2015年9月16日星期三

Chronic renal failure principles and contents of the non-dialysis

Chronic kidney disease patients in the event of renal dysfunction, no matter what its original cause is, regardless of whether their primary disease has stabilized, the deterioration of the patient's kidney function as previously described will continue to progress, the performance characteristics of its irreversible. Non-dialysis therapy purpose is to delay, stop early and mid chronic renal failure patients further deterioration of renal function. Such therapy is currently also used as adjuvant therapy in chronic hemodialysis patients. Its content includes the following aspects:
1. nutrition therapy: to ensure that patients have adequate heat intake per day per kilogram of body weight per day 30 ~ 40kcal sufficient heat into the excessive amount available to ensure that no break down proteins. Protein intake should be high quality low volume principle. When the patient serum creatinine increase up 176.8μmol / l (2mg / dl), the daily intake of protein per kilogram of body weight is 0.6g, where high-quality (animal) protein intake should account for 50%. More patients for serum creatinine increased, protein intake should be reduced. In order to maintain the body without excessive decomposition of protein, essential amino acids can be added with, a- a- keto acids and hydroxy acids. Water-soluble vitamin b family and vitamin c, d should give active vitamin supplement.
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2. maintain water and electrolyte balance, correct acidosis: in water, sodium retention and hypertension patient stay, water intake does not have to be strictly controlled, the daily salt intake to about 3g. Chronic renal failure patients often hyperkalemia, should be actively treated. When serum potassium> 5.5mmol / l, the available drop oral potassium resin. Patients who should be actively correct the acidosis.
3. Control of hypertension and (or) glomerular capillary hypertension: hypertension glomerular sclerosis, so patients with renal insufficiency must be very good control of their blood pressure. ace inhibitors and angiotensin ⅱ receptor antagonists will not only reduce systemic hypertension and may reduce renal hypertension (with or without systemic hypertension) it may be used. But if the patient serum creatinine increase of up to 275 ~ 350μmol / l, or a single kidney, renal artery stenosis, or the elderly, the use of such agents can cause abrupt deterioration of renal function, it should be used with caution or not.
4. Clear the body of toxic metabolites: oral adsorbent or mannitol salt formulation and rhubarb (or plus calcined oyster, dandelion decoction enema), by increasing the excretion of the intestinal tract of toxic metabolites.
5. Other: As previously mentioned various aspects of chronic renal failure patients the body are affected, so the variety of clinical manifestations, should be closely observed give timely symptomatic treatment. Such as anemia patients treated with erythropoietin treatment, most patients can achieve good results.
Chronic kidney disease patients in the event of renal dysfunction, no matter what its original cause is, regardless of whether their primary disease has stabilized, the deterioration of the patient's kidney function as previously described will continue to progress, the performance characteristics of its irreversible. Non-dialysis therapy purpose is to delay, stop early and mid chronic renal failure patients further deterioration of renal function. Such therapy is currently also used as adjuvant therapy in chronic hemodialysis patients. Its content includes the following aspects:
1. nutrition therapy: to ensure that patients have adequate heat intake per day per kilogram of body weight per day 30 ~ 40kcal sufficient heat into the excessive amount available to ensure that no break down proteins. Protein intake should be high quality low volume principle. When the patient serum creatinine increase up 176.8μmol / l (2mg / dl), the daily intake of protein per kilogram of body weight is 0.6g, where high-quality (animal) protein intake should account for 50%. More patients for serum creatinine increased, protein intake should be reduced. In order to maintain the body without excessive decomposition of protein, essential amino acids can be added with, a- a- keto acids and hydroxy acids. Water-soluble vitamin b family and vitamin c, d should give active vitamin supplement.
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2. maintain water and electrolyte balance, correct acidosis: in water, sodium retention and hypertension patient stay, water intake does not have to be strictly controlled, the daily salt intake to about 3g. Chronic renal failure patients often hyperkalemia, should be actively treated. When serum potassium> 5.5mmol / l, the available drop oral potassium resin. Patients who should be actively correct the acidosis.
3. Control of hypertension and (or) glomerular capillary hypertension: hypertension glomerular sclerosis, so patients with renal insufficiency must be very good control of their blood pressure. ace inhibitors and angiotensin ⅱ receptor antagonists will not only reduce systemic hypertension and may reduce renal hypertension (with or without systemic hypertension) it may be used. But if the patient serum creatinine increase of up to 275 ~ 350μmol / l, or a single kidney, renal artery stenosis, or the elderly, the use of such agents can cause abrupt deterioration of renal function, it should be used with caution or not.
4. Clear the body of toxic metabolites: oral adsorbent or mannitol salt formulation and rhubarb (or plus calcined oyster, dandelion decoction enema), by increasing the excretion of the intestinal tract of toxic metabolites.

5. Other: As previously mentioned various aspects of chronic renal failure patients the body are affected, so the variety of clinical manifestations, should be closely observed give timely symptomatic treatment. Such as anemia patients treated with erythropoietin treatment, most patients can achieve good results.

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