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Chronic renal failure is a clinical syndrome consisting of a variety of symptoms and metabolic disorders due to the progressive irreversible decline of the kidney functions. The end stage of chronic renal failure is uremia. Uremia is not an independent kidney disease, but a series of clinical manifestations and it is the common syndrome of nearly all the kidney diseases in their end stages. In the end stage of uremia, nearly all the systems will be involved. The patients will have some severe illness conditions such as heart failure, psychosis, coma and other life-threatening complications.
Back topUremia can be caused by many factors such as chronic glomerulonephritis, chronic pyelonephritis, renal tuberculosis, renal arteriosclerosis, stones in the urinary tract, enlarged prostate, bladder cancer, lupus, and diabetes and so on.
Since the kidneys are damaged by various factors, the kidney functions are severely affected. As a result, the nitrogen metabolism and other wastes can't be excreted out of the body. Too much accumulation of wastes will cause the disorder of the internal environment and cause further damages to the kidneys and other organs. Renal failure can also be caused by other extra-renal factors such as heart failure, urinary tract obstruction, urinary reflux, etc.
Back top1. Uremia patients should have enough rest and adequate nutrition and avoid activities that beyond their strength.
2. Avoid chemicals that have toxicity to the kidneys. It has been proved that some chemical elements such as cadmium have something to do with acute or chronic kidney disease. Therefore foods that are rich in cadmium like halibut, mussels, scallops and oysters should be avoided.
3. Giving up smoking which has great harms to the kidneys and other organs.
Back top1. Blood test
The urea nitrogen and creatinine level will increase;
The hemoglobin is generally below 80g/l and in the end stage it is reduced to 20-30g/l, and the patients can also have the complication of low platelet or high white blood cells;
In the end stage, the PH value will decrease;
The plasma protein can be normal or reduced;
There will be electrolyte disorder.
2. Urine test
Changes in routine urine vary from person to person due to different causes. There may be proteinuria, red blood cells, white blood cells and casts;
The urine specific gravity is between 1.010 and 1.012 and there are more urine output at night than in the daytime.
3. Renal function test
At present the ECT is generally adopted to exam the glomerular filtration rate (GFR).In the stage of uremia, the GFR and endogtenous creatinine clearance rate will decrease. If the GFR is less than 25ml/min or the endogtenous creatinine clearance rate is lower than 10ml/min, it indicates that the patients have developed into the stage of remia;
The pure water clearance rate will become abnormal.
Back topThe most common symptoms of uremia patients are metabolic acidosis, disorders of water and electrolyte and metabolic imbalance of protein, carbohydrate, fat and vitamin. Actually it will affect nearly all the systems.
1. Symptoms in the gastrointestinal tracts are the first and the most obvious symptom. For example loss of appetite, discomforts in the abdomen and then nausea, vomiting, diarrhea, glossitis, oral ulcer, and urine taste in the breath.
2. Symptoms in the nerve system: headache, dizziness, trance, apathy, lethargy, drowsiness and even coma. In the end stage, there will be irritability, muscle trembling, seizures and convulsions.
3. Symptoms in the cardiovascular system: hypertension and arrhythmia are more common and in the end stage the fibrinous pericarditis and heart failure.
4. Symptoms in the hemopoietic system: serious anemia and the tendency of bleeding in the end stage.
5. Symptoms in the respiratory system: deep and long breath in case of acidosis. Patients can also suffer from uremic bronchitis, pneumonia and pleurisy.
6. Symptoms in the skin: there will be uremic frost in the skin due to the secretion of the urea from the sweat glands and the urenic frost will irritate the skin and cause itching of the skin.
7. Metabolic acidosis and acid-base imbalance.
In the stage of uremia, there will be the retention of the acid materials such as phosphoric acid and sulfuric acid and cause the uremic acidosis.
In the stage of uremia, besides the disorders of water, electrolyte, acid-base balance, anemia, high blood pressure, there will also be the dysfunctions of other systems. The common symptoms of uremia include loss of appetite, insensitivity, apathy, lethargy, decreased urine output, edema in the face and lower extremity, anemia, skin ulcers, itching, muscle cramps and even epilepsy. Of cause, according to patients' different illness conditions, not all these symptoms can appear at one time.
Back top1. Dietotherapy
Take 60g glutinous rice, 15g astragalus and 30g bamboo leaves. Put them in the pot and boil them and drink the water. After about 10 times the patients can sense the effect of the therapy. In the daikly time, patients can eat more peeled carrot which is conducive for the recovery of the disease.
2. Western therapies
At present the most widely adopted treatments for uremia are dialysis and kidney transplant. However as the development of the medical science and technology, their shortcomings are more and more recognized by the patients. Dialysis is not a treatment at all and it can only help discharge the small molecule toxins such as creatinine, uric acid and urea nitrogen. Since the metabolic wastes will be produced continuously, so the patients have to do dialysis again and again and become dependent on dialysis. Even though, that does not say patients should try to avoid dialysis. Under certain circumstances, dialysis is necessary renal replacement therapy. In the stage of uremia, more than 90% kidney functions have been damaged and there are excessive accumulation of metabolic wastes and toxins in the body which will cause irreversible damages to other tissues and organs such as heart, digestive system, bone, blood system, etc. Therefore uremia patients should take dialysis under the physician's guidance timely to help discharge wastes and toxins out of the body. As to the kidney transplant, it is the most effective and proper therapy for uremia, however we all know that there is extreme scarcity of matching kidney source and the patients have to take anti-rejection drugs in the rest of their life, not to say the huge cost and the injuries to the patient's body.
3. Chinese therapies
Chinese therapy mainly adopt herbal medicines to repair the kidney damages and improve the patient's immune system. Chinese therapy can aim at both the symptoms and root causes of the symptoms so the curative is durable. However the Chinese medicines usually take effect slowly and the patients have to drink the bitter decoction.
4. The combination of Chinese therapy and the western therapy
Immunotherapy can be said to be the latest treatment for uremia and other kidney diseases and it combines the advantages of Chinese therapy and western therapy. Immunotherapy consists of six steps including immune diagnosis, immune clearance, immune blockage, immune tolerance, immune regulation and immune protection. It can not only alleviate symptoms but also aim at repairing at kidney damages, improving kidney functions and enhancing immunity. Since there are about 95% kidney diseases are caused by dysfunction and disorders in immune system, that is why immunotherapy can have durable effects on uremia.
Back top1. Uremia patients should have low-protein diet to reduce the kidneys' burdens. Excessive intake of protein will produce many nitrogenous metabolic wastes and other toxins. The accumulation of wastes in the body will further damage the kidney functions. Since the protein intake is less, so patients should have high-quality proteins like eggs, milk and other animal proteins instead of vegetable proteins.
2. More energy should be provided to reduce the metabolism of the proteins so as to lower the chance of nitremia.
3. Low-phosphorus diets can help reduce the deposition of calcium in the kidneys, therefore foods that are rich in phosphorus such as yeast, mushroom, pumpkin seeds, watermelon seeds, etc should be controlled.
Back topUremia is end stage renal failure and it is irreversible, therefore the prognosis is poor if not treated well. The prognosis depends on two factors. One is the primary kidney disease and the other are various complications and risk factors. In case of the complication of hypertension the prognosis is the worst. If these complications and risk factors can be controlled well, the illness condition can be relatively stable.
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