Uremia is not a single disease, but rather a common clinical syndrome across various end-stage kidney diseases, signaling the terminal stage of renal failure. Primary, secondary, and hereditary kidney diseases can all lead to severe damage to the nephrons, rendering the kidneys unable to maintain their basic functions. Metabolic waste and toxins cannot be excreted smoothly, remaining in the body. This can lead to fluid and electrolyte imbalances, acid-base imbalances, and systemic toxicity affecting the digestive tract, heart, lungs, nerves, muscles, skin, and blood.
Epidemiology
ContagiousNot contagious.
Incidence
There are no big data studies yet.
High-risk population
It is more common in people aged 15 to 49.
Causes
Overview
Primary, secondary or hereditary kidney diseases lead to chronic, progressive and irreversible destruction of renal units. The remaining renal units cannot metabolize all waste in the body, resulting in the accumulation of metabolic waste and toxins in the body, which in turn causes water, electrolyte and acid-base imbalances, and ultimately leads to the occurrence of uremia.
Basic cause
1. Primary kidney disease
Such as chronic glomerulonephritis, chronic pyelonephritis, interstitial nephritis, IgA nephropathy, arteriolar sclerosis, membranoproliferative glomerulonephritis, polycystic kidney disease, etc.
2. Secondary kidney disease
Kidney damage secondary to systemic diseases. Systemic diseases that may cause kidney damage mainly include: diabetes, hypertension, multiple myeloma, systemic lupus erythematosus, Henoch-Schonlein purpura, Good-Pasture syndrome, tumors, etc.
3. Hereditary kidney disease
Certain hereditary kidney diseases, such as hereditary nephritis (i.e., AIport syndrome) and autosomal inherited polycystic kidney disease, can also lead to uremia.
Predisposing factors
1. Predisposing factors for acute exacerbation
Nephrotoxic drugs, severe infections, heart failure, liver failure, hypercalcemia, and a sharp decrease in local blood supply to the kidneys can all induce acute damage to renal function and ultimately lead to the occurrence of uremia.
2. Chronic inducing factors
If factors such as diabetes, hypertension, hyperlipidemia, hypoproteinemia, anemia, malnutrition, and smoking are not controlled in time, they can also lead to renal damage, accumulation of toxins, and induce uremia.
symptom
Overview
Typical symptoms of uremia patients include edema, itchy skin, nausea, vomiting, decreased appetite, fatigue, weight loss, etc. Complications such as anemia, coagulation dysfunction, hyperkalemia, acidosis, renal osteodystrophy, and sexual dysfunction may also occur.
Typical symptoms
The accumulation of various uremic toxins in the body causes the following symptoms of poisoning in various systems of the body:
1. Manifestations of metabolic disorders
Uremic patients experience metabolic disorders of various electrolytes (such as potassium, calcium, phosphorus, and magnesium), proteins, carbohydrates, lipids, and vitamins, leading to clinical manifestations such as loss of appetite, weakness, subcutaneous edema, and fluid accumulation in body cavities.
2. Skin manifestations
Skin itching is a common symptom in patients with uremia, in addition to dry skin, desquamation, pigmentation and edema.
3. Digestive system manifestations
Including nausea, vomiting, loss of appetite, abdominal distension, diarrhea, constipation, etc.
4. Respiratory system manifestations
These include difficulty breathing, coughing, chest pain, and an ammonia or urine odor in the mouth when breathing.
5. Circulatory system manifestations
Exertional dyspnea (i.e., dyspnea after strenuous activity or physical labor, which is a common symptom of left heart failure), arrhythmia, heart failure, cardiac arrest, etc. may occur.
6. Hematologic manifestations
Involvement of the blood system can cause bleeding tendency and anemia symptoms (such as dizziness, fatigue, pale complexion, etc.).
7. Neurological manifestations
Including impaired consciousness, agitation, delirium, convulsions, etc.
8. Motor system performance
Uremic patients experience increased neuromuscular excitability, which can lead to muscle tremors, muscle spasms, muscle atrophy, and muscle weakness. When the bones are affected, clinical manifestations such as bone deformation, bone pain, difficulty walking, and spontaneous fractures may occur.
9. Endocrine system manifestations
Patients may experience symptoms such as general fatigue, thirst, and weight loss. In addition, patients with uremia are also prone to infection.
10. Others
Patients with uremia have an increased risk of infection and are prone to lung or urinary tract infections.
complication
1. Anemia
In renal failure, erythropoietin decreases, iron and folic acid are deficient, etc., which eventually lead to kidney-related anemia.
2. Coagulation dysfunction
In patients with uremia, due to impaired renal function, toxins are deposited in the blood, which can lead to an increase in platelet metabolism rate or a decrease in platelet adhesion to the vascular endothelium, ultimately causing coagulation dysfunction.
3. Hyperkalemia
Acute or chronic renal failure, acidosis, and excessive intake of certain drugs (such as potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, etc.) can all lead to the occurrence of hyperkalemia.
4. Acidosis
Renal tubular epithelial cells are the main regulators of acid-base balance in the body. As renal function gradually fails, phosphate and other organic acids gradually accumulate in the body, eventually leading to acidosis.
5. Renal osteodystrophy
Uremia can also lead to calcium and phosphorus metabolism disorders, thereby causing renal osteodystrophy.
6. Sexual dysfunction
Uremia can cause sex hormone disorders, causing amenorrhea and infertility in female patients; male patients may suffer from impotence, oligospermia or decreased sperm motility.
7. Heart disease
The accumulation of uremic toxins can also cause uremic pericarditis and pericardial effusion, ultimately leading to abnormal cardiac function.
examine
Scheduled inspection
Doctors should first conduct a comprehensive, systematic physical examination, followed by routine tests such as blood and urine routine, blood biochemistry, and renal function tests to gain a preliminary understanding of the patient’s condition and assess its severity. Depending on the patient’s condition, they may then perform renal ultrasound, CT, MRI, or radionuclide scanning to assess renal function and guide treatment. If necessary, a renal biopsy may also be performed.
Physical examination
1. Check the patient’s general condition
Uremia patients have multiple body systems affected. During the physical examination, close attention should be paid to the patient’s general condition to observe whether there is deep and rapid breathing, delirium, coma, etc.
2. Check the skin and mucous membranes
Observe the patient for signs of renal failure, which are usually manifested by a dull complexion, pale sclera, and slightly swollen eyelids. Also note the patient’s presence of rashes, hemorrhages, or oral ulcers.
3. Limb examination
Check whether the patient has edema in both lower limbs and whether the joints have lesions.
4. Chest examination
Uremic patients are at increased risk for cardiovascular events. Chest examinations reveal increased cardiac dullness in patients with left ventricular hypertrophy. Heart failure patients may experience increased heart rate, heart murmurs, and crackles at the lung bases. Pulmonary lesions may reveal signs of pleurisy, pleural effusion, pulmonary fibrosis, and pneumonia.
Laboratory tests
1. Routine blood test
Uremia can be complicated by serious hematologic disorders, such as anemia, bleeding tendency, and thrombosis. A routine blood test reveals a lower-than-normal hemoglobin level (normal for adult males: 120-160 g/L, normal for adult females: 110-150 g/L), often indicating anemia. A higher-than-normal white blood cell and neutrophil count (white blood cell count for adults should be 4-10 × 10⁹/L) often indicates infection.
2. Blood biochemistry examination
Uremic patients often have multiple metabolic disorders, including those affecting water and electrolytes. Blood biochemistry tests can reveal abnormalities such as decreased plasma protein, decreased serum calcium, increased serum phosphorus, high potassium, and low sodium. The results of these tests vary with the severity of the disease.
3. Urinalysis
Uremia varies in severity, so urine test results can vary widely. Common findings include decreased urine osmolality, decreased urine volume, positive urine protein, hematuria, and cystic urine.
4. Renal function test
Renal function tests in patients with uremia show a severely decreased glomerular filtration rate, elevated blood urea nitrogen (BUN), and elevated creatinine. Typically, the glomerular filtration rate (GFR) is <10 ml/min, the blood urea nitrogen (BUN) is >28.6 mmol/L, and the creatinine (SCr) is >707 μmol/L.
Imaging examinations
1. Renal ultrasound examination
Renal ultrasound is helpful in determining the size, position, and thickness of the kidneys, as well as assessing the presence of hydronephrosis, stones, and tumors. Typically, patients with uremia have bilateral kidney atrophy and thinning of the cortex.
2. CT
Patients with uremia have an increased risk of bleeding and may undergo a head or abdominal CT scan. If the patient has obvious changes in neurological or mental status, such as coma or convulsions, a head CT scan is required.
3. MRI
Magnetic resonance imaging (MRI) can help evaluate for renal artery stenosis or thrombosis and for aortic and renal artery dissection.
4. Radionuclide renal examination
The size, blood flow, secretion and excretion functions of the kidneys can be understood to determine the extent of renal damage.
Pathological examination
Renal biopsy, also known as renal puncture biopsy, involves piercing the skin into the kidney with a special, fine needle to remove a small strip of tissue. The procedure then uses a series of pathological techniques, including electron microscopy, HE staining, special staining, and immunofluorescence, combined with the pathological characteristics of the glomeruli, renal tubules, renal interstitium, and small blood vessels within the kidney for analysis and diagnosis. A renal biopsy helps clarify the pathological changes and types of kidney disease, provide a final diagnosis of acute kidney injury or chronic kidney disease, and assess whether the kidney damage is reversible and treatable. However, a renal biopsy is an invasive procedure, and postoperative symptoms such as hematuria, low back pain, and urinary retention may occur. Patients with severe hypertension, a significant bleeding tendency, small or solitary kidneys, mental illness, or those who refuse to cooperate with the procedure should not undergo this procedure.
diagnosis
Diagnostic principles
Uremia can be diagnosed based on the patient’s medical history, clinical manifestations, and auxiliary test results. Renal function tests are the most valuable indicator. A glomerular filtration rate (GFR) of less than 10 ml/min is recommended for patients with uremia. For patients with kidney disease who experience worsening of existing clinical symptoms or unexplained vomiting, dyspnea, or impaired consciousness, progression to the uremia stage should be considered. A clear diagnosis and early intervention are necessary.
Differential diagnosis
1. Acute kidney injury
Acute kidney injury is often caused by trauma or a history of kidney disease (such as hydronephrosis, renal tumors, renal tuberculosis, etc.). The main clinical manifestations are pain, hematuria, lumps in the waist and abdomen, fever and shock, etc. It can be differentiated by combining the results of routine blood tests, routine urine tests, serum creatinine, and renal ultrasound, CT and other examinations.
2. Prerenal azotemia
Patients with prerenal azotemia can recover their renal function 48 to 72 hours after effective blood volume is restored. However, patients with uremia require surgery or dialysis, and it is difficult for renal function to recover so quickly.
treat
Treatment principles
In addition to general treatments such as a healthy diet, patients with uremia should also actively address the underlying kidney disease, correct severe complications such as acidosis, and protect residual renal function. Renal replacement therapy (dialysis and kidney transplantation) is the primary treatment for uremia.
General treatment
1. Limit protein intake
Restricting protein intake is a key component of treatment, helping to alleviate symptoms and prevent complications. Patients should adjust their protein intake based on their renal function. The recommended protein intake is 0.6g/kg/day. For patients with diabetic nephropathy, the recommended intake should be less than 0.6g/kg/day. Protein intake should primarily consist of high-quality protein, such as eggs, lean meat, fish, chicken, and milk. For patients with advanced uremia or malnutrition, protein intake can be adjusted appropriately to prevent further exacerbation of malnutrition due to insufficient protein intake, which could hinder recovery.
2. Limit salt intake
Salt intake should generally not exceed 6~8g/d; for those with hypertension or obvious edema, salt intake should be limited to about 5g/d.
3. Limit potassium intake
Patients with uremia should avoid eating high-potassium foods, such as thick broth, chicken essence, bananas, cantaloupe, lemons, oranges, bamboo shoots, day lilies, broad beans, potatoes, seaweed, kelp, fungus, and white fungus.
4. Limit phosphorus intake
Patients with chronic nephritis should control their phosphorus intake and try to avoid eating foods such as egg yolks, whole wheat bread, coix seeds, dried lotus seeds, offal, dry beans (red beans, mung beans, soybeans, black beans, etc.), and hard nuts (peanuts, cashews, pistachios, almonds, melon seeds, black sesame seeds, etc.).
Drug treatment
1. Diuretics
Diuretics such as furosemide can be selected according to the patient’s condition to reduce the burden on the heart and lungs and prevent water and sodium disorders.
2. Drugs to correct acidosis
Sodium bicarbonate helps correct metabolic acidosis and should be taken under the guidance of a doctor. Do not adjust the dosage on your own. It is primarily taken orally, but can also be administered intravenously if necessary.
3. Drugs that regulate calcium and phosphorus balance
Commonly used medications include calcium carbonate, calcium acetate, lanthanum carbonate, and sevelamer. Calcium carbonate and calcium acetate are suitable for treating hyperparathyroidism, hypocalcemia, and hyperphosphatemia, and are more effective when taken with meals. Lanthanum carbonate and sevelamer are new calcium-free phosphate binders that effectively lower blood phosphorus levels without increasing blood calcium. Patients with severe hypocalcemia can also take oral calcitriol, but careful monitoring of blood calcium, phosphorus, and parathyroid hormone levels is crucial during medication.
4. Antibiotics
Antibiotics are primarily used to treat infections caused by various pathogens. Clinically, they should be selected based on the results of drug sensitivity tests and should not be used without authorization.
5. Drugs for treating anemia
When the hemoglobin level of anemia patients is <100g/L, recombinant human erythropoietin can be considered for treatment, and iron supplementation should be taken during treatment.
6. Antihypertensive drugs
Patients with hypertension should pay attention to controlling their blood pressure. Generally, blood pressure should be controlled at no more than 140/90 mmHg. It is recommended to use antihypertensive drugs that have less impact on the kidneys.
7. Lipid-lowering drugs
Patients with hyperlipidemia can use statins or fibrates before dialysis to control blood cholesterol and triglyceride levels within the normal range.
Related drugs
Furosemide, sodium bicarbonate, calcium carbonate, calcium acetate, lanthanum carbonate, sevelamer, calcitriol, recombinant human erythropoietin
Surgical treatment
Kidney transplant surgery involves surgically implanting a kidney from a donor into a recipient to restore kidney function. It is the best treatment option for patients with uremia. A successful kidney transplant can fully restore kidney function. Compared to dialysis treatment, patients have a better quality of life and a higher survival rate. It has become the best treatment for patients with end-stage renal disease. However, the cost of surgery is high, the kidney source is difficult to match, and rejection reactions are prone to occur after surgery. Immunosuppressants must be used long-term after transplantation to prevent rejection reactions. Commonly used drugs include glucocorticoids, cyclosporine A, tacrolimus, azathioprine, or mycophenolate mofetil.
Other treatments
If the patient is in poor health and cannot tolerate surgery, or a suitable kidney donor is not found, dialysis treatment can be used to replace the kidneys in removing excess metabolic waste from the body, mainly including hemodialysis and peritoneal dialysis.
1. Hemodialysis
Hemodialysis, abbreviated as hemodialysis, is an extracorporeal blood purification procedure. It typically requires the creation of an arteriovenous fistula in the patient’s arm—an artery and vein connected to each other—to ensure adequate blood flow for dialysis. It is suitable for conditions such as acute kidney injury, acute/chronic renal failure, and uremia. However, hemodialysis cannot be performed for intracranial hemorrhage or elevated intracranial pressure. Complications such as bleeding, air embolism, hypertension, and hypotension may occur after treatment. To prevent these complications, patients require anticoagulation therapy.
2.Peritoneal dialysis
Peritoneal dialysis, also known as peritoneal dialysis, utilizes the patient’s own peritoneum as a dialysis membrane. Dialysis fluid is perfused into the peritoneal cavity, enabling solute exchange between the blood and the dialysate, thereby removing metabolic waste from the body and maintaining electrolyte and acid-base balance. Peritoneal dialysis requires no vascular preparation, minimizes the risk of bleeding, and eliminates the need for anticoagulation. It is simple and convenient to perform, even at home, and is suitable for children, patients with diabetes, and those with severe vascular disease. However, complications such as peritonitis, lung infection, and protein malnutrition are common after treatment.
Treatment cycleThe treatment cycle for uremia is generally 6 months, but there may be individual differences due to factors such as the severity of the disease, treatment plan, timing of treatment, and personal constitution.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
Uremia patients can improve symptoms, avoid complications and prolong their survival through drug therapy, dialysis therapy and kidney transplantation surgery.
Hazards
Uremia is a terminal manifestation of renal failure, which may cause systemic poisoning. If not treated in time, it may be life-threatening, especially increasing the risk of death from cardiovascular disease.
Self-healing
It usually does not heal on its own.
Curative
Uremia cannot generally be completely cured by drug treatment alone; dialysis therapy and kidney transplantation can alleviate symptoms and prolong the patient’s survival.
Lifecycle
The one-year survival rate of kidney transplant recipients is over 95%, the five-year survival rate is over 80%, and the ten-year survival rate is around 60%, which is much higher than that of patients undergoing hemodialysis or peritoneal dialysis.
daily
OverviewUremia is the most serious form of kidney disease, causing significant damage to patients’ physical and mental health. Uremia patients should maintain a positive attitude and healthy lifestyle habits to enhance treatment effectiveness, manage their condition, and improve their quality of life. Regular follow-up visits are also recommended.
Psychological care
Good psychological care is also conducive to the treatment and recovery of the disease. Patients with uremia often lose confidence in treatment or fear death, and often experience low will, pessimism, disappointment, fear, and even thoughts of suicide. Family members should actively do ideological work, talk to them and comfort them, help patients relieve their psychological burden and enhance their self-confidence. Family members can help patients develop interests and hobbies so that patients can have spiritual sustenance while recuperating, such as listening to music, growing flowers, raising birds and other elegant and not very tiring activities as hobbies. This can also eliminate patients’ tension, anxiety, pessimism, depression, and despair, so that patients can restore their self-confidence and actively cooperate with treatment.
Medication care
Patients should take medication as directed by their doctor, avoid stopping medication or increasing or decreasing the dosage on their own, and avoid using medication indiscriminately, as many drugs are nephrotoxic and will aggravate the condition.
Life Management
1. Rest and exercise
Patients with uremia should pay attention to rest, do appropriate exercise under the guidance of a doctor, and strengthen their physical fitness.
2. Living environment
The living environment should be quiet and comfortable, facing the sun, dry and sheltered from the wind, with fresh air and a beautiful environment. Furthermore, attention should be paid to environmental safety, avoiding bumps and trauma that may cause bleeding. The indoor environment of long-term bedridden patients should be regularly optimized and improved, providing patients with a fresh and elegant environment at all times to increase their love for life, build confidence in overcoming the disease, and achieve a speedy recovery.
3. Health care
Since uremia patients cannot excrete toxins from their bodies through the kidneys, it is easy to cause itchy skin. In daily life, patients should avoid scratching to prevent bacterial skin infection and aggravation of the condition; change clothes frequently and keep themselves clean and tidy. Bedridden patients should prevent pressure sores and turn over every 2 to 3 hours. When turning over, avoid dragging, pulling, and pushing; keep the bed and skin clean and dry. Family members can often wipe the patient’s body with warm water and perform local massage. Uremia patients often have a urea smell on their breath. Patients should pay attention to oral care, brush their teeth and rinse their mouths before meals and in the morning and evening to reduce bad breath, prevent oral infections, and increase appetite.
Disease monitoring
1. Pay attention to monitoring vital signs, including respiration, body temperature, pulse and blood pressure.
2. Regularly check various body indicators such as blood sugar, blood lipids, uric acid, etc. in the hospital and follow up on time.
3. If you experience any discomfort during treatment, you should go to the hospital for diagnosis and treatment in time to avoid delaying the disease.
Follow-up Instructions
After discharge, patients should receive outpatient treatment under the guidance of a nephrologist, with regular follow-up at least once every two months, and adjust medication use at any time to maintain kidney function and control the progression of the disease.
diet
Dietary adjustment
A reasonable diet has positive significance for treating and controlling the development of the disease and can help the body recover.
Dietary recommendations
1. Patients should eat a low-protein, low-salt, high-vitamin diet in their daily lives. They can eat high-quality animal protein, such as milk, eggs, and lean meat. This can reduce the burden on the kidneys, ensure the body’s nutrition, and delay the progression of uremia.
2. Patients with severe renal insufficiency need to further reduce protein intake and can use corn starch, lotus root powder, etc. instead of staple foods.
3. Patients with edema or hypertension should be given a low-salt, low-sodium diet. Additionally, patients should take appropriate calcium and vitamin supplements. It is recommended that they consume foods high in calories and relatively low in protein, such as potatoes, sweet potatoes, yams, taro, lotus roots, pumpkins, and vermicelli.
4. When the patient eats less, you can add some sugar or vegetable oil to increase heat energy and meet the body’s basic needs.
5. People with anemia can appropriately supplement with foods rich in folic acid and iron, such as animal blood, offal, and dark green vegetables.
Dietary taboos
1. Patients with uremia should strictly limit their intake of protein, salt, potassium and phosphorus.
2. Avoid plant protein, such as soybeans, soy milk, tofu, corn, etc.;
3. Avoid eating pickled or high-salt foods, such as kimchi, pickles, and soybean paste;
4. When blood potassium is high or urine volume is low, limit the intake of potassium-rich foods, such as mushrooms, dried dates, lilies, cauliflower, rapeseed, bananas, watermelons, oranges, etc.
5. Avoid eating high-phosphorus foods such as egg yolks, whole wheat bread, coix seeds, nuts, etc.
prevention
Preventive measures
Uremia is mainly caused by chronic renal failure. Its prevention focuses on actively preventing and treating the primary disease and avoiding and removing the inducing factors. Specific preventive measures are as follows:
1. Existing kidney diseases or primary causes that may cause chronic renal failure, such as chronic nephritis, pyelonephritis, diabetes, hypertension and other diseases, should be screened early and treated promptly and effectively.
2. Prevent the continued progression and sudden exacerbation of chronic renal failure and avoid factors that exacerbate renal failure. Patients with chronic renal failure should follow strict dietary management, consuming a high-quality, low-protein, low-phosphorus, low-salt, high-calorie diet. Maintain warmth, avoid colds or infections, and get enough rest to avoid overexertion.
3. Patients with end-stage renal failure should be actively treated to prevent the occurrence of serious complications such as hyperkalemia, heart failure, and severe metabolic acidosis, so as to prolong the patient’s survival time.
Medical Guide
Emergency (120) indications
1. Impaired consciousness, agitation, delirium, and convulsions.
2. Cardiac arrest.
Outpatient indications
1. Lack of appetite, weakness, and subcutaneous edema.
2. Skin itching, dryness, desquamation, pigmentation and swelling.
3. Nausea, vomiting, loss of appetite, abdominal distension, diarrhea, constipation, etc.
4. Difficulty breathing, coughing, chest pain, and an ammonia or urine odor in the mouth when breathing.
5. Dizziness, fatigue, and pale complexion.
6. Muscle tremors, muscle spasms, muscle atrophy, muscle weakness, bone deformities, bone pain, difficulty walking and spontaneous fractures.
7. General fatigue, thirst, and weight loss.
Treatment department
1. If the patient has symptoms such as impaired consciousness, agitation, delirium, convulsions, cardiac arrest, etc., he or she needs to go to the emergency department immediately.
2. If the patient experiences general symptoms such as edema, nausea, vomiting, loss of appetite, fatigue, weight loss, and difficulty breathing, he or she should go to the nephrology department for treatment in a timely manner.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
3. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
4. It is best to arrange for family members to accompany the patient to the hospital.
5. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. What are your main symptoms?
2. How long have these symptoms lasted?
3. Do you have any other diseases, such as high blood pressure, diabetes, etc.?
4. Does anyone else in your family have kidney disease?
5. Have you taken any medications recently?
6. What is the specific name of the drug? What is the usage and dosage?
What questions can patients ask?
1. Why do I get uremia?
2. What are the dangers of this disease?
3. What tests do I need to do?
4. Do I need to be hospitalized?
5. What treatment do I need now? Can I be cured?
6. Are there any risks associated with these treatments?
7. How much is the approximate cost of treatment?
8. How long is the treatment cycle?
9. Will the disease relapse after treatment?
10. Do I need follow-up examinations? How often?
11. What should I pay attention to after returning home?