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Treatment plan and principle of chronic renal failure


1, delaying or reversing the early and middle stages of chronic renal failure:
For the existing kidney disease or may cause kidney damage (such as diabetes, hypertension, etc.) in a timely and effective treatment to prevent the occurrence of CRF, known as prevention prevention (primary). Treatment of mild and moderate CRF in time, delay, stop or reverse the progress of CRF, to prevent the occurrence of uremia, known as two prevention (secondary).
2 basic prevention measures:
1 adhere to the cause of treatment: such as hypertension, diabetic nephropathy, glomerulonephritis, such as adherence to long-term rational treatment.
2 to avoid or eliminate the risk factors of CRF: the rapid deterioration of the kidney based recurrent disease or acute exacerbation, severe hypertension, failed to control acute hypovolemia, renal local blood supply decreased sharply, severe infection, trauma, urinary tract obstruction and other organ failure (such as severe heart failure, severe liver failure), the use of drugs the renal toxicity of improper.
3 to block or inhibit the progressive development of renal damage in a variety of ways to protect the kidney and kidney units. The blood pressure, blood glucose, urine protein, GFR, and other indicators should be controlled in the ideal range".
(1) strict control of hypertension: continuous and effective control of hypertension for 24 hours, which is important for the protection of target organs, and is one of the main factors to delay, stop or reverse the progression of CRF. The pre dialysis CRF (GFR = 10ml/min) in patients with blood pressure, usually should be controlled under 120-130/75-80mmHg. Angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor 1 antagonist (ARB) have a good antihypertensive effect, as well as its unique role in reducing high filtration, reducing proteinuria.
(2) strict control of blood sugar: research shows that strict control of blood sugar, so that patients with diabetes fasting blood glucose control at 90-130 mg/dl, <7% (HbA1C), can delay the progress of patients with CRF.
(3) control of proteinuria: control of proteinuria in patients with <0.5g/d, or a significant reduction in microalbuminuria, can improve their long-term prognosis, including delaying the progression of CRF and improve survival.
(4) diet therapy: application of low protein, low phosphorus diet alone or combined with essential amino acid or alpha keto acid (EAA/KA), may have reduced glomerular sclerosis and renal interstitial fibrosis interaction. Most of the results support that dietary therapy is effective in delaying the progression of CRF, but the effect is different in patients with different etiology and different stages of CRF.
(5) other: actively correct anemia, reduce the accumulation of uremic toxins, the use of statins lipid-lowering drugs, smoking cessation, etc., is likely to have a protective effect on renal function, is under further study.

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