The vast majority of nephrologists think that they should use drugs to treat diseases. We often encounter nephrotic patients who were treated in other hospitals or other doctors before. Their diagnosis and treatment process is right: when they find that they are uncomfortable, they go to the hospital for corresponding examination and diagnosis. When the disease is “clear”, they begin to take medicine every day and return visit on time. At this time, the patient also feels that he has “completed the task”, and there should be no problems, and he will not develop into uremia, because he has also done relevant examinations regularly, and all the laboratory indexes are “good”.
recently, the author received such a patient with kidney disease. She is a female patient from a county in Northern Jiangsu Province. She was diagnosed as “chronic nephritis” by the local municipal hospital. She has been given antihypertensive treatment, Tripterygium Glycosides tablets and Jinshuibao Capsules. At ordinary times, she only tests the urine routine, blood routine, liver and kidney function and kidney color Doppler ultrasound, and the blood creatinine before examination is “normal” Scope “. The doctor at the local hospital told the patient, “your kidney function is normal, don’t worry!”. When the patient came to our hospital for further examination for the first time, it was found that the patient’s serum creatinine was 1.1mg/dl, but its endogenous creatinine clearance rate was only 39ml / Mn, which indicated that the patient’s renal function had been seriously reduced, that is, he was in stage 3b of chronic kidney disease, very close to stage 4 of CKD, which could also be said that he was only one step away from stage 5 of CKD or uremia. Perhaps a serious cold or infection, the patient’s serum creatinine can quickly rise to the level of uremia, that is uremia.
it can be said that our kidney friends only know that it is far from enough to treat nephropathy with drugs. If the examination is not comprehensive or the diagnosis is too simple, it will affect the judgment of the disease and the evaluation of renal function, and ultimately affect the treatment and prognosis.
therefore, in addition to some simple tests, kidney friends should at least do the following tests, otherwise uremia will really come.
I often hear kidney friends say “urinary protein 1 +, 2 + or 3 +”, and also say “after taking medicine, urinary protein changes from 3 + to 2 + or 1 + or turns negative”, and so on. It still stays at the level of “+” of urinary protein to judge the curative effect. Some patients, even did not check the 24-hour urine protein quantitative, that is, “do not know how many grams of protein in their urine in the end!”. However, the “+” sign of urinary protein in patients with nephropathy can only be used as a reference, not as a basis. If the 24-hour urine protein of the patient reaches or exceeds 1.0g of the medium level, or even 3.5G of the massive proteinuria level, and continues to do so, the patient is more likely to progress to uremia, perhaps uremia will come.
many nephrotic patients will still judge renal failure based on whether serum creatinine is in the normal range, even many non nephrotic specialists think so. We have met many nephrotic patients from other places who have been suffering from chronic kidney disease for many years. Each time we go to the local hospital, we only check the serum creatinine, urea nitrogen and uric acid of renal function, but never check the glomerular filtration rate or endogenous creatinine clearance rate. In fact, serum creatinine can not fully reflect renal function, it will be affected by a variety of factors. It is more reliable to judge and evaluate renal function that GFR or CCR should be detected. Otherwise, even if GFR or CCR is very low, you may not know. Maybe uremia will come one day.
in some patients with chronic kidney disease, the protein in urine routine is not too high, and even the urine protein is in the range of small amount of proteinuria. At this time, it may be considered that the patient’s condition is not serious. The author said “not necessarily”, this is because the 24-hour detection of total urine protein mainly through the urine protein precipitation method and biuret method to determine the concentration of protein after the calculation of the total urine protein, it does not make specific component analysis, in fact, it includes a variety of proteins, such as albumin, transferrin, microglobulin and NAG and so on. If the urinary microglobulin and nag reflecting renal tubulointerstitial injury are also significantly increased, it indicates that the kidney injury is more serious, and it is “all-round” injury, and patients are more likely to develop uremia, or uremia.
in addition to the above three laboratory indexes, we patients with kidney disease should also have other examinations according to the different conditions. If lupus nephritis is suspected or needs to be excluded, blood C3, IgG, γ, anti dsDNA antibody and SM antibody should be examined; if other manifestations of the lung and the whole body need to be excluded, small vasculitis should be excluded, ANCA and other related examinations should be performed; for example, patients with kidney disease Previous history of hepatitis B, need to exclude hepatitis B nephritis, may need to do renal biopsy and so on. The treatment of secondary kidney diseases such as lupus nephritis, ANCA associated nephritis and hepatitis B virus associated nephritis is different from that of primary kidney diseases. If the treatment is not in place, it is more likely to progress to uremia, and may even have other serious consequences.
is Shenyou still taking medicine? For those patients with kidney disease whose laboratory examination is not comprehensive enough, we must improve the relevant examination as soon as possible, otherwise, your condition has been very serious or in the rapid development also do not know, uremia or come. Pregnant dream “Golden Dragon” is about to “give birth to a boy”? You think too much, the function of fetal dream is not here