How to do next if blood creatinine can’t drop down?

How to do next if blood creatinine can’t drop down?  The patients haven’t been able to reduce the blood creatinine of patients with chronic renal insufficiency for so long. How to do next?

After chronic kidney disease has increased serum creatinine, it often indicates that the patient’s renal function has been impaired, especially those with chronic kidney disease who have been ill for many years. Due to various reasons, it was discovered too late, or the treatment was irregular, or gave up Treatment, emergency medical treatment, special underlying disease, unreasonable diet, or unhealthy life, etc., will cause the patient’s condition to gradually develop, and the blood creatinine will become higher and higher.

Generally speaking, chronic kidney disease has elevated serum creatinine, and it is mostly diagnosed as chronic renal insufficiency, especially those patients with kidney disease whose serum creatinine rises slowly, and there are no acute exacerbations or reversible factors. The purpose of treatment for patients with this type of kidney disease is to protect the residual nephrons and to continue the increase in blood creatinine.

However, Doctors often hear patients with kidney disease consult or ask the doctor “Why, I haven’t been able to lower my blood creatinine for so long?”.

Just recently, the author met such a patient in the outpatient clinic of a nephrology specialist. The surname is Jin. Mr. Jin is a patient with chronic nephritis who has suffered from kidney disease for seven years. He is 41 years old this year. He was diagnosed with kidney disease during a physical examination seven years ago. After that, he went to the nephrology department of the local hospital for further examination (but no renal puncture). He was diagnosed with chronic nephritis (CGN), chronic renal insufficiency (CRF), and he was in chronic kidney disease. At stage 3a of CKD, the patient’s serum creatinine (SCr) is 176.5 μmol/L, and the estimated glomerular filtration rate (eGFR) is 55 ml/min. At that time, it was accompanied by hypertension (BP 180/110mmHg) and A small amount of proteinuria (24 hours urine protein quantitative 0.84 g).

The treatment effect in the local hospital was not good, so I was transferred to my outpatient clinic for treatment. After our comprehensive treatment, the patient’s condition gradually stabilized, blood pressure was controlled up to standard, urine protein was maintained at about 0.5 grams, there were no other complications and complications such as hyperkalemia and anemia, and the patient’s serum creatinine was kept within 190μmol/L. , EGFR is between 50-65ml/min.

In other words, after nearly seven years of treatment and management by both doctors and patients (the patients themselves are also very cooperative with treatment, regular check-ups and regular medication, diet and living habits, etc.), although the patient’s blood creatinine has not fallen to normal, But it did not increase. Since the patient himself has a very good understanding of the disease, he can be regarded as truly understanding the characteristics and prognosis of chronic renal insufficiency.

However, this time, the younger brother of the patient who came to the hospital for the first time accompanied Mr. Jin. Suddenly, he said, “I haven’t been able to lower my blood creatinine for so long, how could this happen?”. Mr. Jin, the author is very familiar, but Mr. Jin’s younger brother, who basically does not live with the patient, does not fully understand his brother’s disease. This is also a common question or problem for many chronic kidney disease patients who do not know the truth.

If someone asks: What should be done if the serum creatinine of patients with chronic renal insufficiency cannot be lowered for so long?

A reliable answer or suggestion is: continue to maintain blood creatinine stability, prevent or delay the progression of chronic kidney disease, and there is no need to pursue the so-called “creatinine reduction”, even if you use a certain drug (such as taking calcium dobesilate) or excessively control your diet (Such as a long-term vegetarian diet) It is meaningless to temporarily decrease the value of serum creatinine, because it does not improve the structure and pathophysiology of the kidney.

To extend this problem, patients with chronic kidney disease with elevated blood creatinine should take the following measures to stabilize creatinine and protect residual renal function, preventing or delaying the development of chronic renal insufficiency to uremia.

1. Those who can use sartan or pristine drugs should strive for long-term use

For patients with chronic kidney disease before stage 3 (or even CKD stage 4) or in the early stage (or even the middle stage) of chronic renal insufficiency, as long as there is no contraindication to the use of sartan or pristine drugs, they should choose to use them as much as possible and strive for long-term use . Short-term users may not see the “benefits” for the kidneys, but if they can be used for a long time, they will generally benefit the kidneys, such as reducing protein, stabilizing blood creatinine, and protecting kidney function.

2. Controlling blood pressure to reach the standard is the prerequisite and basis for ensuring the stability of blood creatinine

Chronic kidney disease patients with increased serum creatinine are more likely to have hypertension. If the above sartan or pristine drugs are used, the blood pressure of the patient is still not up to standard, and other types of antihypertensive drugs (such as calcium Ion antagonists, β or α receptor blockers, etc.) are combined with antihypertensive therapy to ensure that the patient’s blood pressure is controlled to the standard. This is also the premise and basis for ensuring the stability of blood creatinine.

3. Determine whether other drugs should be added depending on the original disease and urine protein

The primary disease of chronic kidney disease patients with elevated blood creatinine can be glomerulonephritis (such as IgA nephropathy), tubulointerstitial nephritis (chronic interstitial nephritis), or primary kidney disease ( Such as chronic nephritis), it can also be a secondary kidney disease (hyperpura nephritis). The urine protein of patients with chronic kidney disease with elevated serum creatinine can be a small amount of proteinuria, or a moderate or large amount of proteinuria. All of this needs to be decided based on the specific condition of the drug, and the decision needs to be made under the guidance of a doctor.

4. TCM treatments containing rhubarb should be used in combination

Existing studies have shown that rhubarb can relieve the hypermetabolic state of residual renal tissue and inhibit mesangial cells, etc., so as to reduce or prevent the accelerated progress of patients with chronic renal insufficiency and stabilize blood creatinine. Shenshuaikang Capsules, Niaoduqing Granules, Shenshuaining Tablets and dialectical Chinese medicines containing rhubarb, etc. Patients with chronic kidney disease with elevated blood creatinine should choose to use Western medicine in combination with Western medicine according to their condition to improve the efficacy.

5. It is essential to maintain good eating and living habits

There is no doubt that good eating and living habits are essential. While carrying out the above-mentioned standard treatment, according to the patient’s blood pressure, edema, blood potassium, blood uric acid and glomerular filtration rate level, the corresponding dietary control or restriction is given. In addition, in terms of lifestyle, we must also pay attention to regular work and rest and avoid fatigue.

Are you still struggling with the problem of “blood creatinine failed to fall”? Don’t always listen to some people’s deception, or the advice of regular hospital doctors.

(source:internet, reference only)

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