Blood creatinine amounts to 200 or so, what level can you fall to?Appendix: treatment measures

2022-09-06 0 By

Zhou Xun, director of the Department of Nephrology, found that serum creatinine was about 200μmol/L, which was not uncommon in clinical practice.The patients we encounter are more common in these three situations: first, through physical examination (such as the physical examination of the staff of the unit) found that the blood creatinine reached about 200μmol/L;Second, due to the related symptoms (such as edema, low back pain or nausea and vomiting, etc.) when going to the hospital for examination, the blood creatinine was found to be about 200μmol/L;3. Serum creatinine of patients with nephropathy (such as IgA nephropathy, nephrotic syndrome or chronic renal insufficiency) was suddenly or gradually found to be about 200μmol/L during follow-up examination.When blood creatinine is found to be about 200μmol/L, if effective measures are not taken, such a high blood creatinine will continue to rise, and even develop to the level of uremia.In addition, with the increase of blood creatinine accompanied by other abnormalities, such as hypertension, hyperuricemia, electrolyte disorder, anemia and metabolic acidosis, serious cases will also appear heart failure and infectious diseases, such as cardiovascular and cerebrovascular and infection-related complications and life-threatening.With active treatment, lowering serum creatinine can not only prevent the disease from progressing towards uremia, but also reduce or avoid serious complications, thereby improving the quality of life and extending life expectancy.Speaking of here, a problem came: the discovery of nephrotic patients with blood creatinine up to 200μmol/L or so, after active treatment, blood creatinine can fall to what extent?Combined with specific patients, it can actually be divided into the following four situations.1. It is not uncommon, even common, for creatinine to fall to normal.In addition to physical examination found that blood creatinine more than 200μmol/L is difficult to drop, due to related symptoms and kidney disease found that blood creatinine more than 200μmol/L are expected to drop to normal.We found that in the patients with nephropathy who went to the department of Nephrology for the first time, there were about 50% patients whose blood creatinine exceeded the normal range, among which a considerable proportion of patients had blood creatinine high to about 200μmol/L.For example, due to edema diagnosis of membranous nephropathy, blood creatinine is relatively high, after a comprehensive examination confirmed as complicated with acute kidney injury, given glucocorticoid and immunosuppressive and diuretic anticoagulant treatment, blood creatinine can be reduced to normal;For example, lupus nephritis was suddenly found to have high serum creatinine during the return visit, which was confirmed to be complicated with acute renal failure through comprehensive examination. After treatment with hormones and cyclophosphamide, serum creatinine could be reduced to normal.For example, IgA nephropathy, which has been treated, has a significant increase in serum creatinine after cold and fever. After anti-infection and symptomatic treatment, serum creatinine can be reduced to normal.2. Decreased serum creatinine is not uncommon, especially in patients with stage 3-4 chronic kidney disease, and stage 5 chronic kidney disease can also be seen.That is to say, the original diagnosis of chronic renal insufficiency, patients with blood creatinine has exceeded the normal range, or more than 100μmol/L, or more than 180μmol/L, the vast majority of patients can maintain long-term stability, that is, blood creatinine changes little.When it is found that the blood creatinine of patients with chronic renal insufficiency suddenly increases significantly, it is often related to some kind of incentive. If measures can be taken in the first time, the part of blood creatinine that suddenly rises can be reduced.These inducement include, cold, calorific, infection, medicaments, poison, food, allergy, lack of water, haemorrhage, trauma, operation, burn, scald and overworked wait, take relevant measure in time, although cannot fall to normal limits, but majority patient is to be able to drop blood flesh anhydride to original level, namely blood flesh anhydride drops somewhat.3. Long-term stable serum creatinine Even if the serum creatinine of patients with chronic renal insufficiency has reached about 200μmol/L, as long as the active and standardized treatment, the serum creatinine can maintain long-term stability.In other words, not all blood creatinine increases gradually, at least over a long period of time.By “considerable time,” we mean anywhere from two to five years, to several years to more than 10 years.The key, of course, is treatment and management.As for the treatment of chronic renal insufficiency, corresponding measures need to be taken from the following aspects: first, to control blood pressure to reach the standard, sartan or Pripril drugs which can reduce blood pressure and have the dual effects of kidney protection should be selected as far as possible;Two, the urine protein down, if the urine protein is still high, can choose some immunosuppressants according to the specific condition, such as for mycopherol ester, tripterygium wilfordii glycosides or hydroxychloroquine, but hormone caution;Three, the treatment of other “three high”, in addition to hypertension, hyperuricemia, hyperlipidemia and hyperglycemia need to be actively treated, the use of febuxostat and other uric acid lowering, the use of statins to reduce blood fat, the use of linide or insulin drugs to reduce blood glucose, which is also very important for the stability of blood creatinine treatment;Other treatments, such as treatment for anemia, treatment to prevent infection, and treatment to correct metabolic acidosis, are important means of stabilizing the condition.4. Blood creatinine continues to rise Chronic renal insufficiency without timely treatment, treatment is not in place and the efficacy is not good, the blood creatinine of patients will continue to rise.Patients need to continue treatment even if their creatinine levels are still rising.For patients with chronic renal insufficiency, the rise of blood creatinine is the same, and if it can slow down the rise of blood creatinine, it is also effective and has therapeutic significance.For example, a patient with chronic renal insufficiency originally developed uremia in one year, but after treatment, it took three or more years to develop uremia, which is of course meaningful.How is it treated?Regarding how to delay the rate of progression of chronic renal insufficiency, the treatment method is basically the same as the long-term stable serum creatinine “3” mentioned above.Based on the above analysis, kidney friends may be able to figure out how low their blood creatinine can go.But either way, timely and standardized treatment is key.The article was originally written by Zhou Xun.Shall not be reproduced without authorization.