Zhou Xun, chief physician of Nephrology
Some friends with kidney disease always worry. When they see words such as "early" or "middle-stage", they will think that "the kidney function has begun to break down" or "the renal failure has become more serious". Earlier, an online patient encountered this situation when consulting the author. He said that he had reached the middle stage, saying that it was the middle stage of renal insufficiency. But when the author saw the patient sending the test and diagnosis pictures, it was not the case. Instead, he was in the mid-stage CKD stage 3 of chronic kidney disease. Then look at his glomerular filtration rate of is 55ml/min (which is the early stage of CKD stage 3a, that is, the early stage of chronic kidney disease stage 3). The patient is 61 years old. The key is that his blood pressure control is also up to standard, and his urine protein is not high. I said, "As long as you cooperate with the doctor to treat and maintain your prognosis, your prognosis will not be bad."
This is what the kidney wants to say first today, that is, do not say "early or intermediate stages of chronic kidney disease" as "early or intermediate stages of chronic renal insufficiency". They are different, and more importantly, their prognosis is very different.
First talk about "chronic kidney disease (CKD)". In fact, most of the kidney diseases we encounter fall into this category. The mild ones can be very light, and the severe ones can be very heavy. Of course, patients with early stages of chronic kidney disease may not be very mild, and patients with late stages of chronic kidney disease may not necessarily feel sick. However, a considerable proportion of patients in the early stages of chronic kidney disease do not develop into chronic renal failure or uremia . Generally, the first phase of CKD with a glomerular filtration rate greater than 90ml/min and the second phase of CKD with a glomerular filtration rate between 90-60ml/min are called early stages of chronic kidney disease. Most of the renal function indicators such as serum creatinine and in patients are normal. In other words, patients with early stages of chronic renal disease have not yet reached chronic renal insufficiency. Generally speaking, the glomerular filtration rate is between 60-30ml/min. The patients' renal function indicators such as serum creatinine are mostly higher than the normal range, but they are usually not too high. In other words, patients with mid-stage chronic renal disease can be diagnosed with chronic renal insufficiency, and most of them are early stages of chronic renal insufficiency.
Let’s talk about “chronic renal insufficiency (CRF)”. Compared with chronic renal disease, there are not so many cases where chronic renal insufficiency can be diagnosed. Only chronic renal insufficiency such as serum creatinine exceeds the normal range and excludes acute renal injury can be diagnosed. Further examination will find that under normal circumstances, the glomerular filtration rate of patients with chronic renal insufficiency will be less than 60ml/min, which is stage 3 and stage 3 after chronic renal disease. Generally, the 3a phase of chronic renal disease with a glomerular filtration rate between 60-45 ml/min (serial creatinine is mostly between normal and 177 μmol/L) is called the early stage of chronic renal insufficiency; the 3b phase and 4 phase of chronic renal disease with a glomerular filtration rate between 45-15 (serial creatinine is mostly between 177-450 or 707 μmol/L) is called the mid-stage of chronic renal insufficiency.
From the above explanation, it can be seen that the difference between the middle stage of chronic renal disease and the middle stage of chronic renal insufficiency is very big, and the prognosis is also different. The difference between the early stage of chronic renal disease and the early stage of chronic renal insufficiency is even greater, and the prognosis is even greater.
First, let’s talk about the early or mid-stage prognosis of chronic renal insufficiency: if the patient with a glomerular filtration rate between 60-45ml/min, if the patient’s blood pressure and urine protein are relatively high, and the treatment and management are not standardized, the patient’s condition will continue to progress, and the prognosis will be relatively poor; if the glomerular filtration rate between 45-15ml/min, even if the patient’s blood pressure and urine protein are not high or not very high, the patient’s condition will still be prone to continue to progress, and the prognosis will be very poor.
Let’s talk about the early or mid-term prognosis of chronic renal disease: the renal function of patients with early-stage chronic renal disease with glomerular filtration rate greater than 60ml/min is not bad. As long as the treatment and management are actively cooperated with treatment and management, the prognosis of most patients will not be poor, which is far better than the prognosis of patients with chronic renal insufficiency, unless the primary disease is a refractory or hereditary disease; while the renal function of patients with intermediate-stage chronic renal disease with glomerular filtration rate between 60-300ml/min is slightly worse (CKD stage 3a) and some are relatively poor (CKD stage 3b). In addition to the CKD stage 3b and the primary disease is particularly difficult to treat, the prognosis of other considerable proportions of patients with intermediate-stage chronic renal insufficiency is also good, far better than the prognosis of patients with early-stage chronic renal insufficiency.
Do you understand? Generally speaking, the early and mid-term prognosis of chronic renal disease is much better than the early and mid-term prognosis of chronic renal insufficiency. Of course, except for special circumstances.
was first published simultaneously with the WeChat public account of the same name "Kidney First". The article was original by Zhou Xun and may not be reproduced without authorization.
