Kidney Failure

　　Uremia is caused by the accumulation of nitrogenous metabolic products and other toxic substances in the body that cannot be excreted, leading to disturbances in water, electrolyte, and acid-base balance, and can cause lesions in multiple organs and systems.

　　The main causes of uremia are:

　　Nephropathy is the main cause of uremia. Among the diseases leading to uremia, chronic glomerulonephritis accounts for 55.7%. Renal pre-factor: such as heart failure, insufficient intravascular water volume, and other factors; renal factor: such as nephrotoxic substances causing necrosis or fibrosis of renal cells, glomerulonephritis, or some systemic diseases, such as poorly controlled hypertension and diabetes, leading to renal sclerosis or diabetic nephropathy. In addition, systemic vasculitis sometimes invades the glomeruli, causing glomerulonephritis and triggering uremia; renal post-factor: urinary tract obstruction, which may be caused by factors such as urethral calculi or urinary tract tumors.

　　15% of hypertension patients will directly develop into uremia, so patients must strictly control their hypertension to prevent the occurrence of uremia.

　　Diabetes directly leads to uremia in 30% of diabetic patients, therefore, diabetics need to strictly control their blood sugar levels.

　　The most common symptoms in the early stage of kidney failure are nausea, vomiting, decreased appetite, and other gastrointestinal symptoms. In the stage of kidney failure, in addition to the further aggravation of water and electrolyte balance, acid-base balance, anemia, bleeding tendency, hypertension, and other symptoms, there may also be clinical manifestations caused by dysfunction of various organ systems and disorders of material metabolism.

　　1. Neurological symptoms are the main symptoms of kidney failure. In the early stage of kidney failure, patients often have symptoms such as dizziness, headache, fatigue, decreased comprehension and memory, and with the progression of the disease, symptoms such as irritability, muscle tremors, convulsions may appear, and finally, it may develop into apathy, drowsiness, and coma.

　　2. Gastrointestinal symptoms When the condition of kidney failure patients worsens, they may experience loss of appetite, nausea, vomiting, or diarrhea.

　　3. Cardiovascular system symptoms Chronic renal failure patients may develop heart failure, arrhythmia, and myocardial damage due to the effects of renal hypertension, acidosis, hyperkalemia, sodium and water retention, anemia, and toxic substances, etc. Due to the stimulating effect of urea, aseptic pericarditis may also occur.

　　4. Respiratory system symptoms When acidosis occurs, the patient's breathing is slow and deep, and in severe cases, it can be seen that the patient has a special Kussmaul breathing due to acidosis, and the exhaled gas has a smell of urine. Severe patients may have pulmonary edema, fibrous pleurisy, or pulmonary calcification and other lesions.

　　5. Skin symptoms Itching is a common symptom in kidney failure patients, which may be caused by the stimulation of toxic products on the skin receptors. In addition, the skin of patients is dry, scaly, and呈黄褐色, and the color of the skin changes.

　　6. Disordered material metabolism Kidney failure patients may also have reduced glucose tolerance, burden balance, and hyperlipidemia.

　　Kidney failure is often ignored in the early stage because the symptoms are not obvious, so early detection and early treatment are very critical once it is discovered to be in the late stage.

　　The early symptoms of kidney failure mainly include the following points:

　　1. Drowsiness and fatigue are the earliest symptoms of kidney failure patients and are also the most easily ignored. Because there are many reasons for causing drowsiness and fatigue, if the symptoms improve after a little rest, it is easier to be ignored by people.

　　2. The yellowish complexion is caused by anemia. Since this kind of manifestation occurs and develops very slowly, it will not appear obvious 'contrast' in a relatively short period of time, just like people can hardly find various slow-developing changes when they meet in the morning and evening.

　　3. Edema is caused by the kidney's inability to remove excess water in the body, resulting in fluid retention in the interstitial tissue of the body. In the early stage, edema is only seen in the ankles and eyelids, which disappears after rest. If it develops into persistent or systemic edema, the disease is quite serious.

　　4. Changes in urine volume Due to the decline in kidney filtration function, the urine volume of some patients will gradually decrease as the course of the disease progresses. Even if the urine volume is normal, due to the reduction in the toxins excreted in the urine, the quality decreases, and it cannot excrete excessive waste in the body, so to some extent, urine volume cannot fully explain the good or bad of kidney function.

　　Kidney failure in the early stage does not have obvious clinical manifestations, and it is usually very late when it is discovered. To prevent the disease from further deterioration, kidney failure patients should pay attention to the following points:

　　1. Take active treatment

　　Although uremia is a fatal disease, it is not incurable. For cases without precipitating factors, when renal function is irreversible, dialysis treatment can be considered to effectively prevent the progression of the disease.

　　2. Take sufficient rest

　　Uremic patients should ensure adequate rest and good nutrition and avoid activities beyond their capacity.

　　3. Avoid chemical substances harmful to the kidneys

　　Uremic patients should avoid products and environments containing cadmium, chloroform, ethylene glycol, and tetrachloroethylene, which are generally found in pesticides, car exhaust, paints, buildings, and household cleaning agents, and should be avoided to minimize contact.

　　4. Do not use utensils containing heavy metals

　　Do not use antique cooking utensils, as these utensils are coated with pigments made from cadmium. Do not smoke, as smoking is harmful to the kidneys.

　　5. Seek medical attention in case of discomfort

　　If uremic patients have symptoms such as anorexia, nausea, vomiting, diarrhea, ulceration and bleeding of oral mucosa, hypertension, chest pain in the precordial region caused by pericarditis and heart failure, palpitations, shortness of breath, upper abdominal pain, edema, and inability to lie flat, they need to seek medical attention as soon as possible.

　　Uremia is not an independent disease but a group of clinical syndromes. The diagnosis of uremia is not only based on the level of serum creatinine but also requires auxiliary examinations for further confirmation in order to better treat the disease.

　　1. Blood routine

　　Blood routine examination during uremia shows that hemoglobin is generally below 80g/L, with most patients only having 40-60g/L, which is normocytic normochromic anemia. Platelet counts are low or normal, but the function is reduced, and the erythrocyte sedimentation rate often accelerates due to anemia and hypoproteinemia.

　　2. Urine routine

　　Urine routine examination shows changes in the urine of uremic patients, which differ significantly depending on the primary disease.

　　3. Blood biochemistry

　　Blood biochemistry shows a decrease in plasma protein, with the total protein content often below 60g/L, and the reduction of albumin is usually more obvious, often below 30g/L. Blood calcium is low, usually around 2mmol/L, and blood phosphorus is often higher than 1.7mmol/L. Blood potassium and sodium levels vary with the condition.

　　4. Imaging examinations

　　(1) X-ray examination: Uremic patients can undergo abdominal X-ray flat film examination to observe the size and shape of the kidneys and whether there are calculi in the urinary system. Lateral abdominal films can show the presence of atherosclerosis.

　　(2) Radionuclide renal scans and renal scans are helpful in understanding the size, blood flow, secretion, and excretion functions of both kidneys.

　　(3) Ultrasound and CT scans are helpful in determining the position, size, thickness of the kidneys, and whether there is fluid accumulation, calculi, or tumors in the renal pelvis.

　　Attention to diet in daily life is one of the effective ways for uremic patients to control the development of the disease.

　　1. It is advisable to eat more foods high in fiber.

　　Starchy foods rich in dietary fiber such as potatoes and sweet potatoes, coarse grains such as corn flour, sorghum flour, buckwheat flour, and oat flour, as well as vegetables, fruits, and hard fruit foods (peanuts, walnuts). If uremic patients consume 270 grams of vegetables daily, they can provide 20 grams of dietary fiber.

　　2. Prefer egg and milk products

　　Due to low protein intake, it is best to choose animal protein foods with high nutritional value, such as eggs and milk, and to use less soy products and other plant proteins.

　　3. Limit the intake of foods high in cadmium content

　　Limit the intake of foods high in cadmium content, such as foods made from animal liver and kidney, flounder, clams, scallops, oysters, and vegetables grown in sludge.

　　4. Control High-Potassium Foods

　　For patients with low urine output and high blood potassium levels, dietary control of high-potassium foods such as pears and bananas is strict. For those with severe hypertension, edema, or high blood sodium levels, sodium intake should be controlled, with a daily salt intake of 4 to 5 grams or less. Patients with oliguria, hypertension, and edema should also strictly limit water intake, and the daily water intake should not exceed the amount of urine excreted.

　　There are many methods of treating kidney failure in Western medicine, but when choosing, it should be decided according to the patient's own condition. Only symptomatic treatment is the most effective method.

　　1. Cure the root cause:

　　Kidney failure caused by ureteral calculi should be removed; kidney failure caused by nephritis should be treated with drugs such as steroids; and for kidney failure caused by electrolyte imbalance, blood transfusion or nutritional injections should be administered according to the situation.

　　2. Kidney Failure Caused by Chronic Diseases:

　　Treating the primary disease and paying attention to diet, maintaining electrolyte balance in the body, and being careful about infections can control the disease from worsening.

　　3. Kidney Transplantation:

　　It involves implanting another person's kidney into the body of a patient with kidney failure through surgery, allowing it to perform kidney functions. If the transplanted kidney does not have rejection reactions, it can completely replace the original kidney function. It is the best method for treating kidney failure with the highest efficacy and the lowest long-term cost, and it is also currently recognized as the best treatment method.

　　4. Artificial Dialysis:

　　Commonly known as dialysis, it is a method of removing harmful substances in the blood from the body through artificial means.

　　(1) Peritoneal Dialysis: Utilizing the patient's peritoneum, after contacting with the perfusion fluid, harmful substances and excess water in the body are removed through diffusion, conduction, and concentration differences.

　　(2) Hemodialysis: Blood in the body is sent to an artificial kidney through a catheter, where harmful substances in the blood are removed through a filter membrane and then returned to the body.