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2012/07/31

Why uremia (end stage renal disease) must dialysis


Uremia two diagnostic criteria in clinical practice, a fourth of the chronic renal insufficiency, chronic renal insufficiency based on the level of serum creatinine in China is divided into four: a renal decompensation, serum creatinine 133-177 (Scr) umol / L; two renal decompensation, serum creatinine (Scr) 177 443umol / L; three renal failure of (uremia early), serum creatinine (Scr) and 443-707umol / L; four uremia, serum creatinine (Scr)> 707umoll / L, respectively. Another is chronic kidney disease (CKD) Stage V chronic kidney disease (CKD) is a foreign based on glomerular filtration rate (GFR) is divided into five: 1 and GFR> 90ml/min/1.73m2; period, GFR, 60-89ml/min/1.73m2; 3, GFR, 30-59ml/min/1.73m2; phase, GFR, 15-29ml/min/1.73m2; and GFR <15ml/min/1.73m2 ( or dialysis).
Uremia, in fact, refers to almost all of fibrosis in kidney tissue, resulting in loss of kidney function, not the human body through the kidneys produce urine, and waste generated by the in vivo metabolism and excessive moisture can not be eliminated from the body, such as glucose, proteins, organic acids , sodium, potassium, sodium bicarbonate, acid-base balance disorders resulting in disorders of the human environment, as well as the endocrine function of kidney abnormalities such as: the secretion of renin, erythropoietin, active vitamin D3, prostaglandin exception. Modern medicine believe that uremia is a complex syndrome of loss of renal function, the body's internal biochemical processes generated by the disorder. Not an independent disease, known as renal failure syndrome, or referred to renal failure.
Uremic kidney failure as the disease progress metabolic disorders caused by the poison of the results. Uremia is not terrible, terrible complications of uremia, in particular, to uremia advanced, involving the heart, lungs, liver, spleen and other organs and systems, and each type of complications are life-threatening, so it should be from the early high degree of attention.
From the Western point of view, clinical serum creatinine (Scr)> 707, will be carried out hemodialysis, but the serum creatinine level is not the only indicator of hemodialysis. In conjunction with the general vital signs of patients with uremia, symptoms, clinical manifestations, and supporting test results to assess the condition, does require dialysis must be timely or urgent dialysis.
Dialysis is the artificial kidney - dialysis membrane and dialysis machines to remove kidney failure when the patient's body more water, toxins, to correct electrolyte and acid-base disorders. Dialysis membrane to separate the blood and dialysate cleared from the serum by the principle of diffusion and convection of water and toxins from the dialysate to supplement the lack of substance, such as alkaline ions and calcium ions. In general, the purpose of dialysis is to quickly bring down the body of water and toxins, alleviate the symptoms of uremic patients, prevention of complications.
Uremic patients due to the role of renal hypertension, acidosis, hyperkalemia, sodium and water retention, anemia, and toxic substances such as heart failure, arrhythmias and myocardial damage. Stimulate the role of urea (and possibly acid) can also occur aseptic pericarditis in patients with heart chest pain, smell and pericardial friction rub on physical examination. Severe pericardial cavity, cellulose and bloody exudate appears.
Dialysis is the most direct way to a rapid elimination of toxins from the body, the body produces a lot of toxins to life-threatening, immediately clear toxins, meet the basic environmental balance in the body, so that life can be maintained, and also bring to the next treatment time.
Another point to emphasize is not the law of dialysis can solve all problems, the control diet, drinking, smoking, alcohol, and to develop good habits, improve immunity.
In general, the weekly dialysis patients, a daily water intake The lOOml and 24 hours of urine output and anuria in patients with daily water intake does not exceed lOOml; patients with dialysis two times a week, daily water intake plus for 300ml 24h urine output and water intake in patients with anuria not more than 300ml; dialysis three times a week, daily water intake for the 500ml plus the amount of urine, the daily water intake in patients with anuria not more than 500ml. Water intake must be limited, otherwise it will result in edema; complications such as hypertension and heart failure. In hemodialysis patients into the water every day how much is good, should be based on the patient's specific circumstances. In principle, Expenditure and Revenues to maintain a balance. The amount of urine, vomiting and diarrhea volume, dominant negative water (400-600ral/24h the) and dialysis dehydration.
Intake including daily water intake, the sum of the water content in food and in vivo metabolism of endogenous water. Determine the water in the body fluid balance is the most simple method is to measure weight, dialysis patients should be weighed in a day, requiring dialysis during the weight increases in the l less than 1.5kg a short period of time the weight changes are result of changes in liquid water in the body. Dialysis patients can not rely on increasing the ultrafiltration to improve the day-to-day into the water, because of the large number of rapid ultrafiltration hemodialysis water will cause the drop in blood pressure, cramps, headaches and other symptoms, and chronic water overload to increase cardiovascular load. The consequences are bad.
As for the management of salt, usually avoid high salt foods such as salted fish, salted egg, bacon, pickles, sauce and a variety of pickled products, oliguria, edema, blood pressure, should be controlled salt intake intake, on behalf of the salt is not abuse. Patients with dialysis three times a week, the daily salt intake of about 4g weekly dialysis patients daily salt intake of 3g.
Therefore, the high toxins in the body of uremic patients to stimulate cholestasis is extremely dangerous to life, we must implement the dialysis quickly to eliminate toxins from the body, meet the basic environmental balance in the body, so that life can be maintained.
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