Questions And Answers About Kidney Disease Prevention And Treatment (part 2)

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If the kidney is not good, use a contrast agent with caution

In recent years, with the extensive development of modern imaging techniques, the application of intravascular contrast agents has become more and more common, and more and more cases of renal damage (contrast agent nephropathy) have occurred due to the use of contrast agents. The incidence of contrast agent nephropathy in the general population is 0.6% to 6%, but the incidence in specific populations (such as the elderly, diabetic nephropathy, chronic kidney disease, chronic cardiac insufficiency, acute myocardial infarction, etc.) is as high as 20% or more. When combined with multiple high-risk factors (renal insufficiency, diabetes, contrast agent overdose, advanced age, arteriosclerosis, concurrent use of nephrotoxic drugs, etc.), the incidence of contrast agent nephropathy can be as high as 40% to 90%.

Those with renal impairment or risk factors for renal damage (such as hypertension, diabetes, arteriosclerosis, etc.) should avoid unnecessary angiographic examinations or treatments. If possible, other methods of diagnosis and treatment should be used. If it is really necessary to create a contrast agent, the doctor will weigh the pros and cons and make a decision after carefully evaluating whether the patient has risk factors for developing contrast agent nephropathy. Serum creatinine levels should be routinely monitored after administration of contrast media. Once signs of renal dysfunction are found, active intervention measures should be taken to prevent the progression of the disease.

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Get your kidneys checked before trying to get pregnant

During normal pregnancy, the burden on the kidneys increases due to the increase in the metabolites of the pregnant woman and the fetus. In order to adapt to fetal development and maternal needs, a series of physiological changes will occur in the urinary system of pregnant women, such as increased kidney volume (about 30% more than before pregnancy), increased glomerular filtration rate, decreased smooth muscle tone of the urinary system, and renal pelvis. And mild ureteral dilatation, ureteral thickening, and so on. Many women may have mild kidney lesions before pregnancy, but because there are no symptoms, they are often unaware. After pregnancy, the load on the kidneys increases greatly, which can easily lead to the rapid progress of the originally mild kidney disease. Before pregnancy, women of childbearing age should go to a nephrologist to receive relevant tests (such as urine routine, urine protein quantification, blood pressure, renal function, etc.) in order to know whether their kidneys are healthy. People with massive proteinuria (>2.5 g/day), uncontrolled blood pressure, renal insufficiency (serum creatinine>1.5 mg/dL), and those uncontrolled blood sugar and lupus erythematosus are generally not suitable for pregnancy. It is necessary to wait for the condition to be controlled before considering pregnancy.

Rational drug use to prevent drug-induced kidney damage

The kidneys are the site of drug metabolism and excretion in the body. The unique anatomical and physiological characteristics of the kidney make it the "number one victim" of drug toxicity.

As the saying goes, "the medicine is three parts poison". All drugs, whether Western or traditional Chinese medicine, may have certain side effects. Many people know that western medicine has side effects, but they don't know much about the safety of traditional Chinese medicine. In recent years, the incidence of adverse reactions to traditional Chinese medicine has been on the rise, and we must pay enough attention to it. Common drugs that can easily damage the kidneys include antibiotics (such as gentamicin, kanamycin, streptomycin, tobramycin, lincomycin, rifampicin, sulfonamides, etc.), non-steroidal anti-inflammatory drugs (such as indomethacin, phenylbutazone, ibuprofen, pyridoxine, aspirin, paracetamol, etc.), antiepileptic drugs (such as phenytoin, etc.), chemotherapy drugs, medical contrast agents, some traditional Chinese medicines (such as Guanmutong, Guangfangji, Magnolia Officinalis, Qingmuxiang and other Chinese herbal medicines, Longdan Xiegan Pills, Guanxin Suhe Pills, Deaf Pills, Gynecology Fenqing Pills, Paishi Granules, Ganlu Disinfection Pills, and other proprietary Chinese medicines), etc.

To avoid drug-induced kidney damage, rational drug use is the key. Especially in the elderly, as the age increases, the renal reserve capacity decreases, the renal cells age, and the ability to clear toxic substances is reduced, which is more prone to drug-induced renal damage. When using drugs with nephrotoxic effects, the pros and cons should be weighed, the dosage and course of treatment should be individualized as much as possible (especially for children and the elderly), and the combination of multiple drugs should be avoided. If combined medication is indeed required, the effect of the drug on renal function should be closely monitored.

High blood pressure hurts the "heart" and even the "kidney"

The kidney is one of the organs with the most abundant small arteries and capillaries in the human body, and it is also the part with the highest blood pressure in the human body. The increase in blood pressure increases the pressure on the walls of the arterioles throughout the body. If this pressure is large enough or lasts long enough, the intima of the arterioles will thicken, the lumen will be narrowed (the blood vessels will become thinner), and the organs supplying blood will be damaged. Ischemia and hypoxia will occur, eventually resulting in abnormal organ function and structure.

If you are a hypertensive patient and want to know whether your kidneys have been damaged, you may wish to think back: Have you increased the number of nights up than before? If so, be alert to the increased nocturia caused by hypertensive nephropathy; is there foam in the urine? If yes, proteinuria caused by hypertensive nephropathy should be excluded; has blood pressure become more difficult to control recently? If so, you should be alert to whether kidney disease aggravates the condition of hypertension. Of course, the easiest way is to go to the hospital for a kidney check, including renal tubular function, urine microalbumin, serum creatinine, etc., in order to determine whether you have hypertensive nephropathy.

Diabetic nephropathy is becoming the "new force" of uremia

Diabetic nephropathy is one of the common complications of diabetes. Studies have shown that 50% of those with a history of diabetes for 10 to 20 years will develop diabetic nephropathy; for those with a history of diabetes for more than 20 years, almost 100% will develop diabetic nephropathy. In European and American countries, 30% to 40% of diabetic patients will eventually develop diabetic nephropathy; in my country, this proportion may be even greater. In developed countries, the vast majority of dialysis patients are diabetic nephropathy; in my country, more than 40% of dialysis patients with diabetic renal pain. In recent years, with the increasing prevalence of diabetes, diabetic nephropathy has become one of the main causes of uremia. Regrettably, however, because many diabetic patients do not fully understand the harm of diabetes to the kidneys, and diabetic nephropathy is difficult to detect in the early stage, most patients go to the doctor too late and miss the best time for treatment.

Diabetic nephropathy is often asymptomatic in the early stage, and can only be detected by systematic examination. At this time, if active intervention measures can be taken, the occurrence of diabetic nephropathy can be prevented. Specific measures include: actively controlling blood sugar and blood pressure, reducing microvascular disease, and minimizing the risk of diabetic nephropathy; actively applying renal protection drugs to delay the progression of nephropathy, such as using angiotensin-converting enzyme inhibitors or angiotensin receptor antagonism To reduce proteinuria, etc.; if diabetic nephropathy has occurred, reasonable treatment can also be used to delay the progression of renal damage to the maximum extent and avoid the occurrence of uremia as much as possible. In the event of chronic renal insufficiency and azotemia, treatment should be performed according to chronic renal insufficiency. If you have entered the uremic stage, dialysis or kidney transplantation should be performed as soon as possible.