The recurrent edema in patients with kidney disease is closely related to these 4 factors!

Recurrent edema is a common problem for many kidney disease patients. Some patients still have recurrent edema even after the cause of edema is identified and active treatment is carried out. Why is this? Let's take a look at a case first.

Lao Wang is 65 years old this year. He has been diagnosed with diabetes for nearly 20 years. He has been taking hypoglycemic drugs, and his blood sugar control has been good and bad. One year ago, he found that his legs were swollen. He went to the hospital for treatment and examination. It was found that his urine protein (+++), urine glucose (+++), and plasma albumin level were as low as 29 grams/liter. He was clearly diagnosed with diabetic nephropathy stage IV. After following the doctor's advice, Lao Wang began to "control his mouth and move his legs", eat a reasonable diet, use subcutaneous insulin injection to control blood sugar, and start taking oral drugs to protect the kidneys and help reduce urine protein levels. More than a month later, Lao Wang found that the edema in his legs had subsided a little. When he went to the hospital for a follow-up visit, a urine routine examination revealed urine protein (++), which was better than before. The doctor reduced the dosage of oral medications. Lao Wang also felt that his efforts during this period were fruitful and very happy. But the good times didn't last long. After more than a month, he found that the edema in his lower limbs had worsened again. What's going on? Lao Wang asked the doctor in confusion: "Why does the edema recur?"

As mentioned earlier, a variety of factors can cause edema symptoms in patients through different mechanisms, and the body's state and condition are in a constant state of change. Therefore, the recurrence of edema is related to multiple factors.

Disease progression

As mentioned above, edema is a common symptom of kidney disease. Chronic kidney disease, such as diabetic nephropathy and chronic nephritis, is characterized by slow progression, and recurrent edema is one of the characteristics of the chronic progression of the disease.

Changes in condition

The occurrence and development of diseases have certain rules, but they are also variable. During the diagnosis and treatment process, the disease may relapse. In this case, the degree of edema will also change accordingly. For example, patients with chronic glomerulonephritis will be completely relieved after treatment, and the degree of edema will be significantly reduced. However, under the influence of fatigue or infection, the disease may relapse, such as increased proteinuria, decreased blood albumin levels, and symptoms of worsening edema. In addition, if the patient has complications, it may also manifest as repeated edema. For example, patients with diabetic nephropathy often have decreased immunity and are prone to infectious complications. If the patient develops new infections such as erysipelas of the lower limbs during the treatment process, it may cause worsening edema.

Treatment adjustment

Various diseases, especially chronic diseases, require continuous adjustment of treatment plans according to the condition during the treatment process, and the dosage of drugs may be increased or decreased, which may be accompanied by repeated edema. For example, patients with chronic glomerulonephritis take oral hormone drugs. During the process of reducing the dosage of hormones, hormone dependence or too fast reduction may cause the disease to recur and lead to worsening edema; some patients take oral diuretics, such as furosemide or spironolactone, to reduce the water load in the body by promoting urine excretion. When the diuretics are reduced, the degree of edema is prone to worsening.

Other causes of sodium and water retention

Aggravated water and sodium retention caused by various causes can lead to repeated edema. For example, after the edema subsides, some patients mistakenly believe that the disease has been completely cured, and no longer pay attention to diet management and do not control salt intake. In fact, increased salt intake will cause an increase in blood sodium levels, which in turn increases plasma crystal osmotic pressure, leading to sodium and water retention and aggravated edema.

Now that we understand the reasons for the recurrence of edema, let's look at Lao Wang's case. It turned out that during the first visit, due to the severe edema in both lower limbs, in order to better alleviate the symptoms, in addition to blood sugar lowering, blood pressure control, and kidney protection drugs, the doctor also prescribed a small amount of diuretics for him. After receiving treatment, Lao Wang's urine volume increased and the edema gradually subsided. During the first follow-up visit, Lao Wang's condition improved significantly. In order to avoid the adverse reactions caused by long-term use of diuretics, the doctor stopped using this type of drug. After returning home, Lao Wang's urine volume decreased compared to before, the water load in the body increased, and the edema recurred. It can be seen that the recurrence of Lao Wang's edema is related to the chronic progression of his disease and the adjustment of the treatment plan.

The body's functional state and condition change dynamically. Therefore, the causes of repeated edema in each patient are often different and need to be analyzed specifically in combination with the condition.