女孩肌酐超标一千多,浑然不知已肾衰竭!这4个误区,耽误了不少人

2021-03-26 39健康网 39健康网

20岁的小悠没有泡沫尿,也没有脚肿。可经医生诊断,她的肾脏已经完全萎缩,属于肾病终末期,到了要做透析治疗的地步。

20岁的小悠(化名),最近两个月总是感觉很累,胃口也不好。做电商三年来,每天工作“黑白颠倒”,玩命似地刷单,她以为自己是太劳累引起消化不良,也许还有贫血,因为时不时会出现头晕。小悠一心想让医生开点肠胃药和补血药,没想到一检查,结果血肌酐严重超标,高达1024μmoI/L。

小悠称,自己没有泡沫尿,也没有脚肿。可经医生诊断,她的肾脏已经完全萎缩,属于肾病终末期,到了要做透析治疗的地步。

本期辟谣指导专家:南方医科大学第三附属医院肾内科主任、主任医师汤颖

“在长期熬夜、高盐高糖饮食、把饮料当水喝、憋尿等不良生活方式影响下,得肾病的年轻人越来越多。”南方医科大学第三附属医院肾内科主任、主任医师汤颖表示,肾病的发生无声无息,不做检查往往不能发现,就诊时已经肾衰竭。而导致就诊晚、发现晚很大程度也是因为公众对肾病的认识存在不少误区。

误区一、肾不好一定会浮肿或泡沫尿、血尿

肾病的常见症状主要有尿频、尿量减少、夜尿增多、颜色异常、尿液泡沫增多、浮肿等,但是有相当一部分肾病患者早期并无这些表现,很多患者进入到尿毒症期以上症状也不明显,而仅仅只是感觉疲劳、乏力、食欲减退、头晕等,错过最佳的诊治时机。

“小悠肌酐都一千多了,连泡沫尿、脚肿都没有,看起来不可思议但这是事实。”汤颖主任表示,不明原因的贫血、胃肠道不适或纳差也可能是肾不好引起的,很多患者在血液科、消化内科、中医科反复就诊,就是想不到要看肾病科。

隐匿的肾病不仅难发现,而且很多时候找不到原因。小悠入院后B超显示肾脏已显着缩小,无法行肾穿刺活检明确病因。通过查体、回顾既往的资料及相关实验室检查,考虑小悠是慢性肾小球肾炎所致肾衰竭。

误区二:肾功能正常,说明肾没事

临床上大多数患者肾功能损害往往会经历一个较长期的过程,从正常至轻度下降、中度下降,到重度下降最终尿毒症需要透析或肾移植。保护肾功能是我们的最终目的。

实际上在肾功能出现损害之前,其实病人的肾脏结构已有异常如肾结石、肾积水或多囊肾等,或者已出现一些肾损害表现,如蛋白尿、血尿,此时肾功能可以是正常的,血肌酐在正常水平,如果不及时诊治,随着病程的延长,肾功能损害必定发生。

汤颖主任提醒,目前我国是糖尿病及高血压大国,发病率很高,这两大疾病与肾损害密切相关,如果不注意监测血压、血糖并管理好,部分患者会出现肾损害,最终进入到尿毒症。

因此,建议这两类疾病患者定期肾科专科门诊随访并监测肾功能,尿常规及肾脏B超指标变化,能及时发现肾损害并得到正确的治疗。

误区三、肌酐在90-100μmoI/L,属于正常范围不必紧张

临床检测血肌酐是了解肾功能的重要方法之一,有人说,肌酐超过90μmoI/L只要不超出100μmoI/L,就是正常的。

“这个观点大错特错,男女的肌酐正常范围是不同的。”汤颖主任澄清说,一般女性肌酐超过90μmoI/L多提示不正常,其正常范围一般是40-70μmoI/L。男性的肌酐往往高于女性,可以超过70-90μmoI/L,对于经常运动、肌肉很发达的人群,肌酐水平还可能更高一些。

因此,肌酐水平是否正常需要综合性别、体型、饮食、职业等因素来判断,尤其是血肌酐水平的动态变化,建议老百姓每年查一次血肌酐,观察指标变化。一般来说肌酐在130μmoI/L以上,肾病多半已是CKD三期,超过200μmoI/L则进展到CKD四期。

此外,有不少病人在早期出现蛋白尿、血尿症状,但肌酐仍然正常,这就需要防微杜渐,早期到肾科专科就诊,明确病因及时治疗,不能坐等肌酐飙升。

误区四、降压药、降糖药、降尿酸药是伤肾药

是药三分毒,很多服用降压药、降糖药和降尿酸药的病人往往会担心这三种药物损害肾脏,对于“长期服药”的医嘱顾虑重重。尤其是听说有病友长期吃着降压药(降糖药/降尿酸药),却发生肾损伤患上慢性肾衰竭,更加认定这三种药就是“罪魁祸首”。

对此,汤颖主任表示,高血压、高血糖、高尿酸这些疾病是肾损害的重要危险因素,正确合理的降糖降压降尿酸其实是保护肾脏。降压药、降糖药、降尿酸药都是为了控制血压、血糖、高尿酸,是预防疾病进展导致肾损害的重要措施。

降压药、降糖药、降尿酸药都有很多种,只是说选择哪一种更合适,在用药时机方面也有讲究。以降压药为例,有的药在某个阶段特别适合这个病人,有些药早期对肾脏保护很好,但到了晚期以后需要慎用,药物的获益没那么大,但风险增大了,这个时候需要由医生来评估调整用药。

提醒:定期做4个检查,帮你预防肾病

肾脏疾病如何早期发现?汤颖主任表示,从年轻就要开始重视预防肾病,建立个人肾脏档案,血常规、尿常规、肾功能(血钾、肌酐、尿素等)和泌尿系B超,这四个检查也就一百来块钱,可以有效及早发现肾病的苗头。反复双下肢或颜面浮肿、尿频或夜尿增多、血尿、泡沫尿、不明原因的贫血、乏力或纳差等都建议及时肾科就医排除肾病;对于有肾病家族史,有高血压、糖尿病等慢病病史的人群,要定期复查上述肾脏相关指标,建议最好半年或一年排查一次;如已经合并肾损害的患者,监测频率随着肾功能进展要加强。

同时要调整生活方式,包括戒烟、适当运动、不要熬夜,饮食上做到少盐、吃优质蛋白质,多吃新鲜的蔬菜和水果,尽量不要憋尿。(通讯员 陈晓霖)

专家介绍

南方医科大学第三附属医院肾内科主任、主任医师汤颖

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    2021-03-29 189****1979

    反复双下肢或颜面浮肿、尿频或夜尿增多、血尿、泡沫尿、不明原因的贫血、乏力或纳差等及时肾科就医排除肾病!

    0

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    2021-03-28 俅侠
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    2021-03-26 妙酒

    肝坏了肾

    0

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    2021-03-26 ms2000001051330459

    学习了,涨知识了!

    0

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