/Stage 4 kidney disease what to expect

Stage 4 kidney disease what to expect

author:admin       pubdate:2017-08-08 15:40

The dialysis and renal replacement therapy, many patients with uremia avoids premature death ending. However, their life is shorter than the general population. According to the US Renal Data System (United States Renal Data System, USRDS) report: once started renal replacement therapy, 40-44 year old dialysis patients expected residual life of about 8 years (with the race, life expectancy varies) in dialysis patients 60-64 years of age is about 4.5 years. In contrast, the expected residual life of 40-44 years in the general population is 30-40 years, 60-64 years old 17-22 years. Ordinary people are investigating the cause of death can be known, most of uremic patients died of cardiovascular disease: heart failure, coronary heart disease and the cerebral infarction. However, further study confirmed that: in uremia before kidney function declines, kidney damage has also prompted high risk of cardiovascular and cerebrovascular diseases. For example, persistent proteinuria itself Direct damage to the cardiovascular system is an independent risk factor for cardiovascular disease and death.

coronary heart disease

Study of modern organization, the basic unit is the kidney glomeruli. While the glomerular capillary formation is glomus. Metabolites of human blood vessels is mainly out of the glomus excretion. Once the cardiovascular problems, the kidney function will also damage. Also, if the kidney problems, will also have cardiovascular and cerebrovascular diseases. In order to better protect the kidney also, in order to control the risk of cardiovascular and cerebrovascular diseases of kidney, today's medical profession more respected the concept of a chronic kidney disease.

Chronic kidney disease model map

Chronic kidney disease is not a disease. It is a characteristic generalization of a large class of diseases involving the kidneys:

1 diabetes

2, hypertension

3, primary chronic glomerulonephritis

4, secondary chronic glomerulonephritis (e.g. lupus nephritis)

5, long-term use of a history of nephrotoxic drugs

6, suffering from cancer,

7, specific diseases, such as hepatitis B, hepatitis C, HIV, etc.

8, other: hereditary nephropathy, history of acute kidney injury, obesity and so on

Department of Nephrology Peking University Hospital confirmed epidemiological investigation led: chronic kidney disease in adults over the age of 18 Chinese prevalence rate is 10.8% (95% CI 10.2% to 11.3%). China chronic kidney disease population. In the early stage through early intervention is possible to reduce the number of final "uremia", can also reduce the "chronic kidney disease" the risk of cardiovascular disease and death.

The principles for the treatment of chronic kidney disease are as follows

First, for the treatment of etiology

The causes of chronic kidney disease are various. To find the cause for treatment is the key to the treatment of systemic lupus erythematosus. For example, to reduce or avoid the use of nephrotoxic drugs. Some drugs for the cause of itself also has renal toxicity, the doctor should weigh the treatment benefits and risks, to seek the best benefit.

Two, control of chronic renal disease progression factors

1, control of blood pressure: high systemic blood pressure will convey to the kidney, because the kidney is composed of glomus, glomerular capillary pressure and promote glomerular injury. In fact, not only damage the glomerular hypertension, and renal tubular injury. Of course, high blood pressure can lead to increased cardiovascular disease and mortality.

Renal vascular changes in hypertension: source 1

2, control blood sugar: high blood sugar may directly lead to mesangial expansion and injury, and glycation of tissue proteins may be the cause of diabetic nephropathy and other microvascular complications

Model map of diabetic kidney injury, source 2

3, reduce proteinuria: proteinuria is an independent risk factor for progression of chronic kidney disease. Not only that, albuminuria also directly increases cardiovascular risk and mortality

How does proteinuria damage the kidneys? Source 3

4, the treatment of anemia: anemia, resulting in hypoxia of tissue cells, thereby accelerating kidney organ damage, functional decline

Anemia leads to fatigue, fatigue, and disease progression

5, control blood phosphate level: calcium phosphate deposition may lead to inflammation in renal interstitium, resulting in interstitial fibrosis and tubular atrophy. High phosphate induced vascular calcification, leading to organ ischemia. Eventually lead to the progression of renal disease, high risk of cardiovascular disease.

Phosphoric acid, parathyroid gland, associated with the kidney, source 4

6, other: do a good job of vaccination, control blood lipids, uric acid and so on

Often heard people say that blood pressure lowering treatment kidney to eat bad. The reason is certain eat blood pressure drugs, but also the inevitable trend of renal uremia. Moreover, often hear the doctor said: certain antihypertensive drugs is not good for the kidney and so on. This is in fact the blood pressure lowering treatment of misunderstanding.

First, the current first-line antihypertensive drugs rarely on renal adverse.

The main line of blood pressure lowering drugs are: long-acting calcium antagonists, such as amlodipine; the angiotensin converting enzyme inhibitor (ACEI): Pedo Pury; 3: diuretic hydrochlorothiazide. These drugs on the kidney are almost especially.ACEI drugs. The protective effect of renal function decline in patients with ACEI can reduce the urinary protein good, reduce glomerular pressure. Although due to reduced glomerular pressure may induce serum creatinine increased slightly. But it shows him to protect the kidneys. Moreover, serum creatinine toxicity was not so sure itself (see "from" uremia "to" chronic kidney disease "(on) >).

The short acting drugs, cheap to give you false blood pressure control effect

A lot of hypertensive patients long-term use of nitrendipine. Although the potent drugs can quickly reduce blood pressure, but its antihypertensive effect only for 4 to 6 hours. So a lot of friends to the fictitious "blood pressure controlled" feeling. But in fact, his blood pressure was not stable under control. The current first-line antihypertensive drugs are selected long acting preparations. Once a day to achieve stable long-term oral blood pressure control. Although the beginning of taking blood pressure control is not ideal, but the slow onset of antihypertensive antihypertensive treatment is good.

It is not enough to just drop in blood pressure, strong delay renal function decline.

The factors that contribute to kidney failure are proteinuria, anemia, blood phosphate accumulation, and so on. It's not enough to control blood pressure

The trust, Chinese medicine, liver and kidney toxicity of drug taking

Nephrology circles are aware of the fact that Beijing is a famous ancient Chinese family all died of kidney failure. But the Chinese are taking the medicine for generations to protect the kidney. Late family to see Western medicine, found nephrotoxic drugs. So stop medicine after no one had uremia. There are many unknown components in plant components there are a lot of, liver and kidney damage. Therefore avoid taking Chinese medicine.

An outpatient intervention study from Peking University Hospital, confirmed that scientific intervention can delay the progression of chronic kidney disease and reduce the risk of cardiovascular and cerebrovascular diseases associated with chronic kidney disease!

 


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