Septic shock

Septic shock is the variety of pathogens and toxins from the body after the invasion caused to the microcirculation, tissue perfusion of blood shortage, leading to an important organ of life of acute dysfunction syndrome, and often occur in toxic bacillary dysentery, and the outbreak of flow Brain, bleeding of necrotizing enterocolitis, sepsis, severe pneumonia and acute biliary tract infection and other infectious diseases on the basis of clinical to looking pale and limbs of the cooler skin Fahua, reduce the amount of urine, blood pressure dropped as the main performance. Pediatrics is one of the common critical illnesses.
Clinical performance
1. Or looking pale lips, Zhizhi cyanosis, skin Fahua. 2. Hand, Foot and a cooler filled capillaries to extend the time. 3. Thin-speed pulse, blood pressure measuring less than even decline, the narrow pulse pressure. 4. Urine output reduction. 5. Fuzzy consciousness, a coma or indifferent expression. 6. Anal toe temperature> 6 ℃.
Diagnosis
1. Are the primary infection. 2. Looking pale, peripheral and mucosal cyanosis, skin-like patterns change, peripheral cold. 3. Pulse of small-speed, filling time again capillary> = 2 seconds. 4. Urine output reduction, mild shock five babies per hour ￣ 10 ml, children 10 ￣ 20 ml, severe shock babies per hour less than 5 ml, children less than 10 ml. 5. Measurement of blood pressure dropped to less than, pulse pressure <4 Kpa (30mmHg), early mild shock to normal blood pressure. 6. Make them apathetic, fuzzy consciousness, respiratory markedly accelerated.
Treatment principle
1. Expansion of blood volume, correct acid poisoning. 2. Microcirculation to lift the vessel spasm. 3. Cardiac treatment. 4. Anti-infection. 5. Application of adrenal glucocorticoid. 6. The protection of critical organ function, prevention and treatment of brain edema, heart failure, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and acute renal failure.
Treatment principle
1. Septic shock, according to the incidence of bacteria on the choice of at least two sensitive to antibiotics, intravenous injection, the dose should be enough, treatment should be enough. Pathogens do not know, the choice of two broad-spectrum, highly effective microbicides, and take into account cocci bacteria, identify pathogens, according to drug sensitivity. 2. Shock patients with various degrees of cardiac function decline in the first batch of quick infusion should be used cardiac drugs, with heart failure, it is necessary to appropriately control the speed and the infusion of liquid aggregate limit Hanna hypertonic dehydration solution and the application of . 3. Fulminant ECM with shock, often disseminated intravascular coagulation and fibrinolysis hyperthyroidism exist, the rescue without waiting for laboratory results when, according to clinical signs and symptoms of immediate treatment, while heparin and 6 — Amino acid. 4. Shock with acute renal failure, should be accurate calculation of access and maintain water and electrolyte balance, improve the application of dopamine and 654-2 renal microcirculation. 5. Naloxone for morphine receptor antagonist, the antagonism of β-brown Fei’s role in reversing the shock when low blood pressure, often used in refractory shock will be good effect, when the shock treatment with traditional methods invalid , Should be timely use of naloxone.

Allergic Purpura

Purpura is allergic inflammation of capillary-based allergic diseases. Purpura is mainly skin, gastrointestinal symptoms, joint swelling and pain and urinary symptoms. More common in children over the age of 5.

[Causes]

Cause is not clear, perhaps because some caused by allergic sensitization due to the original, but direct allergen is not clear. Often before the onset of hemolytic streptococcus caused by the upper respiratory tract infection, the incubation period of one to three weeks after the onset.

In addition, viruses such as measles, mumps, and parasites such as roundworm, hookworm, food such as eggs, fish, shrimp, drugs such as chloramphenicol, salicylic acid salts, such as other Chongyao, pollen, are likely to become Allergen; occurred in the autoimmune response, resulting in capillary inflammatory changes.

[Pathology:

Basic diseases for the capillary wall of the inflammatory response, increased permeability of the capillaries, blood cells and plasma leakage, caused edema and bleeding. Small arteries and veins can also suffer, the small blood vessels around the neutrophils, monocytes, lymphocytes, may have eosinophil infiltration and the different levels of red blood cells exudation, the peripheral vascular involvement can have nuclear weapons And residual swelling of connective tissue, small blood vessels of endometrial hyperplasia, and a transparent degeneration and necrosis, so that narrows blood vessels cavity, or even infarction, and that small necrotizing arteritis. Skin and gastrointestinal tract are visible above changes, intra-articular serous and interleukin leakage, but no bleeding, ureter, urethra and bladder mucosa can have bleeding, and often involving the kidney, Purpura nephritis severity of the pathological changes ranging from . Light, for the focal nephritis, compared Most of those for re-proliferation nephritis with crescent change, immunofluorescence checks can be found in glomerular C3 and IgG, but also to see fibrinogen deposition in vascular Of the film also found that IgA.

[Clinical]

More acute onset, in addition to fever, loss of appetite, nausea, vomiting and other symptoms in general, the main performance skin purpura, gastrointestinal symptoms, joint swelling and pain and urinary symptoms. Onset of different cases from time to the same situation, to see the most skin purpura, may appear separately or simultaneously or one after another with joints, gastrointestinal or urinary tract symptoms.

First, the skin purpura often at the onset of the first performance, Purpura size, higher than the skin surface, a purple, the pressure does not fade, and can be integrated into films, or a herpes-like, urticaria kind or shape Erythema, and with nerve edema.
Even when serious ulcers and necrosis can occur. Purpura more common in the limbs stretch side and hip, leg and ankle, knee and other joints, more significantly, there was symmetry in batches and easy to repeated attack.

Second, many children have gastrointestinal symptoms of abdominal pain, paroxysmal keen for more of colic, or Duntong to Qizhou or significantly lower abdomen, tenderness, but no abdominal tension. May be associated with the severity ranging from diarrhea and blood in the stool, stool or a tar-like bright red. Can have severe vomiting, but hematemesis rare. Such as abdominal pain, blood in the stool before seen in the skin purpura, with the identification of acute abdomen. The disease can intestine mucosal hemorrhage and edema, leading to intestinal disorders, or even induced intestinal sets again and again.

Third, some children with symptoms of joint swelling and pain of the festival, many involving large joints, such as the knee, ankle, wrist, elbow, small joints do not suffer. Can be single, multiple or were migratory. Joint swelling, pain, pain when aggravated, accompanied local micro-hot, hot flu-have. Joint symptoms dissipated after no after-effects.

4, urinary symptoms due to urinary tract mucosa capillary permeability increase, there hematuria and microalbuminuria, with the retirement Purpura disappeared. But the children with Purpura in about 1 / 3 to 1 / 2 kidney involvement, said Purpura nephritis. Pathological changes in the kidney is determined by the prognosis. Urine acute phase of the change more than two to three weeks there, but also in Purpura dissipated in the rear.
Most children showed a small amount of protein in urine and a red blood cell under a microscope, and sometimes see a tube, there can be gross hematuria. Generally good prognosis, even with the radical nephritis, for the development of acute renal failure, poor prognosis. Part of a large number of children with proteinuria, hematuria, edema, hypertension, hypoproteinemia and hypercholesterolemia, such as nephrotic syndrome.

Hematuria, proteinuria sustainable few months or few years, most of the last still fully recovered. A very small number of children with different degrees of renal damage after a chronic nephritis, the final development of chronic renal failure.

5, occasionally other symptoms of cerebral hemorrhage, there may be convulsions, temporary paralysis, aphasia, severe cases can cause death. Others such as nosebleeds, bleeding gums, muscle hemorrhage, bleeding or swollen testicle pulmonary hemosiderosis, are extremely rare.

[Diagnosis]

According to the typical skin purpura, or with nerves and blood vessels and edema, urticaria, and other performance easy diagnosis, with joint swelling and pain, abdominal pain, blood in the stool, laboratory platelets, bleeding, clotting time, and so normal, can be confirmed. Should be asked in detail about history, as far as possible to find allergenic factors.

[Diagnosis]

First, idiopathic thrombocytopenic purpura Purpura under the skin form of not higher than the skin, and the asymmetric distribution of platelet count reduction, it is not difficult to identify. Allergic Purpura rash associated with vessels and nerves such as edema, or urticaria shape more easily distinguish between erythematosus.

Second, sepsis meningococcal septicemia caused by rash and Purpura similar, but the weight of poisoning symptoms, WBC increased significantly, the punctured skin rash smear positive for the bacteria found.

Third, the two are related to rheumatoid arthritis and low heat of swelling and pain, Purpura appear before the more difficult to identify, with the development of disease, skin purpura, help identification.

4, intestinal sets again and again more common in infants and young children. Such as children again and Kujiao, abdominal reach mass, abdominal tension should be suspected of the disease. Barium enema perspective can be identified. However, allergic purpura with intestinal both sets again and again, it should be cause for concern.

5, appendicitis can be both a Qizhou right lower abdominal pain and tenderness associated with. But not allergic purpura abdominal tension, skin purpura, to be identified.

[Treatment]

No special effects therapy, the acute phase should be bed rest, looking for allergens, the suspected food or drug, should not the time being, or of suspicious food, in close observation, from the beginning of application, gradually increase.

First, Chinese medicine treatment of the disease in Chinese medicine in the areas belonging to the spot for the evil of injuries caused by blood, and the plaque-like syndrome, while Qingrejiedu governance, mainly Liangxue Huayu. Huang Jiawei horns commonly used in soup: 1 g horns, Yinhua 15 grams, Forsythia, Shikonin, various Paeonol 10 grams, 6 grams Salvia, situ, Rhizoma Imperatae of 15 grams, 30 grams Chi Xiaodou.

Purpura heavy and deep colors are hot for the drug increases the performance of Super Zixue Dan Chongfu 0.5 to 0.75 grams per day 1-2 times. Yan Hu abdominal pain and weight 15 grams, 6 grams myrrh. Blood in the stool and Garden Burnet carbon, the carbon Wumei 10 grams, 1.5 grams or powder Chongfu March 7.

Such as the amount of bleeding children, and not just deferred, looking pale and flustered, shortness of breath Dengzheng, are two losses of qi and blood, spleen not perturbation of blood, while Ziyin Jianpi governance, blood-based Air perturbation. Common to the spleen Decoction j dangshen 15 grams, white tricks, longan meat, 10 grams of Angelica, 15 grams Shude, Ejiao, 10 grams of carbon Garden Burnet, jujube 5. Qi and 15 grams of astragalus, blood deficiency and TGP, Huang Jing of 10 grams, or reuse Shude.

Second, the adrenal hormone therapy adrenal cortex hormones on the part of children with effective, may improve symptoms of abdominal pain and joint symptoms associated with blood in the stool to good effect, but can not prevent recurrence, the effect of nephritis are often poor, simple skin Purpura can not . Regular use of prednisone 1 to 2 mg / kg / day, the oral administration, ease the symptoms gradually after the withdrawal to the reduction, treatment is generally one to two weeks. Abdominal pain or blood in the stool serious brain hemorrhage, de-hydride can be 150 to 300 mg / day (5 to 10 mg / kg / day), or dexamethasone 15 to 30 milligrams (1 to 2.5 mg / kg / day) vein Drip, kidney involvement with nephrotic syndrome, according to nephrotic syndrome treatment.

Third, symptomatic therapy
(A) joint swelling and pain are available aspirin.

(B) of abdominal pain, can be used tranquilizers, such as Rumi that, while there had abdominal observation sets the signs again and again.

(C) of gastrointestinal bleeding, less time to time, restricted diet, fasting in a long time, can also be used procaine (allergy test should be negative, the optional) in a vein closed, with 8 to 15 mg / kg / day 10% glucose infusion of 200 ml, on the 10th of July to a course of treatment.

(D) infection, especially Streptococcus infection, penicillin and other antibiotics available infection control.

(E) intestinal parasites, have to wait until after the cessation of gastrointestinal bleeding insecticide.

(6) lesions, such as dental caries, sinusitis and tonsillitis, and so should be thoroughly treated.

(7) may generally be added vitamin C, P, or calcium, and so on.

(8) The amount of bleeding, anemia may cause blood transfusion.

Anemia can cause symptoms of the system which

Anemia can cause cardiovascular, nervous, digestive, reproductive and urinary system symptoms, as follows:

(1) cardiovascular system performance:

After physical activity are palpitations, shortness of breath, is the most common symptoms. Severe anemia or heart failure, even when the rest will also appear palpitations, shortness of breath. Have coronary artery disease patients can appear angina. Some patients with angina in peacetime, but because of anemia and increase the level of myocardial ischemia, angina may occur. Physical examination, in the bottom of my heart or apex areas often can hear the soft murmur of the medium-term contraction. Chronic anemia in patients with heart often expanded. To correct anemia, heart murmur and can be expanded disappeared. Anemia can be more serious when a “high output state.” “High-output state,” the clinical features are: jugular vein expansion, the pressure increased, peripheral vascular expansion for the performance of the fall of veins and capillaries pulse, skin warmth, can have Chaohong. Myocardial compensatory function insufficient, there can be congestive heart failure.

Common electrocardiogram ST-segment changes have decreased, T wave flattening or inversion, QRS wave mostly normal. When anemia be corrected, the change could resume normal electrocardiogram.

Patients with severe anemia, even in the absence of heart failure, get up at Yichang in the lower extremities appear mild swelling. Its causes may be related to activities at the veins and capillaries temporarily increased the pressure, penetrating the capillaries and increased sodium retention, and other factors.

(2) nervous system performance:

Severe anemia, nervous system symptoms also Most of the elderly patients in particular. Common symptoms are dizziness, headache, tinnitus, vertigo, now appear black spots or “risk of Venus”, Jingshenbuzhen, burnout sleepiness, attention focused not easy, unresponsive, tingling hands and feet, cold or flu Acupuncture And so on. Anemia can be a serious syncope. If a sharp anemia, patients often irritability.

(3) performance of the digestive system:

Loss of appetite is one of the most common symptoms. There can be abdominal distention, Xinwoweiwan discomfort, nausea, constipation. Sometimes the pain can be a tongue, smooth tongue fur. Severe anemia, enlargement of liver may be mild, particularly in heart failure and often tenderness.

(4) the reproductive system performance:

Female patients often have irregular menstruation and menopause the most common. Anemia often caused by menorrhagia, but occasionally can cause anemia menorrhagia. Patients with more severe anemia have decreased sexual desire.

(5) urinary system performance:

Patients with severe anemia may appear a small amount of protein in urine concentration reduce the function of mild, but in addition there have kidney disease, normally does not cause blood urea nitrogen increased. A large number of acute intravascular hemolysis, urine color or black tea may be a soy sauce-like color (Hemoglobinuria), if at the same time a cycle of failure, can occur oliguria, no urine and acute renal failure.

The treatment of anemia

Since anemia is not a disease but rather the common symptoms of certain diseases, treatment is the first principle of removing causes. If more severe anemia, to be used directly to correct anemia and other blood transfusion or temporary measures to alleviate anemia. But in a clear diagnosis, avoid chaos for drugs, such as vitamin B12, folic acid, liver injection, iron or other so-called “blood medicine.” This treatment will not bear fruit, but due to relax or abandon the cause of the find, the delay condition, this will be harmful to the patient, or even cause serious consequences.

Removal of causes, not only to cure anemia, is more important to the overall health of patients. Because sometimes the basic cause anemia disease far exceeds the seriousness of anemia itself, such as gastric cancer or colon hemorrhage caused by chronic anemia, to identify the causes and treatment of anemia is not only to correct anemia, is more important to the eradication of gastric cancer or colon cancer. Therefore, the only treatment of anemia and blindly ignore the basic treatment of anemia caused disease, it is Shebenzhumo.

The effect of anemia treatment, the majority decision on the nature and cause of the possibility of eradication. If the cause is the complete elimination or correcting the anemia also can be cured. If anemia, though the reasons for the identification, but the basic treatment of the disease to be ineffective, anemia difficult to eradicate, can only take symptomatic treatment.

Bleeding is one of the common causes of anemia may be caused by different reasons, to take appropriate measures to stop bleeding treatment is very important. Or excessive menstrual bleeding with hormones or surgical treatment, generally stop the bleeding and anemia will be cured.

The lack of nutrition caused by lack of raw materials and certain blood of anemia, such as iron deficiency anemia, folic acid or vitamin B12 deficiency caused by giant David cell anemia, respectively, with iron, folic acid or vitamin B12 treatment, good effect, generally . However, attention should be paid to rectify the lack of reasons for these substances. In addition to the reasons for the lack of poor quality food, there may be other factors, such as multiple pregnancy, breast-feeding, the partial eclipse, the long-term loss of appetite, chronic diarrhea, etc.. Arising from lack of nutrition if not remove the causes, effects are often less than ideal, even if temporary effect, the future might relapse.

If inflammation or infection can be controlled, can also reduce anemia. Endocrine disease, as replacement therapy, anemia can also reduce or be corrected, but as chronic renal failure, liver disease, advanced cancer or metastatic carcinoma of the broad, systemic lupus erythematosus, and other advanced secondary anemia, as the basic disease The effect of the poor, in addition to blood transfusion, it is very difficult to reduce anaemia in general.

Drug-induced hemolytic anemia and iron tablets of David cell anemia, patients stop in contact with the drug, most of anemia can be fast or gradually reduce and even disappear. However, certain drugs or poison caused by aplastic anemia, even if the cause of clear, with no access to, but because of the bone marrow hematopoietic tissue has been serious damage, it is very difficult to restore or cure the patient. Then, if adopted and the success of bone marrow transplantation, curable.

The main method of treatment of anemia drug treatment, blood transfusion, splenectomy and bone marrow transplantation. Clinically, according to different causes of different types of anemia, may be one or more of the therapy treatment.

Ureteral stones

[Summary]
The vast majority of ureteral stones from the kidney, including kidney stones or stones after extracorporeal shock wave caused by fragments landed. As more urine salt crystals into the urine of bladder, the primary ureteral stones rarely see. A ureteral strictures, diverticula, foreign bodies, such as predisposing factor, urinary retention and infection will lead to a ureteral stones. Ureteral stones are mostly single, the left side of the incidence broadly similar bilateral ureteral stones about 2 ~ 6%. Clinical more common in young adults, 20 to 40 years old the highest incidence of male and female ratio of 4.5:1, lower ureteral stones at the most, accounting for about 50 to 60 per cent. Ureteral stones on the urinary obstruction and expansion can cause stagnant water, and threaten suffering from kidney, serious renal function can gradually lose.

[Diagnosis]
The correct diagnosis of ureteral stones is not only sure whether stones, stones to determine the size, location, both sides of kidney function and the degree of hydronephrosis, whether infection. Typical of renal colic and hematuria is an important clue to the diagnosis. Pain in the ribs attack ridge area tenderness, Kouji pain. Women greater distal ureteral stones in the vaginal fornix to the touch. More than 90% of ureteral stones in the urinary tract film can be displayed, showed that calcium oxalate best, and subject to the abdominal lymph node calcification, pelvic vein stone, and appendectomy, bezoar differential phase angle of the island. Intravenous urography is mainly aimed at understanding the site of stones and renal function with the availability of stagnant water, if necessary, to large dose urography and radionuclide renography inspection, renal function can be further understand the situation. Cystoscopy and ureteral stones intubation in the disruption, and plain film shoot in the shadow of calcification catheter in the same plane, which can be sure that the diagnosis of ureteral stones. Air stone for the negative contrast agent for retrograde contrast radiography may show that the existence of stone. Another B-mode ultrasonography and CT examinations were helpful for the X-ray image is not stone diagnosis.

[Treatment]
Treatment of ureteral stones including symptomatic treatment, Chinese medicine treatment, extracorporeal shock wave lithotripsy and stone extraction by endoscopy, surgery and other stones.
(1) symptomatic treatment is mainly for controlling the renal colic, and can be used in the diagnosis after 0.5 mg atropine and dolantin 50 mg intramuscular injection, the pain can heat or district to acupuncture, waist sensitive areas can be closed for subcutaneous procaine (produced skin test). Can also be used nifedipine or indomethacin Cypriot anal suppositories.
(2) TCM Paishi suitable for the treatment within 1 cm in diameter, oval shape, smooth surface of the stone, pyelography were without water. Governance and administration are: Qingre Lishi, such as Lysimachia christinae Hance, such as the Jinsha. Qingrejiedu, such as Mr Wong, Yinhua, such as Hypericum perforatum. Blood Circulation, Ruanjian Huashi, such as Spartina, Ezhu such. Bushen such as cinnamon, Aconite, Cistanche, etc.. Air Dangshen such as blood, such as astragalus. There are various kinds of Paishi granules, and convenient.
(C) The use of extracorporeal shock wave lithotripsy Dornier X-ray positioning of the treatment has been expanded upper ureteral stones in the ureter, the calculi. Upper ureteral stones should adopt the semi-supine Chace, the iliac wing overlapping parts of stones should be used prone position under half of the available seats, the upgrade can be made certain of success. Although the total length of the various parts of ureteral stones can be crushed Extracorporeal Shock Wave, but in smaller stones, body fat patients sometimes difficult existence location, location deep, and so more energy, and crush kidney stones compared to the difficulty of ureteral stones to smash the relatively higher , the overall effect worse than kidney stones. Therefore, we must strengthen the positioning accuracy of the shock wave, there are difficulties, at the same time for excretion of urinary bladder angiography or do endoscopic retrograde catheterization and angiography, to help positioning. If stones can be pushed into the renal pelvis waves again, the most ideal. Contrast agent can often easily shattered stones, which emit. On the contrary, even if not stones, and significantly above water, especially with ureteral periimplantitis, retrograde intubation or inaccessible beneath stones, shock wave lithotripsy effects often poor.
The Lower Ureteral smaller stones, can be carried out by cystoscopy ureter expansion sets of stone, cut the mouth. In recent years, under the application of ureteroscopy peep stones or laser, ultrasonic lithotripsy, although there are reports of 40 to 78 per cent success rate, but it is worth noting that operation can cause perforation, tearing, and other serious complications.
(D) Operation and stone removal indications: ① there ureter stenosis; ② bilateral or unilateral ureteral stones incarcerated with urinary infection caused closure; ③ larger stones, hydronephrosis serious, poor renal function; ④ extracorporeal shock wave or waves can not positioning losers; ⑤ clinical tumor or not, except tuberculosis; ⑥ economic factors. Two hours before surgery urinary-ray film to be positioning.

As for the larger female Lower Ureteral stones, and sometimes touched by transvaginal Konglongbu inspection stone, the stone from the massage.

[Clinical]
Ureteral stones and kidney stones similar symptoms. Stones and the size of obstruction, hematuria and not necessarily proportional to the degree of pain. In the ureter, on the site of the stone or stones plug incarcerated in the downward course of a typical side often caused renal colic and microscopic hematuria. To the thigh pain, testicular or labia minora radiotherapy. Accompanied nausea, vomiting, and sometimes for hematuria visible to the naked eye. Ureter and bladder intramural most of the narrow, stone easy to stay. Because the muscles of the lower ureter and bladder linked triangle, and directly attached to the posterior urethra, it accompanied the frequency, urgency and the unique Niaotong symptoms. Not be affected by the larger urinary calculi, only pain, hematuria also light. In the solitary kidney or ureter stones blocking bilateral ureteral obstruction or obstructive ureteral calculi side contralateral to a reflex anuria, and so on, can be acute anuria, and even renal failure.

Diabetic nephropathy

Diabetic nephropathy is a diabetic microangiopathy important, and is one of the major causes of death for diabetes. In the course of more than 15 years in IDDM people will be 30% -40% in diabetic nephropathy; NIDDM in people occurred in 25% of diabetic nephropathy. Generalized diabetic kidney disease include diabetes combined with acute pyelonephritis and renal papillary necrosis, acute renal papillary necrosis relatively rare. Narrow diabetic nephropathy is caused by diabetes and renal glomerular capillary vascular sclerosis caused by the normal excretion and filtration reduction, which eventually led to renal failure.

[Causes]
Diabetic nephropathy is made up of different etiology and pathogenesis of insulin caused in absolute and relative shortage of sugar that protein and fat metabolism disorders, and chronic high blood sugar is the main clinical manifestations of systemic disease. Diabetes can damage the kidneys of these different channels can damage the structure of all involved kidneys, but only glomerular sclerosis and diabetes have a direct relationship, also known as diabetic nephropathy and diabetic microvascular complications systemic one. Diabetic patients kidney damage in the event of persistent proteinuria is often irreversible condition to the development of end-stage renal failure. Diabetic nephropathy has become diabetic patients leading causes of death.

[Clinical performance and staging]
Ⅰ period: increased glomerular filtration rate and renal volume increased features. This early lesions consistent with the high blood glucose levels, but reversible, after insulin treatment can be resumed, but may not be able to return fully to normal.
Ⅱ period: The period of normal urinary albumin excretion rate of glomerular but there has been structural change.
Ⅲ period: called early diabetic nephropathy. Urinary albumin excretion rate of 20 - 200 μ g / min, the patient’s blood pressure increased slightly, and began to glomerular abandoned.
Ⅳ period: Clinical diabetic nephropathy or overt diabetic nephropathy. This period is characterized by macroalbuminuria (more than 3.5 grams per day), edema and hypertension. Diabetic nephropathy more serious edema, poor response to diuretics.
Ⅴ period: end-stage renal failure. Diabetic patients in the event of persistent urinary protein for clinical development of diabetic nephropathy, as widely glomerular basement membrane thickening of the glomerular capillary cavity narrow and more abandoned glomerular kidney filtration function of the decline , resulting in renal failure.

[Treatment]
(A) medical treatment
1. Diabetes treatment:
(1) diet therapy: current advocates of early diabetic nephropathy that should limit the intake of protein (0.8 g / kg.d). To have edema and renal insufficiency patients, in addition to diet restrictions on the sodium intake, protein intake to be taken on the principle of streamlined (0.6 g / kg.d), if necessary, appropriate amino acid and plasma transfusion . Insulin can be guaranteed in the appropriate increase in carbohydrate intake to ensure adequate calories. Fat to use vegetable oil.
(2) drug treatment: oral hypoglycemic agent. For simple diet and oral hypoglycemic drug control has been poor and renal insufficiency patients using insulin should be as soon as possible. Insulin, blood glucose monitoring to timely adjust dosage.
2. Antihypertensive treatment:
Hypertension can accelerate the progress of diabetic nephropathy and deterioration to control the blood pressure level of diabetes than non-diabetic patients with hypertension lower diastolic blood pressure less than 75 mmHg. Should limit sodium intake, smoking, alcohol restrictions, reducing body weight and adequate exercise. First advocated more antihypertensive drug use of angiotensin-converting enzyme inhibitors, often combined with calcium antagonists, can be used as α1 receptor antagonist prazosin. Under appropriate conditions can be added using diuretics.

(B) dialysis treatment:
End-stage diabetic nephropathy patients can only receive dialysis treatment, there are two main ways: long-term hemodialysis and continuous ambulatory peritoneal dialysis. Recently the vast majority of end-stage patients with diabetic nephropathy to peritoneal dialysis, because it does not increase the heart load and stress, can better control of extracellular fluid volume and high blood pressure. Also intraperitoneal injection of insulin, convenient operation cost savings, but some long-term peritoneal dialysis patients absorb large amounts of glucose caused obesity and hyperlipidemia. On dialysis to the timing of earlier in the non-diabetic patients.

(C) renal or kidney pancreas transplantation:
Only a few patients can receive such treatment. Therefore diabetic nephropathy is the most fundamental measures to control diabetes, as far as possible to prevent the occurrence of diabetic nephropathy and development.
On the prevention and treatment of this disease, focusing on prevention, prevention lies in prevention, and correction of all risk factors, including blood glucose and blood pressure control, smoking cessation. In the stage of microalbuminuria, strict control of blood sugar can prevent the occurrence of nephropathy.

Hypertension in children with acute nephritis

Captopril acid (CPT) is the angiotensin-converting enzyme inhibitor, congestive heart failure, severe hypertension significantly, I applied in recent years by CPT treatment of hypertension in 32 cases of acute glomerulonephritis, and achieved good effect, it is reported as follows.
1 Materials and Methods
1.1 All patients with “practical paediatrics,” the acute nephritis and children hypertension diagnostic criteria. CPT treatment group of 32 cases, 17 cases male, female 15 cases, 12 cases of pre-school children, school-age children in 20 cases, systolic blood pressure before treatment in the 128 to 135 mmHg and diastolic pressure 82.5 to 97.5 mmHg in the control group 30 cases, 16 cases male, female 14 cases, 11 cases of pre-school children, school-age children in 19 cases, systolic blood pressure before treatment in the 120 to 135 mmHg and diastolic blood pressure in the 82.5 to 90.0 mmHg. There were no hypertensive encephalopathy, heart failure, renal failure. Case two groups in age, condition, blood pressure similar to the basic.
1.2 Methods in the application of conventional treatment, such as penicillin, on the basis of CPT CPT first group of 0.5 mg kg-1 * each subsequent * 1 ~ 5 mg kg-1, three times a day or q # 8 h oral, reducing blood pressure to normal gradually stop. The control group by reserpine, No. 1 * d 0.07 mg kg-1 were injected, if necessary, with a 12 h later, the next day after the routine of 0.02 ~ 0.03 mg kg-1 * * d - 1 2 ~ 3 oral administration.
GM Cuff width of a long arm in children 2 / 3 mercury sphygmomanometer, supine position of the right upper arm blood pressure, supine before manometry over 15 min, followed by measurement medication, medication after 30 min, 4 h, 72 h compared blood pressure .

Renal failure affect sexual function

Chronic renal failure is often said to have uremia, is a serious health hazard of the disease, according to statistics, with 90 per cent of men uremia a penile erection or not can not maintain an erection erectile state, usually serious degree and the extent of sexual dysfunction in line. Chronic renal failure may be because of the following reasons have sexual dysfunction.
First, the male hormone levels change. Doctors study found that men uremic patients can occur testicular atrophy, blood levels of the male hormone water drop gonadotropin levels increased, in recent years also found their prolactin levels in the blood increased significantly, these are abnormal hormone can lead to sexual dysfunction.
Second, the neural factors, uremia and hemodialysis patients often nervous system dysfunction, or uremic neuropathy, such as uremic encephalopathy.
Third, as with the diabetes, hypertension, tuberculosis, such as systemic lupus erythematosus and complications, such as anemia, abnormal calcium metabolism, electrolyte imbalance can cause sexual dysfunction. In addition, the treatment of many drugs such as anti-hypertensive drugs, diuretics, etc., as mentioned earlier, as varying degrees of interference function.
Fourth, is a psychological factor. Uremia patient prognosis is poor, patients depression, mental depression, even dialysis, kidney transplantation can only maintain their livelihood, the Chinese people but also by the impact of the economic burden may increase sexual dysfunction.
Chronic renal failure induced male sexual dysfunction treatment is difficult, hemodialysis and kidney transplantation can restore some patients, but mainly by doctors should provide advisory services, psychological state of patients with understanding, patient guidance, strengthen psychological treatment to help Patients restore sexual function.

Chronic renal failure and sexual

Chronic renal failure (chronic renal failure) is a serious health hazard diseases, it is almost every physical damage to a system. Past 10-odd years, since the development of dialysis and transplantation, as well as medical equipment, medical personnel, financial sources of the increase in the survival rate of patients with uremia has been significantly enhanced, but the serious harm of uremia still should not be underestimated.

First, uremia, dialysis, transplants and sexual function
Patients with chronic renal failure and dysfunction more common. Generally speaking, the magnitude of uremia and loss of libido and sexual dysfunction extent is the same. With the illness earlier, and 90 percent of male patients and 80% of female patients in loss of libido; 80% of the male patients could not erect penis erection or to maintain an erection can not state. Uremic patients on female sexual function of the relative lack of reliable information also, but about three-quarters of the female patients difficult to arouse sexual excitement, about half of the female patients upsurge in the frequency of sexual desire or intensity decreased or completely lack.
Uremic patients on hemodialysis treatment, their sexual function normally no significant improvement Levy in the 536 cases of chronic renal failure patients digging investigation found that hemodialysis patients, 35% of men and 25% of the female sexual function further diminish, and only 9 percent of men and 6 percent of women in sexual function after hemodialysis has improved. In hemodialysis treatment, the patient’s sexuality may have improved, but other aspects of sexual dysfunction has given the patient a greater distressed. Steele, and other reports, 17 cases of hemodialysis patients, seven cases simply can not achieve sexual intercourse, sexual intercourse is rarely six cases (less than one per month), only two cases of sexual intercourse once a week. In fact, these patients still want their subjective sex life can be carried out normally. Uremia, or a small part of the male patients in dialysis can not ejaculate or ejaculation problems in those taking this issue guanidine or a B-methyl-dopa control of hypertension patients more common. Uremia or female hemodialysis patients, about one-fifth of the existence sexual intercourse difficult.
Successful renal transplantation can not completely solve the patients with chronic renal failure sexual dysfunction problems. Levy reports, the success of kidney transplantation women, their sexual function can be restored to the level before the illness, and a considerable number of male patients is not. Other researchers report, the success of kidney transplantation patients, their sexuality can be restored, but their sexual dysfunction has not fully recovered. Salvatierra and other reports, many male patients in sexual function after renal transplantation restored to the level of before, but Procci, such as Hoffman and Chatterjee found that renal transplant patients after the success of the men and women, the frequency of sexual intercourse was significantly lower than the level before the illness.

Second, etiology
(1) severe renal failure hormone levels in female patients often amenorrhea (or months after less) and infertility. These female sex hormone levels of patients still lack a detailed study. However, the clinical manifestations and common breast atrophy, reduced vaginal lubrication, atrophic vaginitis, and so on, may be the lack of signs of estrogen. Hemodialysis, the girls do not have occurred in patients menorrhagia. Female long-term dialysis patients, full-term pregnancy is extremely rare, but after the success of kidney transplantation dramatically improve fertility, and may have a relatively smooth pregnancy.
Men uremic patients can typically arise testicular atrophy and sperm production obstacles, and in hemodialysis after no improvement in their levels of testosterone is usually lower, even if also a good uremic control remains the same. Many reports that the cycle of these patients gonadotropin (LH and FSH) levels increased, however, some patients LH and FSH levels are normal, and this shows that chronic renal patients may have co hypothalamus dysfunction. On the Leydig cell function is normal, there are different views, some people think that one of their testicular function normally, while some researchers think that such functional decline. Successful kidney transplant within a few months after return to normal levels of testosterone, and the desire to improve patient is the same. Uremia, or hemodialysis patients after oral testosterone-enhanced Although sexuality, but it does not restore ejaculation or erectile function.
Patients with chronic renal failure in the breast of a female who was less see, but in hemodialysis patients with the more common cut. This phenomenon Lactagogue whether the increased levels of hormones is not clear whether the same can be “after the resumption of nutrition-man female breast” comparable to, and no conclusions. The so-called “nutrition men after the resumption of female breast development,” can be found in long-term hunger again after the nutritional intake of a large number of patients.

(B) factors of uremic patients and hemodialysis patients often nervous system dysfunction. Involvement of the pelvic autonomic nervous system uremic neurological disorders, undoubtedly will cause male or female sexual dysfunction, although the mechanism may be only a small minority of patients pathogenic factors. Another found that male patients with blood-line vibration sensitivity increased, it may be all of these patients reduce the excitability of the reasons for the uremic encephalopathy of sexual inhibition, may also be one of the causes.

(C) associated with diseases and drug effects leading to chronic renal failure in certain diseases, the impact on sexual function in the kidney does not rely on the extent of the damage. These diseases include diabetes, systemic lupus erythematosus, nodular more arteritis, scleroderma, amyloidosis, sarcoma, heavy metal poisoning and tuberculosis. In addition, some of the complications of chronic renal failure, such as anemia, abnormal calcium metabolism disorders and other electrolytes, can cause weakness, loss of libido and neuromuscular dysfunction. Uremia often immunocompromised patients, the risk of infection. Female patients often a vaginal infection, resulting in poor or vaginal intercourse Run difficulties.
Many uremic patients with hypertension, it takes control of blood pressure drugs. Some antihypertensive agents on the function of the damage has been described in detail in the section, will not repeat them here.

(D) psychological factors uremia is a serious life-threatening diseases, patients and their families had great mental pressure. Because dialysis patients physical activity is restricted, dependent on dialysis for life, the loss of control over their own lives, and often have depression, depression and other performance. The patient’s family refused to add to the negative economic, wife increasing burden of household chores, and can not be normal life, and some patients may be a harmonious relationship between the husband and wife, thus more emotionally depressed patients. Steele, who report depression hemodialysis patients and the extent of sexual dysfunction in the relationship between the severity of the very close. Because depression can lead to loss of libido and sexual dysfunction, it is likely a common human blood is the main pathogenic factors.

Third, treatment
At present, the majority of organic chronic renal failure complications certainly no effect. Hormone therapy is generally believed that future generations do not have to improve sexual function role. However, a recent report suggested that long-term use of male patients with uremia acid citrate rubber at the end of phenol-amine (clomiphene citrate), 100 mg per day, could resume normal levels of testosterone, and to enhance sexual desire, the capacity to resume normal sexual intercourse. It was also found that zinc deficiency in hemodialysis patients, such as dialysis solution include adequate zinc, the levels of testosterone and sexual function may correct lower, suggesting that Ji may be added as a treatment measures. However, these two methods need further studies to confirm that and I can recommend clinical application. Female patients should be promptly found vaginal infections, timely treatment.
Uremic patients deal with the problem of the most effective ways, the key is to provide advisory services. For consultation work, doctors need to know some of these patients typical psychological defense mechanisms such as denial, speculation, transfer topic or a reflection, and to keep the attention of Mrs. found patients lazy or depressed issues such as suicide attempts, enlighten patients ideas, enhance its Life confidence, while paying attention to help patients deal with family relationships. Training group will be able to necessary medical knowledge and certain social psychology knowledge mastery of expertise, is doing a good job of the work of an important guarantee for advice. If necessary, the patient is individual psychotherapy, group therapy is often used in general, such as in the latter case, consideration should be given to patients and their spouses for as a group.
In some cases, patients can be identified sexual dysfunction is purely spiritual nature. For example, after the success of kidney transplantation, the effect of treatment may be better. On the sex life of the people too eager, in a separate application during the dialysis treatment is often difficult to work, because of their mental burden too heavy, then, should be effective treatment and psychological treatment combination.

Chronic renal failure attention to how water metabolism?

Patients with chronic renal failure in the water metabolic disorders can be manifested as excessive water loss or water, too much water is divided into acute and chronic excess water and water poisoning. ① LOCA: mild thirst can be a moderate oral mucosa can be dry, weakness, oliguria, Nibichong increases can have severe somnolence, agitation, coma, and other neuropsychiatric symptoms ② chronic excessive water and water poisoning: slow development, there can be early weakness, headache, anorexia, nausea, muscle cramps, swelling of subcutaneous tissue, edema. While the further development of anxiety, convulsions, coma, tendon reflexes weaken or even disappear. When a clear neuropsychological symptoms known as water intoxication. ③ acute water intoxication and excessive water: The main cause of cerebral edema due to the spirit of symptoms. Such as headache, blurred vision, ataxia, orientation of the obstacles, muscle convulsions, coma and even from intracranial hypertension, vomiting, respiratory depression, due to the late cerebral hernia, respiratory and cardiac arrest deaths.

On the water in patients with metabolic disorders, and body weight per day should be recorded, the access of water to maintain water balance. ① LOCA: mild water loss can be corrected through oral rehydration, if fever, vomiting, diarrhea, it must supplement water, the maintenance of extracellular fluid capacity, severe water loss must be immediately rehydration expansion. Water intake for the day before the urine, plus 400 to 500 mL / d, combined with vomiting, diarrhea, coupled with the loss. Rehydration attention should be paid to heart function. ② too much water, the water should be strictly controlled intake, severe edema available to intravenous diuretic furosemide, if renal damage is heavier Shen this method. If there with seizures, unconsciousness, coma and other neurological symptoms, urgent measures should be taken, preferably immediately hemodialysis or peritoneal dialysis to remove excess moisture in, save lives. 