Abstract
In the past several years, the clinical courses of various renal diseases have been clarified along with popularization of renal biopsy technique and nation-wide surveys on renal diseases by Ministry of Health and Welfare. For the sake of patients, it is very important to elucidate the deteriorating factors of chronic renal diseases.
This study was done on 339 consecutive patients (150 males and 189 females) in our renal clinic in order to evaluate the contributing factors to the impairment of renal function.
Results and Discussion: 1) The number of patients with impaired renal function (serum creatinine>2mg/dl) was 42 in male and 30 in female. This indicates the male preponderance over female in becoming renal insufficiency (P<0.01). 2) The number of patients with impaired renal function and hypertension increased with aging. This tendency was more marked in male than in female, 3) About half of persistent hypertensives (>160 and/or 95 mmHg) have serum creatinine levels of more than 2 mg/dl. This indicates that persistent hypertension exerted an unfavorable effect on renal diseases. 4) The renal function was impaired in 39% of the patients taking a rest, 17% in working patients and 18% in overworking patients, respectively. We consider that these data do not necessarily deny the favorable effect of taking a rest on renal function. This result was mainly attributed to the relatively short follow-up period and the disparity of age distribution in these 3 groups. 5) Renal insufficiency was more frequently observed in patients with hypertension, urinary tract infections and those having renal impairment since pregnancy. 6) Seven women with renal disease had normal deliveries, but other 4 women experienced abortions or stillbirths. Furthermore, deterioration of the renal disease was seen in 7 women after delivery. Five of the 7 have been receiving chronic hemodialysis. Only one patient with renal disease showed normal urinalysis transiently in the 3rd trimester of pregnancy and relapsed after the delivery. 7) Eleven out of 339 patients died; 4 of them from nephrosclerosis, 3 from chronic glomerulonephritis, 1 from multiple myeloma, 1 from primary amyloidosis, 1 from lupus erythematosus and 1 from unknown cause. Causes of death were cerebral hemorrhage in 4, gastrointestinal bleeding in 3 and pneumonia in 3. These implicate the importance to maintaining blood pressure within normal range as well as keeping patients away from malnutrition.
Finally the risk factors of renal diseases were analyzed. These were age, sex, activities, infection, underlying disease, hypertension, pregnancy and so on. Our study revealed that hypertension and pregnancy were the major risk factors among them. Medical attendants should always keep in mind these risk factors and evaluate properly such laboratory findings as urinalysis, renal function tests and pathological changes in the management of chronic renal diseases.
