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Zhou Qi
Nephrology
About me
An associate chief physician in the Nephrology Department of the People's Hospital of Ma'anshan City, with a Master's degree from a key medical university. Participated or led multiple projects funded by the Natural Science Foundation, and published nearly ten papers in Chinese and core journals.
Proficient in diseases
Glomerular diseases, diabetic nephropathy, lupus nephritis, blood purification.
Voices
Chronic Kidney Failure Various Indicators
In patients with chronic kidney failure, the primary indicator to observe is obviously kidney function. It is essential to regularly monitor the patient's blood creatinine and urea nitrogen levels, which are generally required to be tested every 1 to 3 months when chronic kidney failure is stable. Additionally, urine output should be monitored. If there is a decrease in urine output and swelling occurs, it may indicate that the patient's kidney function is continuously deteriorating. A complete blood count should also be checked to observe changes in the patient's anemia status. Chronic kidney failure often causes hypertension, so blood pressure monitoring is also necessary for these patients. Electrolyte monitoring is important as kidney failure can lead to disturbances in calcium and phosphorus metabolism and subsequent secondary hyperparathyroidism. Therefore, the levels of calcium, phosphorus, and parathyroid hormone also need to be tested.
How to reduce proteinuria in diabetic nephropathy.
A major clinical feature of diabetic nephropathy is the occurrence of proteinuria, which, if the condition continues to progress, can lead to kidney failure. Controlling proteinuria in the early stages of the disease is indeed very important. In terms of treatment, it is primarily necessary to use medications or insulin to control the patient's blood sugar, as hyperglycemia is the fundamental cause of diabetic nephropathy. Additionally, these patients often also have hypertension, necessitating the use of antihypertensive drugs to control blood pressure. When the patient's kidney function is not severely impaired, ACE inhibitors or ARBs can be the preferred choice of antihypertensive drugs, as they not only control blood pressure but also reduce proteinuria. However, if the patient's serum creatinine is significantly elevated, such as over 264 µmol/L, these drugs should no longer be used. (Medications should be used under the guidance of a doctor.)
Is nephrotic syndrome easy to treat in children?
The diagnostic criteria for nephrotic syndrome are a 24-hour urinary protein quantification exceeding 3.5g and plasma albumin levels below 30g/l. This is due to severe damage to the glomerular capillary network, which has many pathological types since there are various components to the glomerular capillaries, and damage to different components is referred to as different pathological types. Among children, the most common pathological types are minimal change disease and mesangial proliferative glomerulonephritis. These two types are relatively easier to treat. Most children are sensitive to steroid medication. However, treatment becomes difficult with other pathological types, such as focal segmental glomerulosclerosis, which shows less sensitivity to steroids. (Medication use should be under the guidance of a doctor.)
Can poor kidney function cause hair loss?
Poor kidney function is actually not significantly related to hair loss. Even in severe cases of kidney failure or patients with uremia, most still retain their hair. Not all patients with uremia experience hair loss. Thus, there is not much of a connection between kidney function and hair growth. If a patient is experiencing hair loss, it could be due to issues with the skin or scalp itself, such as male pattern baldness which is related to an excess of androgens in the hair follicles, or factors like allergies or fungal infections could also cause hair loss.
Is diabetic nephropathy stage 3 reversible?
Patients with diabetic nephropathy actually have an irreversible condition. If a patient has developed mild to moderate proteinuria and entered stage three, it's generally because of long-term high blood sugar, oxidative stress, and an excess of glycation end products damaging the capillaries of the glomerulus, resulting in increased permeability and the occurrence of proteinuria. The damage that has already occurred cannot be reversed; however, patients still need active treatment to control their blood sugar and blood pressure in order to slow down the progression of diabetic nephropathy as much as possible. Stage three diabetic nephropathy is incurable, but treatment can slow the progression of the kidney disease, preventing the development from microalbuminuria to macroalbuminuria. Stage three refers to the early period of diabetic nephropathy, typically seen in diabetic patients who have had the disease for more than five years. It can feature a continuous increase in urinary albumin excretion rates. High filtration rates and long-term poor metabolic control may be reasons for the persistent microalbuminuria. During this stage, patients may experience a mild increase in blood pressure, and reducing blood pressure can decrease the excretion of microalbumin. During this period, strict control of blood sugar is necessary. Oral hypoglycemic drugs can be used for treatment, and it's crucial to regularly monitor fasting blood glucose, postprandial blood glucose, and glycated hemoglobin. Blood pressure should also be actively controlled, generally targeting a value of 130/80mmHg. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are preferred as they can lower blood pressure, reduce proteinuria, and have a protective effect on the kidneys, thus delaying the progression of kidney disease.
Can kidney cancer patients be contagious?
Kidney cancer is not an infectious disease, so it is not contagious. Kidney cancer actually occurs when carcinogenic changes happen in the epithelial cells of the renal tubules, leading to the formation of masses and blood in the urine within the kidneys, and can even cause kidney failure. Moreover, kidney cancer carries a certain risk of metastasis, potentially causing damage to other organs. This disease is not contagious. The so-called infectiousness of a disease is due to the presence of pathogens that can cause infection. For example, hepatitis B can be transmitted because carriers have the hepatitis B virus in their bodies. Kidney cancer, however, does not involve viruses, bacteria, or fungi, so it is not infectious.
How is IgA nephropathy diagnosed?
The diagnosis of IgA nephropathy relies on pathological examination. The name "IgA nephropathy" itself is a term used in immunopathological diagnosis, describing a type of chronic glomerulonephritis. There are many reasons that can cause inflammatory reactions in the kidneys, and the underlying mechanisms of the disease vary. Specifically, IgA nephropathy refers to the abnormal deposition of IgA immune complexes in the mesangial areas of the glomeruli. Therefore, a pathological examination is necessary for diagnosis. Typically, under a light microscope, proliferation of mesangial cells and widening of the mesangial areas can be observed. Additionally, immunofluorescence testing is conducted to detect a large presence of IgA immune complexes in the glomerular mesangial areas, confirming the diagnosis of IgA nephropathy.
Is uremia hereditary?
Uremia is not actually an independent disease, so it's difficult to say that uremia is hereditary. Uremia refers to a condition where the kidneys are 90% damaged. However, there are many reasons that can cause more than 90% of kidney tissue damage; among these, some are genetic diseases, but most are not hereditary. Common causes of hereditary uremia include diabetes, as well as primary chronic glomerulonephritis, hypertension, urinary system stones, and even prostate tumors, allergic purpura, etc., which can all cause kidney damage. These factors are generally not genetic diseases. However, there are very few causes of uremia that are genetic diseases, mainly including autosomal dominant polycystic kidney disease.
What should I do if I have hydronephrosis and atrophy?
Hydronephrosis leading to kidney shrinkage indicates that the condition has persisted for a long time. Long-term hydronephrosis places significant pressure on the kidneys, which in turn compresses the kidney tissues causing tissue shrinkage. The destruction and shrinkage of tissues result in the kidneys' inability to function properly, leading to azotemia. Patients will experience chronic kidney failure, a situation that is difficult to reverse. Even if surgery is performed to relieve the obstruction and allow urine to be excreted, the damaged kidney tissue cannot regenerate. Therefore, it is still necessary to relieve the obstruction as soon as possible to avoid further damage to the remaining kidney tissue. For patients who have progressed to uremia, it may be necessary to consider hemodialysis or peritoneal dialysis, or undertake a kidney transplant to sustain life.
Chronic renal failure inevitably has symptoms.
Patients with chronic kidney failure do not necessarily have symptoms, and the symptoms of each patient are not exactly the same. Chronic kidney failure refers to the damage to the kidneys by various chronic kidney diseases, eventually leading to the kidneys' inability to adequately excrete metabolic waste, causing the accumulation of water and metabolic waste in the body. This leads to disturbances in the patient's electrolytes and may also present clinical symptoms such as anemia and hypertension. However, not all patients feel discomfort, so chronic kidney failure is also known as the silent killer. If a patient undergoes a blood test, it will show an increase in blood creatinine and urea nitrogen, which is the only common feature among all patients with chronic kidney failure.