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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
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.)
Early symptoms of acute nephritis
The occurrence of acute nephritis is related to streptococcal infections and is commonly seen in children. Typically, 1-3 weeks before the onset of acute nephritis, patients often have a history of infections in the throat, upper respiratory tract, or skin. Once acute nephritis occurs, the initial symptoms include hematuria, which can manifest as either gross or microscopic hematuria. There is also the appearance of edema, especially noticeable swelling of the eyelids and facial area upon waking up in the morning, and even a decrease in urine output. Additionally, patients with acute nephritis often experience increased foam in the urine, indicating the presence of proteinuria, as well as general weakness, back pain, nausea, and vomiting. After the onset of acute nephritis, some patients may experience elevated blood pressure and even transient renal failure.
What are the symptoms of acute nephritis?
Acute nephritis is commonly seen in children, and in cases of acute nephritis in children, it is often preceded by an upper respiratory tract infection or skin infection one to three weeks prior to the onset. Once acute nephritis occurs, the most prominent clinical symptom in patients is gross hematuria, though some individuals only show microscopic hematuria, accompanied by an increase in urinary proteins. Additionally, patients with acute nephritis may experience swelling of the eyelids and lower limbs, especially noticeable swelling of the eyelids and facial area upon waking in the morning. Some patients may also experience elevated blood pressure, leading to symptoms such as dizziness and headache. A few may suffer from nausea, vomiting, loss of appetite, reduced urine output, or even symptoms of acute renal failure.
Does stage 2 IgA nephropathy require treatment?
IgA nephropathy can be divided into five stages, where stages one to two are relatively mild, early stages, and generally have a good prognosis. For patients with stage two IgA nephropathy, it is rare for the condition to progress to uremia, but whether treatment is needed largely depends on the clinical manifestations of the IgA nephropathy. If a patient with IgA nephropathy has a 24-hour urinary protein quantification greater than 0.5g, it is advisable to use an angiotensin-converting enzyme inhibitor or an angiotensin II receptor antagonist to protect kidney function and reduce urinary protein. If a stage two IgA nephropathy patient only shows microscopic hematuria, drug treatment is not necessary. However, routine urinalysis and kidney function monitoring should be conducted in daily life, and if an infection occurs, timely anti-infection treatment should be administered. If a stage two IgA nephropathy patient has significant proteinuria, steroid treatment is often required. (Medication should be taken under the guidance of a doctor.)
How is IgA nephropathy caused?
IgA nephropathy is a common glomerular disease and a major cause of uremia. However, the exact cause of IgA nephropathy is not very clear. Current research suggests that it is caused by factors such as infections which stimulate the production of autoantibodies, forming immune complexes that deposit in the glomeruli. This leads to inflammation of the glomeruli, eventually stimulating mesangial cell proliferation and accumulation of extracellular matrix, causing glomerulosclerosis and interstitial fibrosis. IgA nephropathy is a very covert disease, often presenting as asymptomatic hematuria or increased urine protein. Many patients discover this condition incidentally during physical examinations. Some individuals have a history of upper respiratory or gastrointestinal infections before the onset of the disease, followed by the discovery of gross hematuria. IgA nephropathy is more common in children and adolescents.
How should acute nephritis be treated?
Patients with acute nephritis generally have a good prognosis after reasonable and standardized treatment, and rarely develop into chronic nephritis. The main means of treating acute nephritis is symptomatic supportive care, requiring patients to rest in bed during the acute phase. At the same time, spicy food should be avoided and salt intake should be appropriately controlled. If the patient has an infection, sensitive antibiotics should be actively selected for treatment. Additionally, diuretics can be appropriately used for patients with edema, and if the patient also has hypertension, antihypertensive drugs may be used to keep blood pressure within an appropriate range. Of course, some severe cases of acute nephritis may lead to heart failure or renal failure, in which case dialysis should be actively pursued. (Specific medication use should be carried out under the guidance of a doctor.)
How is hypertensive nephropathy treated?
Long-term hypertension can lead to abnormal kidney structure and function, also known as hypertensive nephropathy. Once hypertensive nephropathy is diagnosed, comprehensive treatment measures are often adopted, including both pharmacological and non-pharmacological treatments. In terms of non-pharmacological treatment, patients should maintain a low-salt diet in their daily life, focusing on a light diet, with a daily salt intake of about 4 grams. Regarding pharmacological treatment, the main goal is to control the patient's blood pressure and reduce urinary protein. Medications that can be used include angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists. Any of these medications can be chosen and used long-term to control blood pressure, protect kidney function, and reduce urinary protein. (Medications should be used under the guidance of a physician, and self-medication should be avoided.)
Symptoms of pre-uremia
The pre-uremic stage is the period of chronic renal failure. During the pre-uremic stage, many patients may have no symptoms at all. However, some patients do experience many uncomfortable symptoms, such as back soreness and weakness, fatigue, and feeling cold easily. During this stage, patients may also experience nausea and vomiting, especially pronounced nausea after waking up in the morning, as well as weight loss. Some patients in the pre-uremic stage exhibit symptoms of edema, which can occur in the eyelids, facial area, or in both lower limbs. Additionally, patients may experience feeling cold, anemia, and an increased frequency of urination at night. Of course, some patients may also experience itching of the skin on both lower limbs.