Renal failure is a pathological state in which the renal function is partially or completely lost in the later stages of the development of various chronic kidney diseases, which is divided into acute renal failure and chronic renal failure. Acute renal failure progresses rapidly, mostly due to certain acute factors, early and timely treatment, and most patients have a good prognosis. The onset of chronic renal failure is relatively slow, mostly caused by chronic kidney injury or chronic kidney disease, and the injury is usually unrecoverable and the prognosis is poor.
Patients with acute renal failure (ARF) have a sudden or persistent decrease in glomerular filtration rates, resulting in nitrogen waste retention, water, electrolyte, and acid-base balance disturbances. Decreased renal function can occur in patients with a predominantly asymptomatic kidney disease, or in patients with predominantly stable chronic kidney disease, with a sudden sharp deterioration in renal function. There are many kinds of etiology, which can be divided into three categories: prerenal, renal and retrorenal.
Common causes of prerenal ARF include volume depletion (e.g., bleeding), effective arterial volume depletion, low cardiac output, intrarenal hemodynamic changes, and renal artery obstruction; the etiology of retrorenal acute renal failure is mainly acute urinary tract obstruction; renal acute renal failure refers to renal parenchymal damage, commonly renal ischemia or nephrotoxic damage to tubular epithelial cells (eg, acute tubular necrosis, ATN), but also includes glomerular disease, renal vascular disease, interstitial lesions with a sharp decline in renal function. The causes of ATN are diverse, from infections, factors that cause a decrease in effective circulating capacity or blood pressure, nephrotoxic drugs, and food poisoning.
Zhang Zhenzhong, a traditional Chinese medicine expert at Beijing Lianke Traditional Chinese Medicine Nephrology Hospital, said that the treatment of acute renal failure should first clarify the cause, correct the reversible cause, and treat it symptomatically. If there is severe trauma, heart failure, acute blood loss, etc., corresponding treatment should be carried out, including expansion, correction of volume depletion, shock and control of infection, etc., and nephrotoxic drugs should be discontinued. Maintain the body's water, electrolyte and acid-base balance, necessary hemodialysis in the acute phase, the use of hormones, immune preparations and other drugs. Convalescent therapy involves maintaining water, electrolyte, and acid-base balances, controlling azotemia, treating the underlying disease, and preventing complications. At the same time, it is supplemented by traditional Chinese medicine conditioning to improve kidney function and promote the discharge of waste.
The elderly swallow fish gall for acute renal failure, and chinese medicine conditioning and rehabilitation after dialysis
According to the "Wuhan Evening News", an old man heard that eating fish bile can be blind, but also enhance immunity, swallow 7 fish bile at a time, no urine for four days, was sent to the hospital for examination and found kidney failure.
Patient xxx, female, 70 years old, no history of chronic disease. Some time ago, due to the cold of the limbs, I was particularly afraid of cold, and I heard the neighbors say that my immunity was low. An old neighbor said that he had previously eaten a kind of Chinese medicine containing snake bile, which could not only make his eyes clear, but also detoxify and relieve pain and improve immunity. The patient saw that his son had fished seven or eight fish back that day, and personally cut out 7 fish galls and prepared to take them.
Fearing that eating raw fish bile would be poisoned, the fish bile was specially placed in the pot and boiled for a few minutes, and then swallowed. Unexpectedly, there was no urination for four consecutive days. On the fifth day, he felt that something was wrong and was sent by his family to a hospital in Wuhan for medical treatment. Renal function tests found that the glomerular filtration rate was only 6.53 ml/min, which was 6% of the normal value.
The doctor inquired about the condition and learned that the elderly had severe symptoms of anuria poisoning after taking fish bile, which led to acute kidney failure. Immediate dialysis treatment reduces the degree of organ damage. After treatment, the patient's condition was controlled, followed by integrated traditional Chinese medicine and western medicine, and kidney function was slowly restored.
Doctors said that fish bile contains bile and other toxins, bile toxins heat tolerance is relatively high, whether it is raw food or cooked food, or after taking wine treatment, will cause poisoning reactions, damage to the human liver, kidneys and other organs, resulting in organ degeneration necrosis; may also damage brain cells and heart muscle, resulting in lesions of the nervous system and cardiovascular system. If the rescue is not timely, or the treatment is delayed, it may cause damage to brain cells and cardiomyocytes, cause multiple organ failure, and in severe cases, it may even be life-threatening.
Which foods are susceptible to acute kidney injury?
Zhang Zhenzhong, a chinese medicine expert, said that some foods themselves have nephrotoxicity, if not eaten properly, the light leads to acute kidney injury, there is a possibility of reversal, and the heavy causes kidney failure, or even directly fatal.
1. Carambola. It is an edible fruit known as the high-value star fruit. Carambola is rich in nutritional value, flavonoids, benzoquinones and glycoside compounds are considered to be the most biologically active substances, with antioxidant, anti-hyperglycemia, antihypertensive, anti-inflammatory, cardiac protection and other effects. Traditionally, it has been used to treat diabetes, joint pain, vomiting, urinary retention, cough and chronic paroxysmal headaches.
But starfruit is nephrotoxic. Healthy people can consume star fruit in moderation, because healthy people can excrete oxalic acid and neurotoxins through normal metabolism. Because starfruit contains a lot of oxalic acid and a neurotoxin. After consuming star fruit, vomiting, hiccups, limb numbness, and even status epilepticus may occur. In renal histology, it presents with acute oxalic acid nephropathy, tubular interstitial nephritis, or tubular necrosis.
2. Crayfish. Toxic toxins or mechanisms: damage to the rhabdomyosa, disruption of the integrity of the striated muscle membrane, and leakage of cell contents such as myoglobin, enzymes, creatinine, etc. into the blood circulation caused by a group of syndromes, often accompanied by acute renal failure and metabolic disorders. Rhabdomyolysis is mostly associated with drugs, food poisoning, and muscle damage.
Presents with pain in different parts, such as different degrees of neck, shoulder, chest and lower back muscle soreness, fatigue. Striated muscle lysis due to crayfish consumption is characterized by fever, fatigue, pain or tenderness in the affected muscles, muscle swelling, changes in urine color, and oliguria or anauria, and even septic shock and acute renal failure.
When a large amount of lactate, muscle protein, purine, potassium, phosphorus and neurotoxic metabolites enter the extracellular fluid when the rhabdomyocytes are injured, they can cause hyperkalemia, acid-base balance imbalance, and eventually lead to arrhythmias, respiratory and nervous system complications, which can be manifested as drowsiness, restlessness, agitation, bradycardia and even cardiac arrest and other critical symptoms.
3, fish gall, snake gall and other animal gallbladder. Fish bile poisoning can lead to kidney, liver, heart, gastrointestinal and other organ failure, of which the kidneys are the most vulnerable organs. Mechanism of toxicity: Fish bile contains histamine, bile acid and its derivatives, hydrocyanic acid, etc. can destroy the cell membrane structure, causing tissue edema, organ bleeding, damage to cell lysosomes, mitochondria and other organelles.
The toxic substance in the fish bile is bile toxin, bile toxin into the gastrointestinal tract, the first symptoms of gastrointestinal poisoning, and then absorbed into the blood to reach the liver, causing hepatocyte degeneration, necrosis; and finally through the kidney excretion due to the special anatomical and physiological characteristics of the kidney, causing acute necrosis of the renal tubules; serious cases can cause brain cells, cardiomyocytes damage and metabolic disorders, resulting in damage to multi-organ function.
Fish bile toxins are excreted through the kidneys and cause kidney damage. It has been reported in the literature that 16 cases of fish bile poisoning caused MODS, all of which developed acute renal dysfunction, the incidence of acute liver dysfunction was 40%, and 2 cases died. Toxic manifestations: nausea, vomiting, abdominal pain, diarrhea and other gastrointestinal symptoms are the first symptoms, while acute kidney injury is the most common and serious consequence, the incidence rate is 55% to 100%, accounting for 91.7% of the causes of death.
4. Uncooked yam, yam powder, yam juice. Yam is a medicinal and food homologous plant that contains active ingredients such as mucin, diosgenin, allantoin, choline, plant sterols, oligosaccharides and essential amino acids. It can be used as a traditional Chinese medicine to treat diabetes, diarrhea, asthma, jaundice and other diseases. Fresh yam has a high water content, is not easy to store, in the storage process is prone to rot, mold phenomenon, many times yam is made into powder as raw materials.
Because yam starch is rich in starch and low in protein content, it is delicious and full. Yam powder is also more convenient to eat and is a common food for patients with chronic kidney disease. Yam contains toxic ingredients diosgenin and diospyrine, which can cause acute tubular necrosis and lead to kidney damage. When eating yam, you must not pursue the crunchy texture, and cook it soft and sticky. Because after the yam is cooked, the toxic ingredients will lose their toxicity, and they can be eaten with confidence.
5. Li Dou. It is mainly produced abroad, such as Australia. Ricosum contains toxic non-protein amino acids, a nephrotoxic compound. Dried and roasted at 180 °C, the level of lysoulin can be significantly reduced by more than 90%, which can be safely consumed by humans. If you eat lidou poisoning, gastrointestinal symptoms such as abdominal pain, vomiting, and even hematuria, oliguria, acute kidney injury and so on. It should not be consumed by patients with chronic kidney disease.
(Text/Li Lie, Physician/Zhang Zhenzhong; about 2670 words)