What are you most afraid of with kidney disease? The biggest fear is that it will progress to uremia. From this perspective, severe illness may seem scary, but it is actually an episode in the diagnosis and treatment process; and what is truly scary is a long-term illness. why? S

What are you most afraid of with kidney disease? The most fearful thing is that it will progress to uremia . From this perspective, severe illness may seem scary, but it is actually an episode in the diagnosis and treatment process; and what is truly scary is a long-term illness.

Why?

Severe patients often have large amounts of proteinuria, general edema, nausea and vomiting, difficulty breathing, and even renal tubular necrosis, acidosis , renal failure, heart failure .

It seems scary, but these complications, general edema, proteinuria, acidosis, etc., most severe cases can be alleviated by targeted drugs, and some of the symptoms have specific drugs. When complications are controlled, necrotic renal tubules will regenerate and renal function will be improved. conditions often recover well.

Therefore, when patients with kidney disease suddenly become seriously ill, it may seem scary, but it is not as scary as imagined. What's so scary about

?

Bian Que and Duke Huan of Cai The story is well known to everyone: Duke Huan of Qi When Duke Huan of Qi first fell ill, Bian Que was confident and wanted to treat Duke Huan of Cai three times in a row, but was rejected; as time went on, Duke Huan of Cai was It became a chronic illness. Even if he was as skilled as Bian Que, he could only say that there was no cure, so he turned around and fled to Qin State , and then Duke Huan of Cai died of illness.

Here is a detail: Until there was no cure, Cai Huangong still had no symptoms (fortunately there were no symptoms, otherwise Bian Que would not be able to escape). Prolonged illness without symptoms is the most troublesome thing.

There is a phenomenon in the nephrology department: is not afraid of double high protein and creatinine, but is afraid of single high creatinine.

Because urine protein is the product of early inflammation, inflammation is formed by the intense confrontation between the immune system and pathogenic substances. and high urinary protein indicate that the body is fighting against the disease, indicating that kidney cells have the ability to launch a counterattack. Although renal tubule may be implicated in the confrontation between the two parties, resulting in tubular necrosis and renal failure. but renal tubular epithelial cells can regenerate and renal function can be restored.

We are not afraid of tubular necrosis, but we are afraid of glomerular necrosis. In the advanced stage of kidney disease, glomeruli are sclerotic and necrotic, unable to initiate inflammation, and there is little or no protein in urine, making it difficult to recover.

In short, kidney disease is:

is not afraid of serious illness, but is afraid of long-term illness;

is not afraid of double high protein and creatinine, but is afraid of single high creatinine;

is not afraid of renal tubular necrosis, but is afraid of glomerular necrosis.

These three sentences have the same meaning.

There is another important reason why serious diseases are easy to treat, but long-term diseases are difficult to treat: the doctor-patient relationship is completely opposite.

Sometimes I think: If I were in Bian Que's position, how should I solve Cai Huangong's illness? After much deliberation, there was no good solution. Final conclusion: This is a dead end.

After practicing medicine for many years, I have a deep understanding:

1. The doctor-patient relationship in serious illness is "the patient asks the doctor"

When there are many patients and the queue is long, the seriously ill patients will insist on waiting in line and will not give up easily.

Traditional Chinese medicine is generally not very tasty, but seriously ill patients drink it willingly.

Severe cases require taboos. You should avoid touching delicious food or drink less, or eat less. Is it painful? it's painful! But seriously ill patients take the initiative and have no regrets.

2. The doctor-patient relationship of chronic illness is "the doctor seeks the patient"

You have a positive sign of protein in your urine, and you need to standardize the diagnosis and treatment - I feel that it is nothing, I have been busy recently, I will give you a good treatment after a while.

Although the medicine does not taste good, it is good medicine that tastes bitter and is good for the disease. You must persist in the treatment-hell, I will just stop for a few days, and it won't have much impact.

You need to exercise for half an hour every day, which is good for your kidneys and body - I know it's too late to get off work today, I will do it next time.

At this time, I am not like a doctor, but like a waiter, serving the patient wholeheartedly, but the patient is still reluctant. Now many hospitals have written "registration fee" as " medical service fee ". It is best for doctors to be good waiters. But this waiter is very strange: usually waiters give customers whatever they like and follow their wishes; this waiter is "ignorant" and will let customers do what they don't want to do.

In many cases, it is precisely because doctors cannot help patients that the disease becomes a "chronic illness", just like Bian Que and Cai Huangong. It is said that "the doctor does not knock on the door", but even if Bian Que comes and knocks on the door, it will be of no use. Therefore, I have experienced for many years that the tragedy of Bian Que and Duke Huan of Cai is an irresolvable knot. At this point, we have not made any progress in more than two thousand years. Perhaps in another two thousand years, future generations will have the wisdom to solve this problem.

Of course, there are also many patients who are not like Cai Huan and are health-conscious, so I push popular science articles to prevent long-term diseases. Doctors' salaries partly come from state funds, which come from taxes paid by the general public. From this perspective, regardless of whether the patient calls you or not, you should explain the knowledge about kidney disease to the patient and avoid long-term illness.

There are also some patients who are another matter: they are sick but don’t know they are sick (the awareness rate of kidney disease is only 10%). It has not been checked for many years, and neither doctors nor patients knew it. Unknowingly, kidney fibrosis had become a "long-term disease." How long does

take? It's not easy to set a fixed standard. The longer it goes on, the harder it will be to improve. The earliest "long" is when the glomerular filtration rate of and are lower than 45. After this line, the treatment effect is not as good as in the early stage. The latest "long" is hemodialysis after one year, the kidneys have no improvement value.

Finally, I hope that friends will build up the confidence to defeat the disease, not be afraid of serious illness and avoid long-term illness, so that they and their families can live a healthy life.

If kidney friends still have kidney disease problems, you can click → Kidney problems, find "Dr. Shi, a nephrologist"!