Zhou Xun chief physician of the Department of Nephrology
What kind of kidney disease counts as high urine protein? Is 0.3 grams (a small amount of proteinuria) above the normal range of 24-hour urine protein quantification counted as high urine protein? Or is a 24-hour urine protein ratio of more than 1.0 g (moderate proteinuria) counted as high urine protein? Or is a 24-hour urine protein quantification of more than 3.5 grams (large amounts of proteinuria) counted as high urine protein? To say that patients with kidney disease have high urine protein, in fact, they are relative, not absolute. From the perspective of the risk of uremia, the higher the urine protein, the greater the risk of developing uremia in the future; conversely, the urine protein is not high or too high, and the risk of developing uremia in the future is small.
Some people say that kidney disease with a 24-hour urine protein quantification of less than 1.0 grams has a relatively small risk of uremia in the future, or it is relatively safe. In fact, this sentence is not correct, or it is not comprehensive and accurate.
We found that there are many kidney diseases, patients with urine protein is not high, and even their urine protein is in the normal or near-normal range, but eventually still develop uremia. Hypertensive renal impairment, drug-induced interstitial nephritis, gouty nephropathy, IgA nephropathy, polycystic nephropathy, and chronic pyelonephritis are all present.
We also found that some kidney diseases, although the patient's urine protein is high or high, but after treatment, it is not easy to develop uremia. For example, micronephropathy, membranous nephropathy and hepatitis B virus-related nephritis exist.
However, no matter how high the patient's urine protein is, kidney disease is afraid of the following three major symptoms. Once these symptoms appear, it is often suggested that the patient's kidney function has decreased significantly, or it is already chronic renal failure, or it is not far from renal function.
Easy fatigue and poor energy is a reflection of a person's overall state of the performance, when the kidney disease patient gradually appears this symptom, more suggests that the patient's condition has been a relatively large aggravation or deterioration. Anemia, hypertension, and electrolyte abnormalities can all cause this to occur in patients. Anemia, hypertension and electrolyte abnormalities are all complications of chronic renal failure and uremia. Therefore, when patients have symptoms of easy fatigue and poor energy, they must pay attention.
Patients with kidney disease often get up at night with the appearance of nocturnal urine for a long time, do not think that this is irrelevant. As chronic kidney disease progresses to the middle to advanced stages, patients experience tubular hypofunction and decreased urinary concentration, which is often one of the symptoms of chronic renal failure or uremia. Therefore, when patients with kidney disease for many years appear to have frequent night up and nocturnal urine, they must also be paid attention to. Particularly seen in patients who would otherwise be diagnosed with glomerulonephritis.
Eating is not fragrant and getting thinner and thinner, and it seems that it has little to do with kidney disease or kidney failure. However, if you have suffered from years of kidney disease, you must consider that the kidney disease has progressed to a more serious stage, and even uremia is possible. When chronic renal failure develops metabolic acidosis or affects the digestive system, patients experience poor eating and thinner. Therefore, when patients appear to be unhappy with eating and getting thinner, they must be paid attention to.
When the above symptoms of kidney disease appear, the patient must go to the hospital as soon as possible for relevant examinations to evaluate the condition and formulate further treatment plans, in order to delay the rapid development of slow kidney disease in the direction of uremia.
However, the kidney first should emphasize that patients with kidney disease should pay attention to the following indicators before the above symptoms appear, so as to have the hope of stabilizing kidney function.
1. Urine protein
Once kidney disease is diagnosed, patients should pay attention to the important indicator of urine protein. Is it low-amount proteinuria, moderate proteinuria, or large proteinuria? Is it proteinuria based on trace albumin, or is it proteinuria based on macromolecular urine proteins (such as microglobulin)? And so on, should be figured out and given the corresponding protein-lowering therapy.
2. "Four Highs"
The "four highs" mentioned here include hypertension, hyperglycemia, hyperlipidemia and elevated blood uric acid. Is kidney disease caused by one of the "four highs"? For example, diabetic nephropathy is caused by high blood sugar; or is it the "four highs" secondary to kidney disease? For example, chronic kidney disease may be secondary to renal hypertension. In short, corresponding "high" treatment should be given.
3. Immunity
The prognosis of chronic kidney disease ultimately depends on the patient's own immunity. It should not be taken seriously until it progresses to chronic kidney failure and uremia, but should be preceded by improving the immune function of patients. Immunity is the ability to resist disease, including peripheral blood leukocytes, blood immunoglobulins, factor B and transferrin. During the medication, patients should pay attention to and improve immunity at the same time.
It was released simultaneously with the WeChat public account of the same name "Kidney First", and the article was original by Zhou Xun. Unauthorized reproduction is not permitted.