become uremia and not need dialysis before the life expectancy of 70 or 80 years.

Even if the patient is a young man in his 20s and 30s, he develops uremia and undergoes dialysis at the age of 50 or 60. Dialysis is not the end of his life. You can still survive for 15-25 years in another way. . Although the quality of life of dialysis patients is affected to a certain extent, it will not have much impact as long as the heart accepts it.

However, if chronic renal insufficiency has entered the stage of renal failure, or chronic kidney disease has entered stage 3b-5, or the urine protein and/or blood pressure of patients with chronic renal insufficiency are not well controlled, or often complicated by infection, it is effective Insufficient blood volume, use of nephrotoxic drugs, etc. are not corrected and treated in time, and the patient’s condition will rapidly progress to the uremic stage that requires dialysis. It may only take a few years, less than a year, or a few months.

 

(source:internet, reference only)


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