Pediatric renal anemia

　　Pediatric renal anemia is. Due to the decrease in erythropoietin production due to renal function failure, uremic patients have substances in the plasma that inhibit red blood cell production and shortened red blood cell lifespan. During chronic renal dysfunction, the production of erythropoietin decreases, and a large number of experiments have shown that in patients with renal dysfunction who have severe anemia, erythropoietin in their plasma can only maintain at the lower limit of normal, while in patients with normal renal function and anemia, erythropoietin in their plasma is significantly elevated. The degree of decrease in erythropoietin is parallel to the dysfunction of renal excretion. When erythropoietin is seriously deficient, the bone marrow loses the compensatory ability to erythropoiesis and anemia. About 10% of erythropoietin is produced by the liver, so even if both kidneys are removed, there is still a small amount of erythropoietin in the plasma. There is also evidence that uremic plasma has an inhibitory effect on red blood cells. Therefore, it is currently believed that the bone marrow of uremic patients loses the compensatory function for anemia, which is related to the decrease in erythropoietin and the presence of red blood cell inhibitory substances in the plasma of such patients. In addition to the disorder of bone marrow hyperplasia, the shortening of red blood cell lifespan is also a cause of anemia. If normal red blood cells are transfused into uremic patients, the lifespan of normal red blood cells will also shorten, and conversely, if the red blood cells of uremic patients are transfused into normal people, the lifespan of these red blood cells will be normal. So far, it has not been proven which specific toxins can cause hemolysis in such patients, and hemodialysis and peritoneal dialysis cannot alleviate this hemolysis. Uremia can lead to abnormal platelet function, which can cause gastrointestinal and urinary tract bleeding, and in addition, a small amount of red blood cells can be lost during hemodialysis, causing anemia. There may also be iron absorption disorders, or due to anorexia, iron and folic acid intake may be reduced, leading to anemia.

　　In children with severe renal anemia, complications such as cardiac enlargement, palpitations, dizziness, and so on may occur, mainly due to various complications caused by chronic renal function failure, in addition to anemia, such as hypertension, heart failure, myocardial disease, water and electrolyte disorders and acid-base imbalance, renal osteopathy, fractures, infection, etc. Children with anemia may be crying and restless, restless, and even affect intellectual development.

　　The prevention of pediatric renal anemia mainly involves doing health education work. Parents should recognize the harm of the disease to children and the importance of prevention. Specific measures should include health guidance for pregnant mothers, reasonable feeding of children after birth, emphasizing the timely addition of complementary foods rich in iron, especially animal foods such as various meats and liver. Treating diseases of the digestive system, malnutrition, and infectious diseases. Early iron supplementation should be given to premature infants and twins, and attention should be paid to the supply of nutrients during the recovery period of the disease.

　　Actively prevent and treat various primary diseases that can cause chronic renal failure, such as chronic nephritis and pyelonephritis. For patients with renal damage, it is necessary to actively prevent and treat infections, control hypertension, avoid using nephrotoxic drugs, and at the same time, pay attention to reasonable diet and rest to effectively prevent the progression of the disease and promote the recovery of the disease.

　　The degree of anemia in children with renal anemia varies, most of them are moderate to severe anemia, and they often present with a normal color. The reticulocytes are normal or reduced, and the blood smear shows broken cells in various shapes such as sawtooth, cuirass, and triangular. The white blood cells are normal or increased, the platelets are normal or decreased, the bleeding time and clot retraction are abnormal, the coagulation time is normal, the capillary fragility test may be positive, the bone marrow hyperplasia is usually normal, the granulocyte/erythrocyte ratio increases, the serum iron and total iron-binding capacity are often reduced, the bone marrow iron staining is normal, and the plasma ferritin is often increased. Chest X-ray examination, B-ultrasound examination, and electrocardiogram examination should be performed, and other examinations should be selected according to the need for renal diseases.

      Children with renal anemia should pay attention to eating some foods rich in protein and vitamins in their daily life to ensure sufficient nutritional intake into the body of the patient. The dietary status is usually as follows:.

      1、High protein, low fatFor general anemia patients, it should be considered first to provide a high-protein diet. This can be achieved by eating lean meat of animals as well as organs such as liver and kidney to obtain high-quality protein. Secondly, it should be controlled to reduce the intake of fat. Because fat can inhibit the body's hematopoietic function, and high-fat diet can lead to diarrhea, poor digestion, obesity, and other diseases.

      2、Rich in vitaminsThe content of vitamins in the diet structure is abundant, which is suitable for patients with various diseases. For anemia patients, vitamins B1, B12, C, and folic acid are crucial. The supplement of vitamin B1 can be obtained through grains, especially coarse grains. Vitamin B12 and folic acid mainly come from animal organs and other foods. The main source of vitamin C is various fresh vegetables and fruits.

      3,Supplement trace elements: Eating iron-rich foods has almost become common knowledge for anemic patients. It is noteworthy that the appropriate supplementation of trace element copper is also quite important for correcting anemia, although the physiological need for copper in the human body is very small and can be met through daily diet. However, if the diet is not nutritious and vegetables are eaten less or not at all, it will be disadvantageous for correcting anemia.

      4,Eat less salt-containing food: It is better for anemic patients to eat less salt-containing food, and temporary salt restriction should be temporarily prohibited once edema occurs.

　　The course and prognosis of pediatric renal anemia are affected by many factors, such as age, etiology, complications, whether treatment is timely, whether hypertension is controlled reasonably, whether dietary protein restriction in the early and middle stages is reasonable, nutritional problems, metabolic problems, anemia problems, daily care of patients, and so on. For various factors, there are different traditional Chinese medical treatments, as follows:
　　1, When the main problem is spleen deficiency, focus on replenishing the spleen and supplementing the kidney; when the main problem is kidney deficiency, focus on replenishing the kidney and supplementing the spleen. For replenishing the spleen, human and prepared Huangqi are heavily used; for replenishing the kidney, prepared Shu Di Huang and Shanyao are heavily used.
　　2, Deficiency of both Qi and Yin: General weakness, nausea and vomiting, sticky and dry mouth, not much drinking water, soreness in the lower back and knees, heat in the palms and soles of the hands and feet, pale red tongue, thick and large tongue body, with notched edges, deep and fine pulse. Treatment: tonify Qi, nourish Yin and generate blood. Formula: Modified Shen Qi Di Huang Decoction. Medicines: Ren Shen 5g, Huangqi 30g, Danggui 10g, Shu Di Huang 10g, Shanyao 10g, Dan Pi 12g, Fu Ling 15g, Ze Xie 6g. Decocted for oral administration, one dose per day.
　　3, Deficiency of Spleen and Stomach: Pale complexion, pale lips, decreased appetite and nausea, occasional vomiting, abdominal distension and loose stools, pale red tongue with thin white fur, deep and fine pulse. Treatment: tonify Qi and nourish blood, strengthen the spleen and harmonize the stomach. Formula: Modified Bu Zhong Yi Qi Decoction. Medicines: Danggui 10g, Huangqi 30g, Sha Ren 6g, Ren Shen 5g, Fu Ling 15g, Bai Zhu 10g, Zhigancao 6g, Sang Shen 10g, Chao Nei Jin 10g. Decocted for oral administration, one dose per day.