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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
Can IgA nephropathy hematuria heal itself?
Hematuria is the most common clinical manifestation of IgA nephropathy. As IgA nephropathy is a chronic disease and not self-healing, the hematuria associated with it does not resolve on its own and will repeatedly occur or exacerbate. Typically, patients with IgA nephropathy exhibit microscopic hematuria when the condition is stable. However, gross hematuria may appear during physical exertion or respiratory infections, such as pharyngitis. In addition, IgA nephropathy patients also show increased urinary protein and can experience elevated blood pressure. Back pain is also a common clinical manifestation in patients with IgA nephropathy, so there is no need to be overly concerned about the presence of blood in the urine.
What should I do about acute nephritis?
Once acute nephritis occurs, it should be actively treated. The measures for treatment are that during the acute phase, the patient should rest in bed. The bed rest period is generally 2-3 weeks, and continues until the patient's gross hematuria disappears, blood pressure returns to normal, and edema subsides. In addition to resting, it is also necessary to control salt intake in the diet, especially in cases with edema or high blood pressure, where daily salt intake should generally not exceed 3g. Protein should mainly come from lean meat, fish, eggs, and milk. Furthermore, strict management of water intake is crucial, especially in cases of oliguria, where water consumption should be minimized. Additionally, if there is an infection combined with these conditions, sensitive antibiotics should be used for treatment, usually advocating the use of penicillin-type antibiotics; if there is edema, diuretics can be appropriately used; if blood pressure is elevated, antihypertensive drugs can be used. Besides these, for severe acute nephritis patients who also suffer from acute renal failure, dialysis treatment might be necessary. (Medication use should be conducted under the guidance of a doctor.)
Is uremia serious in the early stages?
In the early stages of uremia, although the condition is not as severe as in full-blown uremia, the patient will still experience many uncomfortable symptoms. For example, after getting up in the morning, the patient may notice swelling in the eyelids on both sides, feel nauseous and have a significant decrease in appetite. They may also feel fatigued and tired after physical activity. Additionally, changes in the volume of urine occur, such as an increase in the frequency of nighttime urination to three to five times. Patients may also experience varying degrees of dizziness, headaches, and gradually increasing blood pressure that is difficult to control. Other symptoms include itchy skin and muscle soreness, among other clinical signs. Therefore, timely treatment in the early stages of uremia is necessary to slow the rapid progression of chronic kidney disease to the uremic stage.
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.