Elderly uremic pneumonia

　　The lung occupies a very important position among all the organs in the body. On the one hand, the lung is directly connected with the external environment and is in contact with the external environment. Therefore, the lung is attacked by external pathogenic factors and affected by changes in the internal environment. Diseases of all systems in the body can lead to changes in the respiratory system. During chronic renal failure, many factors such as infections, toxins, and immunity can have adverse effects on the lungs. These factors include the direct action of bacteria, fungi, viruses, and other pathogens, that is, infection; at the same time, they may have indirect effects on the lungs, such as pulmonary edema caused by sodium and water retention, that is, uremic pneumonia. Pulmonary edema caused by sodium and water retention during chronic renal failure can directly cause damage to lung function; various toxins in the body during chronic renal failure can indirectly cause lung injury; the pathological process that damages the kidneys can also cause changes in the lungs, such as systemic sclerosis, Wegener's granulomatosis, sarcoidosis, and pulmonary-kidney syndrome, and so on.

　　Common causes of uremia in order are diabetic nephropathy, hypertensive nephropathy, glomerulonephritis, polycystic kidney disease, and so on. Most of the patients with diabetic nephropathy and hypertensive nephropathy are elderly, and these patients often have coronary heart disease, so they are more prone to develop uremic pneumonia, that is, uremic pulmonary edema. Generally, patients with polycystic kidney disease will show clinical symptoms around the age of 60, so most of these patients are also elderly.

　

　　Elderly uremic pneumonia is one of the most common complications of elderly renal failure. If the primary disease is not treated in time, elderly uremic pneumonia can lead to other systemic diseases such as pleural effusion, difficulty breathing, and left heart failure.

　　As a complication of chronic renal failure, the first step is to actively prevent the primary disease; once the disease occurs, it should be treated actively, and the prevention of its progression should be the focus. The specific preventive methods are as follows:
　　1. Conduct health screenings for high-risk populations, regularly review urine routine and renal function, and detect the disease early.
　　2. Eliminate the risk factors for the deterioration of chronic renal failure, such as infection, heart failure, dehydration, or improper treatment.
　　3. Adhere to the etiologic treatment of chronic renal failure, such as chronic glomerulonephritis, lupus nephritis, purpura nephritis, IgA nephropathy, hypertensive nephropathy, diabetic nephropathy, and other diseases, all of which require long-term treatment.
　　4. Diet therapy: Use low-protein, low-phosphorus diet. The ability of the kidneys to excrete metabolic products decreases during chronic renal failure, leading to the accumulation of toxins in the body. These toxins are basically metabolic products of proteins, so protein intake should be limited. However, excessive restriction of protein intake can cause malnutrition and lead to hypoproteinemia. Therefore, for patients with chronic renal failure, nutritional therapy should be carried out, using high-quality proteins such as eggs, milk, fish, lean meat, etc.; reduce the intake of plant proteins (such as soy products), ensure sufficient calories, and supplement vitamin C and vitamin B.
　　5. Avoid or use with caution drugs that damage renal function.
　　6. If patients find that their urine output decreases, edema worsens, and nocturia increases, they should seek medical attention at a hospital in a timely manner.
　　7. For patients with confirmed uremia who have difficulty breathing, coughing, inability to lie flat, and blood-streaked sputum, consider the occurrence of uremic pulmonary edema. Immediate hospital treatment should be sought to avoid delay in the disease.

　　Elderly patients may show all the manifestations of chronic renal failure through examination, such as advanced concurrent interstitial pulmonary fibrosis, blood gas analysis may show hypoxemia and metabolic acidosis, etiologic examination is often negative, and pleural effusion routine examination is exudative fluid, etc.

　　Imaging:The manifestations on chest X-rays vary with the severity of the disease and the duration of the course, and are divided into 4 stages:
　　1. Congestion stage: The pulmonary vessels are enhanced, the hilum shadow is enlarged, and the middle and lower lung fields show a milky glass-like change.
　　2. Interstitial edema stage: The bronchial and vascular cross-sections around the hilum are thickened, with blurred edges, known as 'cuff sign', and Kerley B and A lines may appear.
　　3. Alveolar edema stage: Diffuse punctate and patchy shadows, which may merge into large shadows.
　　4. Interstitial fibrosis stage: There are many cord-like and reticular shadows in the lung fields.
　　5. Other: chest effusion, pericardial effusion, pleural thickening, lung calcification and other signs may occur.

　　Pulmonary function test:Reduced lung capacity, decreased diffusion function.

　　Elderly patients with uremic pneumonia should have light and nutritious diet, at the same time ensuring sufficient nutrition, reasonable dietary structure, choosing high-quality protein and appropriately supplementing vitamins; reducing salt intake, avoiding smoking, alcohol, and spicy food.

　　The main treatment principle of this disease is to treat the primary disease and improve renal function. When there is a pulmonary infection, sensitive and non-nephrotoxic antibiotics can be selected, usually penicillin group antibiotics.

　　Patients with chronic renal failure often have a long course of illness, recurrent attacks, and are prone to develop emotions such as tension, anxiety, pessimism, and depression, which can quickly worsen the condition. Therefore, family members should pay attention to communication with the patient to eliminate tension. Inpatients should cooperate with medical staff to facilitate the recovery of the condition. Confidence in overcoming the disease should be established, and it should be recognized that the cycle of life, death, and old age is a natural law of life. Face diseases bravely, give full play to subjective initiative, actively understand the condition from doctors during the hospital stay, understand the nature and pathological process of the disease, cooperate with doctors to perform special examinations such as renal biopsy, read relevant information about kidney disease, understand relevant protective and nourishing knowledge, and achieve the best therapeutic effect.

　　The prognosis of elderly patients with uremic pneumonia and complications is usually poor.