November 30, 2022

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Uremia: Nephrologists should start treatment from 6 aspects in advance

Uremia: Nephrologists should start treatment from 6 aspects in advance

 

Uremia: Nephrologists should start treatment from 6 aspects in advance.   To prevent uremia, nephrologists should start treatment from 6 aspects in advance, don’t wait until creatinine exceeds the standard.

Uremia: Nephrologists should start treatment from 6 aspects in advance


To prevent uremia, nephrologists should prepare and treat them in advance from the following 6 aspects.

It can be said that the ultimate goal of treatment for all patients with chronic kidney disease is to protect kidney function and prevent uremia, prevent complications and complications, and improve the quality of life. Among them, the prevention of uremia is the top priority. The purpose of treatment for patients with nephropathy with normal blood creatinine is to protect renal function, and the purpose of treatment for patients with nephropathy whose blood creatinine has only begun to appear abnormal is to reverse, prevent or continue the progression and progression of renal function.

The emphasis here is on “serum creatinine”, and whether blood creatinine exceeds the standard is often used as a “watershed” for treating kidney disease and judging the severity and prognosis of the disease. In the process of formulating specific treatment plans for patients with kidney disease, serum creatinine is often the key indicator of concern. The treatment plan for nephropathy with normal serum creatinine is completely different from that for patients with excessive serum creatinine.

 

Serum creatinine, as an important laboratory indicator that reflects the severity of renal function impairment, is actually very “sluggish” and not as “sensitive” as other indicators. Because our kidneys have a strong compensatory function, even if one of the two kidneys is removed, only one healthy kidney remains. If the blood creatinine is checked, the result is normal. Similarly, if 2 million functional nephrons (including 2 million glomeruli) of the two kidneys of a patient with chronic kidney disease are left with only 1 million nephrons due to various reasons, the patient’s blood creatinine is also normal.

Only when there are only 500,000 functional nephrons in patients with chronic kidney disease (such as glomerulosclerosis caused by various reasons), the patient’s serum creatinine gradually exceeds normal. Therefore, the treatment of chronic kidney disease and the prevention of uremia cannot be emphasized until the blood creatinine exceeds the standard. Nephrologists should prepare in advance and actively treat them.

 

To prevent uremia, nephrologists should prepare and treat them in advance from the following 6 aspects:

1. When the urine protein is first detected

When urine protein is first detected, it is usually caused by nephritis. If it can be detected early, the patient’s blood creatinine has not exceeded the standard at this time, that is, the patient’s renal function is normal and has not progressed to chronic renal insufficiency. If positive and standardized treatment can be given at this time, it will be easier to cure or control the condition, and it will be relatively easier to prevent uremia.


2. When you have just discovered an increase in urine red blood cells

When an increase in urinary cells is just found, through a comprehensive analysis of the condition and morphological examination of red blood cells in the urine (ie phase contrast microscopy), it can be judged whether it is glomerular hematuria, and whether the urinary erythrocytosis is caused by nephritis cause. Once the hematuria is determined to be caused by nephritis, further examinations are needed to confirm the diagnosis, and immediate measures are taken to prevent uremia.


3. When an increase in blood pressure is detected

When an elevated blood pressure is detected and hypertension is diagnosed, it should be considered at the first time whether secondary hypertension is caused by nephropathy. Especially for young patients with high blood pressure detected by physical examination, it is necessary to rule out renal hypertension. blood pressure. After discovering high blood pressure, one is to make a clear diagnosis, and the other is to actively treat and intervene in diet and lifestyle. In this way, patients are more likely to prevent chronic renal failure from occurring, and more likely to prevent uremia.


4. When edema of the face or both lower extremities just appears

When there is edema on the face and lower limbs, regardless of the severity of the edema, one should think of the edema that may be caused by kidney disease. For initial diagnosis, you only need to do a simple urine routine and kidney color Doppler ultrasound. Once it is determined that it is caused by kidney disease, further examinations are carried out according to the specific situation to determine which kidney disease introduced the edema. We have found that, relatively speaking, those with edema are easier to cure or control, and less likely to progress to uremia.


5. When urinary tract discomfort occurs

When patients have urinary tract discomfort such as frequent urination, urgency, dysuria, etc., urinary tract infection is more likely. In the case of initial urinary tract discomfort or mild symptoms, it is mostly lower urinary tract infection, which has not affected the kidneys of the upper urinary tract. However, if it is not treated in time and is allowed to develop or recurrent urinary tract discomfort such as frequent urination, urgency, dysuria, etc., it will easily affect the renal pelvis and renal parenchyma, and may also progress to uremia. Therefore, when urinary tract discomfort first appears, it should be treated actively, which is more beneficial to prevent uremia.


6. Already suffering from other diseases or when medication is needed for treatment and examination of other diseases

Already suffering from other diseases, such as diabetes, essential hypertension, chronic hepatitis B virus, Henoch-Schonlein purpura, systemic lupus erythematosus, rheumatoid arthritis and Sjogren’s syndrome, etc., should undergo corresponding examinations to clear or rule out secondary Once the possibility of sexual kidney disease is determined, corresponding treatment and intervention should be given. In the process of medication for other diseases or when contrast drugs are used for examination, it is also necessary to prevent the drugs from causing toxicity to the kidneys. Therefore, when you have been suffering from other diseases or when you need medication for treatment and examination of other diseases, you must think about kidney problems or whether the kidneys are injured, so as to better prevent uremia.

(source:internet, reference only)


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