Beware of chronic kidney disease and stay away from the "silent killer"

Today is the 17th World Kidney Day. There are about 150 million patients with chronic kidney disease in my country. How can we detect and prevent it early? Is there any way to stay away from kidney disease, this silent killer?

Written by reporter Li Jing New Media Editor: Li Yunfeng

March 10, 2022 is the 17th World Kidney Day. The theme of this year's World Kidney Day is "Everyone pays attention to kidney health - I love my kidneys, knowledge strengthens kidneys". Since 2006, the second Thursday of March each year has been designated as World Kidney Day to remind the public to pay attention to kidney disease, strengthen prevention and treatment awareness, and protect our kidneys.

With the improvement of economic level and changes in lifestyle and other factors, the prevalence of chronic kidney disease is gradually increasing. Kidney disease is known as the "invisible killer". It is a stubborn and hidden disease. For kidney disease, early prevention and early treatment are always the best policy. What is the current situation of kidney disease in my country? How can the public detect and prevent kidney disease early? How to deal with it after getting sick, and how to get along with kidney disease in life? Is there any way for us to stay away from kidney disease, this silent killer?

▲Liu Wenhu, director of the Department of Nephrology at Beijing Friendship Hospital, spoke at the "Voice of Science" salon event of the Beijing Science and Technology Journalists and Editors Association

6 liang "xi" 100 liters

According to Liu Wenhu, director of the Nephrology Department of Beijing Friendship Hospital, kidneys are important detoxification organs in the human body. They are shaped like broad beans. Although the kidneys on both sides weigh only about 6 taels, they can filter up to 180 liters of primary urine (original urine) every day, which can fill 360 bottles of 500 ml mineral water bottles. Of course, original urine is not the same as the final urine discharged by the bladder. In the meantime, it also needs to be processed by the renal tubules, undergo reabsorption, and then discharge substances that the body does not need. After "fine processing", the urine discharged from the bladder by the human body is about 1.8 liters every day.

In addition to maintaining the body's water balance, the second physiological function of the kidneys is to maintain electrolyte balance, that is, to maintain the balance of salt substances in the body. According to the changes and needs of various electrolytes in the body, the kidneys excrete or reduce the excretion of various electrolytes in a timely manner to avoid hyperkalemia, hypokalemia, hypernatremia or hyponatremia.

Maintaining acid-base balance is also one of the "jobs" of the kidneys. The human body consumes a variety of foods every day, and a large amount of acidic waste is produced during cell metabolism. If it is not discharged in time, it may cause acidosis, nausea, vomiting, fatigue, difficulty breathing, dizziness and even death. At this time, the kidneys will discharge these wastes in time to maintain the body's acid-base balance.

The kidney itself is an endocrine organ that secretes a variety of hormones to regulate body functions. For example, 90% of erythropoietin in adults comes from the kidneys. Once the kidney function is lost and this hormone is lacking, the body's hematopoietic function will be affected, leading to anemia, pale complexion, weakness, etc.

From this we can see that the importance of kidneys to the human body is self-evident.

The prevalence rate is as high as 10%-15%

Continuous high-intensity "work" every day will inevitably damage the kidneys and even cause kidney disease. However, kidney disease can be divided into acute and chronic types, and the effects on the human body are also very different.

Liu Wenhu said that kidney damage is generally divided into two stages. The first stage is acute kidney injury, which is called acute kidney injury if it recovers within three months. For example, if you eat fish gallbladder, snake gallbladder and other bile substances and drink alcohol inappropriately, it may cause acute tubular necrosis. This acute tubular necrosis can generally be recovered within three months.

Acute kidney injury may also turn into chronic kidney disease, at which point the patient will have to live with chronic kidney disease for life. Due to the long course of the disease and the lack of specific drug treatment, the development of kidney disease is difficult to stop or reverse. Once suffering from chronic kidney disease, it will bring tremendous mental and financial pressure to both the patient and his family. We need to pay more attention and attention to chronic kidney disease. During the survival period of chronic kidney disease patients, due to various complications, they will also need to use a variety of drugs. Their health status and quality of life will be affected, and the patient's natural life span will be significantly shortened.

Data show that from 1990 to 2003, the life expectancy of the general population worldwide increased by 5.8 years. At the same time, the life expectancy of people with chronic kidney disease shortened by 0.1 year.

Low awareness and treatment rates

According to statistics from countries around the world, the prevalence of chronic kidney disease has reached 10%-15% in both developed and developing countries. Based on this calculation, there are approximately 150 million patients with chronic kidney disease in my country. In the "2019 Global Health Estimates Report" released by the World Health Organization on December 9, 2020, kidney disease has risen to one of the top ten causes of death in the world.

In contrast to the high prevalence, the awareness rate of chronic kidney disease is very low, the treatment rate is even lower, the recovery rate is poor, and there are many complications. Chronic kidney disease is often regarded as a silent killer, and there may be no symptoms or signs at a certain stage.

Liu Wenhu introduced that regular urine routine tests can detect more than 90% of chronic kidney disease, and renal ultrasound and blood biochemical tests can also provide a more comprehensive and accurate understanding of kidney function. He recommended observing urine color every day, colorless or light amber is normal; urine volume is generally 1500-2500 ml per day; third, observe whether there is edema in the lower limbs and eyelids; and finally, pay attention to measuring blood pressure.

IgA nephropathy is common in young adults

In the past, people thought that kidney disease would only occur when people get old, but in fact, children and young adults can also develop kidney disease, and the latter are even a high-risk group. Liu Wenhu said that the incidence of chronic kidney disease is 140 to 180 per million children, but among people aged 18 to 65, there are 10.8 patients per 100 people.

In addition to the more well-known kidney diseases such as nephritis and renal failure, in fact, the most common and important chronic kidney disease in my country is IgA nephropathy. IgA is a protective antibody and the main antibody that causes immune diseases, while IgA nephropathy is a type of primary glomerular disease. According to current research, due to genetic abnormalities, the IgA molecular structure is abnormal, and IgA is easily deposited in the glomeruli, which produces some inflammatory reactions, causing pathological damage to the glomeruli over time, and then forming IgA nephropathy.

The initial reaction of IgA nephropathy may be a fever caused by tonsillitis, which will be followed by fever and sore throat the next day, and then visible hematuria. This type of hematuria does not hurt or itch, nor is it accompanied by frequent urination or urgency, but only changes in color. If it is just tonsillitis, you only need to take medication, and the urine will return to normal after the inflammation disappears. If this type of hematuria appears repeatedly, most of the time it is IgA nephropathy.

"The age of IgA nephropathy patients who first go to the hospital for diagnosis is about 30 to 40 years old, and there is no difference in the incidence rate between men and women," said Li Wenge, director of the Nephrology Department of the China-Japan Friendship Hospital of the National Health Commission, at the "Voice of Science" salon event hosted by the Beijing Science and Technology Journalists and Editors Association. He also pointed out that IgA nephropathy is divided into two subtypes - IgA1 and IgA2. IgA nephropathy is related to abnormalities of IgA1, which is mainly produced in the gastrointestinal mucosa, especially in the ileum and colon. The human digestive tract is mainly divided into three sections: the mouth and esophagus to the stomach responsible for receiving food; the duodenum, ileum, and small intestine responsible for digestion and absorption; and the colon section that forms stool.

"If we can find a drug that can inhibit the production of abnormal immunoglobulin IgA locally (ileum and colon), it will be very effective in treating IgA nephropathy," said Li Wenge.

Targeting local areas to treat kidney disease

It is understood that the main means of treating IgA nephropathy in the past include antihypertensive drugs, glucocorticoids, and immunosuppressants, among which hormones are the most important aspect. The side effects and risks of hormone use are relatively large, and there are some relative contraindications. For example, for patients with severe renal impairment, the use of hormone treatment is prone to infection; for kidney disease patients who also suffer from diabetes, the use of glucocorticoids will cause more disordered blood sugar metabolism; for patients with cirrhosis, ulcers and ischemia are prone to occur.

Targeted therapeutic drugs for glomerular diseases have always been the direction of research and development, but it is difficult to break through the bottleneck of research and development. With the growing demand for the development of kidney disease drugs, academia and drug regulatory agencies have jointly promoted the accelerated development of new kidney disease drugs, and IgA nephropathy patients have new hope.

The Lancet, the world's top medical journal, once published an article that an oral budesonide targeted controlled-release capsule has the indications for treating IgA nephropathy. According to Zhu Zhengying, Chief Medical Officer of Internal Medicine at Everest, which has conducted Phase III clinical trials of innovative drugs in multiple centers around the world, its budesonide-related drugs can be delivered to specific parts of the intestine with high accuracy. After taking effect at this part, it can inhibit and interfere with the production of IgA1 by the intestinal mucosa, thereby interfering with the subsequent occurrence and development of the disease.

Innovative drugs are not developed overnight, but new drugs for kidney disease or any disease will mean better and more favorable treatment, as well as fewer side effects. "Drugs are the 'weapons' that clinicians use to fight diseases. Without good drugs, there is no weapon to kill the enemy," Liu Wenhu said frankly. Chronic kidney disease cannot be completely cured, but with proper medical treatment, appropriate adjustment of personal lifestyle habits, and active treatment of kidney disease, chronic kidney disease can be stabilized or slowly developed, which will also guarantee patients a healthy life of high quality life to the greatest extent, allowing them to share a wonderful life.

Produced by: Science Central Kitchen

Produced by: Beijing Science and Technology News | Beijing Science and Technology Media

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