The kidneys, an organ that makes up only 0.5% of the body's weight, are an important part of the endocrine system.
Every minute, about 1.2 liters of blood flowing through various places come here to be "filtered", and the garbage, toxins, etc. in it are filtered out and metabolized, so that clean blood can be supplied to the whole body.
Therefore, once the kidneys are damaged, they can affect the whole body, and in turn, other diseases of the body may implicate the kidneys.
Experts interviewed
Yang Xiao, chief physician of the Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University
Cai Jianfang, chief physician of the Department of Nephrology, Fuwai Hospital, Chinese Academy of Medical Sciences
Li Jianbo, Deputy Chief Physician, Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University
Hypertensive kidney: the later the drug is administered, the earlier the injury
Arteriolar sclerotic lesions caused by long-term hypertension throughout the body, kidney is one of the main organs affected, and the kidney can secrete antihypertensive substances, which is an important organ to regulate human blood pressure, so hypertension and chronic kidney disease affect each other and are each other's cause and effect.
The incidence of renal impairment is positively correlated with the severity and duration of hypertension, and hypertensive renal damage will occur earlier if early or long-term pressure control is not emphasized.
Be alert to these symptoms
After high blood pressure causes nephropathy, patients may have symptoms such as increased nocturia, and do not necessarily have proteinuria, and the early symptoms are not prominent overall, and are easy to be ignored.
As the disease progresses, there may be manifestations related to renal failure, as well as damage to other organs such as the heart, fundus, cerebrovascular, peripheral blood vessels, etc., and the manifestations are often atypical, such as myocardial infarction, which is often manifested as chest tightness and breathing.
Most patients with hypertensive nephropathy are elderly people, often have a long course of hypertension, and most of them do not take drugs regularly, monitor blood pressure regularly, and do not regularly follow up with them. Studies believe that hypertension lasting for 5~10 years will lead to varying degrees of glomerulosclerosis, renal interstitial fibrosis, and then cause a decline in kidney function.
How to respond
To prevent hypertensive nephropathy, in addition to improving dietary structure, scientific weight loss, regular work and rest, quitting tobacco and alcohol, etc., it is also necessary to follow the doctor's advice to rationally use antihypertensive drugs.
According to the 2021 guidelines "Improving the Prognostic Organization of Kidney Disease Worldwide", except for dialysis, children and kidney transplant patients, patients with chronic kidney disease are recommended to control systolic blood pressure below 120 mm Hg as long as they can tolerate it, and patients over 60 years old can be appropriately relaxed.
Sugar kidney: Once it occurs, it is difficult to reverse
If blood sugar levels remain high, blood sugar that cannot be used by the body will "wander" to the kidneys along the blood circulation, forcing the kidneys to increase blood filtration, resulting in overwork damage.
Long-term hyperglycemia can also lead to glomerular hyperperfusion, high pressure and high filtration, causing damage, oxidative stress, cytokines, and genetic factors will "add fire".
In addition to hyperglycemia, an acute drop in blood sugar can also reduce renal blood flow by about 22%, resulting in tubular hypoxia, necrosis, and even life-threatening.
Be alert to these symptoms
Diabetic nephropathy is a long-term, prolonged process, and once kidney damage occurs, it is basically difficult to reverse. Because the early symptoms are not obvious, the sugar kidney cannot be paid attention to, and it is often found during physical examination.
Further development may lead to the appearance of microproteinuria; With the gradual increase of proteinuria, there may be increased urine foam, edema and other manifestations; Once renal failure occurs, symptoms such as fatigue and dizziness may be presented.
How to respond
Treatment of irregular, obese, do not pay attention to diet and exercise, genetic factors and other conditions of sugar friends, are all high-risk groups, it is recommended to regularly urine test combined with fundus examination.
At present, the main principle of treating sugar kidney is early intervention, delay kidney failure, such as adjusting diet, early can adhere to high-quality animal protein diet, the recommended intake is 0.6 ~ 0.8 grams / day per kilogram of body weight (according to the specific situation).
Different sugar friends have different blood sugar control goals, such as advanced age and more diabetes complications, the goal is slightly relaxed, fasting blood glucose is about 7 mmol/L, and blood glucose occasionally 10 mmol/L 2 hours after meals is acceptable. Hypoglycemic drugs that have a protective effect on the kidneys may be preferred.
Gout kidney: imperceptible, slow onset
Uric acid is the terminal product of purine metabolism, and after entering the human uric acid pool, about 2/3 is excreted through the kidneys and 1/3 through the intestine.
High uric acid is the main cause of gout and kidney injury, and studies have shown that blood uric acid is an independent risk factor for the progression of kidney disease, and the risk is even higher than proteinuria.
Be alert to these symptoms
Long-term continuous high uric acid, excessive urate crystals are continuously deposited in the kidneys, can cause chronic urate nephropathy, early stage can appear nocturia, foamy urine, late stage can appear hypertension, edema, anemia and other manifestations.
When uric acid concentrations in the urine are supersaturated, they can be deposited in the urinary system and stones can form. Small stones have no obvious symptoms, and larger ones can block the urinary tract, causing renal colic, hematuria, dysuria, etc.
If the uric acid level rises sharply, a large amount of uric acid crystals are deposited, which can cause acute urinary tract obstruction, manifested as oliguria, anuria, and even acute renal failure.
How to respond
Patients with gout attacks
It is generally recommended that the blood uric acid level be less than 360 μmol/L.
Patients with frequent gout attacks
The uric acid target value should be between 180~300 micromoles/liter, and do not fluctuate too much.
Patients with severe chronic kidney disease with gout
It is recommended that blood uric acid be controlled between 180~300 micromoles/liter to reduce the risk of kidney damage.
Patients with renal insufficiency or problems should take their medication strictly according to their doctor's instructions. All urate-lowering drugs should be started at low doses, gradually increased, and closely monitored for potential renal adverse effects.
Medicine kidney: some once, some permanent
The kidneys are the main excretion route of drugs and their metabolites, and have a concentrated function, therefore, the concentration of drugs in the urine is dozens of times higher than in the blood, which can easily damage the kidneys.
Drugs can reduce renal blood flow and glomerular filtration rate by causing hypovolemia; In oliguria, drugs or their metabolites may stagnate and block the renal tubules, and hypersensitivity reactions and metabolic disorders may damage the kidneys.
Be alert to these symptoms
Most drug-induced kidney damage is temporary, and kidney function is reversible as long as the drug is stopped and treated in time, but kidney damage caused by certain drugs, such as traditional Chinese medicine containing aristolochic acid, is usually irreversible.
Symptoms of drug-induced kidney injury are more insidious and, more commonly, nocturia; When combined with glomerular or tubular lesions, foamy urine, edema and other manifestations may occur; When electrolyte abnormalities such as hypokalemia occur, symptoms such as fatigue and tiredness may occur, and once kidney failure develops, symptoms such as nausea and vomiting may occur.
There are risk factors for kidney injury such as diabetes and hypertension, the existence of underlying kidney disease, and poor medication compliance, such as frequent drug abuse, overdose, self-adjustment, long-term non-review, etc., these groups are more likely to develop drug-induced kidney injury.
At present, about hundreds of drugs have potential renal toxicity, it should be emphasized that many drugs are not "used to hurt the kidneys", as long as the doctor's advice is followed, do not use drugs indiscriminately, the risk of kidney damage can be greatly reduced.
How to respond
Patients who must take nephrotoxic drugs should try to follow the principle of "less dose, short course of treatment", and can also use auxiliary drugs to reduce nephrotoxicity under the guidance of a doctor, such as the use of sulfonamides, which are routinely combined with sodium bicarbonate to alkalinize urine to avoid tubular crystal formation.
If symptoms of kidney damage occur after taking the drug, it is recommended to seek medical attention as soon as possible. ▲
Editor of this issue: Xu Menglian