"Why is it like this? Haven't it been fine all the time?" In the ward of
, the daughter still couldn't accept the fact that her father had to live on dialysis in the future.
patient, Lao Liu, 68 years old, got uremia . This time I came to the hospital at my daughter's strong request. The stubborn Lao Liu has been suffering from diabetes for 311 years and rarely comes to the hospital. Like many elderly people, he always feels that as long as he goes to the hospital, all kinds of problems will be found. If he finds out, he will have to spend money to treat the disease. But if he doesn't go, there will be nothing at all.
So, even though Lao Liu was feeling unwell, he never said that because he could tolerate it, only his wife knew.
It was not until a few days ago when his daughter came home and the mother told her daughter about Lao Liu's illness that she accidentally revealed that in fact, his health has been bad recently. He always felt weak all over and had no energy to walk. His legs were obviously swollen, and sometimes he felt nauseous.
The daughter heard her mother's words and immediately called her father to go to the hospital for examination. Lao Liu repeatedly refused, but there was no way to go, so he came to the hospital. But no one expected that this test would cause uremia.
In fact, Lao Liu also thought about his discomfort recently. It may be because his diabetes has worsened, but he never thought that it would be a kidney problem, and it was the most serious uremia.
1. Diabetic nephropathy , a complication that cannot be ignored!
Diabetic nephropathy is one of the most common and most serious complications of diabetes, and diabetes is also the main high-risk factor in inducing uremia, ranking second among all causes. The incidence of diabetic nephropathy gradually increases with the extension of the disease course. According to statistics, the incidence rate of patients with a course of less than 5 years is about 7%-10%, the incidence rate of patients with a course of less than 20-25 years is about 20-35%, and the incidence rate of those with a course of more than 25 years is as high as 57%. Therefore, the longer the course of the disease, the more dangerous it is.
my country's new version of the Diabetes Nephrology Prevention and Treatment Guidelines clearly recommend:
Patients with a history of diabetes for more than 5 years should have a detailed examination of the kidneys in order to detect signs of kidney disease as soon as possible. The main examination items are UACR values (the ratio of urine albumin to creatinine) and eGFR values ( glomerular filtration rate ), which are used to evaluate the function of kidney , and then screen at least once a year.
2. Diabetic nephropathy occurs and the body will send a signal!
There are many patients like Lao Liu in clinical practice. These patients either do not feel abnormal symptoms at all, or even if they feel it, because it is not serious, they will delay it again and again. As a result, when they go to the hospital for examination, they are already uremia and can only survive by dialysis.
The kidney is indeed a very tolerant organ, but the progress of chronic kidney disease also has a long process. If the patient is more alert, it is entirely possible to detect abnormalities in the body early and stop loss early, so as not to wait until it worsens into uremia before realizing it.
1. Symptoms of early renal disease: Chronic kidney disease stage 1 and 2. At this time, the kidneys can no longer work 100% normally. However, because the kidneys have strong compensatory ability, they generally don’t feel anything. A few patients may find foamy urine. This stage is mainly based on examinations. Most patients are accidentally discovered during physical examinations, which are manifested as positive proteinuria and elevated serum creatinine.
Treatment focus: This stage of treatment focuses on controlling risk factors and delaying the progress of kidney disease, including controlling blood pressure , blood sugar, uric acid, changing behavioral habits that damage the kidneys. At the same time, we should actively use drugs to improve proteinuria, reduce the risk of infection, and undergo regular reviews.
2. Symptoms of worsening kidney disease: Stage 3 and 4 of chronic kidney disease are renal insufficiency stages, and stage 5 is uremia stage. Renal insufficiency indicates that the kidneys begin to fail, and the more they go, the harder it will be to reverse it again, because the kidney function can no longer meet the needs of the body, and the body also begins to show abnormal signals, such as anemia , fatigue, easy fatigue, increased nocturnal urination, nausea, vomiting, loss of appetite and other symptoms. Examination will show abnormal symptoms such as serum creatinine , and kidney atrophy.
Treatment focus: If the kidney disease can be controlled well in stage 3, it can maintain renal function from the further deterioration. It is mainly based on controlling risk factors, pay attention to managing blood pressure, blood sugar, blood lipids and uric acid, stay away from kidney damage behavior, and use medicine reasonably. When it develops to stage 4 and 5, it is generally difficult to reverse, and eventually it can only move towards the path of dialysis.
3. How to prevent and treat kidney disease and prevent the aggravation of kidney disease?
Lao Liu's uremia did not occur in one or two days. He had diabetes for 11 years, and perhaps his kidney had problems. Unfortunately, he never thought about going to the hospital for a check-up. Even though he had obviously felt discomfort, he didn't take it to heart, which eventually led to a tragedy. In fact, diabetic nephropathy can be prevented and controlled, and intervention can prevent the occurrence of uremia by early intervention.
1. Control the four highs well: If diabetic patients want to stay away from kidney disease, at least they must ensure that their blood sugar meets the standards. In addition, they must also control blood pressure, blood lipids, uric acid, etc. These indicators are all culprits in the kidneys.
For patients who have been diagnosed with kidney disease, pay special attention to the choice of drugs. The guide recommends the preferred kidney-protecting drugs for lowering blood sugar, such as SGLT-2i inhibitors (dazliflozin, etc.), GLP-1 receptor agonist (dulagapeptide, etc.), etc. Renal function needs to be evaluated and the dosage is adjusted. Priligy or sartan drugs are the first choice for antihypertensive drugs, which also improve proteinuria and protect the kidneys. The first choice is statin , a lipid-lowering drug.
2. Change bad habits: In addition to actively treating related diseases, also needs to start from daily life to change kidney damage habits. It is required to quit smoking and drinking; exercise for half an hour every day; control foods with high protein, high fat, high sugar and high salt; drink more water and try not to drink; hold urine less; stay up late regularly; combine work and rest; maintain a healthy weight, etc.
3. Regular review: patients with diabetes must check the kidneys regularly. The longer the course of the disease, the more frequent the examination. In addition, , hypertension, , and patients with hyperuric acid should also know the health status of the kidneys as early as possible so as to find problems in time.
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