November 30, 2022

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What is the severity and prognosis of kidney disease?

What is the severity and prognosis of kidney disease?

 

What is the severity and prognosis of kidney disease? It can be clear to find out these 5 examination numbers at a glance, and treatment is also needed. Patients with chronic kidney disease must figure out five numbers.

What is the severity and prognosis of kidney disease?

Nephropathy can be found through simple tests such as urine routine and renal function, but it is not enough to know whether there is kidney disease. It is also necessary to find out what kind of kidney disease (primary disease), as well as the severity and prognosis of the disease. Therefore, the medical history, symptoms and signs should be combined with further examinations so that a comprehensive and accurate judgment can be made.

Some people say that it is enough to know what kind of kidney disease it is? Of course this will not work. Take the common IgA nephropathy as an example: IgA nephropathy can be very mild, but it can only be manifested as simple microscopic hematuria (24-hour urine protein quantitative <0.3 g), and the prognosis will be good; IgA nephropathy can also be very severe, showing For chronic renal failure and renal atrophy (the glomerular filtration rate is as low as 30ml/min or even 15ml/min), the prognosis is often very poor.


Therefore, if you want to know whether your kidney disease is mild or severe and what the prognosis is, you must at least figure out the following five laboratory examination numbers, so that you can judge the condition at a glance and help you formulate treatment plans.


1. Kidney size

Renal color Doppler ultrasound is one of the items that patients with kidney disease must check, and it should be checked at the first time. If the kidney color Doppler ultrasound examination report only says that “both kidneys are normal in size”, it is not enough. You must provide specific numbers for the size of the left and right kidneys, and it should also be a total of 6 numbers of “length, width and thickness”.

Under normal circumstances, the left kidney is slightly larger than the right kidney, with a length of about 10-12cm, a width of about 5-6cm, and a thickness of about 3-4cm. The taller ones are larger than the short ones, and the female kidneys are slightly smaller than men. Knowing the size of the kidney can initially determine the severity and prognosis of the patient.

Polycystic kidney disease, hydronephrosis, acute renal failure, renal amyloidosis, early diabetic nephropathy, and rapidly progressive nephritis, etc., the size of the kidney is often enlarged; and various acute and chronic kidney diseases develop to the late stage, the kidney The volume is often reduced.

These kidney diseases can be indicated in the kidney color Doppler ultrasound examination, and play a very important reference role in judging the severity and prognosis of the disease and guiding treatment.


2. Quantitative urine protein before and after treatment

It has just been discovered that kidney disease needs to be tested for 24-hour urine protein quantification. After treatment, the condition is stable or relieved, and 24-hour urine protein quantification is required. These two numbers before and after treatment are very important. Quantify the 24-hour urine protein of less than 1.0 g, called a small amount of proteinuria; quantify the 24-hour urine protein between 1.0 and 3.5 grams, called medium-volume proteinuria; quantify the 24-hour urine protein greater than 3.5 grams , Called massive proteinuria.

Finding out the quantification of urine protein before treatment is very helpful for judging the condition and guiding treatment, while the quantification of urine protein after laboratory treatment can judge the prognosis. In other words, if the patient’s urine protein is still at a moderate or large amount of proteinuria after treatment, the condition is severe and the prognosis is poor, and it is more likely to develop in the direction of uremia.


3. Ambulatory blood pressure monitoring results

At the beginning of the discovery of kidney disease, if urine protein and high blood pressure appear at the same time, it often indicates that the disease is serious and the prognosis is poor, especially for those chronic kidney disease where the urine protein is difficult to drop and blood pressure is difficult to control. Of course, one or two blood pressure monitoring results cannot be used as the basis for judging the severity of the disease, but blood pressure should be monitored dynamically. If blood pressure cannot be controlled to reach the target after active and standardized blood pressure reduction and other comprehensive treatments, the patient’s condition is severe and the prognosis is poor, and it is more likely to develop uremia.

 

4. The proportion of spherical sclerosis and crescent

In the pathology report of a renal biopsy, there are usually several descriptions, such as focal, segmental, diffuse, spherical, hyperplasia, sclerosis, and crescent. Among them, “spherical sclerosis” and “new “Lunar body” has the greatest relationship with the severity and prognosis of the disease. If a total of 30 glomeruli are punctured in the pathological specimen, among which there are more than 20 glomeruli with glomerular sclerosis, or there are a large number of crescents (especially fibrous crescents), it indicates that the condition is more severe. The severity and prognosis are poor. The higher the proportion of spherical sclerosis and crescent, the more severe the disease, the worse the prognosis.

 

5. Glomerular filtration rate in a stable state

The number of glomerular filtration rate is also a very important indicator for judging the severity and prognosis of the disease. In most cases, the glomerular filtration rate or creatinine clearance rate is the result of estimation, which is mostly calculated based on the results of serum creatinine, age, sex, height and weight.

In this case, this estimated result is not the true state of the disease when the patient’s condition is in the acute phase or the weight exceeds the usual edema period. The number of glomerular filtration rate in a stable state can reflect the severity of the patient’s condition and is of greater significance in judging the prognosis. According to the detection or estimation results of glomerular filtration rate after the condition is stable, if the eGFR (that is, the estimated glomerular filtration rate) is ≤15ml/min of chronic kidney disease stage 5, the most severe disease has the worst prognosis.

If the eGFR is >90ml/min in stage 1 chronic kidney disease, the condition is relatively mild and the prognosis is good. If the eGFR is between 90-15ml of chronic kidney disease stage 4-2, and so on.

In summary, patients with chronic kidney disease must figure out the above five numbers.

(source:internet, reference only)


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