Post Date December, 03 2023
When kidney disease develops to a certain extent, it damages most of the renal tissue, and renal function also decreases. When renal function is only less than 10% of normal renal function, renal failure occurs. Less than 10% of the remaining renal function is called residual renal function. The less residual renal function, the more severe uremia.
Due to the lack of residual renal function and the inability to support the needs of life metabolism, dialysis was chosen to replace the original renal function, commonly known as artificial kidney. With dialysis treatment, patients say they are relieved, and the remaining bits of kidney function become dispensable. If they are not noticed, let it disappear naturally. Sometimes, they may even intentionally or unintentionally harm it, making it disappear faster. Few people pay attention to it and protect it.
In recent years, it has been found that residual renal function is very important during dialysis, and people are urged to pay attention to it and protect it.
For all patients with end-stage renal failure, residual renal function not only plays a role in maintaining the stability of the body's water balance (with residual renal function, there will be a certain amount of urine), but also plays an important auxiliary role in clearing metabolic products from the body.
According to scholars' observation, in the total creatinine clearance (a uremic toxin) of dialysis patients, the amount of creatinine released through the residual kidney accounts for 39% of the total. Even if the residual renal function remains only 2%, it can still bear 1/3 of the total clearance of peritoneal dialysis. Regardless of whether hemodialysis or peritoneal dialysis is used, as long as there is some residual renal function, the dialyzer can maintain good dialysis efficiency. To maintain adequate dialysis, it is necessary to redouble efforts, increase the number of dialysis times, extend the dialysis time, and increase the dose of dialysate.
Therefore, it has been called for in recent years that attention should still be paid to protecting residual renal function after dialysis.
Common causes of decreased residual renal function are as follows:
(1) In addition to systemic hypertension, hypertension also causes high pressure in the glomerulus, further exacerbating the original renal lesion, and promoting the deterioration of residual renal function.
(2) In inflammatory hemodialysis, some synthetic membranes can promote the production of inflammatory substances, causing damage to residual renal function.
(3) The use of nephrotoxic drugs is believed to have led to dialysis and the abandonment of the kidneys. Improper use of nephrotoxic drugs, such as gentamicin, kanamycin, and tobramycin, has accelerated the decline in renal function.
(4) The rate of residual renal function decline at the initial stage of hemodialysis with high osmotic pressure of dialysate is the fastest, approximately twice that of peritoneal dialysis, which is estimated to be related to the osmotic effect of dialysate and higher ultrafiltration water content.
(5) "The etiology of kidney disease is a disease that occurs in the glomerulus in the early stage, but develops at a faster rate in the late stage. However, diseases that occur in the renal interstitial tubules have a slower rate of renal function damage.".
For the above reasons, even if patients receive dialysis treatment, it is still necessary to monitor blood pressure changes, actively treat hypertension, and try to avoid using nephrotoxic drugs;
Although dialysis treatment has been received, some renal diseases are continuing to develop. If treatment for these diseases is abandoned, residual renal function will soon be lost. Therefore, active treatment should be taken and reasonable dialysis plans should be formulated to avoid further deterioration of renal function due to excessive dialysis as much as possible.
