Renal insufficiency

　　Chronic renal insufficiency is the final outcome of various progressive renal diseases, so there are many causes of chronic renal insufficiency. The most common ones are as follows:

　　1. Chronic glomerulonephritis: such as IgA nephropathy, membranoproliferative glomerulonephritis; focal segmental glomerulosclerosis and mesangial proliferative glomerulonephritis, etc.

　　2. Renal damage caused by metabolic abnormalities, such as diabetic nephropathy, gouty nephropathy, and amyloidosis nephropathy, etc.;

　　3. Vascular renal lesions, such as hypertension, renal vascular hypertension, renal arteriosclerosis, etc.;

　　4. Hereditary nephropathy, such as polycystic kidney disease, Alport syndrome, etc.;

　　5. Infectious nephropathy, such as chronic pyelonephritis, renal tuberculosis, etc.;

　　6. Systemic diseases, such as lupus nephritis, vascular inflammation kidney damage, multiple myeloma, etc.;

　　7. Toxic nephropathy, such as analgesic nephropathy, heavy metal poisoning nephropathy, etc.;

　　8. Obstructive nephropathy, such as ureteral obstruction; reflux nephropathy, urinary tract stones, etc.

　　(1)Infection is one of the most common and serious complications, often seen in severe trauma, burns, and other causes of hypermetabolic acute renal failure.

　　(2)Cardiovascular system complications include arrhythmias, heart failure, pericarditis, hypertension, and so on.

　　(3)Neurological complications include headache, drowsiness, muscle twitching, coma, epilepsy, etc. Neurological complications are related to the retention of toxins in the body, water intoxication, electrolyte disorder, and acid-base imbalance.

　　(4)Gastrointestinal system complications are manifested as anorexia, nausea, vomiting, abdominal distension, hematemesis, or hematochezia, and bleeding is often due to erosion of the gastrointestinal mucosa or stress ulcers.

　　(5)Blood system complications, due to the rapid decline in renal function, can reduce the level of erythropoietin, causing anemia, but most cases are not severe. In a few cases, due to a decrease in coagulation factors, there may be a tendency to bleed.

　　(6)Electrolyte disorder and metabolic acidosis can lead to hyperkalemia, hyponatremia, and severe acidosis, which are one of the most dangerous complications of renal insufficiency.

　　During the polyuria period, the patient's daily urine output can reach 3000-5000ml. Due to the large amount of water and electrolyte excretion, dehydration, hypokalemia, hyponatremia, and other conditions may occur. If not supplemented in time, the patient may die of severe dehydration and electrolyte disorder.

　　Renal insufficiency is caused by a variety of reasons. It is a clinical syndrome complex after severe glomerular damage, which causes the body to appear disorders in excretion of metabolic waste, regulation of water and electrolyte balance, and acid-base balance. It is divided into acute renal insufficiency and chronic renal insufficiency. The prognosis is severe, and it is one of the main diseases that threaten life. Renal insufficiency can be divided into the following four stages, and different stages will have different symptoms.

　　Stage 1: renal reserve compensatory stage.Because the kidney has a great reserve compensatory capacity, although the renal function has decreased clinically, its excretion of metabolic products and ability to regulate water and electrolyte balance can still meet the normal needs. Clinically, there are no symptoms, and renal function tests are within the normal range or occasionally slightly elevated.

　　Stage 2: renal insufficiency stage.The glomeruli have been damaged to a considerable extent, 60%-75%, there is some obstruction in the excretion of metabolic waste by the kidneys, and creatinine and blood urea nitrogen may be slightly higher or exceed the normal range. Patients may experience anemia, fatigue, weight loss, and difficulty concentrating. However, they are often overlooked. If there is dehydration, infection, bleeding, and other conditions, symptoms will appear quickly.

　　Stage 3: renal failure stageThe kidney function has been severely damaged, 75%-95%, cannot maintain the body's internal environment stability, patients are prone to fatigue, weakness, and inability to concentrate, symptoms such as anemia are more obvious, nocturia increases, blood creatinine and blood urea nitrogen rise significantly, and acidosis is often present. This stage is also known as azotemia stage.

　　Stage 4: uremic stage or end-stage renal insufficiency.At this stage, the damage to the glomeruli has exceeded 95%, with severe clinical symptoms such as severe nausea and vomiting, oliguria, edema, malignant hypertension, severe anemia, pruritus, a smelly urine taste in the mouth, and so on.

　　To protect kidney function, one should eat less salt and keep the diet light, eat less food high in cholesterol, and eat more vegetables and fruits.

      As the main function of the kidneys is to excrete metabolic waste products from the body through urine, abnormal urine composition will be reflected early. Once there are more bubbles in the urine, fatigue, nausea, or edema of the eyelids and lower limbs, increased blood pressure and blood sugar, it is necessary to do a urine test as soon as possible. Urine test is one of the important means for early detection of kidney disease. Early diagnosis and treatment can effectively reduce the damage to the body, get effective control, reduce the occurrence of complications, and delay the progression of chronic kidney disease.

　　Urinary protein qualitative test

　　Usually, three methods are used: protein strip test, sulfosalicylic acid method, and heated acetic acid method. Under normal circumstances, the urinary protein qualitative test is negative. However, this test method is easily affected by various factors, which may lead to false results, such as when the content of uric acid is high, the urine shows an acidic reaction, the result of the protein strip test is lower than the actual situation, and the sulfosalicylic acid method is prone to false positivity; when large amounts of penicillin are used, the sulfosalicylic acid method is prone to false positivity; when using radiographic contrast agents, both the sulfosalicylic acid method and the heated acetic acid method may show false positivity; when the urine is strongly alkaline, there are more false results, or false negative reactions occur in the protein strip test, or false negative reactions occur in the sulfosalicylic acid method and the heated acetic acid method.

　　When urinary protein is only some special proteins, both the protein strip test and the sulfosalicylic acid method are not sensitive. Therefore, when determining urinary protein, various factors should be considered, and specific situations should be analyzed to choose the appropriate method. Although qualitative tests are more convenient, they are sometimes difficult to reflect the actual situation of proteinuria, and it is best to perform quantitative tests when possible.

　　Blood routine examination

　　Significant anemia, normal cellular anemia, white blood cell count normal or increased. Platelet count decreased, erythrocyte sedimentation rate accelerated.

　　Urinalysis

　　There are differences due to the different primary diseases. The common points are:

　　① Decreased urine osmolality, usually below 450mOsm per kilogram, after rehydration, usually below 1.018, and in severe cases, it is fixed between 1.010 and 1.012. During the urine concentration and dilution test, the nocturnal urine volume is greater than the diurnal urine volume, and the specific gravity of each urine sample is over 1.020, and the difference between the highest and lowest urine specific gravity is less than 0.008;

　　② Decreased urine output, usually below 1000ml per day;

　　③ The quantitative increase of urinary protein, in the late stage, due to the vast majority of glomeruli being destroyed, urinary protein actually decreases; ④ Urinary sediment examination, can have an unequal number of red blood cells, white blood cells, epithelial cells, and granular casts, the waxy cast is most significant.

　　Vegetable categoryVegetables such as various radishes, bamboo shoots, Chinese cabbage, green leafy vegetables, lettuce, cabbage, amaranth, celery, green garlic, lotus root, winter melon, cucumber, luffa, eggplant, tomato, green chili, and potato can be selected. Corn flakes, raw lotus root, lettuce, and chrysanthemum flowers should not be used.

　　Fruits and dried fruitsFruits can be selected from various types, and in many cases, fruits high in potassium cannot be eaten if the blood pressure is high, such as bananas and melons. It is not advisable to use peanuts, watermelon seeds, sunflower seeds, almonds, and dried lotus seeds. Egg whites from various types of eggs can be used, but egg yolks should not be used.

　　Seasonings, options include brown sugar, white sugar, and honey, while sesame seeds or sesame paste, and Douban sauce should not be used.

　　Other,Ice lollies, ice cream, and other options can be chosen, while cakes, Peach Crisp, Jiangmi Strips, and others should not be used.

　　Staple Food,Options include Jiangsu Standard One Rice, Middle White Rice, Fortified Flour, and lotus root starch. It is not advisable to use Jiangsu Standard Three Glutinous Rice or Beijing Special Large Rice and Millet.

　　1、Treatment of the Primary DiseaseThis is also something that renal insufficiency patients need to understand clearly. The degree of decline and the speed of progression of residual renal function in kidney disease of different etiologies are different. A large number of clinical cases have proven that even in the terminal stage of renal insufficiency, kidney function can be restored after hormone shock therapy or plasma exchange, and even there are reports of long-term dialysis withdrawal. Therefore, adhering to a good treatment method is the guarantee of overcoming the disease.

　　2、Control HypertensionIt also plays a very important role in the treatment of renal insufficiency. Hypertension is a factor that promotes the progression of kidney disease in any patient, especially in dialysis patients, who are prone to water retention and lipid metabolism disorders, which are also risk factors for increased blood pressure and atherosclerosis of the renal arteries; controlling the blood pressure of dialysis patients within the normal range is very important, and antihypertensive drugs that cause less kidney damage should be chosen. They can play a certain role in controlling the patient's condition.

　　3、Prevent Hypotensive Reactions During DialysisIt also plays a very good role in the treatment of renal insufficiency. Dialysis patients cannot have water retention or excessive weight loss. The rate of water removal during dialysis should not be too fast to prevent hypotension, as insufficient effective blood volume can further ischemia the kidneys, aggravating kidney damage. Some hemodialysis...

　　Hemodialysis is a process where blood is extracted from the body, passed through the permeation membrane of a hemodialysis machine, and cleared of metabolic waste and impurities in the blood, and then the purified blood is returned to the body. Commonly known as 'kidney washing' and 'blood washing'. Hemodialysis can be used for patients with renal failure or situations where harmful substances cannot be excreted by the body. Extending dialysis time can reduce complications of hemodialysis, improve quality of life, and reduce mortality rates.