Uremia

Introduction to uremia Uremia actually refers to the poison that the human body cannot produce through the kidneys, excreting wastes and excess water from the body. Modern medicine believes that uremia is a complex syndrome caused by the disorder of biochemical processes inside the body after loss of renal function. Rather than an independent disease called Kidney Failure Syndrome or Kidney Failure, the term PIORRY and HERITER were described in 1840 after describing renal failure. basic knowledge The proportion of illness: 0.0002% Susceptible people: no special people Mode of infection: non-infectious Complications: hyperkalemia, arrhythmia, heart failure, pulmonary edema, renal failure

Cause of uremia

Kidney disease (35%):

Kidney disease is the main cause of uremia, and the final outcome of all chronic kidney diseases will be uremia. Among them, chronic nephritis is the primary cause, and among the diseases leading to uremia, chronic glomerulonephritis accounts for 55.7%. The cause of uremia is due to loss of kidney function, nitrogen waste produced by metabolism in the body can not be excreted, accumulation in the body and imbalance of water and electricity balance, water retention, electrolyte imbalance caused by kidney disease is the disease and damage of the kidney itself, called Renal renal failure, prerenal renal failure often caused by heart failure or other causes of blood pressure, kidney insufficiency, the main cause of post-renal renal failure is urinary tract obstruction and urinary reflux.

High blood pressure (15%):

15% of hypertensive patients will directly switch to uremia. According to statistics from 1998 in China, hypertensive patients account for 10% of the total population. That is to say, one out of every 10 people has hypertension, and 1.5 of them will become uremic patients.

Diabetes (10%):

30% of diabetic patients, the direct outcome is uremia diabetes. Recent statistics show that in China's population, there are 43.2 million diabetic patients and 50.64 million people with impaired glucose tolerance, and the sum of the two is 93.84 million. In other words, because of diabetes, there are about 13 million uremia patients and more than 15 million people at high risk of uremia.

Urinary tract infection or urinary tract infection (10%):

Caused by urinary tract infection or urinary tract infection. According to statistics, the incidence of urinary sensation in China is 0.23% for men and 2.37% for women. Men, women and children can be affected, especially married women of childbearing age. In China, chronic pyelonephritis is the second factor of uremia, accounting for 21.2%.

Different degrees of toxic side effects of the drug (10%):

The drug is caused by varying degrees of toxic side effects. Studies have shown that about 25% of patients with renal failure are associated with the nephrotoxicity of the drug.

Age (10%):

As the age increases, the structure and function of the kidneys undergo significant degenerative changes. Under normal circumstances, the human kidney has a strong compensatory function. When the kidney function is lost by 50%, the normal life activities of the human body can be maintained. For example, after a kidney is removed, the person can still survive healthily. With the increase of age, the human body's storage function is gradually weakened or even lost. Without additional burden, the kidney function can meet the needs of human life activities, but it has no ability to cope with sudden injuries and diseases.

Uremia prevention

When the kidney causes serious damage to the kidney, the kidney develops lesions and loses the function of purifying the blood. Waste and liquid will accumulate in the body, and the human body will have various symptoms, namely uremia. The causes of uremia are: chronic glomeruli Nephritis, chronic pyelonephritis, renal tuberculosis, renal arteriosclerosis, urinary calculi, prostatic hypertrophy, bladder cancer, lupus erythematosus, diabetes, etc.

The gastrointestinal symptoms of uremia are the earliest, with anorexia, nausea, vomiting and diarrhea, ammonia in the mouth, inflammation of the gums, bleeding of the oral mucosa, etc. The nervous system may have insomnia, irritability, numbness in the limbs, Late-stage sleepiness and even convulsions, coma, high blood pressure in the cardiovascular system, and pain in the precordial area caused by pericarditis and heart failure, palpitations, shortness of breath, abdominal pain, edema, swell, etc., blood system may appear Anemia and mucosal bleeding, the respiratory system may have cough caused by pneumonia and pleurisy, chest pain, uremia is a very dangerous disease, if not treated in time, it will often endanger life.

Family therapy

Active treatment

Although uremia is a fatal disease, it is not without medicine. For cases without predisposing factors, when renal function is irreversible, dialysis treatment may be considered. Dialysis therapy includes oral, peritoneal, hemodialysis (artificial kidney). Oral dialysis treatment is only suitable for patients with mild uremia. In recent years, due to the widespread application of dialysis therapy, patients with advanced uremia have survived for 5 years and maintained a certain labor force. Therefore, dialysis therapy is the late treatment. One of the effective methods of uremia.

Full rest

Patients with uremia should ensure adequate rest and good nutrition, and do not engage in activities that are beyond their reach.

Avoid chemicals that damage the kidneys

To avoid supplies and environments containing cadmium, chloroform, ethylene glycol and tetrachloroethylene, they are commonly found in pesticides, automotive exhaust, paints, buildings and household cleaners.

Limit foods high in strontium

Some chemical elements have been found in general household products related to acute and chronic kidney disease. As long as you carefully read the product description, take some precautions to avoid these harmful substances.

Cadmium: This rare metal is used in the production of pesticides, rubber tires, as well as plastics, coatings and other products. Due to the wide industrial use of cadmium, it has been widely found in some foods and water. The following points should be noted.

Limit food intake to high levels of cadmium, such as food made from animal liver and kidney, flounder, oysters, scallops, oysters, and vegetables grown in sludge.

Ensure that coatings used in spray and process applications, dyes, and porcelain sodium do not contain cadmium.

Do not use antique cooking utensils because they are coated with cadmium-containing pigments.

Do not smoke

Smoke is harmful to the kidneys.

Using a low protein diet

For patients with uremia, a low-protein diet should be given. Normal adults need 1 to 1.5 grams of protein per kilogram of body weight, and uremic patients can only eat less than 0.5 grams per kilogram to reduce the production and retention of nitrogen metabolites in the body.

Use egg milk food

Since the amount of protein to be eaten is small, it is necessary to use eggs, milk, and other animal protein foods with higher nutritional value, and less use of plant proteins such as soy products.

Add water

Supply an appropriate amount of water according to the condition.

Health care diet

Take 60 grams of glutinous rice, 15 grams of raw radix, 30 grams of light bamboo leaves, decoction and drink, about 10 doses, can be effective, usually eat more peeled radish, this disease is also very beneficial (refer to the therapeutic side of nephritis) ).

Dangerous news

If you have any of the following symptoms, please seek medical attention as soon as possible:

* Nagas, nausea, vomiting and diarrhea.

* There is ammonia in the mouth, the gums are often inflamed, and the oral mucosa is bleeding.

* Insomnia, irritability, numbness and burning in the limbs, drowsiness and even convulsions, coma.

* High blood pressure and pain in the precordial area caused by pericarditis and heart failure, palpitations, shortness of breath, upper abdominal pain, edema, and not lying down.

Uremia complications Complications hyperkalemia arrhythmia heart failure pulmonary edema renal failure

Uremia is a general term for a series of symptoms in the late stage of renal failure. Chronic renal failure symptoms are mainly caused by poisoning caused by accumulation of harmful substances and anemia of kidney hormones. The most common early stage is nausea and vomiting appetite. Decreased and other gastrointestinal symptoms, after entering the advanced stage of uremia, the systemic system will be affected, heart failure, mental disorders, coma and other serious conditions, life-threatening, uremia is considered to be incurable in the past, since the 1990s Dialysis methods and kidney transplant surgery significantly extend the life span of uremic patients.

In the uremia stage, in addition to the above-mentioned water, electrolytes, acid-base balance disorder, anemia, bleeding tendency, high blood pressure, etc., the clinical manifestations of various organ system dysfunction and substance metabolism disorders may also occur. .

(a) neurological symptoms

Symptoms of the nervous system are the main symptoms of uremia. In the early stages of uremia, patients often have symptoms such as dizziness, headache, fatigue, comprehension and memory loss. As the condition worsens, irritability, muscle twitching, convulsions may occur; Can develop into apathy, lethargy and coma, the occurrence of these symptoms are related to the following factors:

1 accumulation of certain toxic substances may cause neuronal degeneration;

2 electrolyte and acid-base balance disorder;

3 cerebral vasospasm caused by renal hypertension, increased hypoxia and capillary permeability, can cause brain nerve cell degeneration and brain edema.

(two) digestive system symptoms

The earliest symptoms of the digestive system in uremic patients are loss of appetite or indigestion; anorexia, nausea, vomiting or diarrhea may occur when the condition worsens. These symptoms may be caused by the urease of bacteria in the intestinal tract to decompose urea into ammonia. Intestinal mucosa causes inflammation and multiple superficial small ulcers. Patients often have gastrointestinal bleeding, and nausea and vomiting are also associated with dysfunction of the central nervous system.

(C) cardiovascular system symptoms

Chronic renal failure due to renal hypertension, acidosis, hyperkalemia, sodium retention, anemia and toxic substances, can occur heart failure, arrhythmia and myocardial damage, etc., due to urea (may also have The stimulating effect of uric acid can also cause aseptic pericarditis, the patient has pain in the anterior region; the pericardial friction sounds during the physical examination, and the cellulose and bloody exudates in the pericardial cavity occur in severe cases.

(four) respiratory symptoms

In acidosis, the patient's breathing is slow and deep. In severe cases, the specificity of acidosis can be seen in Kussmaul breathing. The exhaled breath of the patient has a urine smell. This is because the bacteria break down the urea in the sleeping fluid to form ammonia. Edema, fibrinous pleurisy or pulmonary calcification, pulmonary edema and heart failure, hypoproteinemia, sodium water retention and other factors, fibrinous pleurisy is caused by urea stimuli; lung calcification is calcium phosphate in lung tissue Caused by internal deposition.

(5) skin symptoms

Itching of the skin is a common symptom in patients with uremia, which may be caused by the stimulation of toxic products on skin receptors; some people think that it is related to secondary hyperparathyroidism, because the pain can be relieved immediately after removal of the parathyroid glands. Symptoms, in addition, the patient's skin is dry, desquamation and yellow-brown, skin color changes, previously thought to be an increase in urinary pigment, but with an absorption spectrophotometer to verify that the skin pigment is mainly melanin, in the exposed parts of the skin, A slight contusion can cause skin ecchymosis. Because sweat contains a high concentration of urea, there is a white crystal of urea at the opening of the sweat gland called urea cream.

(6) Physical metabolism disorders

1. Impurity tolerance reduces uremia patients' tolerance to glucose, and its glucose tolerance curve is similar to mild diabetes patients, but this change is not sensitive to exogenous insulin, and the mechanism of glucose tolerance reduction may be:

1 insulin secretion is reduced;

2 uremia is due to the increased basal level of growth hormone secretion, so the role of antagonizing insulin is strengthened;

3 Insulin binds to target cell receptors, and the effect of insulin is weakened;

4 The activity of hepatic glycogen synthase is reduced and the hepatic glycogen synthesis is impaired. It is currently believed that the main cause of the above changes may be the toxic effects of urea, creatinine and medium molecular weight poisons.

2. Negative nitrogen balance Negative nitrogen balance can cause patients to lose weight, cachexia and hypoalbuminemia, hypoalbuminemia is one of the important causes of renal edema, the factors that cause negative nitrogen balance are:

1 patients with limited protein intake or reduced protein intake due to anorexia, nausea and vomiting;

2 Certain substances such as methyl hydrazine can enhance the catabolism of tissue proteins;

3 combined infection can lead to enhanced protein decomposition;

4 protein loss due to bleeding;

5 Lose a certain amount of protein with urine.

In uremia, a large amount of urea can be infiltrated into the intestine by blood. The bacteria in the intestine can decompose urea to release ammonia. After the ammonia is transported to the liver by the blood, urea can be synthesized, and non-essential amino acids can be synthesized. The latter is beneficial to the body. Therefore, some people think that the intake of protein in uremic patients can be lower than that of normal people, even if it is lower than 20g per day, the nitrogen balance can be maintained, but the protein with higher nutritional value, that is, nutrients rich in essential amino acids must be given. Some people think that.

In order to maintain the nitrogen balance of uremic patients, protein intake should not be significantly different from normal people; and it is believed that excessive protein production in order to reduce blood urea nitrogen can lead to excessive consumption of protein. Harmful and unhelpful to the patient.

3. Hyperlipidemia Uremia patients mainly due to increased lipoprotein (pre--lipoprotein) required for liver synthesis of triglycerides, so the production of triglycerides increased; at the same time may also be due to lipoprotein lipase (lipoprotein lipase) The decrease in activity leads to a decrease in the clearance rate of triglycerides, so it is easy to form hypertriglyceridemia, and this change may be related to the accumulation of methyl hydrazine.

Uremic symptoms Common symptoms Acute hemolytic uremic syndrome Drowsiness Double kidney diffuse disease Respiratory gas for urine odor Lower extremity edema Appetite loss Nail-Bone quadruple sensory disorder Restless leg syndrome Hypertonic urine

Common symptoms of uremia include loss of appetite, feeling slow, emotional apathy, lethargy, decreased urine output, edema of face and lower extremities, anemia, itchy skin, muscle cramps, sometimes uneasiness, and even epilepsy, uremia symptoms can occur slowly, Long-term concealment is not discovered, acute renal failure can occur within a few days, there are obvious symptoms of uremia, uremia syndrome can be a variety of, and not all symptoms are manifested.

Uremia check

Uremia check

First, blood test :

1 urea nitrogen, creatinine increased.

2 hemoglobin is generally below 80g / L, the end stage can be reduced to 20-30g / L, may be accompanied by thrombocytopenia or high white blood cells.

3 arterial blood gas, acid and alkali determination; late in the common pH value decreased, AB, SB and BE were reduced, PaCO2 was compensatory reduction.

4 plasma protein can be normal or reduced.

5 electrolyte can be abnormal.

Second, urine check:

1 Urine routine changes may vary according to the underlying cause, may have proteinuria, red, white blood cells or cast, can also be changed is not obvious.

2 The specific gravity of urine is more than 1.018, and it is fixed between 1.010 and 1.012 during uremia. The amount of urine at night is more than the amount of urine in the daytime.

Third, the determination of renal function

1 glomerular filtration rate, endogenous creatinine clearance decreased.

3 The phenol red excretion test and the urine concentration dilution test were all reduced.

4 Pure water clearance rate was measured abnormally.

5 Nuclide kidney maps, kidney scans and scintigraphy also help to understand kidney function.

Fourth, other

Examination of urinary X-ray film or angiography, renal biopsy, to help diagnose the cause.

Diagnosis according to the history of chronic kidney disease, clinical manifestations and urine, blood biochemical examination, can be diagnosed.

The degree of renal dysfunction can be divided into three phases according to glomerular filtration rate (GFR), blood urea nitrogen (BUN) and serum creatinine (cr) levels:

The compensated GFR of renal insufficiency is between 50-70ml/min, and the blood BuN>7.14>8.93mmol/L blood Cr>132<177umol/L. There are no other symptoms except clinical manifestations.

Renal function decompensation or azotemia period GFR <50ml / min, blood BuN> 8.93mmol / L, blood Cr> 177umol / L, mild fatigue, loss of appetite and varying degrees of anemia.

In uremic period, GFR<25ml/min, blood BuN>21.42mmol/L, blood Cr>442umol/L, there are obvious clinical symptoms of uremia, such as GFR<10ml/min, which is late uremia; GFR<5ml/min In the end stage of uremia, once the diagnosis of chronic renal failure is confirmed, the cause of the primary disease and the cause of the deterioration should be clarified in order to take effective treatment measures.

Diagnosis of uremia

Uremic disease is not an independent disease but a group of clinical syndromes. In the terminal stage of chronic renal failure, the three major functions of the kidney are lost, and a series of symptoms and metabolic disorders occur, thereby forming uremia. The diagnosis of uremia is not only the level of serum creatinine, but also the clinical manifestations of each of the above systems.

In the early stages of chronic renal insufficiency, there are only symptoms of the primary disease in the clinic, and only a decrease in creatinine clearance can be seen in the examination. These patients with uremia compensatory period often under stress, the renal function suddenly deteriorates, and the symptoms of uremia (the clinical manifestations of the various systems mentioned above) appear, which is clinically called reversible uremia, but Excitatory factors are removed and kidney function can often be restored to the compensation period. If the condition develops into a "skilled" nephron that cannot meet the minimum requirements of the body, even if there is no stress factor, the symptoms of uremia will gradually manifest. The damage of the above various systems of uremia may not be all manifested. In different patients, the symptoms of uremia may be different, and the timing of each system symptom may be different.

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