Kidney patients with serum creatinine 115-700 have to do uremic dialysis?

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Kidney patients with serum creatinine 115-700 have to do uremic dialysis?

Kidney patients with serum creatinine 115-700 have to do uremic dialysis?   Among patients with nephropathy whose blood creatinine ranges from 115 to 700 μmol/L, only a few of them cannot escape long-term dialysis or kidney transplantation for uremia.

Generally speaking, when the blood creatinine test result shows more than 115μmol/L, that is, from 115μmol/L to 700μmol/L, it means that the patient’s renal function has been impaired, and the diagnosis of renal injury or renal failure can be made.

Impaired renal function can occur in people or patients without basic kidney disease (such as people who originally had other diseases or healthy people), or in patients with basic kidney disease (such as membranous nephropathy or people who originally had membranous nephropathy). Lupus nephritis, etc.).

When the blood creatinine just started to rise to a little higher than 115μmol/L, most patients think that uremia is still far away; when the blood creatinine rises to 200-300μmol/L, most patients will worry about which day uremia will come; When the blood creatinine reaches 500-700μmol/L, most patients think that uremia will be unavoidable; when the blood creatinine has risen to more than 707μmol/L, they think they cannot escape the uremic dialysis barrier.

The real situation, is it really what some people think above? In other words, for kidney diseases with blood creatinine ranging from 115 to 700 μmol/L, how many patients will not survive long-term dialysis for uremia? Before answering this question, when blood creatinine exceeds the normal 115-700μmol/L, the nephrologist needs to figure out its “nature”.

After the blood creatinine is found to be excessive, there may be four situations:

1. Acute kidney injury or acute renal failure (no underlying kidney disease, sudden increase in blood creatinine), such as acute tubular necrosis or acute allergic interstitial nephritis;

2. Acute kidney injury or acute renal failure (with basic kidney disease, sudden increase in blood creatinine), such as primary nephrotic syndrome (including minimal changes) complicated by idiopathic acute renal failure;

3. Chronic renal insufficiency combined with acute kidney injury (patients with chronic renal insufficiency for many years have a long-term relatively stable blood creatinine that suddenly rises a lot), such as IgA nephropathy in stage 2 of chronic kidney disease combined with acute kidney injury;

4. Chronic renal insufficiency or chronic renal failure (the blood anhydride of patients with chronic kidney disease has slowly increased for many years), such as diabetic nephropathy in stage 3 of chronic kidney disease.

After understanding the above conditions, you will find that the word “acute” is mentioned in the diagnosis of three of the above four conditions, and the word “chronic” is mentioned in the diagnosis of two of the four conditions. Renal injury and renal failure with blood creatinine rising to 115-700μmol/L, those related to “acute”, the increased blood creatinine hopefully will drop or reverse, and those related to “chronic”, the increased blood creatinine Most can control or delay its continued ascent speed.

In clinical practice, the above four conditions will occur, that is to say, the vast majority of kidney disease patients whose blood creatinine rises to 115-700 μmol/L can be cured of kidney damage or renal failure, and will not develop into a long-term need Uremia on dialysis.

• Acute kidney injury caused by acute urinary obstruction, blood creatinine can be as high as 300μmol/L, and after the obstruction is relieved in time, blood creatinine can quickly recover;
• Acute renal tubular necrosis caused by poisons can be manifested in patients with oliguria-type acute renal failure. The blood creatinine can be very high. Diuretic symptomatic and supportive treatments are given. After the patient passes the oliguria period, the blood creatinine can quickly fall to normal range;
• Highly edematous membranous nephropathy is prone to complicated with idiopathic acute renal failure, and the blood creatinine is often high. After treatment with hormones, diuretic and anticoagulation, the blood creatinine can be reduced to normal, and the concurrent acute renal failure can be completely cured;
• Chronic renal insufficiency combined with infectious diseases, the patient’s serum creatinine can rise from the original 160μmol/L to 250μmol/L, or even higher, that is, combined with acute kidney injury, after active anti-infection treatment, the patient rises Most of the blood creatinine can be lowered and restored to the original basic level of about 160μmol/L.

Through the above analysis and introduction, can nephrologists still think that patients with nephropathy whose blood creatinine ranges from 115 to 700 μmol/L cannot escape uremic dialysis? of course not! Speak up, don’t believe it, only a few of these patients with kidney disease will eventually have to undergo long-term dialysis or kidney transplantation.

Among these “a few”, mainly include the following three “chronic” conditions.

1. Chronic kidney disease (CKD) has progressed to CKD stage 3b-5

No matter what kind of chronic kidney disease, once it has progressed to CKD stage 3b-5, the patient’s serum creatinine will continue to rise, and the glomerular filtration rate will continue to decline, until it develops to the stage of uremia that requires dialysis, that is, the patient The blood creatinine is as high as 707μmol/L and/or the glomerular filtration rate drops below 15ml/min. Therefore, it is necessary for patients to pay attention to the protection of renal function and other comprehensive treatments before CKD 3a.

2. The urine protein and blood pressure of chronic kidney disease are always difficult to control

The serum creatinine of patients with chronic kidney disease has exceeded the normal range, and their urine protein is high or very high (moderate or large proteinuria). After active treatment, the patient’s urine protein is not controlled, or accompanied by untreated If hypertension or hypertension is difficult to control, the patient’s serum creatinine will continue to rise at a relatively rapid rate. Even if it has not yet reached CKD stage 3b, it may not be long before the disease will progress to the severe stage of chronic renal insufficiency. Uremia.

3. The underlying diseases of chronic renal insufficiency are refractory or have many complications

Some special types of chronic kidney disease, such as polycystic kidney disease, hereditary nephritis and diabetic nephropathy, etc., once the blood creatinine exceeds the normal 115μmol/L, the condition will continue to develop thereafter, and uremia is often unavoidable. In addition, some complications and chronic kidney disease with many complications and difficult to control, such as chronic kidney disease with poorly controlled hyperuricemia and difficult to control infectious diseases, these factors will affect kidney function and lead to The blood creatinine, which has exceeded the standard, continues to rise at a relatively rapid rate, and often cannot escape uremia.

Finally, in one sentence, only a few of the patients with nephropathy with blood creatinine ranging from 115 to 700 μmol/L cannot escape long-term dialysis or kidney transplantation for uremia. Don’t believe it, it’s true

(source:internet, reference only)

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