Subscribe
165
Zhou Qi
Nephrology
About me
An associate chief physician in the Nephrology Department of the People's Hospital of Ma'anshan City, with a Master's degree from a key medical university. Participated or led multiple projects funded by the Natural Science Foundation, and published nearly ten papers in Chinese and core journals.
Proficient in diseases
Glomerular diseases, diabetic nephropathy, lupus nephritis, blood purification.
Voices
How to check for pyelonephritis?
Pyelonephritis, also known as upper urinary tract infection, is mostly caused by bacterial infection and the inflammatory response of the urinary system. The screening for this disease involves routine urine tests. Presence of white blood cells in the urine, coupled with symptoms like fever and back pain, can lead to a preliminary diagnosis. However, to confirm the diagnosis and identify the specific infecting pathogen, a culture of midstream urine is needed. Generally, to exclude certain causes of pyelonephritis, it is also necessary for the patient to have blood sugar levels checked and an ultrasound of the urinary system conducted. These tests can confirm whether the patient has diabetes, urinary system stones, or obstructions in the urinary system. Male patients can also undergo a prostate ultrasound to rule out urinary obstruction caused by prostate enlargement. These examinations can also help determine why the patient might have developed pyelonephritis.
How to check for diabetic nephropathy?
For the examination of diabetic nephropathy, patients first need to undergo routine urinalysis and check for the urinary albumin excretion rate. Generally speaking, one characteristic of diabetic nephropathy is the presence of urinary protein. A urinary albumin excretion rate between 20 and 200 µg/min is an important basis for diagnosing early diabetic nephropathy. If a patient’s urinary albumin excretion rate consistently exceeds 200 µg/min, significant diabetic nephropathy is often considered. Of course, this is under the assumption that the patient has had diabetes for at least ten years and has diabetic retinopathy. A kidney biopsy is needed for confirmation. Of course, to assess the impact of diabetic nephropathy on kidney function, blood tests for serum creatinine and urea nitrogen are necessary.
How is diabetic nephropathy treated?
The treatment of diabetic nephropathy also depends on the specific stage the patient is in. During stages one to three, the main clinical treatments include controlling blood sugar, blood pressure, and lipids. Patients with diabetes often also have these metabolic disorders, including hypertension and hyperlipidemia, which can damage the kidneys. In addition, in the early stages, some medications are often chosen to reduce the pressure on the glomeruli. For example, using ACE inhibitors or angiotensin receptor blockers (ARBs) and inhibitors of the sodium-glucose cotransporter, these drugs can also slow the progression of kidney failure. However, if the patient's condition has progressed to stage five, which is essentially equivalent to the state of uremia, the patient will then need dialysis treatment.
Treatment of Anemia in Diabetic Nephropathy
Compared to primary chronic nephritis, patients with diabetic nephropathy develop anemia earlier and more severely. The treatment for this type of anemia is divided into two aspects. Firstly, since it is anemia caused by renal lesions leading to a lack of erythropoietin, it is necessary to supplement erythropoietin, as well as iron and folic acid, which are raw materials for blood production, for the anemia caused by diabetic nephropathy. Additionally, patients with diabetic nephropathy are prone to malnutrition and should enhance nutritional support, especially by increasing the intake of high-quality animal protein.
How is hydronephrosis treated?
The treatment of hydronephrosis often requires surgery. Decisions about diagnosis and treatment plans should be based on clinical symptoms, the duration of the obstruction, the location of the obstruction, and whether there is an infection. Since hydronephrosis is typically caused by a pathological factor that blocks the ureter, surgery is often necessary to remove the obstruction in order to address the hydronephrosis and prevent further damage to kidney function. The principle of the surgery is that if the obstruction is minor, a simple corrective surgery may suffice. However, if the dilation of the ureter and renal pelvis is very significant, a reanastomosis of the ureter and renal pelvis might be needed.
Will hydronephrosis cause facial swelling?
In cases of hydronephrosis, it is not certain whether facial swelling will occur. Since the human body has two kidneys, the kidneys have strong compensatory capabilities. Even if one kidney is completely damaged, if the other kidney remains healthy, the remaining kidney can still perform the function of two kidneys. It can ensure sufficient excretion of water and metabolic waste. When water is sufficiently excreted, swelling should not occur. However, if both kidneys are affected by hydronephrosis, or if the opposite kidney also has problems, then the ability of the kidneys to excrete water may decrease. With both kidneys having issues, it can lead to poor and insufficient water excretion, consequently causing swelling, such as bilateral eyelids, facial areas, and both ankles.
Can IgA nephropathy patients eat watermelon?
IgA nephropathy is a chronic glomerulonephritis with varying degrees of severity and diverse clinical manifestations. Whether patients can eat watermelon depends on their kidney function and the presence of edema symptoms. If patients have kidney failure and noticeable edema, it is advised that they avoid eating watermelon, as it contains a significant amount of potassium ions. Consuming watermelon may lead to hyperkalemia due to the intake of large amounts of potassium ions. The main component of watermelon is water, and if patients have noticeable symptoms of edema, eating watermelon may exacerbate these symptoms and even cause issues like hypertension. If patients do not have noticeable edema and their kidney function is normal, eating small amounts of watermelon should not be a major concern.
Does chronic renal failure require dialysis?
Not all cases of chronic renal failure require dialysis. It is only considered when chronic renal failure progresses to an advanced stage, causing severe consequences, and the kidneys are unable to maintain normal body functions, leading to many complications. Generally, when chronic renal failure progresses to its final stage, i.e., uremia, the kidney function is left with about 10% capacity. The body then experiences a disruption in its internal environment, including the accumulation of a large amount of metabolic waste, serious electrolyte disorders, and severe metabolic acidosis. It is at this point that dialysis is considered. In the early stages of chronic renal failure, dialysis is not necessary.
What should I do about hydronephrosis?
Hydronephrosis is merely a consequence of urinary system diseases, indicating that the urine produced by the kidneys cannot be normally transported through the ureter to the bladder due to narrowing, adhesion, scarring, or obstruction somewhere. This causes the urine to accumulate in the renal pelvis and calyces. Therefore, the treatment of this disease requires identifying the cause, and then selecting a surgical treatment plan based on the situation. For instance, urinary system stones can cause hydronephrosis, and patients might need extracorporeal shock wave lithotripsy or open surgery for stone removal. Tumors in the urinary system can lead to hydronephrosis, and prostate hyperplasia can also cause similar symptoms, necessitating open surgery to resolve the obstruction. Some patients have congenital abnormalities, adhesions, or scars in the ureter, which might require surgical corrections of the ureter.
Can acute nephritis patients eat red dates?
In cases of acute nephritis, it is recommended that patients avoid eating red dates. During the acute phase of acute nephritis, there is severe inflammatory reaction in the glomeruli of the patient, and the extensive cellular proliferation may affect the filtration barrier of the glomeruli. If the glomeruli cannot filter blood, it leads to the accumulation of metabolic waste in the body, reduced urine output, and also affects the regulation of electrolytes and acid-base balance. Therefore, patients with acute nephritis may experience kidney failure and hyperkalemia, among other issues. Red dates contain a high amount of potassium ions, making them a high-potassium food, especially dried dates, which are even richer in potassium ions. Therefore, in cases of acute nephritis, especially if the patient has renal failure, it is advised to avoid eating red dates.