Renal failure

　　Regarding the main causes of chronic renal insufficiency, there are many in clinical practice, with chronic glomerulonephritis being the most common, accounting for about 50-60%. Other common causes include renal arteriosclerosis, chronic pyelonephritis, systemic lupus erythematosus, and so on. Other causes that can lead to chronic renal insufficiency include urinary obstruction caused by kidney tuberculosis, diabetic glomerulosclerosis, polycystic kidney disease, renal hypoplasia, and kidney stones, tumors, and benign prostatic hyperplasia. In addition, complications of hypertension can also lead to the occurrence of hypertension-related renal insufficiency.

　　Common complications include hypertension, anemia, heart failure, pericarditis, cardiomyopathy, water and electrolyte disorders, acid-base imbalance, renal osteodystrophy, fractures, infections, and others.

　　In addition to the complications of the above systems, patients with chronic renal insufficiency and long-term dialysis can also have the following complications:

　　Aluminum poisoning

　　End-stage renal disease patients undergoing routine dialysis treatment are prone to develop aluminum poisoning.

　　2. Dialysis-related amyloidosis

　　Dialysis-related amyloidosis (DRA) is a bone and joint disease seen in long-term dialysis patients. Its clinical symptoms and incidence are closely related to the duration of dialysis.

　　3. Changes in trace elements

　　Renal failure and dialysis have a great impact on trace element metabolism. They accumulate in various parts of the body and can cause toxic reactions.

　　1. Aluminum:See aluminum poisoning.

　　2. Copper:The plasma copper levels of patients with chronic renal failure who have not undergone dialysis are often normal, but they can also be slightly low.

　　3. Zinc:In chronic renal failure, patients on a low-protein diet and those with nephrotic syndrome who lose a large amount of urinary protein often have extremely low plasma zinc levels.

　　1. Oliguria phase:Decreased urine volume leads to hyperkalemia, water intoxication (severe edema, increased blood pressure, pulmonary edema, or brain edema), metabolic acidosis, and acute uremic symptoms. Hyperkalemia and water intoxication are the main causes of death.

　　2. Polyuria phase:After the regeneration and repair of renal tubular epithelial cells, urine volume gradually increases, causing blood potassium and sodium levels to decrease. Patients with persistent polyuria may die from dehydration and electrolyte imbalance.

　　3. Recovery period:After the polyuria phase, urine volume decreases to normal, blood BUN, creatinine (Scr), and electrolytes all return to normal levels. However, it takes 3 to 6 months for renal tubular function and structure to recover. Those who do not recover may develop chronic renal failure. Non-oliguric renal failure, although urine volume is not low, the blood BUN and Scr levels increase daily and toxic symptoms appear due to mild renal injury, so the prognosis is good.

　　1. Nourish the five internal organs

　　Maintain a regular lifestyle and diet, pay attention to hygiene, avoid external evil invasions, especially in seasons and regions where infectious diseases are prevalent, and strengthen preventive measures. Avoid excessive intake of spicy, fried, and rich foods to prevent damp-heat. Regulate emotions, maintain a cheerful spirit, and ensure the smooth flow of Qi and blood to avoid Qi stagnation and blood stasis. Strengthen physical exercise to improve the body's defense ability.

　　2. Prevent poisoning

　　According to relevant data, 20% to 50% of acute renal failure is caused by drugs, and some are due to exposure to harmful substances. Therefore, it is best to avoid using and contacting drugs or toxins that are harmful to the kidneys. If accidental ingestion or contact occurs, it should be discovered and treated early.

　　3. Timely prevention and treatment

　　Once an underlying disease that can trigger acute renal failure occurs, early treatment should be sought, with attention to expanding blood volume, correcting water and electrolyte imbalances, and restoring circulatory function. If it is found that the disease is about to occur, early measures should be taken to supplement blood volume, increase cardiac output, restore renal perfusion and glomerular filtration rate, remove obstructive substances in the renal tubules, prevent infection, and prevent renal parenchymal damage caused by DIC and renal ischemia. At the same time, the application of blood-activating and blood-removing drugs should be started as soon as possible, which has a positive effect on preventing the occurrence of the disease.

　　1. Laboratory examination

　　1. Urinalysis

　　Urinary routine protein is generally >2.0g/L, and in late stages of renal function damage, urinary protein may actually decrease. The specific gravity of morning urine may decrease to below 1.018, or remain fixed at around 1.010.

　　Since all patients with CRF have anemia, routine blood tests are important for indicating CRF. Other tests include total protein, albumin, globulin, and their ratios; blood electrolytes (HCO3-, K, Na, Ca, Mg2+, P3, etc.) level determination.

　　Serum creatinine (Scr), blood urea nitrogen (BUN) rise, and urine concentration-dilution function tests indicate a decrease in内生肌酐清除率 (Ccr).

　　2. Liver function and hepatitis B two pairs and half examination.

　　3. Serum Immunology Examination

　　Including serum IgA, IgM, IgG, complement C3, complement C4, T lymphocyte subsets, B lymphocyte population CD4/CD8 ratio, etc.

　　4. Nutritional Status Indicators Detection

　　Determine serum total protein, serum albumin, serum transferrin, and low molecular weight protein. Extremely low levels of cholesterol are also considered as indicators of malnutrition.

　　Second, Imaging Examinations

　　1. Kidney Ultrasound

　　Cortical thickness of the kidney

　　2. Other

　　Routine electrocardiogram, X-ray chest film, bone film, and gastroscopy, as well as certain special examinations such as X-ray contrast, radionuclide renal scan, CT, and MRI, are helpful in determining the shape, size, and whether there is urinary tract obstruction, hydronephrosis, calculi, cysts, and tumors in the kidneys.

　　Patients with this disease should pay attention to light diet, try to avoid spicy and刺激性 foods, and at the same time, pay attention not to eat greasy foods. If necessary, consult a doctor and follow medical advice for eating.

　　1. Targeted treatment for the cause, such as expanding volume to correct pre-renal factors, removing post-renal obstruction factors, and using hormone shock for severe acute or other glomerulonephritis can be effective. For allergic interstitial nephritis, medication should be stopped immediately, and antiallergic drugs should be given.

　　2. During the oliguria period, the principle of 'input should equal output' should be followed for fluid intake.

　　3. Correct hyperkalemia and acidosis.

　　4. Early dialysis therapy has the functions of dehydration, detoxification, correcting electrolyte imbalance and acid-base imbalance, helping patients to pass through the difficult period of oliguria. During the polyuria period, strict monitoring of water and electrolyte balance is necessary to prevent death from dehydration and electrolyte imbalance. It is very important to pay attention to strengthening nutrition, rest, and avoiding nephrotoxic drugs during the recovery period.