Regarding the relationship between chronic kidney disease and uremia, kidney friends need to correct 4 misunderstandings

Zhou Xun, Chief Physician, Department of Nephrology

Do you know? Currently, there are approximately 132 million people suffering from chronic kidney disease (CKD) in my country, and more than 700,000 uremia patients are receiving dialysis, and this number is increasing year by year. Many kidney diseases seen in daily life are chronic kidney diseases, such as IgA nephropathy in primary glomerulonephritis, minimal change disease, mesangial proliferative nephritis, membranous nephropathy, membranoproliferative nephritis and focal segmental nephritis. Glomerulosclerosis, etc., lupus nephritis, hepatitis B virus related nephritis, allergic purpura nephritis and diabetic nephropathy in secondary glomerulonephritis, analgesic nephropathy, chronic pyelonephritis, uric acid in renal tubulointerstitial injury Sexual nephropathy, hypertensive renal damage and aristolochic acid nephropathy, as well as hereditary kidney diseases such as polycystic kidney disease and hereditary nephritis, all belong to the category of chronic kidney disease. Among the causes of uremia, these chronic kidney diseases are possible. Which type of kidney disease is more likely to develop into uremia depends on many factors, such as the type of underlying kidney disease, the efficacy of drugs, the control of related indicators and the patient's own management status, etc.

Therefore, it can be said that the relationship between chronic kidney disease and uremia is very close. However, regarding the relationship between chronic kidney disease and uremia, kidney friends still need to correct the following four misunderstandings.

Misconception 1: Chronic kidney disease can easily develop into uremia

It is a misconception that "chronic kidney disease can easily develop into uremia". In other words, the vast majority of chronic kidney diseases will not develop into uremia. According to statistics, only about 1-2% of chronic kidney diseases eventually progress to uremia, that is, more than 98% of chronic kidney diseases will not develop into uremia that requires dialysis or kidney transplantation. Almost all simple hematuria, more than 99% of minimal change nephropathy, most IgA nephropathy, most membranous nephropathy, and a very high proportion of lupus nephritis and hypertensive renal damage will not develop into uremia. Some stage V diabetic nephropathy, polycystic kidney disease and hereditary nephritis are prone to develop into uremia.

Misconception 2: Chronic renal insufficiency will all develop into uremia

It is also a misconception to think that "chronic renal insufficiency will all develop into uremia". In the early stage of chronic renal insufficiency or chronic kidney disease stage 2-3a, with active and standardized treatment, the kidney disease can develop very slowly or not at all, and the patient may die before the normal life span (70-80 years old). Does not become uremic. Especially those with low urinary protein drop, blood pressure always under control, basic kidney disease not serious, IgA nephropathy, chronic nephritis, Henoch-Schonlein purpura nephritis, drug-related tubulointerstitial nephritis, hypertensive renal damage and infection-related Tubulointerstitial nephritis, etc., even if they have been diagnosed as early stage chronic renal insufficiency or chronic kidney disease stage 2-3a, there is a hope that they will not have uremia.

Misconception 3: Chronic kidney disease must be irreversible if its blood creatinine is high.

It is also a misconception that "chronic kidney disease must be irreversible if its blood creatinine is high". As mentioned above, various chronic kidney diseases can cause an increase in serum creatinine, some of which are related to chronic renal insufficiency, and some are related to acute kidney injury or idiopathic acute renal failure. For example, membranous nephropathy is complicated by idiopathic acute renal failure, IgA nephropathy is complicated by infection-related acute kidney injury, nephrotic syndrome is prerenal acute kidney injury caused by insufficient blood volume, etc., and glucocorticoids and anti-infection drugs are given respectively. Serum creatinine can be reversed with corresponding treatments such as rehydration and rehydration. Only those patients with chronic renal failure whose slowly elevated serum creatinine is irreversible.

Misconception 4: Uremia all develops from chronic kidney disease

It is also a misconception that “uremia all develops from chronic kidney disease” . It can only be said that the vast majority of uremia develops from chronic kidney disease. In addition, a small number of acute kidney diseases will also evolve into uremia. For example, acute glomerulonephritis, rapidly progressive nephritis, acute tubular necrosis, and acute allergic interstitial nephritis may also become the uremic stage of chronic renal failure if they are not treated in time or are not properly treated. . Especially among them, rapidly progressive nephritis (also called crescentic nephritis) will develop if hormone-based treatment is not taken promptly and the patient's cellular crescents turn into cellular fibrous crescents or fibrous crescents. It becomes irreversible uremia, and ultimately the only way to survive is through long-term dialysis or kidney transplantation.

Got it? I hope kidney friends can correct these misunderstandings and point the way for our kidney health.