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A sudden increase in serum creatinine is a sign of uremia?
A sudden increase in serum creatinine is a sign of uremia? No, these 4 are signs of progression of chronic kidney disease
Don’t think that a sudden increase in blood creatinine must be a bad thing, and timely treatment will not turn into uremia.
Some people say that a sudden increase in blood creatinine is a sign of uremia! In fact, this is not very accurate. Serum creatinine does reflect the renal function status of patients with kidney disease. When the serum creatinine of patients with chronic kidney disease gradually rises above 707 μmol/L or the glomerular filtration rate slowly drops below 15 ml/min, Can be diagnosed as uremia.
But there are two key words in the sentence, namely “sudden increase in blood creatinine” and “uremia”. Among them, a sudden increase in blood creatinine is mostly indicated as an increase in blood creatinine caused by acute factors, that is, acute kidney injury or acute renal failure.
Among them, uremia gradually develops from various chronic kidney diseases, and finally leads to the late stage of irreversible chronic renal failure. Although there is an increase in blood creatinine in both “sudden increase in blood creatinine” and “uremia”, there is a connection between them, but there are essential differences.
The difference is that one is acute kidney injury or acute renal failure, and the other is chronic renal insufficiency or chronic renal failure. Moreover, the vast majority of chronic renal failure and uremia do not develop from acute kidney injury or acute renal failure.
Such as acute tubular necrosis, acute allergic interstitial nephritis, prerenal acute kidney injury related to hypovolemia, acute renal failure complicated by acute nephritis, and idiopathic acute kidney complicated by nephrotic syndrome (including minimal changes) Failure and so on, there will be a sudden increase in blood creatinine, but they rarely or hardly become uremia.
Except in some cases, if it has been diagnosed as a severe stage of chronic renal insufficiency, the basic renal function is already very poor, that is, the basic blood creatinine is already relatively high. At this time, if there is a sudden increase in blood creatinine, it will easily develop Uremia.
Therefore, a sudden increase in blood creatinine is not a sign of uremia in most cases. The following four conditions are the signs of the gradual progression of chronic kidney disease to uremia.
1. Serum creatinine slowly rises, or glomerular filtration rate gradually decreases
Contrary to a sudden increase in blood creatinine, it is a slow increase in blood creatinine, which is often a sign of the progression of chronic kidney disease. Perhaps in a short period of time (such as within 1-3 months) there is no significant increase in bleeding creatinine. Can be placed in a longer period of time (such as 3-5 months or more), you can find that the blood creatinine is slowly rising.
Some chronic kidney disease progression signs show blood creatinine, but some chronic kidney diseases (such as long-term vegetarianism, weight loss, and female patients) can show signs of progression not in blood creatinine but glomerular filtration rate (GFR) Or creatinine clearance rate (CCr), that is, the patient’s serum creatinine has not changed much, but GFR or CCr is slowly decreasing, which is also a sign of the progression of chronic kidney disease.
Therefore, to observe changes in the condition, it is necessary not only to check the blood creatinine, but also to detect or estimate its GFR or CCr, so as to detect the signs of chronic kidney disease progression as soon as possible.
2. There is no obvious blood loss, but the patient’s anemia is getting more and more serious
Hemoglobin was checked regularly, and it was found that the anemia of patients with chronic kidney disease was getting more and more serious. Further comprehensive examination did not find that the patient had gastrointestinal bleeding, menorrhagia, or obvious blood loss in other parts. At the same time, blood system diseases and other affecting blood system were also ruled out. For diseases (such as lupus nephritis), it is necessary to consider the progress of patients with chronic kidney disease in the direction of chronic renal failure and uremia.
The anemia associated with the progression of chronic kidney disease is mostly renal anemia, that is, anemia caused by insufficient secretion of erythropoietin due to severe structural damage to the kidney. Therefore, patients with chronic kidney disease need to check hemoglobin regularly to observe whether the condition is progressing.
3. Urine protein remained high before the medication, but now it is not high without medication
The urine protein of patients with chronic kidney disease has always been high, reaching moderate proteinuria or large proteinuria, but the patient’s urine protein is still high after the previous treatment with drugs. Such high urine protein will inevitably lead to accelerated development of the disease.
However, even if chronic kidney disease is developing, the patient will not feel it. In the early stage, blood creatinine and glomerular filtration rate (GFR) may not be found to have obvious abnormalities. However, the ratio of glomerulosclerosis and tubulointerstitial fibrosis in patients with kidney disease will become higher and higher. This ratio will increase from 10% to 30%, and then to 50% to 75%, and the patient’s serum creatinine will not be seen. There is an obvious abnormality. When this ratio is higher to a certain extent, the patient’s urine protein drops instead without using protein-lowering drugs.
In other words, when the proportion of patients with glomerular sclerosis is too high, while detoxification is affected, urine protein will not leak out or the leakage will be reduced. Therefore, in the absence of medication, the urine protein, which had always been high, has dropped. This is mostly a sign of the progression of chronic kidney disease, which also requires attention.
4. High blood pressure that could have reached the standard can be controlled, but now it is difficult to reduce it
Long-term uncontrolled high blood pressure can damage the kidneys and cause chronic kidney disease to continue to progress. Therefore, it is necessary to give active antihypertensive treatment in the early stage of chronic kidney disease, and strive to control blood pressure to reach the standard.
Generally speaking, it is relatively easy to control high blood pressure in patients with kidney disease with completely normal renal function and patients with early chronic kidney disease. It may only need one (sartan/pril antihypertensive drug) to reduce blood pressure. Come down.
Some patients with kidney disease may also only need two antihypertensive drugs (sartan/pril+dipine), which can also lower blood pressure. When it is found that the blood pressure of patients with chronic kidney disease is difficult to control and reach the standard, even with three or even four antihypertensive drugs (sartan/pril+dipine+zosin/lohr+diuretic drugs), the patient’s blood pressure is still difficult to control and reach the standard , Which often indicates that the condition is getting worse and chronic kidney disease is progressing.
Don’t think that a sudden increase in blood creatinine must be a bad thing, and timely treatment will not turn into uremia. However, the above four situations require sufficient attention from nephrologists, and this is the sign of the progression of chronic kidney disease.
(source:internet, reference only)