Sugar metabolism disorder

Clinical studies have shown that, regardless of type 1 or type 2 diabetes, the average glycosylated hemoglobin (HbAlc) levels below 7%, the incidence of long-term complications were significantly reduced. Therefore, dialysis patients should be taken to strengthen the treatment of insulin, so that blood sugar remained in a stable state. Dialysis patients should not be controlled HbAlc level is too low, or easy to induce hypoglycemia; also should not be controlled HbAlc level is too high, otherwise the prevalence of hospitalization, mortality increased.

In the impact on DKD glucose metabolism, HD may be more beneficial than PD. First, dialysis can reduce the concentration of plasma insulin to avoid excessive accumulation, long-term dialysis can reduce body weight, remove excess fat, thereby improving insulin resistance, contribute to the normal level of blood glucose regression; Second, the removal of uremic molecules can improve the liver Glycogen gluconeogenesis, can improve the ability of peripheral tissue sugar uptake, help to improve glucose metabolism disorders. The PD treatment of conventional use of peritoneal dialysis fluid, to a certain extent, increased insulin resistance, and bring a new series of metabolic disorders. Therefore, diabetic patients with PD, you must actively control blood sugar.

However, HD and PD based on the pros and cons of sugar metabolism is not absolute. Diabetes hemodialysis patients with hypotension, hypoproteinemia, hemodialysis before the low blood sugar levels, the risk of hypoglycemia higher than PD; PD treatment can also choose sugar-free peritoneal dialysis solution as a penetrant to reduce serum insulin Level, increased insulin sensitivity, which helps to improve glucose metabolism disorders.

Western medicine treatment of kidney disease routine means.

1. Diuretics

    Diuretics are commonly used drugs for the treatment of kidney disease, can increase urine output, remove the body too much sodium, nitrogen and water, thereby reducing the extracellular fluid capacity, to achieve the purpose of treatment of edema and high blood pressure. But repeated application of diuretics, often the body reaction is not sensitive or even failure of the phenomenon, that is, resistance.

    Only for the rational use of different diseases or a reasonable combination of diuretics in combination, in order to play the best diuretics, reduce side effects.

 2. Glucocorticoid

    Glucocorticoids have a strong anti-inflammatory, immunosuppressive effects. Mild nephrotic nephropathy, clinical manifestations of nephrotic syndrome, mild mesangial proliferative glomerulonephritis, radical glomerulonephritis, lupus nephritis and other treatment response is good; for IgA nephropathy, focal segmental glomerular sclerosis Treatment has a certain effect.

 3. Immunosuppressive agents

    Immunosuppressive agents are a class of non-specific drugs that inhibit the immune function of the body. At present, due to the development of pharmacology, many new immunosuppressive agents came into being, immunosuppressive agents alone or in combination treatment of various types of kidney disease, and achieved good results. But must master the use of immunosuppressive agents to adapt to the application of the timing, type and side effects, must not be used casually.

 4. Application of anticoagulation therapy

    Hypercoagulable state can be seen in many primary or secondary kidney disease patients. At present, glomerular coagulation and platelet, fibrin-associated antigen deposition is one of the important factors in the progress of kidney disease. So anticoagulant, antiplatelet and fibrinolytic therapy, aimed at the prevention of blood tethered, embolism complications, reduce glomerular coagulation and fibrin-related antigen deposition, change the pathological process of glomerular lesions.

 5. Dialysis therapy and kidney transplantation

    Kidney disease can not be effectively treated, will make kidney damage, long-term development, and ultimately cause kidney failure. After renal failure, because the blood of toxic metabolites can not be excreted by the kidneys, will produce uremia, the current Western medicine, can only rely on dialysis or kidney transplantation to treat.

    Dialysis therapy is the body's blood into a machine, the machine is equivalent to the human kidney, through this machine so that the toxic waste in the blood cleared.

    Renal transplantation refers to the loss of renal function in patients with a well-transplanted kidney, the source of the kidney is generally provided by relatives or taken from the body.

    The above two kinds of treatment methods that are compelling are expensive.

How to determine their own kidney is healthy and more cystic kidney

Polycystic kidney disease in life is a common hereditary kidney disease, the cause of the disease is more complex, mainly due to genetic inheritance, had a great deal of polycystic kidney disease, and ultimately destroy the kidney structure and function, leading to end-stage renal failure The Therefore, to understand the symptoms of polycystic kidney disease early treatment is a very important thing, and then for everyone to make a detailed introduction.

Polycystic kidney disease common symptoms

(1) kidney pain.

For the important symptoms of polycystic kidney disease, often for the back of the oppression or dull pain, there are pain, and sometimes polycystic kidney disease symptoms of abdominal pain. Pain may be due to physical activity, walking time is too long, sedentary and so exacerbated, after bed can be reduced. Renal hemorrhage, stone movement or infection is also the cause of sudden pain.

(2) kidney enlargement.

Both sides of the renal disease is not symmetrical, the size of the difference, to the late two kidney can fill the entire abdominal cavity, kidney surface cloth has a lot of cysts, so that irregular kidney, rugged, hard texture. This is also a common symptom of polycystic kidney disease.

(3) Hypertension.

For the symptoms of polycystic kidney disease in the common performance of serum creatinine did not increase before the emergence of about half of hypertension, which oppression of the surrounding tissue, activation of renin - angiotensin - aldosterone system. In the past 10 years, Graham PC, Torre V and Chapman AB have confirmed that the normal renal tissue, cysts adjacent to the interstitial and cyst epithelial cells increased renin particles, and increased renin secretion. These are closely related to the growth of cysts and the occurrence of hypertension. In other words, the emergence of hypertensive cysts grow faster, can directly affect the prognosis.

(4) hematuria.

About half of the patients were microscopic hematuria, may have paroxysmal hematuria, the Department of cyst wall caused by rupture. Hemorrhagic clotting through the ureter can cause colic. Hematuria often accompanied by white blood cell urine and proteinuria, urine protein less, generally not more than 1.0g / d. Renal infection when the pyuria was obvious, hematuria increased, low back pain with fever. This is a common symptom of polycystic kidney disease.

Reminder

Polycystic kidney disease is undoubtedly very troublesome, and the main treatment is to control complications (such as bleeding, pain, etc.), thus delaying disease progression. If not timely control, then the consequences will be difficult to imagine. Therefore, the hope that patients with polycystic kidney disease symptoms should be actively when the corresponding treatment, not because of delay delay the disease. If there is a health question,

Kidney cysts: do not go anxious, but also cause attention

With the progress of doctors to detect technology and the popularity of health examination, the detection rate of renal cysts is getting higher and higher. Almost every person who is told to suffer from renal cysts will ask the doctor the same question: strict serious? Need to be treated? Different types of renal cysts clinical manifestations are different, the prognosis is not the same. Correct treatment of renal cysts is the practice: neither to paralysis, and do not panic.

As soon as possible to find a specialist consultation, in order to obtain the most appropriate treatment programs and life guidance.

Different renal cysts vary

Mr. Zhang took part in the health examination of the unit organization a few days ago. When doing kidney B, the doctor said he had two cysts in the kidney, suggested that he go to the hospital for referral. Yesterday, he specially went to the hospital for treatment, the admissions doctor advised him to regularly review B super, temporarily do not need to deal with.

Ms. Wang is also found in the physical examination with renal cysts away from the hospital. And Mr. Zhang is different, Ms. Wang's kidney cysts, all over the entire kidney. The doctor said she was not suffering from the general renal cysts, but polycystic kidney disease, should be actively treated, or poor prognosis.

Lin aunt two years ago was diagnosed with renal cysts, was not because of cysts, it was not treated. This year, Lin aunt to review, found cysts larger, the doctor advised her to do puncture.

The same is the renal cysts, why treatment is so different? Not say kidney cyst "does not matter", "do not need treatment"? May wish to listen to the doctor's argument.

Renal cysts are generally asymptomatic

Renal cysts can generally be divided into: simple renal cysts, polycystic kidney disease and acquired cystic nephropathy (common in dialysis patients) three categories. Among them, the most common simple renal cysts. When the renal cyst volume is small, generally no symptoms. If you do not do routine physical examination, not easy to be found.

Renal cyst disease progression speed mostly slow. Simple renal cysts generally little change, a small number of patients with cyst size or number can be slightly increased, there are a small number of patients with cysts can be narrowed. The number and size of cysts in patients with polycystic kidney disease increased with age. Acquired cystic nephropathy patients longer dialysis time, the higher the incidence of cysts.

Treatment stress "priorities"

Although the renal cysts are benign, but whether there will be cancer so far controversial. In addition, should also be alert to the possibility of tumor renal cysts. Therefore, renal cyst patients do regular follow-up is very important.

Many patients with renal cysts that the presence of renal cysts, fear; there are many patients after hearing the kidney cyst "does not matter" after the relaxation of vigilance. These two practices are not correct. Treatment of renal cysts, should pay attention to "light", "heavy", "slow", "urgent".

"Light": a small number, smaller, no local pain and other symptoms of simple renal cysts, polycystic kidney disease early renal damage, hypertension, infection, etc., is a "light" disease. Patients only once every six months or one year follow-up once, check the urine, urine culture, renal function, do B-observation of cyst size, shape and internal texture changes, no treatment.

"Heavy": polycystic kidney disease in patients with a wide range of disease, rapid progression of the disease, renal function was impaired, or infection, high blood pressure and other serious complications, is "heavy" disease. Should be timely to accept anti-infection, and even dialysis and other treatment.

"Slow": kidney cyst is a chronic disease, should adhere to regular follow-up. The patient should treat the disease objectively. Especially polycystic kidney disease, be sure to maintain a good mood, and actively cooperate with the treatment.

"Urgent": when the cyst was significantly increased, increased, bleeding, infection and other emergencies, is "urgent" disease. Should be timely medical treatment, active treatment.

Although there is no cure for renal cysts of the special effects, but does not mean that the kidney cysts can only "resigned". When the cysts increased symptoms of compression, timely puncture fluid treatment to prevent impaired renal function; polycystic kidney disease in patients with active treatment of hypertension and other complications, are optional treatment.

Simple renal cysts are not inherited

Most people in the first time that they have kidney cysts, is an adult, very concerned about whether the kidney cysts will be passed to the next generation. Simple renal cysts are acquired, not inherited. Polycystic kidney disease is relatively clear genetic disease. To adult polycystic kidney disease, for example, if one parent is sick, the child's prevalence rate of 50%; parents are sick, the child's prevalence rate of 75%.

The causes of polycystic kidney disease

The exact cause of this disease is unclear, about half of a family history, in adults as dominant inheritance, while the baby for the hidden genetic. Pathology of the kidney is often swollen, 2-3 times larger than normal, depending on whether the color or bleeding and other factors may be dark red, dark brown, brown and so on. Cysts may be large or small, small diameter of less than 0.1cm, large can be very large, cut the kidneys were honeycomb-like blocks, cysts can communicate with each other, but not connected with the renal pelvis, cystic compression of renal parenchyma fibrosis Changes, the capsule liquid was pale yellow or bloody, the wall by the cubic epithelial cells, the wall below the many arteries, due to increased pressure and combined infection and other reasons, or even bleeding caused by bleeding hematuria.

Polycystic kidney disease is a common hereditary nephropathy, polycystic kidney disease is mainly genetic factors. There may be three mutant genes that cause polycystic kidney disease in adults. PKD1, PKD2 and PKD3, respectively, which have been identified as PKD1 and PKD2 genes have been cloned. PKD1 is the most important cause of adult polycystic kidney disease, accounting for about 85%, and the most serious symptoms. PKD1 gene located in 16p13.3-p13.12, long 52kb, containing 46 exons, of which exon 1 to 34 for the multi-copy area, exon 35 to 46 for the single copy area, accounting for 70% And 30% of the region, the protein product consists of 4302 amino acid residues of a glycoprotein, known as polycystin-1. The content of G and C in the gene sequence was 62.5%, and exon 22 and intron 21 were enriched with a long 2.5kb and 0.5kb polypuronine-polypyrimidine sequence, which was easy to form three strands of DNA. The 1-33 exons contain the number of Alu repeats (2-11), and there are 6 homologous sequence regions in other parts of the chromosome. It is estimated that more than 80% of the pkd1 gene mutations occur in the repetitive sequence of the gene. There are few types of gene mutations in the region, most of which are concentrated in the 3 'end-specific fragment (the repeat region), and the remaining mutations may spread throughout the gene , There are missing, shift code, no sense and missense mutation. PKD2 gene located in 4q21-q23, gene length 68kb, composed of 15 exons, encoding polycystin-2 is composed of 968 amino acid residues in the membrane channel protein. PKD2 gene mutations are both germ cell and somatic. These mutations include small deletions, insertions, and single base substitutions that lead to early termination of translation, as well as missense mutations and mutations in the cleavage site.

Although most of the symptoms occurred in adults, but in the fetus began to form. Cysts originated in the renal tubules, the liquid properties with the origin of different parts, originated in the proximal tubules, cyst fluid components such as Na +, K +, CI-, H +, creatinine, urea and plasma similar to the origin; The concentration of Na +, K + in the cysts was lower, and the concentrations of CI-, H +, creatinine and urea were higher.

Abnormal proliferation of intraepithelial epithelial cells is one of the significant characteristics of ADPKD, in a mature incomplete or re-development state, highly suggestive of the development of mature regulation of bacteria obstacles, so that cells in an immature state, which shows strong proliferation Sex. The abnormality of this cell is another significant feature of ADPKD, which is manifested as the subunit combination, distribution and activity of Na + -K + -ATPase, which is closely related to cell transport, and changes in cell signaling abnormalities and ion transport channels. Abnormal proliferation of extracellular matrix is ​​the third significant feature of ADPKD. Many studies have shown that these abnormalities are involved in cell growth-related activity factors. But the key part of the unusual links and the way is not yet clear. In short, due to genetic defects caused by cell growth changes and interstitial abnormalities, one of the important pathogenesis of this disease.

Polycystic kidney is what it is harmful to.

Polycystic kidney disease is a hereditary nephropathy, accounting for end-stage renal insufficiency of the total 5% --- 10%.
Polycystic kidney disease with age, cysts gradually increased, the earliest performance is:
        Waist pain, elevated blood pressure, kidney B-type abnormalities. If not timely control, renal cysts continue to increase, oppression of the surrounding renal function unit will cause its damage, start the process of renal fibrosis, early manifestations of urine test: protein and blood cells;
If the process of renal fibrosis has not been effectively stopped, there will be increased serum creatinine or glomerular filtration rate decreased, and ultimately the development of end-stage renal failure.
I think we may have a common language, make friends?

The cause of kidney disease

Chinese medicine believes that: the body is the lack of righteousness is the root cause of kidney disease.

The body appears to lack of righteousness, in addition to a small part of the inherent defects, the majority is due to diet unrest, living disorders (often stay up all night) and overwork three caused by blood disorders. Once the body is lack of righteousness, it is vulnerable to six prostitution, but also easy in the body of the five evil gas. Outside the six prostitution plus endogenous five evil, mutual stalemate, common injury to the human body internal organs, and ultimately, will choose the most vulnerable part of the internal organs - the kidney manifested