It is true that you only have kidney disease and no other diseases. For example, IgA nephropathy was diagnosed by renal puncture, and there were no diseases such as hypertension and diabetes in the past. Generally speaking, this disease is far lighter than other basic diseases in the same period, and it is relatively easy to treat. In other words, if there are other basic diseases at the same time, it is easier to develop into chronic kidney disease, and the risk of uremia will further increase in the future. Why is this happening? This is because: on the one hand, some abnormal indexes in other diseases may also be factors that promote the progress of chronic kidney disease; On the other hand, other diseases may also damage the kidney during medication, leading to the progress of the disease. Therefore, in order to reduce or avoid the influence of basic diseases on the kidneys, kidney friends should pay different attention to the treatment of basic diseases while treating kidney diseases.
We say that nephropathy with underlying diseases is more likely to occur. If the following eight basic diseases exist at the same time, the emphasis of treatment should be different.
1. The basic disease is hypertension.
Nephropathy complicated with hypertension is a common basic disease, which can be divided into three situations: first, nephropathy caused by hypertension, that is, hypertensive renal damage; Second, hypertension complicated with renal diseases, that is, renal hypertension; 3. Kidney disease and hypertension are two unrelated diseases. In either case, the focus of treatment must be on lowering blood pressure, because hypertension of any cause is a promoting factor for the progress of chronic kidney disease. When using antihypertensive drugs, we should not only consider lowering blood pressure, but also consider whether it can protect the kidneys. If the patient's renal function is already poor, then there will be fewer antihypertensive drugs to choose from, which will be emphasized. For example, if the serum creatinine exceeds 265μmol/L, in principle, sartan or pril drugs cannot be used; Patients with kidney disease with acceptable renal function should try to choose sartan or Pulitzer.
2. The basic disease is diabetes.
Nephropathy with diabetes is becoming more and more common, which can be divided into three situations: one is nephropathy caused by diabetes, that is, diabetic nephropathy; Second, diabetes is a kidney disease that occurs in the process of using hormones and other drugs, such as steroid diabetes; 3. Diabetes and nephropathy are two unrelated diseases. No matter what kind of disease, the focus of treatment is to lower blood sugar. When using hypoglycemic agents, we must consider whether it is beneficial to protect the kidney. We can choose double-specification (such as metformin) or pure-specification (such as dapalezine) hypoglycemic agents as the first choice. If the glomerular filtration rate of patients decreases, the choice of hypoglycemic agents will be different. For example, if the GFR is lower than 45ml/min, dimethyl dicarbonate cannot be used in principle, and so on.
3. The basic disease is chronic hepatitis B..
Nephropathy complicated with chronic hepatitis B is not uncommon, which can be divided into two situations: first, nephropathy complicated with chronic hepatitis B, that is, hepatitis B virus-related nephritis; 2. Nephropathy and chronic hepatitis B are two unrelated diseases. But in any case, these two diseases should be treated at the same time, and the treatment of chronic hepatitis B needs to be based on liver function indicators and hepatitis B virus replication. In the process of treating nephropathy, the attending doctor must consider the damage of drugs to the liver and whether it affects virus replication. Various immunosuppressants may also damage the kidney, and glucocorticoid can cause virus replication, which are the key points and aspects to be considered in treatment.
4. The basic disease is wind-like.
Nephropathy with rheumatoid arthritis, a basic disease, is also very common in clinic, which can be divided into three situations: first, rheumatoid arthritis leads to nephropathy, that is, rheumatoid arthritis kidney damage; 2. Nephropathy is caused by long-term use of antipyretic and tenderness agents in patients with wind-like diseases, that is, analgesic nephropathy; 3. Nephropathy and rheumatoid arthritis are two unrelated diseases. In either case, kidney disease and wind-like diseases must be treated, and which disease is serious should be emphasized. For some cases, such as glomerulonephritis and rheumatic diseases with high urinary protein, one drug can be used to treat two diseases at the same time, such as leflunomide or hydroxychloroquine. If you are still using antipyretic and analgesic drugs (painkillers), you must reduce the dosage or find alternative drugs under the guidance of a doctor.
5. The basic disease is gastrointestinal disease.
Nephropathy complicated with gastrointestinal diseases is also common. Chronic gastritis, gastric and duodenal ulcers, ulcerative colitis and Crohn's disease are all common gastrointestinal diseases. Most of them belong to the coexistence of gastrointestinal diseases and renal diseases, and some patients have certain correlation, but the relationship between them is not very close. However, in the process of treating nephropathy, the attending doctor has to consider the influence of drugs on the digestive system, such as tripterygium wilfordii polyglycoside tablets and other drugs should be taken after meals to reduce the irritation to the gastrointestinal tract; In the process of treating gastrointestinal diseases, the attending doctor must also consider the influence of drugs on patients' renal function, such as omeprazole and other drugs may damage renal function. These are all aspects that need to be considered.
6. The basic disease is anemia.
It is not uncommon for renal diseases to be complicated with anemia, which can also be divided into three situations: first, anemia caused by chronic renal insufficiency; That is, renal anemia is mainly related to the relative or absolute lack of erythropoietin in the body; Second, anemia is due to the combination of multiple system diseases related to nephropathy, such as systemic lupus erythematosus complicated with lupus nephritis and anemia; Third, anemia has nothing to do with kidney disease. For example, anemia is iron deficiency anemia, and patients with kidney disease have normal renal function. No matter what kind of situation you belong to, anemia should be treated, iron deficiency anemia should be supplemented with iron (such as ferrous succinate), and renal anemia should be supplemented with erythropoietin or Roxastat. These should be emphasized.
7. The underlying disease is kidney calculi.
Nephropathy complicated with renal or ureteral calculi is also a common basic disease. Perhaps there is a connection between the two, such as uric acid nephropathy and renal or ureteral calculi; Perhaps there is not much connection between them, such as IgA nephropathy or other glomerulonephritis and kidney calculi's or ureteral calculi. Nephropathy is associated with uric acid nephropathy in kidney calculi. The focus of treatment is to reduce the patient's blood uric acid level as much as possible, and at the same time reduce the concentration of uric acid in urine to prevent further aggravation of urinary calculi. We must carefully choose drugs for reducing uric acid (including promoting excretion or inhibiting production), pay attention to alkalizing urine and drinking more water, which is also the focus of treatment.
8. The underlying disease is obesity.
There is also a basic disease of nephropathy that is complicated by obesity, which can be divided into three situations: one is nephropathy caused by obesity, that is, glomerular lesions related to obesity; Second, the long-term use of certain drugs (such as glucocorticoids) in patients with kidney disease leads to obesity; Third, they are not related to each other. For example, the patient was originally obese and later found to have nephrotic syndrome (membranous nephropathy). In either case, patients must "lose weight" under the guidance of the attending doctor, and all patients need to control their diet and properly strengthen their exercise. Nephropathy patients with glucocorticoid indications should try to find alternative drugs when accurately considering the use of hormones. If there is no substitute medicine, the dosage of hormone and the time of medication should be minimized. This is also the focus of treatment and cannot be ignored.
Of course, there are far more than the above eight kinds of kidney diseases complicated with other basic diseases. Some patients with kidney diseases may be complicated with multiple basic diseases at the same time, which requires patients with kidney diseases and doctors to have different treatment priorities. Remember, doctors and patients should not only pay attention to nephropathy with basic diseases, but also pay attention to it when considering it comprehensively.