Chronic Kidney Insufficiency

Chronic Kidney Insufficiency
Chronic Kidney Insufficiency refers to primary kidney disease or secondary kidney disease continuous progression leading to kidney function continuous decrease until to renal failure, and thus occurs to metabolic product retention, water, electrolyte, acid-base balance disorder and all organs and tissues involvements and such a series of clinical syndrome.
The Clinical Stages of Kidney Insufficiency
National Standard
StagesCcr (ml/min)Creatinine (umol/L)
Renal function compensatory stage50--80133--177
Renal function decompensatory period20--50 186--442
Renal failure stage10--20 451--707
Uremia stage below10Above 707
International Standard
stagesymptomsGFR ml/minPrevention and treatment measures
stage IKidney disease occurring> 90 Relieve symptoms and reduce CKD progression
Stage IIGFR slight decrease60--89 Evaluate and reduce CKD progression, reduce cardiovascular complications
Stage III GFR middle decrease30--59 Reduce CKD progression and treating complications
Stage IVGFR severe decrease15--29 Systemic treatment and preparing dialysis
Stage V GFR(kidney failure)<15 If occurring to Uremia, patients should receive dialysis timely.
The Pathogenesis of Chronic Kidney Insufficiency
The essence of Chronic Kidney Insufficiency is kidney pathological changes. The final reason is intrinsic cells damage due to various factors and then it caused fibrous tissue proliferation, resulted to glomerular sclerosis and interstitial fibrosis, normal kidney structure damaged and functional nephron replaced by fibrous tissues. The decline level of renal function and renal fibrosis is in direct proportion.
The Factors Which Can Worsen Kidney Insufficiency Progression.
1. Hypertension: hypertension may not only accelerate kidney damage progression, but also may damage heart, brain and other vital organs.
2. Proteinuria: large volume of proteinuria may worsen the damage of glomerular and tubular, promote the progression of glomerulosclerosis and interstitial fibrosis.
3. High protein diet: high protein diet may cause high glomerular filtration and high tubular metabolism. If the Urine Protein ++ continues for one year, the GFR may decrease 10%-20%.
4. in function of Uremia: such as Methylguanidine, Parathyrin and henols, they all have toxin to kidneys.
5. erlipidemia: Hyperlipidemia may cause damage to glomerular mesangial cell and endotheliocyte cells and stimulate mesangial cell secreting extracellular matrix or induce glomerular mesangial cells apoptosis.
6. Chronic Hypoxia: Chronic Hypoxia may activate Angiotension II and certain growth factors and induce extracellular matrix increasing and then accelerate tubular---interstitial damage which plays an important role in renal tissue sclerosis and fibrosis.
7. Glomerular ischemia: the role of glomerular ischemia in interstitial fibrosis has been stressed. And it is also closely related with tubular atrophy and interstitial fibrosis.
The Dangerous Factors Which Can rapidly Worsen Chronic Kidney Insufficiency.
1. The diseases involved to kidneys recurrence or worsen.
2. Hypovolemia, low blood pressure, dehydration, shock and so on.
3. The renal local blood supplement rapidly reduce, such as artery stenosis or use ACEI, ARB and such drugs
4. Tissue injury or massive hemorrhage.
5. Serious infection
6. Renal toxic drugs
7. Severe hypertension which is unable to control.
8. Urinary tract blocking
9. Others: such as hypercalcemia, hypercoagulable or hyperviscosity, serious malnutrition and so on.
The Clinical Symptoms of Chronic Kidney Insufficiency
For Chronic Kidney Insufficiency, according to different clinical stages, the clinical symptoms may involve to all systems in the whole body, from slight to severe, from less to more.
1. Balance disorder of Water and electrolyte: water metabolic disorder presents urine concentration decrease leading to nocturia increase and specific gravity decrease. The electrolyte disorder includes low sodium, high potassium, low calcium, high phosphorus and high magnesium and so on.
2. Acid-base balance disorder: all patients with kidney failure may have different levels of metabolic acidosis, may have fatigue, poor appetite, the blood PH decline and HCO3 decline
3. Anemia: all patients with kidney failure have different levels of anemia.Generally speaking, the level of anemia is coinciding with the level of the disease. If the anemia is occurring earlier in interstitial damage, and the degree of the damage is not coinciding.
4. Hypertension: most of patients with kidney failure have different levels of hypertension, some of them may have refractory hypertension.
5. Heart insufficiency: it is the common complication and death cause.
6. Digestive system disorder: patients may have anorexia, nausea, vomiting, diarrhea, gastrointestinal bleeding and so on.
7. Respiratory system: when the patient is in serious acidosis, they may have deep respiration, and pulmonary edema
8. Nerve and mental disorder: patients may have uremic encephalopathy, peripheral neuropathy, its manifestation is restless legs syndrome.
9. Metabolic & endocrine disorder: The manifestation is metabolic disorder of carbohydrate-lipid-protein.
The Treatment of Chronic Kidney Insufficiency.
1. The general treatment: patients should pay attention to the diet, following the principle of ‘five low and one high’ (five low means: low potassium, low salt, low phosphorus, low lipid, low protein; one high means: high vitamin), pay attention to have rest and not catch cold and so on.
2. Symptomatic treatment:
1) To correct acidosis: when the carbon dioxide combing power is at 16--13mmol/L, patients may take some sodium bicarbonate and such alkaline drugs by oral taken or by vein injecting .
2) To correct low calcium and hyperkalemia: The common calcium supplement drugs include: calcium carbonate, Rocaltrol, Calcitriol, Caltrate and so on. Control hyperkalemia may use: oral taken ion-exchange resin, vein injecting calcium gluconate, intravenous drip 10% glucose 500 ml with 10 units insulin, and using diuresis to remove potassium. When the potassium is more than 6.5mmol/L, patients will prepare for dialysis.
3) To control hypertension: Some antihypertensive medicine can be used together, But one thing should be cared that when the serum creatinine is more than 264mmol/L, the ACEI and ARB should be used cautiously. It would be better if the blood pressure is to be controlled at 140/90 and 125/75
4) To correct Anemia: The common treatment is EPO subcutaneous injection and chalybeate supplying, etc.
5) To improve renal blood circulation: The common Chinese herbal drugs to promote blood circulation to remove blood stasis are: Salviae Miltiorrhizae, Flos Carthami, Herba Erigernotis and so on. The common western medicine is Sodium Ferulate,etc.
6) Treatment of other complications and primary diseases.

7) Dialysis: the indicators: for Diabetes, the creatinine is more than 530 mmol/L. For non-diabetes, the creatinine is more than 707 mmol/L, blood potassium more than 6.5 mmol/L, or patients have heart failure, refractory hypertension and so on.