The "heavy" that life cannot bear: What happened to the kidneys of more than 100 million people?
Our reporters Li Bin, Lin Miaomiao, and Gai Boming
March 11 this year is the 16th World Kidney Day.
For most people, the kidney is an obscure organ, and it is rare to feel pain and discomfort in its temper.
However, after the reporter conducted an in-depth investigation, several authoritative experts revealed an astonishing number—one out of every ten adults in my country suffers from chronic kidney disease, and only about one-eighth of them know that they are suffering from the disease. Expenses have accounted for a considerable proportion of the total medical expenses.
Is kidney disease a "patent" for the elderly?
What are the signs?
What are the factors of kidney damage that can be avoided?
How can we scientifically "protect the kidney"?
How much is the burden of kidney disease treatment?
…With a series of questions, the reporter interviewed a number of experts to uncover the "mystery" of the "silent killer".
One out of ten people with chronic kidney disease?
According to Yang Li, deputy dean and director of the Department of Nephrology, Peking University First Hospital, according to the results of the "China Chronic Kidney Disease Epidemiological Survey", "the prevalence of adult chronic kidney disease in my country is approximately 10.8%." There are more than 100 million patients with chronic kidney disease.
"Among chronic kidney disease patients in China, only about 12.5% are diagnosed." Liu Wenhu, director of the Department of Nephrology, Beijing Friendship Hospital, said that this means that only one-eighth of these patients are aware of their illness.
Kidney disease can be divided into acute kidney injury and chronic kidney disease according to the course of the disease, and acute kidney injury can develop into chronic kidney disease.
In my country, chronic kidney disease is the eighth cause of "healthy life lost years" caused by disability caused by disease.
In the "2019 Global Health Assessment" report released by the World Health Organization in 2020, kidney disease has been among the top ten causes of death in the world.
alert! This type of kidney disease is growing rapidly?
According to the classification of etiology, kidney disease is mainly divided into primary and secondary.
In recent years, with the changes in the spectrum of chronic diseases, coupled with factors such as population aging, the incidence of some secondary kidney diseases caused by diabetes, hypertension, etc. has increased significantly.
"According to the statistics of hospitalized patients with chronic kidney disease in my country, the most common causes are diabetic nephropathy, hypertensive nephropathy, obstructive nephropathy, glomerulonephritis, etc." Yang Li said that research shows that about one-third of diabetic patients It will progress to kidney failure and eventually require dialysis or kidney transplantation.
The number of uremia patients in our country is increasing by 140,000-150,000 every year, many of whom are diabetic patients.
"Illness comes from the mouth," Yang Li said. Eating habits are one of the influencing factors of kidney disease. Some people like to drink soup, which leads to high uric acid, which is prone to hyperuricemia nephropathy. In some areas, salt intake is too much and worsened. The risk of hypertension and cardiovascular disease increases the incidence of chronic kidney disease; the incidence of type 2 diabetes is inseparable from eating habits.
Low back pain? Edema? What are the signs of kidney disease?
"Chinese medicine believes that the kidneys dominate water in the five elements, and the five colors dominate black. Therefore, the complexion of some patients with kidney disease is floating and dark (black, yellow and dull)." said Han Dongyan, chief physician of the Department of Nephrology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences. Say.
"Edema is a common symptom of kidney disease." Liu Wenhu told reporters that edema of the eyelids is most common after getting up early in the morning.
Except for kidney stones or acute pyelonephritis, generally speaking, low back pain rarely occurs in kidney disease.
"Kidney disease is known as the'silent killer'. Some kidney diseases have unobvious clinical symptoms and lack of specific symptoms for identification. In addition, many people don't pay enough attention to kidney disease. The early abnormalities of renal function-related test indicators are not taken seriously, causing many patients to miss the opportunity of treatment. When the abnormalities are found, it is the end stage of the disease, which gives people the feeling of illness."
Is kidney disease a "patent" for the elderly?
Except for hereditary kidney diseases such as polycystic kidney disease, most kidney diseases have no obvious family inheritance.
Since the kidneys are extremely rich in capillaries, diseases that are susceptible to the elderly, such as arteriosclerosis, hypertension, and diabetes, will exacerbate the risk of secondary kidney disease.
However, there are also some kidney diseases that "specialize" young people.
Among chronic kidney diseases, IgA nephropathy is the most common type of glomerulonephritis in China, and it is also the most common cause of uremia in the young and middle-aged in my country.
The pathogenesis of primary IgA nephropathy is still unclear.
It is estimated that there are more than millions of patients with IgA nephropathy in our country.
According to Li Wenge, director of the Nephrology Department of the China-Japan Friendship Hospital, according to statistics, the average age of patients with IgA nephropathy at the first diagnosis was 30 to 40 years old, and patients aged 25 to 44 accounted for more than half of all patients.
Most patients are still relatively young when they progress to end-stage renal disease, and require kidney replacement therapy (dialysis or transplantation) for a long time, causing a heavy economic burden on individuals, families, and society.
What kidney damage factors can be avoided if you take medicine and keep health careless?
Many kidney injuries can actually be avoided.
"my country is one of the hardest hit areas for drug-induced kidney injury. About 40% of patients with acute kidney injury are caused by drugs. Irrational use of drugs is an important factor in causing kidney damage." Yang Li gave an example of self-abuse of antibiotics and painkillers. Etc., may cause serious consequences such as acute kidney injury.
When using RAAS blockers to control high blood pressure (ie, "sartan" and "pril" drugs), one should avoid taking painkillers or antipyretics, otherwise it may easily cause kidney damage.
Han Dongyan pointed out, “The damage caused by heavy metals to the kidneys should not be ignored. Some Aimi women use whitening cosmetics illegally added with heavy metals such as lead, or have long-term exposure to unqualified nail art and hair dye products, and serious consequences of kidney damage and even dialysis have also occurred. "In addition, clinically, kidney damage caused by indiscriminate use of medicines and health care products is not uncommon.
Will Chinese medicine hurt the kidney or protect the kidney?
"Some Chinese medicinal materials have been found to have a certain protective effect on the kidneys, such as angelica and astragalus." Yang Li said.
However, Chinese medicine powders and folk remedies with unknown ingredients are likely to cause damage to the kidneys.
Yang Li mentioned, “A patient once bought a folk medicine powder to treat joint pain, which caused kidney damage. Later, it was found that there were at least four painkillers in the powder.”
"Guanmutong and other medicinal materials contain aristolochic acid, which is nephrotoxic, and the kidney damage caused is often difficult to reverse." Han Dongyan said.
Han Dongyan also pointed out that traditional Chinese medicine has its unique advantages. Some difficult chronic kidney diseases are treated with a combination of traditional Chinese and western medicine. Traditional Chinese medicine has shown good effects in alleviating clinical symptoms and delaying the progression of renal function.
What are the health hazards of kidney disease?
Liu Wenhu said that in addition to kidney damage, chronic kidney disease can also cause systemic complications, such as high blood pressure, cardiovascular disease, weakened immunity, and osteoporosis, which can reduce the quality of life of patients.
After chronic kidney disease patients enter end-stage renal failure, they need expensive renal replacement therapy to maintain their lives.
Cai Jianfang, director of the Department of Nephrology, Fuwai Hospital, Chinese Academy of Medical Sciences, said that heart and kidney diseases "coincide with each other" because they share many common pathogenic mechanisms and risk factors, such as high blood pressure, diabetes, hyperlipidemia, and obesity; second, Because heart and kidney diseases affect each other and cause each other.
For example, patients with acute kidney injury are prone to acute heart failure; patients with chronic kidney disease are prone to various cardiovascular diseases, including hypertension, heart failure, coronary heart disease, etc., and with the progression of kidney disease, the prevalence of cardiovascular disease increase.
How much health economic burden does kidney disease cause?
The results of a survey on acute kidney injury led by Yang Li were published in the authoritative journal "The Lancet" in 2015, which caused concern.
Researchers analyzed and evaluated the medical records of 374,286 patients who attended 44 university hospitals or local hospitals in 22 provinces in mainland my country in 2013. The detection rate of acute kidney injury was 2.03% (7604 cases).
Based on this estimate, there were 1.4 million to 2.9 million acute kidney injury patients hospitalized in my country in 2013, with a total medical expenditure of approximately 84.5 billion yuan.
"The unrecognized rate of acute kidney injury is very high whether it is in large hospitals or primary hospitals. 17.6% of the patients who have been identified have delayed diagnosis. Acute kidney injury has become a huge medical burden in my country, and there is a serious shortage of diagnosis and treatment. "Yang Li said that with the changes in lifestyle and population structure, the burden of kidney disease in my country is increasing. The prevention and treatment of kidney disease has become an issue that my country's medical and health system and policy makers need to address and pay attention to. .
Is "eating more roasted kidneys to nourish the kidney" science?
"Don't just look at the advertisements, search on the Internet, etc. and give yourself a diagnosis." Han Dongyan said, "Poor sexual function is kidney deficiency", "eat more roasted kidneys to invigorate the kidney" and so on are unscientific.
The onset of kidney disease is insidious, and the examination of urine and kidney function should be emphasized during the physical examination, which helps to find more than 80% of kidney problems.
The treatment cycle of kidney disease is long and easy to repeat.
For patients, the key to scientific treatment is to follow the doctor's advice.
Liu Wenhu reminded that patients do not need to "talk about hormonal discoloration", they must follow the doctor's advice and do not self-administer or stop medication.
"Lack of doctors and medicines", what barriers have to be overcome to overcome kidney disease?
"There are still not many drugs available in the field of kidney disease treatment," said Yang Li and other experts.
Genting Xinyao Chief Medical Officer Zhu Zhengying revealed: "Compared with two or three years ago, the current research and development of innovative drugs for the treatment of IgA nephropathy is very active, and it is expected to break through the limitations of existing treatments in the future."
"The incidence of kidney disease in my country is on the rise, and it is now also an important window for prevention and control." Yang Li said that the number of patients with chronic kidney disease and diabetes in my country is comparable, and there is an urgent need to establish a national prevention and control system.
Many experts report that many patients are in the terminal stage when they come to the top three hospitals for treatment and the disease is irreversible.
Compared with some major chronic diseases, the basic diagnosis and treatment capacity of kidney disease is still insufficient, which restricts the early detection and early treatment of the disease.
Yang Li said, “Prevention and control will sink to communities and families. Our research has found that many community doctors understand chronic diseases such as diabetes and hypertension, but lack understanding of kidney disease. They should strengthen training so that community diagnosis and treatment can protect people’s lives and health. First line of defense."
Many experts called for the prevention and treatment of kidney disease to be included in the prevention and treatment of major national chronic disease projects, to formulate overall prevention and treatment strategies as soon as possible, to strengthen the daily management of key populations at risk of kidney disease by primary medical institutions, and to make urine examinations and renal function important for regular physical examinations One is to strengthen public awareness and education, encourage scientific research and research and development of new drugs and medical devices, and contribute to the construction of a healthy China.
(Participate in the collection and writing: Wang Yihan)