If you have uremia, is there no way out?

Mr. Li, 43 years old, was found to have slightly elevated blood pressure and increased urine protein during a physical examination 7 years ago. His renal function was normal at the time, and the doctor diagnosed him with chronic nephritis. As the symptoms were not obvious at the time, Mr. Li had not taken it seriously and had not received regular treatment. During a physical examination 2 years ago, it was found that his blood creatinine was 268 micromoles/liter and his blood pressure was 190/120 mmHg (25.3/16.0 kPa). As there were still no obvious symptoms of discomfort, Mr. Li still did not take it seriously. Since then, he has taken antihypertensive drugs intermittently, and his blood pressure is generally (150~170)/(90~100) mmHg [(20.0~22.6)/(12.0~13.3) kPa]. He also took Chinese medicine intermittently for "kidney protection" treatment. In the past month, he has experienced fatigue, decreased appetite, nausea, vomiting, generalized edema, chest tightness, inability to lie flat at night, and decreased urine volume. He went to the hospital for examination and found that his blood creatinine was nearly 1000 micromoles/liter and his urea nitrogen was 38 mmol/liter. The doctor said he had uremia. Mr. Li was shocked and disappointed, thinking he would not live for more days. So, is there no way out for uremia?

Control of underlying diseases and exacerbation of chronic renal failure

Some of the underlying diseases that cause uremia are reversible after treatment. Even if the kidney disease is slightly improved, renal function can be improved to varying degrees. For example, in uremia caused by lupus nephritis, if the renal biopsy shows that the lesion is moderately chronic and the activity index is high, renal function will improve after treatment.

In addition, correcting certain reversible factors that worsen renal failure can also improve renal function. These factors include the following. (1) Primary disease activity or poor control of the kidney, such as various nephritis activities, hypertension, and poorly controlled diabetes. (2) Insufficient blood volume, such as vomiting, diarrhea, or large amounts of diuresis, which cause dehydration, heavy bleeding, and hypotension. The reason for the short-term deterioration of renal function in Mr. Li's case may be related to dehydration caused by vomiting and diarrhea. (3) Severe hypertension that is not controlled, especially when blood pressure is continuously above 180/120 mmHg (24.0/16.0 kPa). (4) Heart failure or severe arrhythmia. (5) Use of nephrotoxic drugs, such as certain antibiotics, analgesics, contrast agents, and Chinese medicine containing aristolochic acid. (6) Urinary tract obstruction, such as urinary tract stones and prostatic hypertrophy. (7) Various infections, including respiratory, digestive, urinary or skin infections. On the one hand, bacterial infection toxins can directly damage the renal tubules; on the other hand, water and electrolyte disorders or circulatory failure caused by infection can aggravate the damage to the kidneys. (8) Electrolyte disorders, such as hypercalcemia or hyperphosphatemia. (9) Acute stress states, such as trauma, major surgery, etc. Delaying the progression of chronic kidney disease

The progression of chronic kidney disease can be slowed through integrated treatment.

1. Diet therapy

(1) Low-protein diet: A low-protein diet can delay the symptoms of uremia, but it is necessary to supplement with compound α-keto acid preparations and pay attention to monitoring nutritional indicators to avoid malnutrition. Since being diagnosed with uremia, Aunt Wang has almost stopped eating protein-rich meat dishes such as chicken, eggs, meat, and fish, and she also eats less rice and noodles. When she was reexamined one month later, her blood creatinine level had indeed decreased. Aunt Wang was very encouraged and continued to control her diet. However, Aunt Wang soon became noticeably thinner, her physical strength declined significantly, and she often caught colds and fevers. What was the reason? Aunt Wang reduced the production of protein metabolic waste in the body by restricting her protein diet, but the synthesis of protein required for human life activities was also reduced, leading to malnutrition and decreased body resistance. Therefore, the doctor recommended that she supplement with compound α-keto acid preparations while reducing her protein diet. After entering the human body, compound α-keto acid preparations can synthesize protein through a series of reactions with ammonia, a waste product produced by metabolism in the body. This not only reduces the level of urea nitrogen in the blood and alleviates the symptoms of uremia, but also supplements protein, thereby maintaining a good nutritional state for patients with uremia.

(2) Calorie intake: Intake of sufficient carbohydrates to provide the body with sufficient calories can reduce the decomposition of protein to provide calories and reduce the consumption of protein stores in the body. Calorie intake must be maintained at 125~146 kJ/(kg·day). Patients who have the conditions can eat some flour with low protein content. Obese patients must appropriately limit calories (total calorie intake can be reduced by 1046~2092 kJ/day compared with the above recommended amount) until they reach the standard weight. When patients eat less, they can add sugar and vegetable oil when cooking to meet the calorie intake.

(3) Supply of potassium and sodium: This should be flexibly controlled according to the patient's edema and condition. When hyperkalemia occurs, fruits and vegetables should be used with caution. When cooking, they can be boiled in large amounts of water to remove some potassium. The amount of sodium intake depends on the degree of edema in the patient. If there is sodium retention, the salt intake should be limited, but it should be noted that "too much is as bad as too little". Some patients with uremia do not add salt or soy sauce to any dish. They soon develop general fatigue, anorexia, nausea, and drowsiness. When they go to the hospital for a checkup, their blood sodium level is significantly reduced. If not corrected in time, it may be life-threatening in severe cases.

(4) Vitamin intake: Eat appropriate amounts of fresh fruits and vegetables to get enough vitamins.

(5) Drinking water: People with oliguria, edema, and heart failure should strictly control their water intake. However, for those with urine volume >1000 ml and no edema, water intake should not be restricted.

(6) Other precautions: Patients with high uric acid levels should limit their intake of foods high in purine. To minimize the phosphorus and purine content of food, lean meat and chicken can be blanched and then eaten. For patients with high blood lipid levels, various foods should be boiled or steamed as much as possible during the preparation process, and stir-fried foods should be avoided as much as possible. Animal offal, fish roe, pig brain, etc. should not be eaten. With the above-mentioned dietary treatment plan, the symptoms of uremia in most patients can be improved. For patients who have already started dialysis, they should switch to the dialysis diet plan.

2. Effectively control blood pressure: It is advisable to maintain blood pressure below 130/85 mmHg (17.3/11.3 kPa). Angiotensin-converting enzyme inhibitors and (or) angiotensin I receptor blockers are recommended because they can directly reduce high pressure in the glomeruli, reduce urine protein, inhibit the inflammatory response and sclerosis of renal tissue cells, and thus delay renal function decline. Patients with renal insufficiency should be particularly careful when taking these drugs, because these drugs reduce the high filtration state of residual glomeruli, which may lead to further deterioration of renal function and a mild to moderate increase in blood creatinine (10%~30%), but it is not necessary to stop the drug. If blood creatinine increases further or even hyperkalemia occurs, angiotensin-converting enzyme inhibitors and (or) angiotensin I receptor blockers must be discontinued and other antihypertensive drugs should be used instead.

3. Lipid-lowering treatment: The treatment of hyperlipidemia is the same as that of general hyperlipidemia, and should be treated actively.

4. Treatment with Chinese medicine: Traditional Chinese medicine has a long history and is profound, and has accumulated considerable experience in the treatment of kidney disease. The protective effect of various Chinese medicines on kidney function has attracted worldwide attention, such as Cordyceps sinensis and rhubarb. Rhubarb has a laxative effect and promotes intestinal detoxification; Cordyceps sinensis has antioxidant effects, inhibits renal fibrosis, and delays the progression of kidney disease. Of course, Chinese medicine is not completely harmless. Studies have confirmed that some Chinese medicines have nephrotoxic effects. For example, Belgium has reported "Chinese medicine kidney disease treatment, and later studies have found that it is related to the adverse reactions of Akebia." Therefore, we should seek medical treatment scientifically, avoid seeking medical treatment in a hurry, do not blindly believe in "folk prescriptions" and "secret recipes", do not use medicines casually, and take Chinese medicines in regular hospitals.

Patients with uremia who do not respond to the above integrated treatment or who develop certain complications require renal replacement therapy.