Patients with chronic kidney disease, dialysis can avoid it?

Dialysis is called artificial machine, he replaces the kidney function, but long-term dependence generated so severe loss of kidney function, then for kidney disease patients, can not avoid dialysis? We together look at some treatment cases.

Chen is a longtime diabetic medication irregularly, so bad blood glucose and blood pressure control. He heard no medicine can treat kidney disease, but recently heard radio ads, buy some "cure for kidney disease," eat, the results because the moon face, severe high blood pressure and breathing difficulties and kidney to National Cheng Kung University Hospital inpatient, It was diagnosed as "acute pulmonary edema uremia" and begin receiving hemodialysis treatment.

Lin five years ago due to edema and urinary bubble and found to have severe proteinuria, to hospital check are 4 chronic kidney disease (serum creatinine was 4.5mg / dl), and kidney shrank case, the daily urinary protein excretion was 2 g. After giving vasopressin converting enzyme inhibitors (ACEI) and the second type 2 vasopressin (ARB) therapy, proteinuria decreased to 0.3 g / day, renal function remained at 4 to 5 years after 5mg / dl or so, the situation does not worsen.

In Taiwan, the most common cause of chronic renal failure and uremia diabetic nephropathy (such as Chen), the second is chronic glomerulonephritis (eg Lin), the third is hypertension. But whatever the reason, once the serum creatinine greater than normal, it means the patient's kidney function only less than half, and each patient deterioration of renal function speeds are fixed, but if the patient like Mr. Chen as irregular medication , taking away the recipe, then the speed becomes faster, whereas if the patient and physician collaboration and treated properly, the speed will slow down, and may even not deteriorate, that the patient did not live long enough to need dialysis.

In the past, when the kidneys shrank to a certain extent, the continued deterioration of renal function is inevitable, but in recent years in the treatment of chronic kidney disease gradually breakthrough. National Cheng Kung University Hospital, chronic kidney disease prevention and promotion of the inclusion of case management in the first four renal disease (glomerular filtration rate of 15 ~ 30ml / min, normal to 100ml / minute) of patients in the 2 years of follow 57% worsening renal function in patients through five or subject to dialysis treatment, while 43% of patients with renal function remained stable, and in the analysis, it was found proteinuria in patients with stable renal function are low, and the use of ACEI or ARB ratio 亦较high, exactly what is so magical and treatment can make from dialysis patients with chronic renal failure? This thanks to recent advances in basic and clinical medicine, have to make this the doctor was previously thought sooner or later "must" dialysis disease Treatment glimmer exposed, and therefore, this disease should be early to see a kidney specialist, and in close cooperation with the medical staff, so that it can achieve the best therapeutic effect, after all, if the patient does not need dialysis, then the state, society, family and individuals are a great help.

Treatment of chronic renal failure as follows:

First, the need to strictly control blood pressure to 130 / 85mmHg or less (if proteinuria> 1g / day, the blood pressure to be controlled to 125 / 75mmHg or less), the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin first type by Inhibitors (ARB) for the treatment of first-line medication.

Second, reduce proteinuria: ACEI and ARB have a very good therapeutic effect.

Third, low-protein diet: body weight daily intake of 0.6 grams per kilogram of high quality protein physiological value (eg: animal protein, eggs, milk, etc.).

Fourth, if high blood pressure, hear t failure or severe edema, it must absorb low-salt diet (3 grams of salt per day), but the absence of these cases, the salt intake must be patient urinary excretion of salt daily basis to decide, and therefore the market rumors of "kidney disease patients need to eat a low-salt diet," you are wrong.

Fifth, to avoid possible deterioration of renal function following factors: such as the abuse of drugs (steroids, cold medicine, analgesics, X-ray contrast agents, some of this antibiotic drugs of unknown origin, etc.), dehydration, heart failure, low blood pressure or shock, urinary obstruction, infection, electrolyte imbalance.

Six, if oliguria (urine less than 500 ml per day) and severe kidney failure, low potassium intake must diet.

Seven, treatment of primary disease: such as diabetes and autoimmune glomerulonephritis.

In short, the treatment of chronic renal failure in recent years has made great progress, but the medical community for this disease are not so pessimistic, and now nephrologists have more aggressive treatment of these patients, If you could add a high degree of patient cooperation itself, the chronic kidney disease is definitely treatable, and uremia be avoided.

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