renal insufficiency
Introduction
Introduction to renal insufficiency Renal insufficiency (renalinsufficiency) is caused by a variety of causes, the glomerular destruction, the body in the excretion of metabolic waste and regulation of water and electrolytes, acid-base balance and other aspects of the clinical syndrome after the disorder. Divided into acute renal insufficiency and chronic renal insufficiency. A serious prognosis is one of the major life-threatening conditions. basic knowledge The proportion of sickness: 0.06% - 0.09% Susceptible people: no special people Mode of infection: non-infectious Complications: acute renal failure heart failure pericarditis hypertension headache narcolepsy coma epilepsy nausea and vomiting bloating electrolyte disorder metabolic acidosis
Cause
Cause of renal insufficiency
Kidney disease (40%):
Such as acute, chronic glomerulonephritis, pyelonephritis, renal tuberculosis, acute tubular degeneration, necrosis, kidney tumors and congenital kidney disease caused by chemical poisons and biological poisons. Renal insufficiency decompensation, renal insufficiency, is in the stage of renal fibrosis.
Extrarenal disease (30%):
Such as systemic blood circulation disorders (shock, heart failure, hypertension), systemic metabolic disorders (such as diabetes) and urinary tract disorders (urinary tract stones, tumor compression). According to the latest pathological stage of renal fibrosis, the renal insufficiency compensation period is in the inflammatory reaction period, the kidney damage is light, only mild proteinuria, hematuria and edema symptoms, this period of experts through clinical practice observation, through standard treatment can Get a complete elimination of symptoms.
Renal insufficiency decompensation, renal insufficiency, is in the stage of renal fibrosis. The pathological damage in this period is heavier than the previous stage, and complications begin to appear, such as elevated blood pressure, anemia, dizziness, headache, fatigue, loss of appetite, blood creatinine, blood urea nitrogen began to rise. In this period, after repairing damaged kidney tissue and restoring kidney function, the symptoms will be eliminated, serum creatinine and urea nitrogen will return to normal, preventing the disease from developing into uremia and avoiding dialysis and kidney transplantation. However, if this period is not paid attention to and the treatment will continue to worsen, it will progress to end-stage renal disease. In the uremic period of renal insufficiency, the kidneys almost form scars, and more than 90% of the nephron functions are lost. In this period, complications can be alleviated by treatment, the dialysis interval can be maximized, or dialysis can be eliminated. Generally speaking, it is a clinical reversible period of renal fibrosis. As long as the kidney function is prevented from deteriorating, it is possible to repair the kidney function in time, clinically cure and let the patient achieve benign disease. At this time, the focus of treatment for renal insufficiency is to block from the source, correct vasospasm, and ensure the smooth circulation of blood circulation; in addition, inactivate all kinds of pathogenic inflammatory mediators and nephrotoxic factors to promote intrinsic Cells are reversed to healthy tissue after phenotypic transformation.
Prevention
Renal insufficiency prevention
Precautions for renal insufficiency
Patients with chronic renal insufficiency must first strengthen self-care, exercise the body, enhance disease resistance, timely treat upper respiratory tract infections, remove infected lesions, treat primary disease, diabetes, systemic lupus erythematosus, hypertension, etc. Kidney damage.
Second, pay attention to observe some changes in the body: such as edema, high blood pressure, fever, fatigue, loss of appetite, anemia, etc., and observe the changes in urine, the amount of urine, if there is any discomfort, you should do blood, urine Analysis, urine bacterial culture and counting, renal function measurement, and even kidney biopsy and renal imaging examination to determine the cause, pathological changes and renal function of kidney disease, for the treatment and prognosis of kidney disease Provide evidence.
The treatment of kidney disease is mainly divided into general treatment and special treatment. In general treatment, you should pay attention to rest, and how to rest depends on the condition. Depending on the type of disease, the degree of disease is treated accordingly. Control infection, remove primary lesions, treat primary disease, adjust water and electrolyte balance, and enhance the body's disease resistance. In special treatments, different treatment options are also applied depending on the type of kidney disease.
Prevention and treatment of senile renal insufficiency
With the rapid growth of the elderly population, the number of elderly patients with chronic renal insufficiency is also increasing. The disease develops rapidly, the complications are high, the mortality rate is high, and the age of onset is more common in elderly patients over 60 years old. As the age increases, the small arteries of the kidney become transparent and gradually harden. When suffering from hypertension, chronic glomerulonephritis, diabetic nephropathy, obstructive nephropathy, chronic pyelonephritis, polycystic kidney disease, renal cancer, and prostate cancer, the progression of tubular arteriosclerosis and glomerular sclerosis may be aggravated. Causes chronic renal insufficiency. Therefore, how to protect the kidney and delay the occurrence and development of renal insufficiency in the elderly is a very important clinical issue.
1, first treatment of primary diseases, such as high blood pressure, diabetes and so on. Prevents the severity of renal artery and glomerular sclerosis.
2, actively control infections, especially urinary tract and respiratory tract infections, to prevent double infection.
3. Actively correct the imbalance of water and electricity and acid-base balance.
4, diuretic, correct heart failure.
5, diet with high calorie, high quality low protein, low phosphorus diet with essential amino acids, appropriate vitamins, minerals and trace elements.
6, to avoid cold, wet and overwork, to prevent colds, do not use kidney drugs.
7. Fully effective dialysis.
8, comprehensive treatment of complications, correct anemia, prevent gastrointestinal bleeding, hypercoagulable state need anticoagulant therapy. Those who progress with the disease should switch to blood purification therapy as soon as possible.
Complication
Renal dysfunction complications Complications acute renal failure heart failure pericarditis hypertension headache narcolepsy coma epilepsy nausea and vomiting bloating electrolyte disorder metabolic acidosis
(1) Infection is one of the most common and serious complications, and it is more common in severely decomposed acute renal failure caused by severe trauma and burns.
(2) cardiovascular system complications, including heart rhythm disorders, heart failure, pericarditis, hypertension, etc.
(3) Neurological complications include headache, lethargy, muscle twitching, coma, and epilepsy. Nervous system complications are associated with retention of toxins in the body as well as water toxicity, electrolyte imbalance, and acid-base balance disorders.
(4) Digestive system complications manifested as anorexia, nausea, vomiting, abdominal distension, hematemesis or blood in the stool. Hemorrhage is mostly caused by erosion of the gastrointestinal mucosa or stress ulcer.
(5) Hematologic complications As a result of a sharp decline in renal function, erythropoietin can be reduced, causing anemia, but most are not serious. In a small number of cases, there may be bleeding tendency due to a decrease in coagulation factors.
(6) Electrolyte disorders, metabolic acidosis, hyperkalemia, hyponatremia and severe acidosis are one of the most dangerous complications of renal insufficiency.
In the polyuria period, the daily urine volume of the patient can reach 3000-5000ml. Dehydration, hypokalemia, hyponatremia, etc. may occur due to the discharge of a large amount of water and electrolytes. If not replenished in time, the patient may die from severe dehydration. And electrolyte imbalance.
Symptom
Symptoms of renal insufficiency Common symptoms Urine dark black immunonephritis Kidney cold Metabolic acidosis Lack of nephrotic edema Facial dehydration Nausea and vomiting Itching azotemia
symptom
In the early stage of renal insufficiency, there are only symptoms of the primary disease in the clinic, which can affect all organs and tissues of the body, and the corresponding symptoms appear:
First, the gastrointestinal manifestations are the earliest and most common symptoms of uremia. In the early stage, anorexia and abdominal discomfort were the main complaints. Later, nausea, vomiting, diarrhea, glossitis, mouth odor and oral mucosal ulceration, and even gastrointestinal bleeding were observed.
Second, the spirit, nervous system manifestations of mental weakness, fatigue, dizziness, headache, memory loss, insomnia, may have limbs numbness, hand and foot burning pain and skin itching, and even lower limb itching is unbearable, must move often, can not rest, etc. Drowsiness, irritability, slang, muscle fibrillation and even convulsions, convulsions, and coma can occur in the advanced stage.
Third, the cardiovascular system often has elevated blood pressure, long-term high blood pressure will enlarge left ventricular hypertrophy, myocardial damage, heart failure, retention of toxic substances can cause myocardial damage, uremic pericarditis.
Fourth, the hematopoietic system showing anemia is a must-have symptom for uremic patients. In addition to anemia, there are still easy bleeding, such as subcutaneous ecchymosis, nasal discharge, bleeding gums, black stools and so on.
Fifth, the respiratory system shows deep and long breathing when it is acidosis. The retention of metabolites can cause uremic bronchitis, pneumonia, pleurisy, and corresponding clinical signs and symptoms.
Sixth, the skin shows that the skin loses its luster, dry and desquamation.
Seven, metabolic acidosis.
Eight, dehydration or edema.
Nine, electrolyte balance disorder.
(1) hyponatremia and sodium retention;
(2) Hypocalcemia and hyperphosphatemia.
X. Patients with metabolic disorders have obvious hypoproteinemia and weight loss. In addition, patients with uremia often have hyperlipidemia.
Renal insufficiency can be divided into the following four phases:
The first phase
Renal function reserve compensation period. Because the renal reserve has great compensatory capacity, although the renal function has decreased in clinical practice, its excretion of metabolites and regulation of water and electrolyte balance can still meet normal needs. Clinical symptoms do not appear, and renal function tests are also normal. The range or occasionally slightly higher.
the second term
Insufficient renal function. The glomerulus has more damage, 60%-75%. There are certain obstacles in the kidney excretion of metabolic waste, and the creatinine urea nitrogen may be higher or exceed the normal value. The patient can have anemia, fatigue, weight loss, difficulty in concentration, and so on. However, it is often overlooked. If there is water loss, infection, bleeding, etc., obvious symptoms will soon appear.
Third period
Renal failure period. Kidney function has been seriously damaged, 75%-95%, can not maintain the body's internal environment stability, patients are prone to fatigue, fatigue, attention can not concentrate and other symptoms, anemia, obvious nocturia, increased serum creatinine, urea nitrogen, And often have acidosis. This period is also known as the period of azotemia.
Fourth period
Uremia or renal insufficiency. This period of glomerular damage has exceeded 95%, with serious clinical symptoms, such as severe nausea, vomiting, oliguria, edema, malignant hypertension, severe anemia, itchy skin, mouth urinary odor.
Examine
Examination of renal insufficiency
Urine protein qualitative test
Generally, three methods of protein test paper method, sulfosalic acid method, and heated acetic acid method are employed. Under normal circumstances, the urine protein qualitative test was negative. However, this method of inspection is susceptible to a number of factors, which can lead to false results. For example, when the urate content is high, the urine is acidic, the protein test paper results are lower than the actual situation, and the sulfosalic acid method is false positive; When a large amount of penicillin is used, the sulfosalic acid method is easy to be a false positive reaction; when a sulfonate contrast agent is used, a sulfosalic acid method and a heated acetic acid method can all have a false positive reaction; when the urine is strongly alkaline, the false result is more More, or a false negative reaction of the protein test paper, or a false negative reaction of the sulfosalic acid method and the heated acetic acid method.
When the urine protein is only some special proteins, the protein test paper method and the sulfosalic acid method are not sensitive. Therefore, when performing urinary protein characterization, various factors should be integrated, specific conditions should be analyzed, and appropriate methods should be selected. Although qualitative tests are convenient, it is sometimes difficult to reflect the actual situation of proteinuria. When conditions permit, it is best to perform quantitative tests.
Blood test
Obvious anemia, normal cell anemia, normal or increased white blood cell count. Decreased platelets and accelerated cell sedimentation rate.
Urine routine examination:
There are trapping differences depending on the primary disease. The commonalities are:
1Urine osmotic pressure is reduced, mostly below 450mOsm per kilogram, the weight is low, mostly below 1.018, and when it is severe, it is fixed between 1.010~1.012. When used for urine concentration dilution test, the night urine volume is greater than the daily urine volume, and the urine specific gravity Both exceed 1.020, the highest and lowest urine specific gravity difference is less than 0.008;
2 The amount of urine is reduced, mostly below 1000ml per day;
3 urinary protein quantitative increase, the majority of glomeruli have been destroyed in the late stage, and urine protein is reduced;
4 urine sediment examination, leukocytosis in urine sediment (usually full of vision in the acute phase, 5 / high power field in the chronic phase), sometimes white blood cell cast;
5 urine bacteria examination: this method of nephritis is relatively simple, when the urine contains a lot of bacteria, due to urinary sediment coating for Gram staining, 90% can find bacteria. The positive result of the test is high.
X-ray examination
X-ray examination when the patient with nephritis repeated, or the patient's condition developed to the point of difficulty to control, at this time X-ray for nephritis examination, including abdominal X-ray, intravenous pyelography, urinary bladder urography. The purpose is to rule out the presence or absence of stones, congenital malformations of the urinary system, renal ptosis, and other pathological changes.
Diagnosis
Diagnostic identification of renal insufficiency
It can be diagnosed based on symptoms and examination results.
Differential diagnosis
1, ARF is caused by a variety of reasons, the two kidney excretion function rapidly decreased in a short period of time, the average daily increase in serum creatinine 44.2umol / L.
2, further determined to be oliguria, non-oliguric, or high decomposition.
3, pay attention to the following two points: 1 the application of diuretics can increase the discharge of urinary sodium, so at this time can not rely on urine sodium discharge and sodium excretion score as a basis for diagnosis; 2 with proteinuria or diabetes and application of mannitol, dextran or angiography After the agent, the urine specific gravity and urine osmotic pressure can be increased, so it should not be used as a basis for diagnosis.
4, should also rule out chronic renal failure. The use of B-ultrasound to measure kidney size and nail creatinine determination helps identify acute and chronic renal failure. B-ultrasound is not small, and the thickness of the renal parenchyma is not thin to support acute renal failure. Nail creatinine represents the level of serum creatinine in the patient's serum 3 months ago, so the diagnosis of acute renal failure is supported if nail creatinine is normal.
5, the gold standard is the pathological diagnosis of renal biopsy, early emergency renal biopsy to confirm the diagnosis.
