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Li Liu Sheng
Nephrology
About me
Master, chief physician, deputy director of nephrology, master supervisor. Presided over and participated in 3 research projects, presided over a project that won the second prize of scientific and technological progress in Yichang City, won a third prize, published 26 papers in core journal magazines, and contributed to the compilation of a monograph "Urology". Member of the Hubei Biomedical Dialysis Engineering Society, youth member of the Hubei Nephrology Society, member of the Yichang Kidney Disease Quality Control Center.
Proficient in diseases
There is unique experience in the diagnosis and treatment of various chronic kidney diseases, including renal biopsy, central venous catheter placement, peritoneal dialysis, hemodialysis, etc.
Voices
Precursors of renal failure
The kidneys have a very strong compensatory ability. When kidney function is slightly impaired, many people do not have any uncomfortable symptoms and feel everything is normal. However, if one actively seeks out early signs, it is possible to detect precursors to kidney failure. At this time, if one can go to the hospital in time for routine blood tests, urine tests, and kidney function tests, it is possible to determine if there is kidney failure. The most obvious precursor symptom of kidney failure is usually general fatigue, which many people tend to overlook. This is because there are indeed many reasons that can cause fatigue, especially since many people attribute it to fatigue or stress factors. Additionally, many patients with precursors to kidney failure experience edema, particularly the kind that disappears after rest, so it is especially not taken seriously. Another symptom of kidney failure precursors is a significant increase in the frequency of urination at night, which is also often overlooked.
Acute nephritis etiology and pathogenesis
The primary cause of acute nephritis is related to antigen-antibody mediated immune damage. This means that when patients with acute nephritis are infected by streptococci, certain components within the streptococci can act as antigens and bind to corresponding antibodies produced in the body, forming immune complexes. These immune complexes circulate through the bloodstream and eventually deposit in the glomeruli. When the complement system is activated, inflammatory cells infiltrate, ultimately leading to the development of acute nephritis. Acute nephritis is a common group of primary glomerular diseases, characterized by a sudden onset, with hematuria, reduced urine output, proteinuria, edema, and hypertension as its most significant features. Once acute nephritis occurs, bed rest is usually required, along with active treatment. After treatment, most patients with acute nephritis can recover fully, with few recurrences.
Acute nephritis clinical manifestations
Acute nephritis is commonly seen in pediatric patients. One to three weeks before the onset of acute nephritis, infections often occur in the throat, upper respiratory tract, and skin. Once acute nephritis occurs, the typical clinical manifestations of the patient are hematuria, which can be gross hematuria or microscopic hematuria. There is also edema, especially noticeable swelling of the eyelids and face after getting up in the morning. Due to the edema and reduced urine output, the patient often experiences a significant increase in blood pressure. Of course, in addition to these clinical manifestations, the patient may also experience irritability, back pain, nausea, loss of appetite, and poor spirit. Patients with acute nephritis can also experience severe complications, such as hypertensive encephalopathy, acute heart failure, acute renal failure, etc. Therefore, acute nephritis must be given sufficient attention and actively treated.
Foods to Avoid with IgA Nephropathy
IgA nephropathy patients are a very common type of glomerular disease. For IgA nephropathy patients, it is crucial to adhere to a light diet, meaning they should avoid foods such as pickles, salted vegetables, kimchi, cured products, smoked products, and barbecues, focusing primarily on fresh vegetables and fruits. Of course, if IgA nephropathy patients also suffer from renal insufficiency, they must avoid various soy products including tofu, bean sprouts, soybean sprouts, mung bean sprouts, and nut-based foods. These foods contain a lot of plant proteins, which can increase the burden on the kidneys, leading to potential renal insufficiency. Additionally, they should not consume foods high in potassium, such as oranges, bananas, pineapples, etc. Therefore, it is essential for IgA nephropathy patients to be cautious with their diet.
Conditions for discontinuing medication for nephrotic syndrome
The main clinical manifestations of nephrotic syndrome are significant proteinuria and hypoproteinemia, along with varying degrees of hyperlipidemia and edema. Nephrotic syndrome often requires treatment with corticosteroids. The general principle for using steroids is to start with a sufficient dosage and administer it slowly, maintaining it for a long duration, approximately around one year. Therefore, the conditions for discontinuing medication in nephrotic syndrome include: if the patient has been treated with steroids for about a year, and the proteinuria has resolved, 24-hour urinary protein quantification is normal, there is no edema, blood albumin levels have returned to normal, and kidney function is also normal, then discontinuation of steroid treatment can be considered. Of course, after stopping the medication, it is essential to regularly visit the hospital for monitoring of routine urine tests, kidney function, and blood pressure to prevent the recurrence of nephrotic syndrome due to infections or fatigue.
Does uremia transmit to others?
Uremia is not contagious to others because it is not an infectious disease. Uremia is a severe renal failure, so patients with uremia can interact, communicate, live, work, and study with healthy people without the need for gastrointestinal or respiratory isolation. Normally, if a patient with uremia is stable, they can engage in sexual activities and the disease will not be transmitted through sexual contact. Uremia usually presents symptoms such as nausea, vomiting, edema, and increased blood pressure. Therefore, patients with uremia need to undergo dialysis treatment. They can choose either hemodialysis or peritoneal dialysis. Dialysis treatment can significantly improve the symptoms of uremia and enhance the quality of life of the patients.
Symptoms of acute nephritis include back pain.
Patients with acute nephritis usually have hematuria as their main symptom. Initially, the condition presents as gross hematuria, but within 1-2 days, the patient transitions to microscopic hematuria, and the gross hematuria disappears. Patients may also experience edema, particularly noticeable in the eyelids and facial area upon waking up in the morning, along with varying degrees of increased urine protein. Typically, acute nephritis patients may also experience nausea, vomiting, abdominal distension, and discomfort in the lower back, but not back pain per se, as back pain is not a symptom of acute nephritis. However, if a patient with acute nephritis does develop back pain, it is crucial to rule out other diseases, such as kidney stones, ureteral stones, acute pyelonephritis, and acute renal infarction, all of which can cause sudden back pain in patients with acute nephritis. Back pain should be taken seriously, and appropriate exams, such as an immediate ultrasound, should be conducted.
What to do if acute nephritis worsens?
Typically, after two to three weeks of treatment, the condition of most patients with acute nephritis can recover. However, if the condition of acute nephritis worsens, patients should return to bed rest and adopt different treatment methods based on their clinical symptoms. If the patient presents with edema, it is essential to maintain a low-salt diet, with daily salt intake less than 2-3 grams. Additionally, the patient's blood pressure must be addressed. If there is a significant rise in blood pressure, it is advisable to start with a low dose of diuretics, which can facilitate urination, fluid excretion, and lower blood pressure. If blood pressure control is inadequate, calcium channel blockers should be considered. Moreover, if a patient with acute nephritis develops acute renal failure, dialysis treatment may be necessary; similarly, if acute heart failure occurs, medications to control blood pressure and dilate blood vessels should be used to reduce the cardiac workload, thereby facilitating recovery from acute nephritis. (Specific medications should be used under the guidance of a physician.)
Precursors of uremia
The kidneys have a very strong compensatory ability. When kidney function is slightly impaired, they can generally still handle the basic physiological functions of the human body through compensation, so patients may feel that everything is normal. Despite the fact that the occurrence and development of uremia is a long and gradually worsening process, which can sometimes be very severe, it is still possible to detect early signs of uremia if one actively seeks them out early on. Early indications of uremia can be identified in time by going to the hospital for urine and blood tests. The early signs of uremia often manifest as general fatigue, which is the symptom most easily overlooked. Other symptoms of early uremia include edema, especially noticeable swelling of the eyelids and facial area after waking up in the morning. If it develops into systemic or persistent edema, the condition is already very serious. Additionally, early-stage uremia patients may also experience an increase in the frequency of nocturnal urination and more foam in the urine, as well as increased blood pressure, and even dizziness, headaches, and a lack of appetite. These are all early signs of uremia.
How to treat IgA nephropathy?
IgA nephropathy has many clinical manifestations and pathological types, and the treatment of IgA nephropathy is selected based on different clinical manifestations and pathological types. Usually, for patients with IgA nephropathy who only show microscopic hematuria, drug treatment is not necessary. They only need to regularly monitor routine urine tests, kidney function, and blood pressure changes in daily life, and must avoid using medications that are toxic to the kidneys. If the patient presents with gross hematuria related to tonsillar infection, tonsillectomy is recommended. If an IgA nephropathy patient has increased urinary protein, and the 24-hour urinary protein quantification exceeds 1g, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers can be used. Of course, for patients with significant proteinuria, steroids or immunosuppressants may also be used. In addition, IgA nephropathy patients can also be treated with traditional Chinese medicine. (Medication use should be under the guidance of a professional doctor.)