Are you afraid of kidney disease? Let's talk about the prevention and treatment of chronic kidney disease

Author: Zhang Lan, deputy chief physician of China Rehabilitation Research Center

Reviewer: Ma Yingchun, Chief Physician, China Rehabilitation Research Center

In the outpatient clinic, we encounter quite a number of patients who are found to have urine protein, positive occult blood or high blood creatinine during physical examinations or tests for other diseases. When they are told that "there may be something wrong with the kidneys", they usually come to the nephrology clinic anxiously, and then they have a series of questions.

"Is he suffering from uremia?"

"Do you need dialysis?"

“Can this disease be cured?”

…

The reason why everyone is afraid of talking about kidneys is that everyone realizes the importance of kidneys to the human body. Next, let us learn some specific knowledge about the prevention and treatment of chronic kidney disease.

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What is chronic kidney disease?

Chronic kidney disease ( CKD ) refers to renal structural and functional disorders caused by various reasons for more than or equal to 3 months, including pathological damage with normal and abnormal glomerular filtration rate, abnormal blood or urine components, and abnormal imaging examinations; or unexplained decrease in glomerular filtration rate (GFR), GFR < 60ml/(min·1.73m2) for more than 3 months.

If a patient is clinically diagnosed with CKD, how do we determine the severity of the disease? That depends on the specific stage (Table 1).

CKD is staged based on the GFR value, an indicator of kidney function. CKD stages 1 and 2 are early-stage and the condition is not serious, but the cause needs to be found, and early intervention and treatment are needed to prevent the progression of the disease; CKD stages 4 and 5 are late-stage and the condition is often severe, prone to multiple and serious complications, especially CKD stage 5, which usually requires preparation for renal replacement therapy (hemodialysis, peritoneal dialysis, kidney transplantation).

What are the symptoms of chronic kidney disease?

You may ask, what symptoms or manifestations should alert us to CKD? In fact, kidney disease is also known as the "silent killer". Most kidney diseases have a hidden onset. Patients with CKD stages 1 and 2 may not have any clinical symptoms and are usually discovered during physical examinations. After CKD stage 3, symptoms such as fatigue, edema, loss of appetite, nausea, decreased urine volume, and increased foam in the urine may occur. In severe cases, chest tightness, wheezing, and paroxysmal nocturnal dyspnea may occur. Patients may first visit other departments. It is worth noting that the above symptoms vary greatly from person to person. Some patients only experience symptoms such as fatigue and loss of appetite even when they reach CKD stage 5. Therefore, regular annual physical examinations are very important.

What are the aggravating factors of chronic kidney disease?

For some patients, chronic kidney disease was once well controlled and renal function was very stable, but they will suddenly show signs of renal function progression. Clinically, they may experience edema, decreased urine volume, fatigue, loss of appetite, etc. Laboratory tests may show increased urine protein and blood creatinine. Doctors diagnose this as "acute exacerbation of chronic kidney disease."

So what are the factors that lead to acute exacerbation of CKD? Common ones include: ① fatigue; ② staying up late; ③ infection (respiratory tract, digestive tract, urinary system, skin, etc.); ④ use of nephrotoxic drugs; ⑤ poor control of blood pressure and blood sugar; ⑥ digestive tract bleeding; ⑦ heart failure; ⑧ post-renal obstruction caused by various reasons. Any one or several of these factors occurring at the same time may lead to acute exacerbation of CKD in a short period of time.

How should chronic kidney disease be treated?

Once CKD is diagnosed, don't be anxious. First, ask the doctor about your CKD stage, then clarify the cause of CKD, and finally talk about treatment. Different causes, different stages, and different complications require different treatment plans. Therefore, here are the treatment principles for CKD: treat the primary disease, eliminate aggravating factors, delay renal function decline, avoid the use of nephrotoxic drugs, correct complications, and provide renal replacement therapy when necessary. The treatment plan is formulated by a kidney specialist, and the patient himself needs to pay attention to: ensure a high-quality protein diet; avoid fatigue and infection; strictly control blood pressure and blood sugar standards; exercise scientifically and rationally; if other medications are required, inform the doctor of the CKD history in advance; follow up regularly and monitor changes in renal function every 3 months or so.

How should patients with chronic kidney disease exercise?

Some patients may wonder, isn't it contradictory that you ask us to avoid fatigue and exercise at the same time? This is not contradictory. The exercise proposed here must be scientific, reasonable and moderate. The department where the author works is dedicated to the rehabilitation of chronic kidney disease, and the focus is on exercise rehabilitation. Regular and scientific exercise training can improve the body function, muscle strength, psychological function and quality of life of CKD patients, reduce the body's inflammatory state, and delay the progression of renal function.

On the contrary, unscientific and inappropriate exercise will aggravate the progression of renal function. In general, exercise prescription is individualized and cannot be generalized. It is closely related to the patient's age, CKD stage, comorbidities, and complications. Patients who have the conditions can consult professional doctors for professional advice.

How to detect chronic kidney disease early?

I would like to emphasize again here that regular annual physical examinations are extremely important!

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Physical examination is the most effective means of early detection of CKD. In addition, pay attention to the characteristics of urine, such as color, presence of foam, etc., and do urine routine test in time. It should be noted here that the sensitivity and specificity of urine routine test are not high. If conditions permit, it is best to do urine microalbumin test to increase the screening rate of early CKD.

How to prevent chronic kidney disease?

As with any disease, prevention is better than cure. To prevent CKD, you need to do the following:

(1) Maintain a healthy lifestyle, avoid staying up late, overwork, smoking, drinking, etc., eat a healthy diet, and exercise appropriately.

(2) For patients with a history of chronic diseases such as hypertension and diabetes, blood pressure and blood sugar should be strictly controlled to meet the standard, and indicators such as urine microalbumin and blood creatinine should be closely monitored.

(3) Patients with a family history of hereditary kidney disease can go to the hospital for genetic testing or family pedigree analysis to assess the risk of kidney disease if conditions permit.

(4) Avoid using nephrotoxic drugs as much as possible.

With the above information, we can answer the questions that patients are concerned about at the beginning of this article. Chronic kidney disease is a clinical diagnosis, and the cause needs further examination and clarification. It includes the entire process of the disease from mild to severe. Only when it reaches CKD stage 5 is it uremia and renal replacement therapy is required. However, CKD is indeed a chronic disease. Except for very few cases that can be cured, most patients need long-term maintenance treatment.

I hope everyone has healthy kidneys!