When the creatinine exceeds 300 and the kidney function enters stage 4/renal failure, the nephrologist is almost faced with a situation where there is no cure, so they watch the kidney function gradually disappear in vain , trying to control all kinds of complications, how long can it be delayed.
Why “no medicine”?
Currently, there are four main types of drugs that can restore, block or delay the progression of kidney damage:
1. Traditional Chinese medicines for strengthening the body and promoting blood circulation: Salvia miltiorrhiza, Chuanxiong, leeches, astragalus, rhubarb, etc.
2. RAS blocker( steroid inhibitors, i.e. Pulis/Sartans)
(sodium-glucose co-transporter-2 inhibitor, i.e., lysine)
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4. Immunosuppressants (including hormones such as prednisone, methylprednisolone, cyclophosphamide, tacrolimus, cyclosporine, mycophenolate mofetil, etc. Classic immunosuppressants, as well as thunderbolt vine, rituximab and other special immunosuppressants)
but once the creatinine exceeds 3
0p> , 4 major categories of main drugs are all discontinued:
1. Traditional Chinese medicine is generally not easy to use
Salvia, Astragalus, tangerine peel These traditional Chinese medicines for renal failure have a higher potassium content (700) than bananas (300). High potassium will affect the safety of the heart.
Many western doctors oppose the use of traditional Chinese medicine for renal failure, and they are also afraid of high potassium.
2.RAS blockers are generally not good.
These drugs not only increase potassium, but also It will reduce the filtration rate of the kidneys, and many doctors abandon it because of concerns about increased serum potassium and increased serum creatinine.
3. SGLT-2 inhibitors are contraindicated
These drugs have just been used in recent years, and renal failure ( filter rate below 30) is also disabled. After all, they need to be excreted by the kidneys. If the renal excretion function is weak, and the metabolic components of the drug cannot be excreted, it may be dangerous. For example, dapagliflozin, a drug with the strongest evidence for renal treatment, has not yet been approved for use in patients with renal failure with a filtration rate below 30.
Canagliflozin is less excreted by the kidneys and can be used up to a filtration rate below 30. However, canagliflozin only has evidence for the treatment of diabetic kidney disease and has not yet become a real drug for kidney disease .
4. Immunosuppressive agents are ineffective
Because immune inflammation (nephritis) is a kind of “nephritis and pathogenic substances” Fight”, only the early and middle kidneys are capable of fighting. In the advanced stage, the kidneys with large areas of necrosis are almost unable to initiate inflammation, and there is not much inflammation to suppress, and the immunosuppressant draws his sword and looks around at a loss.
Some kidney patients in the early stage are reluctant to use hormones, and in the advanced stage they can’t use hormones if they want to.
Therefore, kidney patients with creatinine of 300 to 400, 500 or 600, often can only control the complications, and when the complications cannot be controlled, dialysis is performed.
Is there really no medicine for creatinine over 300?
Don’t panic, there is still hope.
There is really no way for banned and ineffective drugs. And the drugs that do not work well, you can also find ways to make them work:
1. Traditional Chinese medicine can also be used
Although traditional Chinese medicine contains high potassium content, professional nephrology departments use traditional Chinese medicine to remove potassium element in advance to reduce potassium content. (In fact, some high-potassium vegetables should be blanched with water before cooking to reduce potassium intake)
In addition, it is not advisable to take too many traditional Chinese medicines for renal failure, moreThe traditional Chinese medicine is for external use, avoid eating too much potassium.
2.RAS blockers can also be used
It is true that patients with renal failure are taking puri/sartans The drug needs to be more careful, the dose should not be too large, and electrolytes (serum potassium) and kidney function need to be checked regularly, but this is not the reason why we don’t use it.
Academician Hou Fanfan conducted a large-scale trial that included patients with creatinine over 265 who were given RAS blockers. The findings are still valid: compared with placebo, patients with a creatinine above 265 who took benazepril had a 43% lower risk of worsening renal function (doubling of serum creatinine, entering uremia), confirming that patients with advanced renal failure taking Benazepril /Sartans can still benefit, and the safety is passed.
Early-stage patients have more drug options, which may take into account efficacy, safety and economy , Convenience. And at the advanced stage, where there is almost no cure, is there any other option?
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