NTU Hospital Deputy Superintendent Hung Kuan-yu "Hung Chun-pei Cultural and Educational Foundation" Public Welfare Lecture

(Taiwan Business News) Taiwan, China has the highest dialysis density in the world, and a recent string of food safety issues has aroused public concern. Taiwan Business News and the Hung Chun-pei Cultural and Educational Foundation invited Professor Hung Kuan-yu, Deputy Superintendent of NTU Hospital, on May 11 to speak on "Kidney Health, Happy Life," hoping to raise public knowledge about kidney protection.

Many people fear developing kidney disease, yet do not know how to detect the signs of kidney disease early. Hung Kuan-yu stated that because kidney disease has no obvious symptoms in its early stages, it is not easily noticed by the public. For this reason, only a medical examination can reveal clues in the early stage. He recommends that the public undergo regular health checkups, which can help detect and prevent kidney disease early. In addition, understanding proteinuria, hematuria, nocturia or polyuria can help prevent and treat kidney disease early.

NTU Hospital Deputy Superintendent Hung Kuan-yu Public Welfare Lecture: Kidney Health, Happy Life

1. Proteinuria: A single instance of proteinuria has no clinical significance. The key points are whether the proteinuria is persistent, the amount of protein in the urine, and the source of the protein in the urine - whether it is caused by glomerular lesions, a problem with the renal tubules, or even by the body producing too much protein that exceeds the reabsorption limit of the renal tubules. In outpatient clinics, patients often seek medical examination because of bubbles in their urine, but the test results do not necessarily show proteinuria; however, patients who do have proteinuria usually show a pattern in which the more bubbles there are, the more proteinuria there is.

2. Hematuria: Unless there is obvious bleeding in the urine, slight hematuria is not easily detected without urine screening. In addition, a single instance of hematuria also has no clinical significance, but if a patient has persistent hematuria, follow-up is necessary in order to find the cause of the hematuria.

3. Nocturia or polyuria: There are many causes of nocturia or polyuria, but when renal tubular function is abnormal, the ability to concentrate urine is often relatively poor, which can also cause nocturia or polyuria. Therefore, examination and regular follow-up treatment are necessary.

There are often some high-risk groups for kidney disease, including people with diabetes, people with hypertension, people with gout, people with a family history of kidney disease, people over 65 years of age, people with proteinuria, and people who abuse drugs. These high-risk groups should ideally undergo regular urine screening and kidney function tests, so that kidney disease can be detected early and followed up and treated one step earlier.

Hung Kuan-yu emphasized that the early symptoms of kidney disease include proteinuria, hematuria, nocturia or polyuria. Generally speaking, unless urine screening is performed, these symptoms are easily overlooked, leading the disease to progress to stage 4 or stage 5 chronic kidney disease. At that stage, patients will experience symptoms such as edema, anemia, nausea, vomiting, hypertension, poor appetite, itchy skin, and pulmonary edema. If it is only discovered at that point, the disease may already have worsened to a serious degree.

People in Taiwan, China love salt, consuming an average of 15 grams of salt per person per day, which is three times the amount recommended by the World Health Organization. Hung Kuan-yu stated that salt contains many electrolytes needed by the body, and body muscle contraction and other functions all require electrolytes to operate. Electrolytes generate electrical waves in the body, such as the commonly seen electrocardiogram waves. When the heart contracts, it needs three different electrolytes: sodium ions, potassium ions and calcium ions, in order to complete the contraction action. Many sports drinks on the market emphasize that they contain electrolytes. Family medicine physician Chen Po-chen explained that when exercising and sweating, the body not only loses water but also loses electrolytes. When electrolytes are insufficient, muscle weakness occurs, just like with gastroenteritis and diarrhea: after losing a lot of water, the limbs become weak and one may even be unable to stand. Therefore, when electrolytes lost after exercise need to be replenished, maintaining the body's electrolyte balance is very important.

Hung Kuan-yu stated that salt is generally believed to have a sterilizing function. Salt is sprinkled on preserved foods because sprinkling salt on food causes dehydration, making it impossible for bacteria to survive. However, sprinkling salt on a mouth ulcer wound not only fails to dehydrate it but also causes stinging; if instead saline solution is applied to the wound, it will feel more comfortable, because saline solution contains the same electrolytes as the body. There are many types of salt, especially when eating steak, when premium, beautifully colored rose salt or rock salt is sprinkled on top. These salts contain minerals, but not everyone necessarily needs these minerals; in particular, refined salt does not contain iodine, and long-term iodine deficiency can cause hypothyroidism. In addition to the neck becoming thicker, it can also cause endogenous obesity, the so-called puffiness. In particular, the thyroid is closely related to children's growth. If thyroid function is low, children may not grow tall, and more seriously, it may affect intellectual development.

Kidney disease patients need to pay special attention to salt intake. Refined salt contains more than 99.5% sodium chloride. Consuming too much sodium increases the burden on the kidneys and also raises blood pressure. Therefore, some people have designed "low-sodium salt" suitable for people with hypertension, in which the sodium content is about half reduced and replaced with potassium ions. However, poor kidney function reduces the ability to metabolize potassium ions, so kidney disease patients are not suited to eating low-sodium salt.

Potassium ions in the diet are easily absorbed in the small intestine. In general, the main route by which the human body loses potassium ions is urinary excretion, with 80-90% being excreted by the kidneys through urine, and a small portion (10-20%) being excreted through feces. Normally, the kidneys regulate potassium ions in order to maintain potassium ion concentration within the normal range, so that the myocardium remains active and as an indicator of electrolyte balance. In addition, the acid-base balance state of human blood also has an effect on potassium ions.

When the potassium ion concentration in human plasma is lower than 3.5 mEq/L, it is called hypokalemia. Common causes are reduced intake, excessive loss such as from diarrhea and vomiting, and potassium ions shifting from extracellular fluid to intracellular fluid. When hypokalemia occurs in the human body, it will affect the cardiovascular, central nervous, digestive, urinary and muscular systems. With the severity of hypokalemia, the cardiovascular system may first show orthostatic hypotension and weak pulse, and in severe cases electrocardiogram changes, myocardial damage, and cardiac arrest. The central nervous system may show fatigue, lethargy, confusion, paresthesia, and weakened DTR, and in severe cases even coma. The digestive system may show anorexia, nausea, vomiting, weakened intestinal peristalsis, and constipation, and in severe cases paralytic ileus. The urinary system may show reduced renal concentrating ability, diluted urine, polyuria, and intense thirst. The muscular system may show weakness, flaccid paralysis, respiratory muscle weakness, and respiratory arrest.

Conversely, when the potassium ion concentration in human plasma is higher than 5.5 mEq/L, it is called hyperkalemia, commonly caused by excessive intake, reduced excretion, or potassium ions shifting from intracellular fluid to extracellular fluid. Hyperkalemia generally occurs more easily in patients with kidney failure. When hyperkalemia occurs in the human body, there will be decreased blood pressure, arrhythmia, electrocardiogram changes, and in severe cases ventricular fibrillation and cardiac arrest. Neuromuscular symptoms in the early stage include muscle tremors, spasms, and paresthesia, while in the late stage there will be muscle weakness, flaccid paralysis, and respiratory arrest. In addition, digestive system symptoms such as nausea, vomiting, increased intestinal peristalsis, diarrhea, and abdominal cramps, as well as urinary system symptoms such as oliguria and anuria, will also appear.

Normally, if human kidney function is normal, excess potassium ions ingested each day can usually be excreted with the help of the kidneys. Therefore, appropriate potassium ion intake does not place a burden on the human body. However, for patients with chronic kidney failure, because the kidneys' ability to excrete potassium is reduced, the RDA recommends a daily maximum upper limit of 99 mg, and recommends reducing intake of high-potassium foods. For fruits, try to choose fruits with relatively low potassium content, such as Asian pear, watermelon, pineapple, wax apple, mangosteen, peach, mango, etc.

▲This newspaper and the Hung Chun-pei Cultural and Educational Foundation invited Professor Hung Kuan-yu, Deputy Superintendent of NTU Hospital, on May 11 to speak on "Kidney Health, Happy Life," hoping to raise public knowledge about kidney protection.

Profile of NTU Hospital Deputy Superintendent Hung Kuan-yu

Professor Hung Kuan-yu, Deputy Superintendent of NTU Hospital, graduated from the School of Medicine, National Taiwan University College of Medicine, and holds a doctorate from the Graduate Institute of Clinical Medicine, National Taiwan University, and an EMBA from the Executive Master of Business Administration program (Finance Group) of National Taiwan University College of Management. He has served as Director of the Department of Medical Education and Deputy Superintendent of Banqiao Far Eastern Memorial Hospital; Director and Chairman of the Education Committee of the Taiwan Society of Nephrology; Director of the Taiwan Society for Clinical Nutrition; Supervisor of the Taiwan Hospital Quality Association; Director of the Taiwan Hypertension Society; Standing Director of the Taiwan Society of Atherosclerosis and Vascular Disease; Medical Review Advisory Committee Member of the Ministry of Health and Welfare; Health Quality Policy Advisory Committee Member; Representative in the National Health Insurance Hospital Global Budget Negotiation; Member of the Medical Review Committee of the Department of Health, Taipei City Government; Deputy Secretary-General of the Taiwan Society of Internal Medicine; Deputy Director of the Department of Internal Medicine at NTU Hospital; Medical Secretary of NTU Hospital; Director of the Quality Management Center; Director of the Department of Integrated Diagnostics and Therapeutics; Editor-in-Chief of the Journal of the Taiwan Society of Nephrology; Editor-in-Chief of the Journal of Medical Quality; and Editorial Board Member of SCI journals. He currently serves as Deputy Superintendent of NTU Hospital. He has received honors including the Taiwan Cheng Hsin Medical Award, twice the NTU Hospital Special Excellence in Medical Teaching Award, the Taiwan Society of Internal Medicine Best Research Paper Award (the society's highest research award), the Professor Chen Wan-yu Outstanding Paper Award (the highest research award of the Taiwan Society of Nephrology), the 3rd Yu Ziang Outstanding Professor Award, the Taiwan Society of Nephrology Research Award, and twice the NTU Hospital Teaching Material and Publication Award.

Hung Chun-pei Cultural and Educational Foundation 2014 Public Welfare Lecture