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Wu Ji
Nephrology
About me
- Dr. Wu Ji, Master of Medicine, Associate Chief Physician. Engaged in clinical specialty of nephrology and blood purification for over 10 years.
Proficient in diseases
Integrative treatment for chronic kidney disease, treatment and management of maintenance hemodialysis patients, and continuous renal replacement therapy for critically ill patients.
Voices
Principles of Treatment for Chronic Renal Failure
The principles of treatment for chronic renal failure include early-stage non-dialysis conservative treatment as well as end-stage renal replacement therapy. Non-dialysis conservative treatment includes delaying the progression of kidney damage, which requires treating the primary disease, implementing nutritional support, and controlling factors that accelerate kidney disease progression, such as controlling high blood pressure, proteinuria, and hyperlipidemia. Additionally, it is necessary to eliminate metabolic waste from the body, and maintain the body's water, electrolyte, and acid-base balance. Renal replacement therapy includes hemodialysis, peritoneal dialysis, and kidney transplant therapy.
Symptoms of Chronic Kidney Failure
The clinical symptoms of chronic renal failure mainly include symptoms related to disturbances in electrolyte and acid-base balance, as well as symptoms of metabolic disorders of proteins, carbohydrates, fats, and vitamins. There are also manifestations in various organ systems, including the cardiovascular system, respiratory system, gastrointestinal tract, hematologic system, neuromuscular system, endocrine system, and bone lesions. Metabolic acidosis is common; patients may also exhibit water and sodium retention or hypovolemia and hyponatremia. Potassium metabolism disorders are often characterized by hyperkalemia, while disturbances in phosphorus and calcium metabolism are mainly manifested as hyperphosphatemia and calcium deficiency. Patients may also show cardiovascular manifestations, primarily hypertension, left ventricular hypertrophy, heart failure, and uremic cardiomyopathy. Gastrointestinal symptoms in patients may include loss of appetite, nausea, and vomiting. Additionally, renal anemia and a tendency to bleed are common, and skeletal changes are quite frequent, leading to malnutrition of bones, osteomalacia, and osteoporosis.
What is nephrotic syndrome?
Nephrotic syndrome is a common manifestation of glomerular disease, caused by a variety of etiologies, with large differences in treatment response and prognosis. The pathological causes of nephrotic syndrome are diverse, with the most common types being minimal change disease, focal segmental glomerulosclerosis, mesangial proliferative nephritis, membranous nephropathy, and membranoproliferative glomerulonephritis. Nephrotic syndrome can be classified into primary and secondary types based on its cause. The diagnosis of primary nephrotic syndrome mainly depends on the exclusion of secondary nephrotic syndrome. Common causes of secondary nephrotic syndrome include diabetic nephropathy, lupus nephritis, renal amyloidosis, drug-induced nephropathy, and renal tumors.
Criteria for the diagnosis of nephrotic syndrome
The diagnostic criteria for nephrotic syndrome include massive proteinuria, with urinary protein greater than 3.5 grams/day, hypoalbuminemia, with plasma albumin less than 30 grams/liter, severe edema, and hyperlipidemia, which includes significant increases in plasma cholesterol and triglycerides. The first two criteria are essential for the diagnosis of nephrotic syndrome, while the latter two are secondary. Clinically, if the two necessary criteria are met, the diagnosis of nephrotic syndrome is established. Patients with nephrotic syndrome should undergo a renal biopsy to determine the pathological type and guide clinical treatment.
How to treat polycystic kidney kidney stones
Patients with polycystic kidney disease who develop kidney stones should be treated the same as patients without polycystic kidney disease. It is encouraged for patients to drink more water. If the stones are symptomatic, treatments such as extracorporeal shock wave lithotripsy or percutaneous nephrolithotomy may be considered. The main principles of treatment include managing renal colic, promoting stone expulsion, dissolving stones, or surgical interventions, as well as preventing recurrence. During a renal colic episode, it is primarily recommended to administer antispasmodic analgesics. Commonly used medications include scopolamine butylbromide and atropine, or combinations of atropine with pethidine or morphine. Expulsion therapy mainly involves drinking plenty of water, proper physical activity, and the use of some antispasmodic drugs to help expel the stones. Surgical treatment is aimed at patients with anuria and post-renal acute renal failure, or in cases where the stone diameter is larger than one centimeter, or if the expulsion therapy is ineffective, especially if there are still episodes of renal colic. Systemic metabolic disorders are an important cause of kidney stone formation, thus even after stones are cleared, recurrence is possible. Therefore, to prevent recurrence, it is advisable to ensure a daily urine output of 2000 to 2500 milliliters, avoid drinking tea and coffee as much as possible, adjust dietary habits, and treat systemic metabolic abnormalities, such as hypercalcemia, hyperuricemia, and cystinuria, among others.
Symptoms of chronic renal failure
The clinical symptoms of chronic renal failure vary at different stages. In the compensatory and early decompensatory stages of chronic renal failure, patients may experience no symptoms or only mild discomforts such as fatigue, back pain, and increased nocturia, while a few may suffer from reduced appetite, metabolic acidosis, and mild anemia. The main clinical symptoms include disorders of water, electrolyte, and acid-base balance, presenting metabolic acidosis, sodium retention or hypovolemia, or hyponatremia, along with hyperkalemia. Moreover, there are significant manifestations of excess phosphorus and calcium deficiency. Patients may also experience disruptions in the metabolism of proteins, carbohydrates, fats, and vitamins. Cardiovascular symptoms mainly include hypertension, left ventricular hypertrophy, heart failure, and uremic cardiomyopathy. Gastrointestinal symptoms can manifest as loss of appetite, nausea, and vomiting. Hematological manifestations may include renal anemia and a tendency to bleed.
Causes of Anemia in Chronic Renal Failure
The causes of anemia in chronic renal failure, also known as renal anemia, occur in chronic kidney disease and are related to chronic renal failure. There are multiple reasons for this anemia, such as the lack of raw materials for red blood cell production caused by chronic renal failure, including deficiencies in iron, folic acid, and vitamin B1, shortened lifespan of red blood cells, and blood loss including non-gastrointestinal blood loss. Moreover, uremic toxins including parathyroid hormone can suppress the production of red blood cells in the bone marrow. However, the primary cause is the decreased production of erythropoietin by the kidneys during chronic renal failure.