A 16-year-old sunshine teenager, who was still active on the stage of various performances a few years ago, accidentally found that the blood creatinine index was seriously exceeded by more than 1,000 in a recent physical examination, and further kidney ultrasound was eventually diagnosed as "chronic kidney disease stage 5 (uremia stage)", which means that he has to undergo dialysis or kidney replacement for a lifetime.
At a public welfare event on the 17th World Kidney Disease Day this year, Professor Zhang Jun, chief physician of the Department of Nephrology, Pearl River Hospital, Southern Medical University, shared the case. He said that there are about 120 million patients with chronic kidney disease on the mainland, but due to insufficient awareness and the fact that chronic kidney disease is often hidden, only 12.5% of patients know that they have the disease. Children are not good at expressing themselves, and the occurrence of symptoms is easily masked in other growth and development problems, and it is easier to miss the time for treatment.
"Early screening and early diagnosis and treatment can greatly reduce the risk of developing to the end stage, once the early kidney disease is not continuously treated and effectively controlled, and it develops to the stage of end-stage uremia, it can only face long-term dialysis or kidney replacement, which brings great burden to the family and society, and for child patients, it is a lifelong impact." In fact, the screening of chronic kidney disease (CKD) is very simple, and a urine routine test can find problems. Professor Zhang Jun said.
Increase in patients with chronic kidney failure The reserve of knowledge of kidney health is important
At this public welfare activity for children with kidney disease called "Walking with Cute Children, Transparent Life Home", experts in kidney disease and children's kidney disease from many hospitals in Guangzhou provided health science publicity for local dialysis children and parents.
At the event, the parents of the children also shared and exchanged the feelings of having a "dialysis baby" at home, and jointly absorbed the strength to accompany their children forward. "Now that medicine is more and more developed, and even peritoneal dialysis can be carried out at home, I hope that I can master more relevant knowledge, take care of my child, accompany him to the road of the future, and hope that he can grow up happily like an ordinary child." One parent shared.
Professor Zhang Jun introduced that the relevant data of epidemiological surveys show that the prevalence of chronic kidney disease in Adults in China is 10.8%, and at the end of 2020, 800,000 people in mainland China are undergoing dialysis; according to statistics, there are currently more than 2 million children with kidney disease in mainland China, of which chronic kidney failure is increasing at a rate of 13% per year. The treatment of end-stage renal disease requires great economic investment, and relevant data show that Chinese uremia patients account for only 0.03% of the main population, but medical expenditure accounts for 2% to 3% of the whole.
"In the end-stages of kidney disease, these patients require renal replacement therapy options such as hemodialysis, peritoneal dialysis, or kidney transplantation. For children, because of the particularity of physiology, not only the burden of medical expenses is much greater than that of adults, the family also needs to free up the manpower of care and companionship, parents and children are facing challenges in many aspects such as physiological psychology, family relations and social relations, how children learn normally, grow up, and integrate into society, they all need to face. They need more social support and more knowledge. Professor Yang Fang, deputy director of the Department of Pediatrics of the First Affiliated Hospital of Jinan University, said.
Observing these signs helps to detect kidney disease in children early
"Chronic kidney disease can be divided into 5 stages, and only 20% or 30% of patients in the first 3 stages can be diagnosed with chronic kidney disease in time. And it is precisely this part of the patients that if they get timely intervention, the treatment effect is very good. Studies have found that early intervention in CKD can reduce the risk of developing to mid-to-late renal disease by up to 80%. Therefore, early detection and diagnosis are particularly important, and for pediatric patients, early detection and treatment will be better. Professor Zhang Jun introduced.
The current international definition of the duration of chronic kidney disease is a persistent onset of more than three months. But in fact, many patients with chronic kidney disease are found to have impaired kidney function, and an important reason is that the onset of kidney disease is very hidden, and the early symptoms are not obvious, such as edema, headache, easy fatigue, etc., which are easily ignored. Some inherited kidney diseases can occur in the fetal period or recur in adulthood. When the child is sick at a very young age, it is not easy to be found, on the one hand, the young child will not express his discomfort, on the other hand, the symptoms of kidney disease are also easy to hide in other growth and development problems.
Professor Sun Liangzhong, director of the Department of Pediatrics of Nanfang Hospital of Southern Medical University, reminded that parents should pay attention to if they find that their children have slow growth and malnutrition. Children who are not long are usually taken to see nutrition, growth and development, child health, etc., if the doctor you meet has kidney-related background knowledge, a little check of the urine routine, do a kidney ultrasound, it is possible to find some patients earlier. Some children have long-term urinary tract infections, recurrent attacks, or anemia, which are worth noting.
Regarding children's kidney disease, the most intuitive way to live is to observe the change of urine, if you find that the child's urine foam is a lot, the color is dark, and the urine of the young child leaves white stains after the ground is dry, which may be abnormal.
Professor Sun Liangzhong also called for paying attention to urine examination and kidney ultrasound in the routine physical examination, such as the physical examination of kindergarten and enrollment, if a simple urine screening can be added, problems can be found.
Trend: Patients have more new options Peritoneal dialysis at home
Professor Tang Xun, deputy director of the Department of Nephrology, Pearl River Hospital, Southern Medical University, introduced that with the continuous maturity and advancement of renal replacement therapy technology, patients have more choices. For example, at present, peritoneal dialysis can already be achieved through home treatment, especially automated peritoneal dialysis according to the patient's daily living habits to arrange dialysis treatment, before going to bed at night, get off the machine after getting up, instead of traditional manual abdominal dialysis, so that patients can go to work and school normally during the day and return to society. At the same time, it can also automatically upload the patient's dialysis treatment data to the monitoring platform of the medical center, and the doctor can monitor the patient's treatment situation throughout the process and adjust the patient's treatment prescription directly online.
Professor Tang Xun said that under the situation of normalization of epidemic prevention and control, home dialysis reduces traffic restrictions, avoids travel to and from hospitals to increase the risk of cross-infection, and also saves a lot of travel costs. However, ensuring that children can complete treatment on time and on demand requires comprehensive management of the entire social system, from medical staff to hospitals to communities. Medical staff should conduct professional and standardized training for patients with abdominal dialysis to ensure that parents can complete the treatment operation independently at home and prevent the occurrence of complications; the hospital should follow up patients with abdominal dialysis in layers and grades.
According to Yang Qixuan, chief nurse of the Department of Nephrology of Pearl River Hospital, since 2020, many hospitals in Guangzhou, including Pearl River Hospital, have opened Internet hospitals to provide online consultation follow-up and prescription of drugs, including service functions such as the distribution of intra-peritoneal dialysis, which provides more convenience for patients and partially solves the problem of difficulty in seeking medical treatment.
Text/Guangzhou Daily, New Flower City Reporter: Zhou Jieying
/ Guangzhou Daily New Flower City Editor: Li Jin