Good news for patients with chronic renal failure - how to "eat" for healthy kidneys?

In daily life, we must have heard of kidney diseases, such as nephritis, nephrotic syndrome, renal failure and uremia. Among them, renal failure and uremia are neither as rapid as cancer nor as well known as cancer. However, the progression of this kidney disease is irreversible, just like cirrhosis of the liver. The burden on the family and the torture on the patient are no less than cancer. So today, I will introduce you to chronic renal failure.

What is chronic renal failure? Chronic renal failure (CRF) is the common outcome of various chronic kidney diseases (CKD) that continue to progress to the late stage. It is a clinical syndrome characterized by metabolic product retention, water, electrolyte and acid-base imbalance, and systemic symptoms.

The prevention and treatment of chronic kidney disease has become an important public health issue faced by countries around the world. In recent years, the prevalence of chronic kidney disease has shown a clear upward trend. Epidemiological survey data show that the prevalence of chronic kidney disease in adults in the United States reached 15.1% in 2011. According to data from 2012, the current prevalence of chronic kidney disease in my country is 10.8%.

What are the causes of chronic renal failure? In developed countries, diabetic nephropathy and hypertension-induced renal arteriosclerosis are the main causes of chronic renal failure; in developing countries such as China, the most common cause of chronic renal failure is still primary glomerulonephritis. In recent years, chronic renal failure caused by diabetic nephropathy has increased significantly and may become the primary cause of chronic renal failure in my country.

The mechanism of the progression of chronic renal failure has not been fully elucidated. The theories currently accepted by most people are the "healthy nephron hypothesis" and the "three highs theory". Each kidney of the human body contains 800,000 to 1 million nephrons. Each nephron has the function of producing urine independently and is the basic functional unit of the kidney. The kidney cannot regenerate new nephrons. The number of nephrons will gradually decrease in the case of kidney damage, disease or normal aging. After the age of 40, the number of functional nephrons decreases by about 10% every 10 years. However, under normal circumstances, the remaining nephrons are sufficient to complete normal urinary function. Various factors that damage the kidneys continuously act on the kidneys, causing the nephrons in the severely affected part to lose their function, while the "remaining" nephrons with less severe damage or no damage work twice as hard to compensate and adapt to the needs of the body. Overperfusion and overfiltration of healthy nephrons lead to glomerular fibrosis and sclerosis, further destroying healthy nephrons, leading to secondary nephron loss, and thus promoting renal failure.

This is like a factory that is losing money due to a business downturn and has to lay off employees from 100 to 50. The remaining 50 not only have their wages unchanged, but they have to do twice as much work, and they are overwhelmed and exhausted. In the end, only a dozen people are left. The factory has no ability to recruit new workers to replace them, so it eventually falls into a state of paralysis.

Chronic renal failure usually progresses slowly and gradually, but it can aggravate and worsen rapidly in a short period of time under certain inducements. Risk factors for the progressive development of chronic renal failure include hyperglycemia, hypertension, proteinuria (including microalbuminuria), hypoproteinemia, smoking, etc. In addition, anemia, hyperlipidemia, hyperhomocysteinemia, old age, malnutrition, accumulation of uremic toxins (such as methylguanidine, parathyroid hormone, phenols), etc., also play a role in the progression of chronic renal failure.

What are the manifestations at different stages of chronic kidney disease and chronic renal failure? The clinical manifestations vary at different stages of chronic kidney disease and chronic renal failure. Patients in CKD stages 1 to 3 may have no symptoms, or only mild discomfort such as fatigue, backache, increased nocturia, and loss of appetite. After entering CKD stage 3b, the above symptoms become more obvious. By CKD stage 5, acute left heart failure, severe hyperkalemia, gastrointestinal bleeding, central nervous system disorders, etc. may occur, and even life-threatening. Among them, digestive system symptoms are usually the earliest manifestations, mainly manifested by lack of appetite, nausea, vomiting, and urine taste in the mouth. Gastrointestinal bleeding is also common, and the incidence is significantly higher than that of normal people, mostly due to gastric mucosal erosion or peptic ulcer.

Early diagnosis, active and effective treatment of primary diseases, and avoidance and correction of risk factors that cause progression and deterioration of renal function are the basis for the prevention and treatment of chronic renal failure, and are also the key to protecting renal function and delaying the progression of chronic kidney disease. The prevention and treatment of CKD is systematic and comprehensive, and individualized countermeasures are also needed. Long-term follow-up and management of patients with chronic kidney disease should be carried out, and patients should be treated in a targeted manner to delay the progression of CKD. First of all, we should raise awareness of chronic kidney disease, attach importance to asking medical history, physical examination and renal function examination. Even for normal people, screening is required once a year, and efforts should be made to achieve early diagnosis. At the same time, timely and effective treatment should be given to existing kidney diseases or diseases that may cause kidney damage (such as diabetes, hypertension, etc.), and urine routine and renal function tests should be regularly checked at least twice a year or more to detect chronic kidney disease early.

For patients with chronic renal failure, "eating" is very important. For patients with chronic renal failure, diet is an important issue in their lives, because it is directly related to the patient's kidneys, so patients should pay attention to the following points in their daily diet:

l Optimize protein intake. Patients with chronic renal failure should pay attention to controlling protein intake in order to reduce the burden on the kidneys. However, if the protein intake is too little, it will not be conducive to recovery. Therefore, protein intake must be optimized and the quality of protein intake must be improved.

l Ensure adequate calorie intake. While controlling protein intake, you should also pay attention to consuming enough calories. In order to prevent insufficient calorie intake, you should pay attention to using some low-protein, high-calorie foods.

l Pay attention to controlling water intake. Drinking too much or too little water is not good for patients with chronic renal failure. If the patient urinates less, water will accumulate in the patient's body, causing an increased burden on the patient's cardiovascular system, and symptoms such as rapid breathing, edema, fatigue, headache, nausea, high blood pressure, and heart failure.

l Pay attention to controlling salt intake. Patients with renal failure have difficulty excreting water and salt, which can easily lead to edema or high blood pressure. Therefore, patients also need to pay attention to controlling salt intake. The daily salt intake should be less than 5g.

l Beware of excessive potassium ions. Severely damaged kidneys have difficulty effectively eliminating potassium ions, which can lead to hyperkalemia in patients, causing weakness in the limbs, fatigue, chest tightness, difficulty speaking, decreased consciousness, and in severe cases, it may also cause patients to have irregular heartbeats or cardiac arrest. Therefore, patients should pay attention to controlling their intake of high-potassium foods.

In summary, the causes of chronic renal failure are relatively complex, and the patient's own living habits and eating habits will have a great impact on the patient's condition, so patients must pay more attention to their daily lives and ensure scientific living and diet while actively receiving treatment.

References

[1] Internal Medicine, People’s Medical Publishing House, 9th edition

[2] People’s Medical Publishing House, Physiology, 9th edition

[3] Pathophysiology, 9th edition, People’s Medical Publishing House

[4] Zhai Bo. Daily precautions for chronic renal failure[B]. Diet and health care. 2020-04-24(7)