A few days ago, a kidney friend chatted with me and said: I am under a lot of psychological pressure now. I am just 35 years old. Especially difficult. Can the current situation last for twenty or thirty years?
The patient’s condition is very stable now, and the serum creatinine has dropped from more than 450 to about 200. The condition has not fluctuated much in three years. For patients with kidney disease, youth is an advantage, and the physical fitness is stronger, and with the treatment, it is more beneficial to the recovery of the disease. But at the same time, it is also a burden for some patients. Having this disease at such a young age is doomed to not be easy in the future.
Will I have uremia? What is the chance of kidney disease to uremia? Kidney failure in a few years? These questions are like a mountain pressing in the hearts of many people.
But it is safe to say that in the case of this kidney friend, it will not be a problem to persist for 20 years. Not to console him, but the truth.
First of all, how fast is kidney function deteriorating?
The most direct indicator for evaluating uremia—serum creatinine, can be divided into four stages according to the level of creatinine:
Serum creatinine<133μmol/L, which is normal, but does not mean that the renal function is not damaged;
133 186＜serum creatinine≤442μmol/L, in the stage of renal decompensation, the filtering and detoxification effect begins to decline; 443＜serum creatinine≤707μmol/L, in the stage of renal failure, the filtering and detoxification effect began to decline; serum creatinine≥708μmol/L, in the stage of uremia, this When the glomerular filtration rate is less than 15ml/min. Creatinine is maintained at around 200, currently in stage 3a of renal disease, that is, in the early stage of renal insufficiency, cells have just developed fibrosis, and the estimated glomerular filtration rate is about 50- between 59ml/min. According to the average annual glomerular filtration rate decreased by 1ml/min, 20ml/min after 20 years, 30-39ml/min after 20 years, still In the stage of renal insufficiency, it has progressed to stage 3b of renal disease, and has not yet developed renal failure, let alone uremia. In patients with timely initial detection and timely treatment, the annual decline of glomerular filtration rate is relatively optimistic, and some patients can control it within 0.8. There is less risk of collapse. Stabilize renal function and delay the decline of glomerular filtration rate. In the process of disease progression, some influencing factors should be paid attention to. I. Prevention of serious complications, especially heart disease Nephropathy progresses to the stage of renal insufficiency and accelerates renal function The factor of failure is not only the inflammatory reaction in the kidney, but also the development of various complications. Including hypertension, anemia, hyperkalemia caused by electrolyte disorders, calcium and phosphorus disorders, acidosis, etc., as well as heart disease. More dangerous than uremia. The key to the treatment of kidney disease is to control the stability of the disease on the one hand, and prevent the disease and ensure the quality of life on the other hand. For some relatively young patients, it is still part of the treatment to still work normally, prevent more complications, and improve the quality of life. Second, strengthen the care and management of the disease Kidney disease is not a disease that is easily relapsed, as long as all aspects of management Well, the recurrence rate is relatively low. Especially for nephrotic syndrome-like nephropathy with symptoms such as massive proteinuria and edema, proteinuria can generally be stabilized as long as the selection and treatment plan are made. Some pathological types may lead to intractable proteinuria. Generally, there are two reasons, the drug is not symptomatic, and the nursing is not in place. Such as hormone-dependent patients can be treated with immunosuppressive drugs. The frequent recurrence of some patients is mainly related to the lack of attention to daily care, such as intake of too much high-protein food, irregular work and rest, Overworked, smoking, drinking, etc. There are also a small number of patients whose glomerular filtration rate decreases by 4-5ml/min every year, and the risk of uremia is high. In addition to pathological factors, it is necessary to review whether they maintain a stable condition. .