What is the most taboo for chronic diseases? That is to give up treatment

Chronic disease refers to a disease that does not constitute infection and accumulates for a long time to form morphological damage. If we don't take precautions, it will do harm to economy and life. Let me show you what is the most taboo of chronic diseases. That is to give up treatment.

Uremic patients with green intestines.

Some time ago, I received a patient with chronic kidney disease, specifically uremia. His situation is very regrettable, and it is also a microcosm of a large number of similar kidney friends.

Some words have to be said, lest more kidney friends take such a detour again.

What chronic disease is the most taboo?

In my opinion, there is a taboo that is more important than the severity of the disease itself, and that is to give up treatment.

This kidney friend 10 years ago found proteinuria during physical examination. At that time, he also had a renal biopsy pathology, and then began a long road of seeking medical treatment, seeking medical treatment everywhere.

But after two years of treatment, proteinuria is still one or two plus signs. I gave up treatment because I thought it was incurable.

It was not until recently that I felt weak and had edema in my ankle that I was introduced to see a doctor by an acquaintance. After the test results came out, people felt very frustrated: the serum creatinine was over 700, and the estimated glomerular filtration rate was only 12 (one tenth of that of normal peers), and the kidney B-ultrasound showed obvious atrophy of both kidneys. In other words, his kidney disease has progressed to the fifth stage of chronic kidney disease-uremia.

When I honestly told him about my kidney disease, he said with a sigh:

"I'm really afraid of what will happen. This nightmare has come true. "

Talking about what to do next, I told him about dialysis or kidney transplantation.

However, the economic conditions at home at that time did not allow him to have a kidney transplant. I suggest that he first understand the mode of dialysis treatment, consider which mode of dialysis to choose and establish the corresponding dialysis channel as soon as possible. If you choose to do peritoneal dialysis, put the peritoneal dialysis catheter first. If you choose hemodialysis, do arteriovenous fistula surgery as soon as possible.

Today, we will not focus on dialysis or renal replacement therapy for uremia, but mainly talk about various problems in this kidney friend's medical experience for friends to sum up experiences and lessons.

Why give up treatment?

Carefully ask about the medical history, and in the first two years after the diagnosis of kidney disease, he went to almost all major hospitals in Nanjing, Beijing and provincial capitals. During the two years of treatment, I tried many different schemes, from hormones to tripterygium wilfordii polyglycoside to tacrolimus and leflunomide. It's just that every plan is not enough: if you can't see the so-called improvement for a month or two, you will change hospitals and doctors. In the end, you will not spend less money, but your condition will not improve.

Later, he came back for a follow-up visit, and finally brought some medical records of previous visits as I requested. I turned it over and found that his 24-hour urine protein content had been controlled within 1g at one time:

This is a satisfactory state change. If we continue to treat correctly, it is entirely possible to stay away from uremia.

"Why don't you go ahead with that correct plan?" I asked him.

"At that time, there were two plus signs in urine protein, and I only looked at the plus sign."

I took a closer look, and sure enough, urine routine showed that urine protein was still two plus signs.

I said it should be quantitative, but in fact your condition is getting better. He said:

"Experts are very busy, and no one has explained this to me. I think since urinary protein is still two plus signs, hormones have no effect, so I stopped taking drugs when I left the hospital.

"Then I went to see another doctor, and the result was the same. I thought to myself: this disease is neither painful nor itchy, and I won't delay eating and drinking, so I just stop taking the medicine. Then pretend to be a person who is not sick. I have been confused for these years. "

However, it was in recent years that he was afraid of doctors, hid his ears and deceived himself. His original good renal function was quietly lost, and finally he had to enter the dialysis treatment stage ahead of schedule. Isn't it a pity? ...

He himself felt very sorry.

"At that time, if I met a patient doctor and explained the long-term treatment clearly, I wouldn't give up treatment so easily ..."

There is no regret medicine in the world. In fact, the plus sign of urine protein in routine urine is only a qualitative examination, and there are many influencing factors. For example, the urine protein concentration in morning urine is generally high. Doesn't mean that there are so many urine proteins at other time points.

In addition, even if the treatment effect is really poor, don't give up all the treatments. Long-term adherence to diet control, rational selection of necessary drugs under the guidance of doctors, active control of blood pressure and urinary protein, prevention and treatment of reversible factors that can be corrected as much as possible, and protection of renal function can completely delay the progress of renal diseases and avoid uremia.

This kidney friend has been to so many cities, hospitals and experts, but he doesn't understand a simple truth: kidney disease needs long-term treatment!

It's no use regretting. We haven't noticed that people with uremia should take a warning.

Our disease education is still lacking, not only chronic kidney disease, but also many other chronic diseases, and the public can't accept the concept that diseases need long-term attention.

Cases like this are very common in China. It is not that the prognosis of chronic kidney disease itself is poor, but that many patients have not been effectively managed during the period from onset to progress of kidney disease, resulting in a worse prognosis!

If we patients don't pay attention to our illness and take the initiative to seek the management of reliable doctors, then the reality is: no one will help you pay attention. When renal function has made rapid progress and you regret trying to save it, the effect will be greatly reduced for you personally than in the early stage of the disease.