Clinical performance of renal cyst

Most kidney cysts are asymptomatic. Normal, even in the kidney area or hitting a palpable mass and physical examination. If the infection of the cyst, threatening abdominal tenderness. Some patients may be due to the cyst itself and increase in intraluminal pressure, infection, etc following:

1.Wwaist, stomach or abdominal pain

The reason is because kidney enlargement and expansion, the tension increases renal capsule, renal pedicle by traction or pressure caused by adjacent organs. In addition, polycystic kidneys produce kidney water content, becomes heavy, falls tranche can also cause back pain. The pain is characterized by pain, dull, fixed on one side or both sides of the waist Ministry lower background radiation. If the intracapsular bleeding or secondary infection, and then make the pain suddenly intensified. If fusion stones or urinary tract bleeding, blood clots, it is possible that renal colic.

2. Hematuria

It can be expressed as gross hematuria or microscopic hematuria. Cyclical episodes. Often compounded by the emergence of low back pain, vigorous exercise, trauma, infection can cause or aggravate. The reason is because many of bleeding under the arterial wall due to increased pressure or infection, so that the vessel wall due to over-stretching and breakage.

3. Abdominal mass

Sometimes, the main reason for patients to seek treatment, 60% to 80% of patients with palpable enlargement of the kidneys. In general, the higher the kidney, renal worse.

4. Proteinuria

Generally small 24-hour urine does not exceed 2 g. The nephrotic syndrome does not happen much.

5. Hypertension

Solid oppression kidney cysts, causing renal ischemia, increased renin secretion, causing high blood pressure. In normal renal function, there were more than 50% of patients with hypertension, renal dysfunction, a higher incidence of hypertension.

6. Release renal dysfunction

From cyst occupation, oppression, so the normal kidney tissue was reduced significantly decreased renal function.

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Pathology of acute renal failure

Kidney failure divided into acute renal failure and chronic renal failure, acute renal together today we see pathology.

Shen Qianxing

Oliguria (urine output <500 ml / d) due to the decrease in glomerular filtration rate and sodium and water reabsorption, is a type of hypovolemia normal reaction cycle.

Shen houxing

Bladder outflow obstruction may be an adult urine suddenly interrupted (often completely) the most common cause, which causes include benign prostatic hyperplasia, prostate or cervical cancer and retroperitoneal disease. If azotemia, certainly had bilateral urinary tract exit or only one functional kidney patients with unilateral obstruction of urine flow. Less common causes of urinary cavity has bilateral kidney stones, papillary necrosis, blood clotting and bladder cancer; extraluminal retroperitoneal fibrosis causes such as cancer, colorectal cancer and other malignant transformation. Because it can be a collection of urinary tract obstruction and congenital urinary system

Shen Xing

Reduce the incidence of renal filtration mechanisms include decreased renal blood flow, decreased glomerular permeability, interstitial cells and cause swelling of the wreckage resulting cell renal tubular obstruction or blockage, and the filtrate diffuses through the glomeruli damaged tubular epithelium renalLa interdependence of these factors, but not all of these factors for each patient, but are different in different patients, and sometimes in the same patient is different. The importance of these factors strongly suggest acute tubular necrosis originally referred to the basic abnormality is inappropriate.

Endothelin is a reduction in renal blood flow and renal GFR potent vasoconstrictor, vascular which is very sensitive. The anti-endothelin receptor antagonists, or endothelin antibodies can protect the kidney against ischemic ARF.

Tubular and changes according to the severity of the damage, interstitial edema and inflammation, but is always present ischemia, proximal tubule cells often form one side of the chamber cavity membrane structure disappears brush border , cell polarity and goes closely between interconnected cells rupture. SEM examination revealed that although the overall structure of blood vessels remain intact but glomerular epithelial cells normally swelling.

Any cause of IRA usually accompanied by hypocalcemia, hyperphosphatemia and secondary hyperparathyroidism. These phenomena in the pathophysiology of damaged kidneys produce temporary reduction calcitriol and phosphorus retention. Myoglobinuria caused ARF in patients with hypocalcemia may seem obvious, apparently due to deposition of calcium in muscle necrosis, decreased production of calcitriol and parathyroid hormone bone (PTH) is no resistance in the United effects. The recovery process in the ARF, with the kidneys produce calcitriol increases, increasing bone response to PTH and calcium deposition removed from tissue damage can be complicated by hypercalcemia ..

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Acute renal failure

The acute renal failure secondary to shock, trauma, severe infection, poisoning and other causes of hemolysis and acute kidney injury in general, is a syndrome. Its main pathological changes of renal tubular necrosis, clinical oliguria or anuria, accompanied by severe water, electrolyte and metabolic disorders and uremia. In recent years, another normal urine or urine more acute renal failure, which is characterized by normal or urine, but increased day by day azotemia and even uremia, known as non-oliguric acute renal failure.

Acute renal failure, renal failure quickly (a few days to several weeks) continued to decline (azotemia) when the clinical situation, oliguria dispensable.

Classification and aetiology

Acute renal failure (ARF) can be divided into pre-renal, renal and post-renal. And pre-renal causes post-renal, diagnosis and treatment of early and reversible if possible. Some acute renal vascular and tubular interstitial etiology causes, such as malignant hypertension, glomerulonephritis, vasculitis, bacterial infections, drug reactions and metabolic disorders (such as hypercalcemia, hyperlipidemia, hyperuricemia) nephropathy can also be treated. Prerenal azotemia ARF causes account for 50% to 80%, renal hypoperfusion is due to extracellular fluid loss or cardiovascular disease. Post-renal azotemia: about 5% to 10%, urination and urinary tract obstruction is a collection of some of the various reasons. In the etiology of ARF renal failure, often associated with prolonged renal ischemia (hemorrhage, surgery) or kidney toxins. Acute tubulointerstitial nephritis and acute glomerulonephritis can occur ARF. Many patients with ARF may find there are more than one cause, promote and sustain the ARF ARF factors may be different.

Diagnostic criteria

1, The following information is available clinical data to identify Reference: ① has a history of bedwetting? Nocturnal enuresis refers to urine urine during the night the day 1/2, suggesting that the concentrated distal renal tubular dysfunction, is not history more for CRF.

2, Although a variety of image imaging test can detect the size of the kidney, but commonly used for clinical ultrasound B. ARF is often much renal congestion, edema, renal often increases the volume; volume Renal CRF, glomerulosclerosis , tubular atrophy, and interstitial fibrosis, and therefore often is reduced. To this end, the kidney increases more volume in the IRA (renal amyloidosis caused by CRF or early diabetic nephropathy, renal and sometimes large volume, must be identified), and volume reduced renal therefore CRF. However, care must sometimes FRA and FRC early, the patient does not increase or decrease the volume of the kidney, then imaging studies for identification does not help chronic and acute renal failure, but must rely on other controls.

3 Laboratory tests can be used for acute and chronic renal failure is a nail creatinine test identification checks, recent reports have controls creatinine hair. Nails (hair) creatinine tests often only in the kidney imaging test in the differentiation of acute and chronic renal failure without help when (ie the size of the kidney is normal) before application.

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The clinical manifestations of renal failure

With the development of society, many people are renal failure, therefore, we see together the clinical manifestations of renal failure.

1. Main sorina period

The most critical stage of the disease, a serious disorder in the environment. Patients may be oliguria (<400ml / day) or no urine (<100 ml / day), low specific gravity urine (1010 ~ 1020), urinary sodium is high, hematuria, proteinuria, urinary tube and so in turn. Severe water intoxication can occur in patients, hyperkalemia (often this term cause of death), metabolic acidosis (can promote hyperkalemia) and azotemia (uremia progressive increase may occur), etc, endangering the lives of patients. This period lasts a few days to a few weeks, continuing the longer the worse the prognosis.

2. Long-term sorina

After sorina meno period gradually increase the amount of urine, when the output of urine a day more than 500 ml is introduced poliuria.A Thereafter, the production of urine twice daily, to a daily urine sample 3000-6000ml , even more than 10000ml. In the initial period of polyuria, urine output, although increased, but the rate of renal clearance remains low, the accumulation of metabolites remain. About 4 to 5 days, serum urea nitrogen, creatinine gradually decreased with increasing urine output, along with the improvement of symptoms of uremia. Potassium, sodium, chloride and other electrolytes large amount of discharge of urine can cause electrolyte imbalance and dehydration, oliguria should be noted that the phase can be converted to peak hypokalemia. This period lasts 1-2 weeks.

3. Convalescence

Urine gradually returned to normal, from 3 to 12 months, renal function gradually recovered, most recovered renal function to normal levels, only a small number of patients with chronic renal failure.

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Complications of renal failure

Renal impairment bring many complications, why? What's the complications of renal failure?

Neurological symptoms

The nervous system symptoms are the main symptoms of uremia. In the early uremia, patients often have dizziness, headache, fatigue, understanding and memory loss and other symptoms. With the worsening of the disease may be irritability, muscle tremors, seizures and may eventually become apathy, lethargy and coma. These symptoms occur with the following factors:

① Accumulation of toxic substances can cause degeneration of nerve cells;

② Electrolyte and acid-base disturbances balance;

③ Renal hypertension caused by cerebral vasospasm, hypoxia and increased capillary permeability, that can cause degeneration of brain cells and brain edema.

Digestive symptoms

Patients with early symptoms digestive uremic are loss of appetite, indigestion, exacerbations when anorexia, nausea, vomiting or diarrhea may occur. These symptoms can occur with intestinal bacterial urease urea decomposes into ammonia, stimulate gastrointestinal mucosa causing inflammation and multiple small superficial ulcers and so on.The patients often complicated by gastrointestinal bleeding. Also nausea, vomiting, but also with the central nervous system dysfunction.

Symptoms of cardiovascular system

Chronic renal failure due to renal hypertension, acidosis, hyperkalemia, sodium and water retention, anemia, and the role of toxic substances can lead to heart failure, arrhythmias, and myocardial damage and so on. Since urea (possibly uric acid) in the stimulating role, but also aseptic pericarditis, determined to patients with chest pain, Wen physical examination and pericardial rub. Cellulose severe pericardial cavity and bloody exudate appears.

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The causes and treatment of acute renal failure

1. Trauma: Trauma war severe crush injuries, burns, shock, trauma, infection, trauma can be a timely manner. Therefore, the mortality statistics of acute renal failure have been greatly reduced.

2. Infection: biliary or gastrointestinal surgery, some resistant to antibiotics often caused by sepsis or shock harmful bacteria. severe acute pyelonephritis, renal papillary necrosis, may lead to acute, often very difficult to effectively treat renal failure.

3. Other bodies of the primary disease: As acute myocardial infarction, acute pancreatitis, abdominal visceral perforation, can lead to kidney failure. If the active and effective in the treatment of renal failure, the patient can not die from uremia, but died of severe primary disease.

4. Poisoning cytoplasm: Acute barbiturate poisoning can occur quickly shock, anuria, pulmonary edema and death. Carbon tetrachloride poisoning, sometimes causing acute tubular necrosis occurred simultaneously extensive liver damage, whether acute yellow atrophy of the liver. Although successful treatment of acute renal failure, the patient may die of liver failure.

Disease treatment

Principles of Treatment

1. General treatment: bed rest, proper nutrition supplement etc.

2. Keep water, electrolyte and acid-base balance.

3. sensitive antibiotics to control infection

4. The dialysis include hemodialysis, hemofiltration or peritoneal dialysis.

5. Promote the renal tubular epithelial cell regeneration and repair.

Of the medication

1. Early mild patients can use to item, and pay attention to control fluid intake, vitamin supplements and energy, to maintain electrolyte and acid-base balance.

2. Severe cases should be timely, early dialysis treatment, if necessary, dialysis every day, and transfusions and human albumin.

3. The infection can be chosen according to the specific circumstances of drugs C item.

4. When hypertension drugs can choose the item A or C item

5. When heart failure, I can Cedilanid another heart medicine.

6. When the key is combined with drugs bleeding item A or C item.

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The cause of proteinuria

Proteinuria is a symptom of chronic renal failure, why? What causes proteinuria?

Under normal circumstances, glomerular filtration membrane filtration effective pore radius of about 30 angstroms. When a molecular weight above 000 6-70 substances through the filtration membrane is difficult. A molecular weight of 69,000 plasma albumin radio molecular approximately 37 angstroms, it is difficult to enter the urine, only small molecular weight lysozyme, β2-microglobulin, immunoglobulin light chain may be of glomerular filtration .Meanwhile urine, the membrane glomerular basement proteins rich in sialic acid, a negative to the surface to form a layer of plasma proteins although some small molecular weight, however, with a negative charge, repel each other, filtered and urine, serum load serum albumin under the conditions of pH was 7.42, showing a state of negative charge, and therefore is hard to pass. In addition to tubular proteinuria was not selective reabsorption.

Since glomerular diseases, glomerular filtration membrane or barrier load is damaged, there will be a large number of plasma proteins in urine leak, resulting in high levels of protein in urine of normal. Common in acute and chronic glomerulonephritis, glomerular nephropathy, secondary glomerular diseases such as diabetic nephropathy, lupus nephritis, renal amyloidosis, and so on.

Pathological urinary protein in addition to glomerular proteinuria, there tubular proteinuria, overflow proteinuria, renal proteinuria. The tubular proteinuria is due to pathological conditions, the tubular reabsorption of the most common dysfunction caused protein in tubular and interstitial diseases. Overflow proteinuria is due to pathological conditions, the plasma protein molecules some large increase, and exceeds the capacity of tubular reabsorption in the urine, the formation of proteinuria. More common in multiple myeloma, severe crush injuries and other diseases. Proteinuria in renal tissue proteins refers to kidney tissues or urine in kidney tissue in a condition of urinary protein excretion.

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The food of proteinuria

Since urinary protein metabolic waste generated is a kind of high protein in the urine when the body can easily lead to abnormal physical state. High protein urine, urine volume will be limited, so the long-term accumulation of proteins, blood content is too high, would be prone to a variety of situations, fraudulent claims will result in the appearance of uremia. High protein urine, urine volume will be limited, so the long-term accumulation of proteins, blood content is too high, would be prone to a variety of situations, fraudulent claims will result in the appearance of uremia.

The proteinuria in patients who pay attention to the following aspects:

1, the condition of different standards are different. Urine protein should be based on the type and different disease caused by using various standard protein diet. Nephritis, in general agreement with the normal requirements for the provision of 0.8-1.0g / kg daily adult. If you choose a high biological value protein, such as eggs, milk, fish, lean meat, etc. For non nephrotic syndrome, renal failure, could provide a high protein diet, protein 1.5-2.0g adults / kg daily, and supplies high quality protein, levels of plasma urea nitrogen were generally low-protein diet in order to take appropriate action.

2. Note micronutrient supplementation. Nephrotic syndrome, besides losing a large amount of protein in the urine, but also lost while binding protein and calcium, magnesium, zinc and other trace elements, should eat more fresh vegetables and fruits, foods rich in calcium supplementary such as milk and its products, shrimp, sesame, seaweed, fish and vegetables. Rich foods such as millet, wheat, barley, meat and offal of animals magnesium.

3. Plant proteins should eat. Vegetable proteins, containing a large purine base, intermediary metabolism may aggravate kidney load, which must be less. Including soybeans and soy products, although high in protein, due to the above reasons, the protein in the urine patients should be hanged.

In short, people with high urinary protein diet should be light, low fat low salt, avoid spicy food supplement fat indigestible nutrient-rich cold. If you are other problems, please leave a message at the bottom or free with our customer communication online part. Our mailbox is mailto: enfermedad-renal@hotmail.com.

Prevention of chronic renal failure

As early prevention in patients with chronic renal failure and slow the progression of chronic renal failure, has become a national issue of great concern.

1. Primary prevention, also known as early prevention.

It is the existing kidney disease or can lead to CRF primary disease, such as chronic nephritis, pyelonephritis, diabetes, hypertension, etc. For early detection and timely and effective treatment to prevent possible chronic renal failure.

2. Secondary prevention

That is, to prevent the constant progression of chronic renal failure and sudden increase in patients with chronic renal failure, and actively correct dyslipidemia in the low protein diet quality, Controlling high blood pressure, to avoid aggravating factors, proper cold temperatures, winter shelter. Avoid exogenous infection, while attention to proper diet and rest, in order to effectively prevent progression of the disease, and promote recovery from illness.

3. Tertiary prevention
It is entering end-stage renal failure patients on active treatment of health seeking to prevent life-threatening complications such as hyperkalemia, heart failure, metabolic acidosis serious, to prolong the survival of our country a developing country as settlement should be strengthened to prevent and delay early CRF progression, emphasis on the development of non-dialysis treatment, improvement and promotion. Dialysis and Transplant treatment should be used when saving lives.

4. Trace tracking

Patients with chronic renal failure should be regular monitoring visits, according to the frequency of the disease should be decided, otherwise hypertension, heart failure and speed of deterioration of residual renal function and so on. All patients required at least once every three months of treatment, treatment should be asked about the history and physical examination, While doing the necessary laboratory tests, such as blood, urine, blood urea nitrogen, creatinine and electrolyte concentration, serum proteins, parathyroid hormone, ferritin, C-reactive protein, according to the active disease and symptomatic treatment.

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Diet therapy and alternative treatment of uremia time for chronic renal failure

Diet Therapy

1. Give a diet low in high quality protein 0.6 g / (kg bw · day), vitamin diet, such as eggs, milk and meat and other high-quality protein. Patients should be sufficient caloric intake, usually of 30-35 kcal / (kg · day). Can be used as basic protein necessary for wheat starch plant.

2. Diet low in more proteins essential amino acids or α-keto acid treatment, treatment application note review concentration of calcium α-keto acid, hypercalcemia caution. In the absence of severe hypertension and edema, urine output> 1000 ml / day, salt of 2 to 4 grams / day.

Alternative Treatment time for uremia

When the CRF in patients with CRF 6 ~ 10ml / min (serum creatinine> 707μmol / L) and a clear clinical manifestations of uremia, no remission after treatment, the patient should be prepared mentally prepared for dialysis. Diabetic nephropathy may be appropriate in advance (CRF 10 ~ 15ml / min) arrange dialysis.

1. Dialysis

(1) Hemodialysis Patients should be made in advance to the arteriovenous fistula (general location in the forearm), fistula maturation requires at least four weeks, it is best to wait for 8-12 weeks before you start drilling. Usually three times a week hemodialysis treatment, every 4 to 6 hours. Six weeks at the start of hemodialysis, uremic symptoms gradually improved. If they can adhere to a reasonable dialysis, most quality of life significantly improved hemodialysis patients, many patients can survive for 15 to 20 years.

(2) Peritoneal dialysis therapy continuous ambulatory peritoneal dialysis (CAPD) applies filtering function and peritoneal dialysis, continuing to clear uremic toxins, simple equipment, easy, safe and efficient operation. Chronically. The medical silicone tube implanted intraperitoneally, applies this tube enter peritoneal dialysis solution, 1.5 ~ 2L increasingly 6 hours after exchange, four times a day. Effectiveness of CAPD uremic hemodialysis similar, but residual renal function and cardiovascular protection than hemodialysis, and the cost is relatively low. CAPD devices and operations have been significant improvements in recent years, peritonitis and other complications have been greatly reduced. CAPD is especially suitable for the elderly, patients with cardiovascular complications, diabetes, pediatric patients with arteriovenous fistula or for those who have difficulties.

2. Kidney transplantation

Patients should normally make a dialysis period, a stable condition and in accordance with the relevant conditions, can be considered for renal transplantation. Successful kidney return to normal renal function (including the metabolic and endocrine function), so that the patient is almost totally recovered. Living donor kidney transplant kidney may corpse or their relatives (siblings or parents for a kidney from a donor), renal transplantation is relatively better. For determination of ABO and HLA appropriate game, based on kidney donors blood group selection. Renal transplantation require long term use of immunosuppressive drugs to combat rejection of common use corticosteroids, cyclosporine, azathioprine, and (o) acetate to mofetil (MMF) drugs etc. In recent years, the efficiency of kidney transplantation improved significantly, the graft survival rate is approximately 1 year 85% 5 year survival rate is approximately 60%. HLA rather than survive longer graft.

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Pharmacological treatment of chronic renal failure

The purpose of CRF drug treatment include: ① Relieve symptoms of CRF, reduce or eliminate the patient's suffering, improve quality of life. ② Delay progress of disease course of CRF to prevent its further spread. ③ Prevent complications and improve survival.

1. Correct acidosis and water, electrolyte imbalance

(1) Proper metabolic intoxication: Treatment of metabolic acidosis, especially oral sodium bicarbonate (NaHCO3) .Pacientes moderate and severe when necessary, intravenous infusion, 72 hours or more after the correction of the basic acidosis. for no obvious for patients with heart failure should prevent excessive amount of NaHCO3 input, the input speed should be slow, so as not to aggravate cardiac stress even aggravate heart failure.

(2) Prevention and treatment of disorders of water and sodium: suitable for sodium intake restrictions, NaCl general consumption should not exceed 6 ~ 8 g / d. Significant edema, patients with hypertension, sodium intake is usually 2 ~ 3 g / d (consumption of NaCl 5 ~ 7 g / d), severe cases may be limited to person 1 ~ 2 g / d (NaCl 2.5 ~ 5 g) .Also may be necessary to loop diuretics (furosemide, bumetanide, etc), thiazide diuretics and potassium-sparing diuretics for storage disease CRF (Scr> 220μmol / L) treatment is very poor, no should be applied. For patients with acute heart failure, severe pulmonary edema, the need for timely given simple ultrafiltration, continuous hemofiltration (as a continuous veno - venous hemofiltration).

For patients with mild to moderate chronic renal failure, hyponatremia generally have no active treatment, and should discuss their various reasons, only those genuine lack of sodium salt supplement carefully. Severe shortage of sodium hyponatremia, also staged in the state of hyponatremia gradually corrected.

(3) Prevention and treatment of hyperkalemia: Patients with renal failure prone to hyperkalemia, the serum potassium level> 5.5mmol / L particular, should be stricter limits the intake of potassium. Limit consumption of potassium should also pay attention to the timely correction of acidosis and appropriate application of diuretics (furosemide, bumetanide etc), increased urinary potassium excretion in order to effectively prevent the occurrence of hyperkalemia .

The existing hyperkalemia in patients, and limit your intake of potassium, should take the following steps: ① Actively correct acidosis, if necessary (serum potassium> 6 mmol / L) may be sodium bicarbonate intravenously. ② Given loop diuretics furosemide bumetanide injection or preferably intravenously or intramuscularly. ③ Application of glucose-insulin solution inlet. ④ Resin potassium Oral drop: more applicable to calcium polystyrene sulfonate, because the ion exchange process is only released from sodium calcium not release without increasing the sodium load. ⑤ For severe hyperkalemia (serum potassium> 6.5 mmol / L), accompanied by oliguria, diuretic is effective, it must give the hemodialysis system.

2. Treatment of hypertension

Hypertension timely and reasonable treatment, not only to control some of the symptoms of high blood pressure, but also to proactively protect the target organ (heart, kidney, brain etc) .Inhibidores-converting enzyme inhibitors (ACEI) agonists ⅱ receptor blockers (ARB) antagonists, calcium channel blockers, loop diuretics, β-blockers, vasodilators can be applied to ACEI, ARB, wider application of calcium antagonists. Blood pressure before predialysis CRF patients should be <130 / 80mmHg, blood pressure maintenance dialysis patient is usually not higher than 140 / 90mmHg.

3. Treatment of anemia and applications erythropoiesis stimulating agent (ESA)

When hemoglobin (Hb) <110 g / L or hematocrit (Hct) <33%, the cause of anemia should be checked. If iron deficiency should iron treatment, if necessary, can be applied to therapy of ESA, including recombinant human erythropoietin (rHuEPO), epoetin way to Hb increased to 110 ~ 120 g / L.

4. Treatment of hypocalcemia, hyperphosphatemia and renal osteodystrophy

When GFR <50ml / min after which the intake should be restricted appropriately phosphorus (<800 ~ 1000 mg / d) .When GFR <30ml / min, while limiting phosphorus intake, be applied oral phosphate binders to carbonate calcium, calcium citrate is better. To clear hyperphosphatemia (serum phosphorus> 7 mg / dl) or serum Ca, P product> 65 (mg 2 / dl2) who should suspend the application of calcium to prevent aggravation of metastatic calcification. Then you can consider taking aluminum hydroxide preparations short-term or sevelamer, which Ca, P product <65 (mg 2 / dl2), then take calcium.

For obvious patients oral hypocalcemia 1.25 (OH) 2D3 (calcitriol) .even portion 2 to 4 weeks, and if the blood calcium levels and no improvement of symptoms, increasing dose. Control therapy requires blood Ca, P, PTH levels, so predialysis blood PTH CRF patients maintained at 35 ~ 110pg / ml. make dialysis patients blood phosphorus product <55mg2 / dl2 (4.52mmol2 / L2), serum PTH remained at 150 ~ 300 pg / ml.

5. Prevention of infection

Usually must be taken to prevent colds, prevention of infection by pathogens. Antibiotic selection and application of the principles and infections generally the same, only the dose should be adjusted. For similar efficacy, should choose the least nephrotoxic drugs.

6. The treatment of hyperlipidemia

Before predialysis patients with CRF and the general principles of treatment of hyperlipidemia itself, should be actively treated. However, for maintenance dialysis patients, hyperlipidemia standards should be relaxed, and cholesterol levels in the blood are maintained at 250 ~ 300mg / dl, triglyceride levels in serum remain at 150 ~ 200mg / dl all right.

7. Therapy oral absorption and catharsis therapy

Therapy oral absorption (oxidized starch or oral formulations of activated carbon), catharsis therapy (oral formulations rhubarb) ect.Puede increase colon dialysis using parenteral discharged uremic toxins. The therapy is mainly used in patients with predialysis CRF prior to relieve the patient azotemia play a supporting role.

8. Other

(1) Patients with diabetic renal insufficiency with decreased GFR, should be adjusted accordingly insulin dose, the general should be gradually reduced.

(2) Hyperuricemia: Generally do not need treatment, but gout, then allopurinol.

(3) Itching: emulsified oil topical, oral antihistamines to control hyperphosphatemia and strengthening high dialysis or dialysis cash flow for some patients.

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Clinical manifestations of chronic renal failure

1. Digestive System

It is the symptom of early and frequent.

(1) Anorexia (loss of appetite often appeared before).

(2) Nausea, vomiting, bloating.

(3) The tongue and mouth ulcers.

(4) The smell of ammonia in oral.

(5) upper gastrointestinal bleeding.

2. Blood System

(1) anemia: It is symptoms of uremia patients. The degree of anemia in parallel with the degree of uremia, erythropoietin (EPO) is mainly due to the reduction.

(2) Tendency to bleeding: can be expressed as skin, mucous membrane bleeding ect, and increased platelet destruction, prolonged bleeding etc, which can be caused by toxins, correctable dialysis.

(3) abnormal white blood cells, leukopenia, chemotaxis, phagocytosis and bactericidal capacity and prone to infection, dialysis can improve.

3. Cardiovascular System

It is most common cause of death from renal failure

(1) Hypertension: The majority of patients (80%) have different degrees of high blood pressure, can cause atherosclerosis, left ventricular hypertrophy, heart failure.

(2) Heart failure: They often appear cardiomyopathy performance by sodium retention, hypertension, uremic cardiomyopathy caused.

(3) Pericarditis: inadequate dialysis urea or disease due mainly blood, usually late performance.

(4) The atherosclerosis and vascular calcification: Proceed quickly, hemodialysis is more evident, coronary, cerebral artery, peripheral systemic artery may occur, especially hyperlipidemia and hypertension due.

4. Nervous and muscular systems

(1) Early stage: Fatigue, insomnia, lack of concentration etc.

(2) Subsequently period: Peripheral neuropathy, sensory nerve that represents a significant move.

(3) dialysis disequilibrium syndrome: With dialysis-related, often occurs in the initial dialysis patients. Reduce excess blood urea nitrogen, intracellular osmotic imbalance, causing increased intracranial pressure and cerebral edema caused by performance nausea, vomiting, headache, severe convulsions.

5. Renal osteodystrophy

It refers in general bone changes when uremic. Hypocalcemia, hyperphosphatemia, the active vitamin D deficiency can be induced secondary hyperparathyroidism. The variety of factors that lead to renal osteodystrophy (ie osteodystrophy, renal) include fibrocystic osteitis (high turnover bone disease), osteomalacia (bone disease low turnover), bone formation and mixed osteodystrophy. Renal osteodystrophy clinically manifested as:

(1) can cause spontaneous fractures

(2) The symptoms are uncommon as bone pain, difficulty walking etc.

6. Respiratory system

(1) When acidosis, respiratory are deep and long.

(2) uremic bronchitis, pneumonia (butterfly wings), pleurisy etc.

7. Skin symptoms

Itching skin, deposition of urea cream, face uremia, dialysis does not improve.

8. Endocrine dysfunction

Main manifestations are

(1) Endocrine dysfunction own kidney: By implementing 1,25 (OH) D3 2vitamina, erythropoietin deficiency and renal renin - angiotensin Ⅱ excessive.

(2) external endocrine dysfunction: The majority of patients had secondary hyperparathyroidism (elevated serum PTH), insulin receptor disorders, as elevated glucagon ect. About 1/4 of patients with mild decrease levels of thyroid hormone. Some patients may experience hypogonadism, manifested as disorders of gonadal maturation or atrophy, decreased libido, amenorrhea, infertility etc., can be associated with levels of abnormal serum sex hormones and other factors.

9. With a serious infection

Easy to infection, pulmonary infection is more common. When fever infection, it may be normally not evident.

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The causes and various periods of chronic renal failure

Chronic renal failure (CRF) is to create several causes chronic progressive renal damage, resulting in a dramatic drop in the kidneys can not maintain basic functions, clinical metabolites retaining water, electrolytes, acid-base appearance, all the commitment body system as the main manifestation of the clinical syndrome.

The causes of chronic renal failure

The main causes no primary glomerulonephritis, chronic pyelonephritis, renal arteriosclerosis, hypertension, diabetic nephropathy, secondary glomerulonephritis, tubulointerstitial lesions, hereditary kidney disease and long-term use of antipyretic analgesics and exposure to heavy metals ect.

1. They must strive to define the etiology of chronic renal failure, renal failure should be clear is based glomerular damage or renal tubular interstitial disease base, or to prominent renal vascular lesions, so based on the clinical features, targeted therapy.

2. Chronic renal failure should be identified to promote the progressive deterioration of renal function reversiblescomo factors infection, drug-induced renal injury, metabolic acidosis, dehydration, heart failure, low blood pressure too fast, too low ect.

3. You must find certain factors exacerbate chronic renal failure progressive deterioration, such as hypertension, hyperlipidemia, hypercoagulable state, high protein intake, proteinuria, etc.

The various periods of chronic renal failure

When chronic renal failure, is called uremia, is not an independent disease, is caused by a variety of causes progressive deterioration of renal damage, when the development of renal function in terminal stage near the normal 10% to 15% there were a number of clinical syndromes.

Especially due to renal dysfunction in a long process of development, different stages have different levels and features of the level of kidney function traditionally divided into the following period.

1. decompensated renal function

When the glomerular filtration rate (GFR) ≥Normal value 1/2, BUN and creatinine is not high, the metabolic balance, no symptoms (Serum creatinine (Scr) in 133 ~ 177μmol / L (2 mg / dl)).

2. The time of renal failure

The glomerular filtration rate (GFR) <50% lower than normal value, serum creatinine (Scr) rose to above 177μmol / L (2 mg / dl), levels of blood urea nitrogen (BUN) rises > 7.0mmol / L (20mg / dl), patients with fatigue, loss of appetite, bedwetting, mild anemia and other symptoms.

3. The time of renal failure

When the rate of endogenous creatinine clearance (Ccr) Pasha to the next 20ml / min, BUN levels above 17.9 ~ 21.4mmol / L (50 ~ 60mg / dl), Scr rose 442μmol / L (5mg / dl) over the patients with anemia, increased phosphorus levels, decreased blood calcium, metabolic acidosis, water, electrolyte disorders.

4. Uremia end stage

Ccr to 10ml / min least rose Scr 707μmol / L more obvious acidosis symptoms occur each system, resulting in coma.

American Renal Disease Foundation DOQI expert on the method of chronic kidney disease (CKD) stage submitting new proposals. The phased approach has been widely recognized and used by clinicians.

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The clinical manifestations of hematuria

1. The change in urine color

The main manifestations of hematuria are changing color of urine, color except microscopic hematuria is normal, macroscopic hematuria is based on the number of bleeding displays different colors. Urine sample pale red, like water washing meat, suggesting that blood exceeds more than 1 ml per liter of urine. When severe bleeding can show blood form. when bleeding kidney, urine and blood uniformly mixing, urine dark red color mostra, bladder or prostate hematuria bright red, sometimes with blood clots.

2. Urinary abnormalities segmentation

Urine whole part color pieces was observed as three cups of urine test with three clean vessel segments beginning, middle and terminal observed in the urine is left, such as hematuria suggesting that lesions in the segment initial urethra. terminal segment hematuria bleeding requested position on the neck of the bladder, prostate and seminal vesicles triangle or posterior urethra. Three segments showed red urine, suggesting that the urine from the kidney or ureter.

3. Renal or post-renal hematuria

Microscopic hematuria normal color, but microscopic examination of the urine can be determined, and can determine renal and post-renal hematuria. RBC microscopic sizes varied forms of glomerular hematuria is common in glomerulonephritis.

4. The type of symptoms of hematuria

While patients with hematuria local or systemic symptoms. Urinary tract symptoms. For example the kidney area pain or cramps suggesting that lesions in the kidneys. Injury urinary tract and bladder are often urinary urgency and dysuria.

5. Asymptomatic hematuria

Some patients with hematuria or urinary tract symptoms and the absence of systemic symptoms, which are common in certain diseases of early, such as renal tuberculosis, kidney or bladder cancer in early stage.

6. Accompanying symptoms

① The hematuria associated with renal colic is characteristic of ureteral or renal stones. ② The hematuria with interrupted flow of urine is common in the bladder and urethra stones. ③ hematuria with urinary fine and difficulty urinating common in prostatitis, prostate cancer. ④ The hematuria with urinary urgency and dysuria is common in cystitis and urethritis, accompanied by back pain, fever, chills often pyelonephritis. ⑤ The hematuria accompanied by edema, hypertension, proteinuria is common in glomerulonephritis. ⑥ The hematuria associated with kidney tumors, unilateral common being in tumors, hydronephrosis and renal cysts, bilateral increase is common in congenital polycystic kidney disease, kidney affected mobility is common in renal ptosis or kidney wandering. ⑦ The hematuria associated with skin and mucous membranes and other parts of bleeding is common in blood diseases and certain infectious diseases. ⑧ The hematuria is common in merger Chyluria filariasis, chronic pyelonephritis.

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Symptoms hematuria

What about the symptoms Hematuria following is about the symptoms of hematuria Intro?

Normal urine contains a very small amount? A of red blood cells in the urine without centrifugation under the microscope can have red blood cells per high power field 0-2 If more than this number is hematuria.

1. The change in urine color

The main manifestations are hematuria change urine color, in addition to its normal color outside microscopic hematuria gross hematuria and urinary according to the amount of blood it was like a urine color pale wash water red meat per liter of bloody urine prompted severe bleeding in the urine of 1 ml can be presented as the ri ng bleeding blood in urine and blood mixed dark red urine;? the hematuria, bladder or prostate red color, but red blood clots sometimes hematuria urine is not necessarily a need to carefully distinguish as urine or dark red color of soy sauce not cloudy without precipitation microscopy no or only a small amount of red cells blood found in hemoglobinuria; Brown-red or wine is not any red blood cells found in urine cloudy microscopic porphyrin; Taking certain medicines such as rifampicin or eating some rhubarb plant row red red may also have red blood cells in the urine, but microscopic examination.

2. Pause be full of urine urinary abnormalities observed color segmentation as urine testing three cups were cleaned glass initial segment of the second name and the terminal segment and the initial segment of the urine was observed hematuria suggesting injuries urethra segment Terminal hematuria caused bleeding in the bladder neck or urethra Triangle area of the prostate and seminal vesicles; Three sections of urine showed hematuria prompted red urine from the ri ng o? ureter.

3. Blood uric microscopic normal color, but microscopic examination and judgment to determine renal hematuria and microscopic hematuria size after years of varied forms red cell renal glomerular hematuria Seen as glomerulonephritis due to leakage of red cells blood of the glomerular basement membrane osmotic gradient through a tubular having different chemical and physical effects when hemoglobin in the red blood gives? or cell membrane and microscopic deformation overflow red cell morphology as a single homogeneous type blood peripheral is about hematuria Councils post-renal hematuria seen in the renal pelvis ureter bladder and prostate disease.

4. Hematuria symptoms, patients with local or systemic symptoms, such symptoms in urinary system associated with the area of the kidneys dull pain or cramps suggesting that lesions in the kidneys and lesions bladder are often urinary urgency and dysuria

5. Asymptomatic hematuria

Some patients with hematuria or urinary tract symptoms without systemic symptoms were found in some early disease, such as tuberculosis Kidney Cancer Kidney or bladder cancer early.

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Nephritis treating

Hospital treatment of kidney disease is characterized by traditional Chinese medicine. Is to use the methods of traditional Chinese medicine to treat the blood system, cleaned through the blood for treatment of kidney disease. The treatment of blood stains is also known.

Our hospital treatment of kidney disease is unique, we have changed the ideas of Western medicine treatment, and does not follow similar drugs to deal with different types of treatment of inflammation. But through the blood rule for achieving phase of inflammation, in addition to the lesion, to achieve the purpose of curing the renal disease. After years of trial and error, which is a unique method of treatment. This method is: where there is no specific pharmacological treatment of inflammatory lesions, continuing to switch to clean the blood approach to treatment. According to the medical theory, regardless of any position of the inflammatory lesions of the body, due to human blood caused by inflammatory cytokines.

You can say, blood, body inflammatory cytokines and inflammatory lesions mutually influence living conditions. Our idea treatment is finding ways to reduce both dependencies between them to promote the removal of conditions. Our focus is the treatment of choice of the best efforts to eliminate inflammatory factors in the blood. We believe that the time we have the means to inflammatory cytokines in the patient's blood removed, then gathered in inflammatory lesions around the inflammatory cytokines will become less.

In this case, we talk about the use of some medications restoration inflammatory lesions, the patient's body is the treatment of inflammatory lesions day is reduced. So, gradually formed a less inflammatory cytokines, a good situation smaller inflammatory lesions. With the gradual consolidation of this situation, renal disease slowly restored.

1. Quickly Relieve symptoms: individual differences according to the cause and his own group of experts to develop the best treatment plan, one party, the dialectical therapy, multi-channel and multi-target, multi comprehensive Medicine treatment means, effectively improving renal microcirculation, renal ischemia and hypoxia eased.

2. Preventing the progression of the disease: renal repair damaged tissue and protecting the residual tissue provides a relatively stable and relaxed atmosphere, slow the progression of impaired renal disease uremia, effective containment of recurrent disease .

3. Delaying dialysis until no dialysis: From injury, blocking the progression of disease differentiation, and can accurately and quickly repair damaged diseased cells, promote cell regeneration and recovery of residual renal function enabled the effective protection of residual renal units, an overall improvement in renal function system, to avoid dialysis, reducing the number of intervals dialysis, prolonged dialysis in order to get rid of dialysis.

4. Improve the quality of life and prolong life through a scientific, standardized and effective treatment can repair damaged and diseased cells, promote cell regeneration and recovery of residual renal function activated, the effective protection of the units residual kidney, improve quality of life and prolong life.

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The treatment of Micro-Chinese Medicine Osmotherapy

Traditional Chinese medicine for its wide variety of assets and more ingredients, biological activity and long-term toxicity and other characteristics, put a unique advantage in the international arena. The world moves, Chinese medicine to develop, "Times" is the trend, innovation is the only way. Officials from the World Health Organization stressed that in the 21st century to solve the difficult problems of human diseases, hoping to combine traditional Chinese medicine with modern medicine.

1. Introduction Therapy

Penetration Therapy Micro-Chinese Medicine is the largest specialist hospital in kidneys of the nation in Shijiazhuang Hospital Renal Disease 20 years a large number of clinical practice in the long term, summarized as a treatment for kidney disease innovative therapies proven chronic, Micro -Medicine Osmotherapy China Shijiazhuang Kidney Disease Hospital patents, other hospitals elsewhere are not.

Therapy penetration Micro-Chinese Medicine in the treatment of many years of practice, summarized an innovative therapy, its core technology is an effective prescription treatment for ultra fine grinding purposes kidney disease is the active ingredient in the drug release and mix well. And then, with a sharp and effective permeation device through topically effective drug penetration through the kidneys and the site of injury, for effective treatment of kidney disease. sta innovative therapy, eliminating the problem of side effects of oral drugs but also for effective drug ingredients in the effects of injury. This innovative therapy, clinically proven to be effective and convenient. Its therapeutic mechanism is: vasodilator through anti-inflammatory blood anticoagulant,,, viscosity biodegradable substances to achieve blocking the progression of renal fibrosis fibrosis, renal intrinsic repair and reconstruct the damaged cells suitable structure kidney. It is known as: lock + fix + rebuild.

The meaning of "Micro"

① Micro-meaning refers to the processing method of traditional Chinese medicine is crushing and boiling. Below we provide a new method of processing, fine dust, easier absorption, solid called micro-based, in essence, is more granular. Of course, the specific processing method for the protection of the hospital is the aim of any detailed explanation.

② meaning penetration is, our hospital in the formation of the Court of treatments effective use of traditional Chinese medicine in the topical treatment. But over the years, because there is always a difficult topical medication to overcome the problem that the drugs are effective and penetrate the body, was less than ideal, so people suspected that the real effect of this therapy. To this end, the design institute in topical formulations of drugs, using a unique method of drug penetration, thus ensuring a single topical treatment medication. In order to highlight the particularity of this method is introduced in therapy that emphasizes the word "penetration".

③ In therapies Micro-Chinese Medicine designed to penetrate fully absorb foreign advanced technology of Western medicine, so the theory of Chinese medicine treatment has been very good performance. Therefore, the diagnosis of kidney disease scientific method became the basis of the analysis of cell damage cellular dysfunction situation. The original theory intrinsic renal injury kidney damage cellular function today, diagnostic theory become damaged. On this basis, the treatment of kidney disease, renal cell intrinsic become slow and continuing damage repair function intrinsic renal cells. But to repair the inherent renal cells, it is necessary to solve a problem is completely clean inherent cause renal cell damage, damage to the culprit - intrinsic renal cells, extracellular matrix.

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Diagnosis and treatment of glomerulonephritis

The diagnosis of allergic purpura nephritis

Diagnosis points

(1) renal involvement occurs in purple skin after a month, usually purple gastrointestinal symptoms often recurrent, prolonged and severe renal impairment easier.
(2) the severity of symptoms and the poor, and view the skin, gastrointestinal tract, joints and other symptoms, most patients with early visible hematuria and proteinuria, microscopic hematuria only see the light. The edema and high blood pressure, mostly mild to moderate.

(3) clinical types

① light only a slight change in urine, hematuria, short, edema, hypertension is not obvious;

② acute nephritic syndrome and post-streptococcal glomerulonephritis similar, mild haematuria, edema, hypertension, most of the normal complement, purple subsided after normal urinary changes;

③ edemaLa significant proteinuria nephrotic syndrome, with or mild hematuria, hormone therapy as the primary nephrotic syndrome;

④ acute onset rapidly progressive glomerulonephritis, significant hematuria, first stage high degree of inflammation, little or no urine, often in the three months to the development of renal failure and death;

⑤ Purple chronic nephritis often repeated, prolonged course, and finally the development of chronic renal failure.

(4) focal mesangial proliferative lesions common diseases, severe diffuse proliferation and crescent formation, immunofluorescence granular IgA mesangial area is characterized by calm.

(5) Laboratory Tests.

① See urine hematuria and / or proteinuria, especially for low selectivity;

② serum complement C3, C4 were normal;

③ blood IgG, IgM standard, early increase in some patients;

④ some positive immune complex patients.

Henoch-Schonlein nursing and Prevention of nephritis

1. diet to restore

Clinical disease with the actual situation of the points, plus the dialectical therapy, with proper diet, often to get the desired results. Diet in tandem with the real situation and the severity of the condition applies. The diet should eat nutritious, easy to digest food, eat more vegetables and fruits, eat fat objects seafood, dry goods acres and fish, shrimp, crab, milk and other foods rich in protein heterosexual, stop drinking.

2. Combine work and relaxation

Daily diet to law, the acute phase of bed rest, stabilization period appropriate activities. Usually prevent colds, exercise active, improve fitness. Winter Refuge, sexual section, patients should not become pregnant soon after the disease.

3. Spirit nursed back to health

To be comfortable to avoid arousal, to avoid exacerbation or recurrence. Please psychological care, and improve the confidence to overcome the disease.

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The causes of hematuria

1. Diseases of the kidney and urinary tract

(1) Inflammation: acute and chronic glomerulonephritis, acute and chronic pyelonephritis, acute cystitis, urethritis, urinary system tuberculosis, fungal infections of the urinary system ect.

(2) Stone: The renal pelvis, ureter, bladder, urethra, any part of the calculation, when the stones move pierced the urothelium, both also easily prone to secondary infection hematuria. Large stones may cause obstruction of the urinary tract even damage renal function.

(3) T umor: Any part of malignant tumors of the urinary system or malignant tumors invade adjacent organs and urinary tract can cause hematuria.

(4) Trauma: Refers to violence damaging the urinary system.

(5) Congenital malformations: Polycystic kidney disease, congenital thin glomerular basement membrane nephritis phenomenon Nutcracker (The disease is congenital vascular malformation caused by traveling in the abdominal aorta and superior mesenteric artery, squeezing between the left renal vein, cause intractable hematuria. the right renal vein straight into the inferior vena cava, left renal vein must pass through the abdominal aorta and superior mesenteric artery angle formed by the inferior vena cava. This is the normal angle of 45 ° ~ 60 °, congenital if this angle is too small mesenteric fat or lymph nodes, peritoneal filling can cause nutcracker phenomenon. the diagnosis depends primarily on the CT, B ultrasound, renal venography. the treatment requires surgical correction).

2. Systemic disease

(1) Bleeding disorders: Thrombocytopenic purpura, purpura nephritis, hemophilia, leukemia, malignant histiocytosis, aplastic anemia ect.

(2) connective tissue disease: Systemic lupus erythematosus, dermatomyositis, polyarteritis nodosa, scleroderma ect.

(3) Infectious diseases: leptospirosis, hemorrhagic fever, filariasis, bacterial endocarditis, scarlet ect.

(4) cardiovascular disease: Congestive heart failure, renal thrombosis, renal vein thrombosis.

(5) endocrine and metabolic diseases: gout, kidney disease, diabetic nephropathy, hyperparathyroidism ect.

(6) Physical and chemical factors: As food allergies, radiation, drugs (such as sulfonamides, phenol, mercury, lead, arsenic poisoning, an infusion of large mannitol, glycerol, etc.), poison, after exercise, etc.

3. Diseases of adjacent organs

The tumor of the uterus, vagina or rectum invade the urinary tract.

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Diagnosis and treatment of hematuria

When appears red urine, the patient has no means for diagnosing hematuria first cause, then, how diagnosis of hematuria?


Hematuria urine red color is not necessarily to be careful to distinguish. Such as urine or dark soy sauce red, not cloudy without precipitation, no or only a small amount of red blood cells, the microscopic hemoglobin found in the urine; Brown-red or burgundy, is not clear, no red blood cells found in the microscopic examination of the urine porphyrin; Taking certain medications, such as rhubarb, rifampin, or eat some red vegetables can also be rows of red urine, but the test microscopic no red blood cells. Whether the cause of hematuria accompanied by other symptoms of analysis. Asymptomatic hematuria should first consider the possibility of urinary tract tumors, hematuria accompanied by pain, especially with colic should consider urolithiasis; If accompanied by dysuria and interrupted urine flow, consider bladder stones, if accompanied by significant irritation bladder, placed urinary tract infections, tuberculosis and common bladder tumors. Furthermore, it should be combined with patient history, age, hematuria color, the degree of hematuria reasons for a full trial.


Hematuria requires bed rest to minimize strenuous activities. Drink plenty of water to accelerate the excretion of drugs and stones. Edema nephritis has occurred should be less water. The application of hemostatic agents but also in combination with vitamin C. Caution cause hematuria drugs, especially in patients with renal disease. The hematuria caused by a urinary tract infection, oral and injectable antibiotics and urinary tract cleanser. Hematuria complex etiology, a condition is very serious and should be diagnosed as early as possible to hospital, early treatment.

1. Active treatment of urinary tract inflammation, stones and other diseases.

2. In normal life, not always up so that the bladder filling. Feel urinate, urination, urine in the bladder to reduce the residence time is too long.

3. Pay attention to rest, avoid strenuous exercise.

In short, find hematuria, early detection, diagnosis, timely treatment, so it is difficult diagnosis to be reviewed periodically.

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The cause of glomerular filtration rate

In society there are many people has nephropathy, glomerular filtration rate is one of the major diseases, therefore,? Which is the cause of glomerular filtration rate?

Actually play the role of renal function is the function of the kidney cells. Main function is to clear the blood of harmful substances from the body, such scanning is the glomerular filtration. For this reason, people attach great importance to the ability of glomerular filtration of this force.

So what GFR refuse? To understand this problem, we first analyze how the glomerular filtration rate is achieved. One study found that the glomerular filtration is achieved by means of two functions, one function glomerular mechanical barrier, the second is responsible for glomerular barrier function. Mechanical barrier function means there is a way for glomerular filtration of small molecules, macromolecules and do not allow the ability to filter. This ability of macromolecules in the blood remaining in the blood, and small polar molecules in urine. The glomerular barrier is called charge is a positive charge to the material through the ability to ensure that the material to remain negatively charged blood. Through the above two functions is performed in the glomerular filtration process to ensure the blood with a positive charge of small molecules in the function of urine, through the above two functions is performed in the glomerular filtration process to ensure the blood with a positively charged small molecules function in urine.

Later, when medical science has found further that people also opened a glomerular filtration rate and renal tubular absorption secret. Found that mechanical barrier function of the glomerular capillary endothelium glomerular layer is derived from a functional cell - capillary endothelial cells and mesangial cells within the capillaries together and play a mechanical barrier. The glomerular barrier function of load is derived from a layer of glomerular function of skin cells - capillary epithelial cells have a capacity of negative charge control through the material. The three functional cells together before glomerular filtration process to ensure blood with a positively charged small molecules leak into the urine. The urine in the renal tubules, tubules have a function in endothelial cells - make the urine of renal tubular epithelial cells positively charged, while the body of the material that needs to be re-absorbed. These four functional across multiple cells ensures that controls useful in the blood retained in the blood substances, harmful substances in urine are eventually excreted. But once queapareceel cuerpocontra the disease, queprimerodará acambiosenla place compositionof human blood .And cause glomerular and tubular outside the capacity of their work, and for injury or damage to the balance of the initial filtration. Breaking the essence of this destruction of the four functions of cells or one or two or all damaged. This study found that it is often said that the decrease in GFR, glomerular and tubular function essentially on the basis of four cells the damage occurred. At this point, people come to a meaningful conclusion: the decline in renal function renal units - the glomerular filtration and tubular function and return results in decreased absorption, and decreased glomerular and tubular function right for this function is the glomerular and tubular cells - glomerular capillary endothelial cells, mesangial cells, epithelial cells and the role of tubular epithelial cells in the impairment of function after the destruction. Study here, finally found a GFR of the real reason - the composition of renal cell units, that is, the inherent functional cells are damaged renal function after damage was reduced.

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The food nephropathy patient

How food the patient can eat food nephropathy today mention understanding of it.

It can eat salt and alkali nefropatía?el normal adult daily intake of about 5 to 6 grams of salt, overeating sodium salt, easy water retention in the body, the edema induced, therefore, in patients with renal edema should control salt intake 2-3 grams of salt intake per person is the low-salt diet.

You can eat fish, shrimp, egg, meat, etcétera?alimento fish, and some kidney patients eat consciously, that's not good for the kidneys, in fact, that type of food is high quality protein in allergic diseases such as allergic purpura nephritis due to heterosexual protein allergy or suspected allergy history should be used with caution fish, usually without taboos. Fish, shrimp, eggs, meat, protein-rich animal foods is the body's cells, tissues, mainly building materials, the human body is very important, after eating the liver breaks down foods containing protein excretion renal, so when kidney function decreases, reducing protein intake must be appropriate, not only to meet the nutritional needs of human metabolism, without increasing the burden on the kidney with the principle. Some patients with renal disease is not serious and do not dare to eat protein or protein disease sometimes have to limit care are not correct.

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Symptoms of kidney failure

Patients with renal impairment should be aware of the signs and symptoms can worsen kidney function and may warrant evaluation and treatment of your nephrologist.

What are the symptoms of acute renal failure?

Swelling, especially in the legs and feet

Lack of appetite, feeling not like to eat

Nausea and vomiting

When you urinate, little or no urine


Anxiety, confusion, disturbed and drowsiness

What are the symptoms of chronic kidney failure?

Since decreased renal function, symptoms of kidney failure are unable to regulate water and electrolyte balance, removing waste from the body, and promotes the production of red blood cells.

Swelling: Because the kidneys can not adjust the balance of the wastewater.

Proteinuria: glomerular damage, Protein molecules can pass filtration membrane, at this time, otherwise it may be damaged tubular, proteins can not be reabsorbed.
Anemia: Tenal not produce erythropoietin (EPO), and to promote the production of red blood cells. In addition, toxins in the body shorten the life of the red blood cells.

High levels of creatinine: For body can not excrete creatinine. Lack of appetite, fatigue, drowsiness and even coma: because the creation of waste products in the blood. Anemia can also aggravate these symptoms.

A shortness of breath: Because the kidneys are unable to meet the growing burden of acid in the body.

Hypertension: As the body of excess fluids

Nausea and vomiting

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The causes of proteinuria

(一) Kidney Proteinuria

1. Proteinuria glomerular

Common in acute glomerulonephritis, various types of chronic glomerulonephritis, IgA nephritis, nephritis hides.

Common secondary ect as renal lupus, autoimmune disorders, diabetic nephropathy, purpura nephritis, renal arteriosclerosis ect.

Common metabolic disorders in gout kidney

According to the degree of filtration membrane disease injury and proteinuria is divided into two components:

Proteinuria selective ①: mainly albumin, and a small amount of low molecular weight proteins, no large proteins Urine (IgG, IgA, IgM, C3, C4), semi-quantitative especially in +++ ~ ++++ typical disease is nephrotic syndrome.

② Proteinuria nonselective: Description fracture of the glomerular capillary wall severely injured in urine is large molecular weight proteins such as immunoglobulins, complement, the average molecular weight and low molecular weight protein albumin in urinary protein, immunoglobulin / albumin ratio> 0.5, semiquantitative + ~ ++++, quantification between 0.5 ~ 3.0g / 24h, common in primary glomerular disease as rapidly progressive glomerulonephritis, chronic nephritis, membranous glomerulonephritis and mesangial proliferative diseases ect.y secondary glomerular nephritis as diabetes, lupus nephritis ect. The emergence nonselective proteinuria bad prognosis.

Vigorous exercise, long march, high temperature environment, fever, cold environment, nervousness, congestive heart failure ect, also appear proteinuria.

2. tubular proteinuria:

The most common variety of causes interstitial nephritis, renal vein thrombosis, renal artery thrombosis, salts of heavy metal poisoning ect.

Proteinuria in renal tissue:

Also known as secretory proteinuria. Since during the formation of urine, renal metabolism of protein in the urine caused by infiltration.

(二) Proteinuria no renal

proteinuria humoral

Also known as overflow proteinuria, such as multiple myeloma.

proteinuria organization

As protein in urine cancer, viral infection of host proteins produced ect.

Lower urinary tract mixed with proteinuria cause proteinuria

Common urinary tract infections, urinary tract epithelial cells and peeling of the urinary tract secrete mucin.

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How to treat glomerulonephritis

There are many people with glomerulonephritis, then? How to treat glomerulonephritis? Today we see together how to treat glomerulonephritis.


The disease is critical for the symptomatic treatment, essential for the prevention of sodium and water retention component, controlling circulating blood volume, to achieve relief of symptoms, prevention of fatal complications, renal function (heart failure, hypertensive) encephalopathy and protection of renal function, and prevent a variety of factors predisposing to worsen, promote kidney histological and functional repair.

Specific treatment programs

1. General deal

After acute onset must bedrest. The principles of food with low salt, high in vitamins, based diet high in calories. Protein intake to maintain 40 ~ 70G / día.Sal intake 2 ~ 3G / day, while limiting food intake of potassium.

2. Symptomatic treatment

Diuretic, overall use of thiazide diuretics, Step-down, usually using thiazide diuretics, vasodilators, ganglionic blockers used when needed, or in combination with blockers, calcium channel; hyperkalemia treatment limiting diets poor in high potassium and mainly due to one potassium-sparing diuretics.

3. Complications of treatment

Control failure, treatment should focus on correcting Shuinazhuliu restore blood volume, instead of the application to improve myocardial contractility drug digitalis, where the main measures antihypertensive diuretic, hypertensive encephalopathy, intravenous infusion of sodium nitroprusside other medicines, seizures may use intravenous stability; Uremia, see "ARF"

4. foci Treatment

When positive bacterial culture currently advocated in the lesion, should be actively treated with antibiotics, typically penicillin or macrolide antibiotics are used to control the lesions of infection, the prevention of the spread of germs paper disease for a period of approximately two weeks or until cure. Tonsillectomy in the progression of acute glomerulonephritis certainly no effect.

5. Anticoagulant and Thrombolytic

Urokinase infusion, but can be extended diuretic, potassium.

6. Dialysis

Acute glomerulonephritis following conditions should be used dialysis, which Shuinazhuliu serious, acute renal failure, oliguria two days or more, hyperkalemia, acute left ventricular failure, severe acidosis situation.

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The cause of renal failure

Now many people are renal disease, renal failure is a very important type of which, why? What causes the cause of kidney failure?

The cause of kidney failure is abnormal innate immune system of the body for some reason, resulting in reduced immunity appears This reduction in the human immune system, which has led to toxic and harmful elements related to human enter inside the human body. These toxic and hazardous substances in the human body, trying to do everything possible to find an organ or tissue deposited. If these dangerous substances selected organs kidneys, kidney somewhere will be deposited, causing different nephropathy. If these dangerous substances selected organs kidneys, kidney somewhere will be deposited, causing different nephropathy.

Different causes, can lead to substances kidney disease causing look different deposition to remove this foreign matter, different inflammatory mediators are produced, these inflammatory mediators, will mobilize a large number of proteins in the human body in inflammatory cytokines, these different cytokines inflammatory substances are deposited in the pathogenic inflammatory response occurs on.The purpose of the inflammatory response occurs is to remove these deposits. This cleaning process is different renal lesions occur in the process. The body structure according to the normal and normal human, after inflammatory factor clears the sediments deposited in kidney disease, inflammatory cytokines should stop inflammation, the formation of local lesions also deposited heal slowly. However, when the body is abnormal immune, inflammatory cytokines scanning capability appeared uncontrolled situation in which the inflammatory cytokine response status or that the long-term state of arousal. This leads to injury has gathered a large number of inflammatory cytokines, inflammatory cytokines, clear finish without matter sediments are always non-stop inflammatory response occurs, and to further expand the injury. This inflammatory reaction in constant expansion in the renal damage.

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The causes of renal failure

The causes of kidney failure are:

1. The elderly and children: The renal function of the elderly degenerate, and diminished capacity of drug detoxification, high sensitivity nephrotoxic drugs, is the cause of renal failure, hypovolemia. Hypovolemia: Bleeding due to various reasons also causes kidney failure. Kidney and gastrointestinal fluid out, leaving skin fluids (eg burning, excessive sweating) ect, hypovolemia cause. When hypovolemic, reduction in renal perfusion, low GFR, while sympathetic excitation and cause rise vasopressin renal vasoconstriction, which further decrease GFR does induce ARF. Circulatory failure: Clash of several causes, heart failure and other circulatory failure causes renal hypoperfusion, GFR floor.The excessive use of antihypertensive drugs is also a cause of renal failure.

2. After surgical: severe primary disease, the use of anesthesia and sedation, tissue trauma, fluid loss, blood loss, and other factors make after major surgery prone. The opportunity after cardiac surgery accretes renal failure depends on cardiopulmonary short time and the situation of cardiac function restored. Obstetric complications: Pollution during early pregnancy abortion: Late Stage severe hypertension induced by pregnancy, bleeding, pain ect child, complications were easily induced, these are the reasons for kidney failure.

3. Severe infections and sepsis: Variety cause serious infections is also renal failure, in particular, those with sepsis may renal ischemia induced renal toxicity mechanisms. Severe Trauma: as burns, crush injuries, severe fractures ect because organizations infection shock and trauma, such as the release of myoglobin likely ARF. Severe burns are a large amount of fluid loss and kidney failure intravascular hemolysis is also one of the reasons.

4. cirrhosis and ascites: Now plasma renin - aldosterone system is activated, vasopressin secretion increased as a result of renal sodium retention. Abnormal liver function capacity makes drug detox to get off. At this point is likely to cause acute renal failure if ascites too much too fast, these patients use nephrotoxic drugs are also vulnerable to disease. Kidney disease: Chronic kidney disease can affect self often function of the kidneys, may be due to an illness or aggravate certain additional factors (infections, urinary tract obstruction, water and electrolyte imbalance, use of nephrotoxic drugs etc.) inducing. Nephrotic syndrome associated with idiopathic acute renal failure in recent years, attention may circulating blood volume because insufficient effective protein renal tubular obstruction, renal edema thrombosis oppression tubular and interstitial renal vein and other mechanisms to the nephrotic syndrome ARF, description itself renal disease should be considered as an independent cause of kidney failure. Moreover elderly prostatic hypertrophy use of anticholinergic drugs, renovascular hypertension using angiotensin-converting enzyme inhibitors, abuse of non-steroidal anti-inflammatory drugs, overdose of drugs cyclosporine and acute chemotherapy-induced hyperuricemia are also what are the reasons for the renal failure.

5.La application of nephrotoxic drugs: The use of nephrotoxic drugs such as aminoglycosides, contrast agents and cephalosporins, especially in the elderly, children, dehydration, diabetes, cirrhosis, kidney diseases that are particularly dangerous when applied, it is also one of the reasons of the kidney.

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Treatment of renal failure

Many people want to know how to treat kidney failure, now I would like to introduce several methods of treatment of renal failure, I want to help your condition.

1. Cause of treatment

The reasons, as the treatment of renal failure caused by insufficient blood flow or blood loss will be given to patients to replace lost fluids and moisture; If there is an infection, then do another treatment for infection .

2. Renal function

Has been lost due to kidney function, so that the doctor temporarily take the form of dialysis (commonly known as dialysis), to help the body get rid of toxins and waste; failure patients with acute renal failure receive a proper treatment can not control or leave evolved from acute renal failure to chronic diseases, may be due to uremia and dialysis for life.

Dialysis is through filtration, to selectively exclude certain substances in the blood. Namely through artificial means in renal failure patient after accumulation of toxic waste in vivo, and salt water discarded, so that the physical condition of the patient to return to a healthy state. Currently used in dialysis in two forms: hemodialysis and peritoneal dialysis. Hemodialysis is a special type of machines to replace kidney function. Peritoneal dialysis is the peritoneum body acts as a filter to rid the body of toxins.

3. Food

control of food, for patients with renal insufficiency, renal function due to damage, after eating the food in the body, toxins and wastes, usually is not excreted, so essential in the diet on the special precautions body burden.

4. Treatment of renal transplantation

Some patients with terminal renal failure requiring dialysis long term, patients themselves when conditions are appropriate, kidney (kidney) can lead to a better quality of life for patients; But a kidney transplant it is a great project, although the current medical technology is pretty good, still have to do a lot of pre-assessment, in order to improve the chances of successful kidney transplant.

Kidney transplantation is through surgery, organ donor kidney transplant a transplant. Possible sources of the kidneys: family, spouse, friend or brain death, and during his lifetime a person to sign an agreement to donate organs. Of course, the best option is usually kidney transplant recipients brothers and sisters, because of their genes with the most likely.

Kidney transplantation is the best way to treat kidney failure, because I transplanted kidney failure patient has been almost completely superseded by renal function and patients can live a normal life.


The classification of glomerulonephritis

Want to know the knowledge about the classification of glomerulonephritis? If you know, please read.

(一) According to the basic types

It can be divided into primary glomerulonephritis and secondary glomerulonephritis. Primary glomerulonephritis is the independence of primary kidney disease, lesions mainly involving the kidneys. Secondary glomerulonephritis caused by other diseases, kidney disease is a systemic disease part. Primary glomerulonephritis can be divided into 4 types: ① mild glomerular lesions, focal segmental lesions ②, ③ diffuse glomerulonephritis, glomerulonephritis ④ no classification. But secondary glomerulonephritis can be divided into 3 types: ① Lupus glomerulonephritis, glomerulonephritis Purpura ②, ③ Diabetic nephropathy.

(二) By type of macroscopic

It can be divided into acute glomerulonephritis and chronic glomerulonephritis. Chronic glomerulonephritis can be divided into the pathological: ① mesangial proliferative glomerulonephritis, chronic diffuse glomerulonephritis ②, ③ membranous nephropathy, ④ Membrane proliferative glomerulonephritis, focal segmental glomerulonephritis ⑤.

(三) According to clinical classification criteria

Reference 1992 primary glomerulonephritis criteria glomerulonephritis primary clinical classification, can be divided into acute glomerulonephritis, the rapidly progressive glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome, glomerulonephritis Hidden.

1. Acute glomerulonephritis (known as acute nephritis)

It is a type because both sides of the infection caused by diffuse allergy damage renal glomerular based acute illness, the particularities of this disease is more acute onset in 1-3 weeks after infection, appears hematuria, proteinuria, urinary tube, edema, oliguria, hypertension ect.

2. Chronic glomerulonephritis (known as chronic nephritis)

It results from a variety of primary glomerular disease cycle of a leader (or even decades) with proteinuria, hematuria, edema, hypertension clinical manifestations of the disease. The disease is common, particularly high incidence of youth young men. It is very difficult cake disease, more progressive chronic renal failure, poor prognosis. Chronic glomerulonephritis is caused by various causes of a group of glomerular diseases. Clinically, it manifests as proteinuria, hematuria, edema, hypertension, etc. But the performance of each patient may have different degrees of severity, patients with edema as the first symptom, early in the morning when the light eyelids slightly swollen and facials, later slightly lower limb edema, the rest can disappear shortly after rest. Some patients with blood pressure as the first symptom, then it appears that chronic glomerulonephritis.

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TCM etiology and pathology irritability purpura nephritis

Purpura patients sensitized about 1/3 of kidney damage, the prognosis depends on the severity of nephropathy, down introduction to TCM etiology and pathology purpura nephritis irritability.

(一) The cause of the disease

1. Exogenous:

(1) wind-heat

Wind-heat evil intrusion, damage to the business of the bloodstains and hair, full of toxic heat, hot spots blood, red blood injured overflow, caused hematuria, purple, or wind-heat evil and the intrinsic heat by the kidney and bladder cause hematuria, edema. Therefore, early disease, more symptoms of exogenous wind-heat, acute onset, moody, often accompanied by itchy skin purple, bright early purple, multi purple red, as Jin Wen, accompanied by vomiting or bleeding from the nose, blood, since both wind and heat infestation.

(2) Blood

Early due to thermal disturbance in contact with blood, spills endosmosis like purple, hematuria, gas falling into the consumption of blood from a wound stasis. Clinical observation, the disease no matter how dialectical because "from the blood stasis," has a different degree of stasis, blood stasis and qi stagnation is the result of a virtual increase.

2. Internal Injury

The imaginary: Mal wind-heat, houses in the kidney, more performance for early renal blood heat, following the outcome of evil fire Shangyin gas consumption, leading to Qi, falling sinister and yang, so the spleen qi deficiency and blood loss. Spleen l lost clear, sealed reservoir renal failure, then proteins and other nutrients from urine leakage.

Form of the disease, especially the loss of Yin because it is very bad six evils of the invasion of evil, the heat of bad blood, disruption of blood contact, forcing blood Wang Xing, excess skin and purple hair, bleeding in the kidney is urinating blood. Heat stasis is the main reason.

(二) Pathology

Henoch-Schonlein glomerulonephritis incidence beginning, many have exogenous history, its pathogenesis in patients with blood heat primarily known intrinsic, complex due to exogenous, food, insect venom, drugs or toxic chemicals such as touch, wind-heat Racing , in contact with blood burns, forcing the blood, skin Spillover, into the stomach hard, worse kidney, therefore, the purple skin, often abdominal pain during, and even then the blood in the stool, blood in the urine, etc; length of the injured kidney yin, causing wang, burning blood contact burns, lesions in contact with the blood of kidney and bladder, and see the purple, hematuria. It follows that, allergic purpura nephritis Wang is both hot evils falling pathological product of the heat loss of body fluid, but still causing purple, hematuria pathogenesis; Diseases long, the loss of abuse of government, can damage the spleen and kidney, spleen and kidney deficiency, lack of temperament, transport dereliction of duty, moisture does not run, renal impairment, can not water, gas lines, causing loss the company gasification bladder opening and closing unfavorable, spleen and kidney deficiency, flood wet body swelling, kidney failure to open and close the retention of urine, thus forming allergic nephritis oliguria erythema, edema and other clinical manifestations.

Purpura nephritis performance

The clinical manifestations of nephritis, I hope that through the introduction of help for their condition.

Renal manifestations

(1) Purple Skin: Clinical diagnosis of the disease is one of the main basis for the vast majority of patients with purple skin as the first symptom. Purple skin often occurs in the distal extremities extended side, buttocks and lower abdomen, mostly symmetrical distribution of lesions vary in size, hemorrhagic spots, slightly prominent skin, can be integrated into the film, no itching, no pain, may have a relapse of one or several times, but also occur in batches, 1-2 weeks after he disappeared gradually, there 4-6 weeks delay decreased. Sometimes it can occur in batches and hemorrhagic rash hives, swelling and other symptoms.

(2) The joint symptoms: 1/2 -2/3 of patients with joint symptoms occurred in large joints such as the knee, ankle, followed by the wrist and finger joints, usually around tenderness and swelling of the joints, but not red hot without malformations.

(3) Digestive symptoms: Approximately 2/3 of patients with gastrointestinal symptoms, abdominal cramps positioning is more common. Review abdominal tenderness, usually no muscle tension or rebound tenderness, accompanied by nausea, vomiting, often gastrointestinal bleeding, intestinal edema, hemorrhage, or stiffness, can form intussusception, intestinal perforation, clinical manifestations of vomiting blood or black stools. Combined pancreatitis have been reported.

(4) Other manifestations: History of upper respiratory tract infection may include headache, fever, malaise. Epistaxis or occasional hemoptysis, nervous system involvement manifesting as headache, abnormal behavior and seizures. Few patients have a myocarditis performance.

Nephritis treating edema

The treatment of nephritis edema is a long process, the patient must have patience. The following are treating nephritis edema.

1. The etiological treatment is critical, aggressive treatment of glomerulonephritis, nephrotic syndrome, but slow effective.

2. Limit salt: nephritis or renal edema are the retention of sodium and water, limit sodium intake, but should be appropriate, sodium prohibition long term can cause hyponatremia.

3. Diuretic: If necessary, while diuretics voted to limit sodium, can promote sodium and water discharge and relieve edema, can relieve high blood pressure and reduce the burden on the heart.

4. Controls proteinuria: nephrotic edema should control the proteinuria, immunosuppressive drugs available (dexamethasone, prednisone, etc) to resume normal glomerular permeability. Plasma protein supplement.

If you just normal edema, you can take the following initiatives:

1. It is recommended to choose your own pair of comfortable shoes. Compare the best choice for a comfortable and soft, and can reduce fatigue efficacy of feet as edema, more than the original, being fat, feet so if wear tight shoes will be hard to accept. Suggestions: best tight shoes do not choose, because the causes swelling worsens.

2. Eat more fruits and vegetables diuretic swelling: Such as watermelon, beans, onion, mint, garlic, eggplant, celery and other foods. Helps relieve edema!

Chinese medicine treatment of nephritis edema

Metabolism of Chinese medicine and water is more closely organs lung, spleen, kidney, these three organ dysfunction is caused by swelling of the key and, the treatment of edema, Chinese medicine generally Xuanfei, spleen, heating as the basic principle. Specific methods are as follows:

(1) Xuanfei diuresis: The main clinical manifestations of the fever caused by the cold wind outside attack, aversion to cold, bad wind, headache, limb and joint pain, cough, thin white tongue coating, floating pulse .Visto first facial edema after whole body, difficulty urinating. Chinese medicine called edema as geomancy, common in acute nephritis or acute exacerbation of chronic nephritis. Drugs commonly used ephedra, gypsum, Ginger, Atractylodes, wind, Morus alba, double flowers, forsythia, mint, Peucedanum, red beans, plantain, Alisma, plants have cogongrass rhizome, motherwort so on.

(2) Invigorate spleen function transform wet, water swelling: The clinical manifestations of systemic pitting edema, spreading below the waist, body weight, fatigue, decreased urination, loss of appetite, chest tightness , greasy moss, pulse. Drugs commonly used Poria, Polyporus, Alisma, Atractylodes, Gui, Morus alba, arecae, skin ginger, orange peel, Poria, etc. Very swollen upper body Erchuan more ephedra, almond, Tinglizi; Bottom of the body swelling even add fangchi, Sichuan pepper, Magnolia, such as humidity heat, Fan thirst, scanty dark urine, constipation, moss yellow grease, increase the yellow, wood, thistle, etc.

(3) During warm invigorating spleen function, gas lines and water: This law applies to the weakness of the spleen. The main clinical manifestations of lower limb edema, and even more, according to depression is not easy to restore, chest tightness, abdominal distension, pay less, diarrhea, pallor, tired limbs ??, less urine, pale tongue, white, Chenhuan slippery pulse. Drugs commonly used are: Poria, Atractylodes, aconite, ginger, Magnolia, woodland, arecae, papaya, strawberry, licorice, can add Polyporus, Alisma, Codonopsis, Astragalus.

(4) Heating and Water: For those who decline of kidney. Height of the main manifestations of systemic edema, particularly at night below the waist, waist and knees, cold extremities, chills, fatigue, Shenpi pale, scanty urine, pale tongue with teeth marks, thin weak pulse. Drugs commonly used Poria, Atractylodes, white peony root, root, ginger, foxglove, Dan, Alisma, yam, cornus, cinnamon, etc.

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