syphilis nephropathy
Introduction
Introduction to syphilitic nephropathy The syphilis infection and pathogenesis is characterized by cyclical latent and recurrence, which is related to the body's immunity. When the body's immunity declines, Treponema pallidum can invade certain parts of the body. Syphilis-related nephropathy mainly occurs in acquired secondary syphilis, and its incidence is low. The clinical manifestations of acquired syphilis and kidney damage are various, such as acute nephrotic syndrome, membranous glomerular nephropathy, acute progressive glomerulonephritis, etc., while the incidence of the latter is not high, but it is newly occurring. Patients with nephrotic syndrome should be routinely tested for syphilis to rule out the possibility of syphilis. basic knowledge The proportion of illness: 5% (about 5% of people with multiple sexual partners) Susceptible people: no special people Mode of infection: blood transmission Complications: aortic regurgitation myocardial infarction aortic aneurysm sudden death acute glomerulonephritis membranous glomerulonephritis
Cause
Cause of syphilis nephropathy
Causes:
The pathogen of this disease is Treponema pallidum, belonging to the genus Helicoverpa armigera. The pathogen of syphilis is named as Paleus pallidum because of its transparent body fluid, smooth surface, strong refractive power and not easy to stain. The globose spiral is a kind of slender spiral microbe. It can be found by oil mirror observation. It can be moved in the following way. The rotation forward depends on the long axis to rotate forward. It is the most important way to invade the human body; the swinging body swings to the left and right. Before, it is the most common form of exercise; the other way is to move the body to stretch and shrink, change the pitch and crawl forward, the speed of the spiral is very fast, often in the above three ways of mixing movement, P. pallidum It can grow and grow in the body for a long time, and it has strong fertility and pathogenicity. However, after leaving the human body, its viability and resistance are very weak. It is sensitive to dryness, temperature, humidity and chemicals. In a dry environment 1 2h is death, sensitive to high temperature, strong resistance to low temperature, immediate death at 100 °C; 3 to 5 minutes at 60 °C; rapid death under sunlight; 1 to 2 days at 0 °C Survival at -78 ° C for several years, immediately died in soapy water; 15 min died in 0.1% phenol solution; 5 min died in 5% formaldehyde solution; immediately killed with 1:5000 oxidized mercury solution; 0.1% Clean and extinguish solution and Potassium permanganate solution has a good killing effect.
Pathogenesis:
The pathogenesis of syphilis is described in the relevant section. The pathogenesis of syphilis-associated nephropathy is mainly due to the formation of immune complexes and deposition under the renal epithelium, causing kidney damage. Currently, immune complexes are also found in peripheral blood of patients (eg complement C1q). - Binding activity and anti-complement), suggesting that immune complexes in these peripheral blood are important for the pathogenesis of syphilis-associated nephropathy.
Prevention
Syphilis nephropathy prevention
The prevention of syphilis should have the following points:
1. Active and thorough treatment: Regular review of patients who have been cured, and re-treatment if necessary, in order to cure, if necessary, preventive syphilis treatment.
2. Sexual love should be specific, not jealous, not prostitution, do not engage in extramarital or premarital sexual activities, fix a sexual partner, if the sexual partner suffers from syphilis, should be able to live a sexual life after the cure, and take barrier contraceptive measures.
3. Pay attention to personal hygiene: The contaminated items of syphilis patients should be disinfected in time. The prevention and treatment of syphilis directly affects the recovery of syphilis-related kidney disease.
Complication
Syphilitic nephropathy complications Complications aortic regurgitation myocardial infarction aortic aneurysm sudden death acute glomerulonephritis membranous glomerulonephritis
1. Mucosal lesions are easy to develop into chronic interstitial glossitis is a precancerous lesion should be strictly observed.
2. Cardiovascular lesions may occur in a simple aortic sinus aortic regurgitation, myocardial infarction, aortic aneurysm or sudden death.
3. The onset of neurosyphilis can occur slowly. The meningitis can be compressed by the spinal cord.
The clinical manifestations of acquired syphilis and kidney damage are various, such as acute nephrotic syndrome, membranous glomerular nephropathy, acute progressive glomerulonephritis, etc., while the incidence of the latter is not high, but it is newly occurring. Patients with nephrotic syndrome should be routinely tested for syphilis to rule out the possibility of syphilis.
Symptom
Symptoms of syphilis nephropathy Common symptoms Urine routine abnormal proteinuria edema nephrotic syndrome hematuria
The main clinical manifestations of syphilis-associated nephropathy are massive proteinuria, edema, and generally normal renal function and blood pressure. Generally, the clinical symptoms and signs of the patient and proteinuria disappear within 6 months, and some patients can last for about 1 year. Syphilis-related nephrotic syndrome is often self-relieving, and syphilitic nephropathy can often disappear completely after anti-syphilis treatment.
In recent years, syphilitic-related nephropathy caused by congenital syphilis has also been reported. Its clinical manifestations are edema, hematuria, severe proteinuria and mild renal insufficiency. Under normal and electron microscopy, mesangial proliferation can be seen. , focal extra-proliferative glomerulonephritis and extensive immune complex deposition between the membrane epithelium, the earlier the diagnosis, the better the prognosis.
Examine
Examination of syphilis nephropathy
1. Laboratory examination of syphilis
(1) P. pallidum examination: It is an important method for the diagnosis of syphilis etiology. It is a strong evidence for the diagnosis of syphilis laboratory. The examination methods are: 1 dark visual field examination; 2 smear staining examination; 3 immunofluorescence examination 4 rabbit infection tests ( RIT); 5 tissue section staining examination.
The results of the examination: positive for primary syphilis lesions; secondary syphilis skin, mucosal lesions or positive blood, the detection rate is 80% to 85%; late syphilis skin, mucosal lesions or blood is mostly negative.
(2) syphilis serum test: also known as syphilis serum reaction, is the main means of syphilis immunological examination, an important indication for the diagnosis of syphilis laboratory. This test or clinical application for routine diagnosis; also suitable for screening in a large number of people Or to observe the effect; to determine whether recurrence or reinfection; for early diagnosis (such as RPR test); for quantitative test to determine the patient's responsiveness, and to exclude the anterior band phenomenon; identify early or late latent syphilis; Identification of fetal syphilis and passive responsiveness; if cerebrospinal fluid is used for VDRL test, it also contributes to the diagnosis of neurosyphilis. The results are as follows:
1 stage syphilis: early negative, late positive, positive rate of 53% to 86%, generally within 4 weeks after infection, sometimes 5 to 6 weeks, VDRL (USR) test is negative, to 6 to 8 weeks after the positive rate The test was 90% to 100%, and the FTA-ABS test was positive at the 2nd week.
2 secondary syphilis: no matter what kind of test, the positive rate is 95% to 100%, the untreated or positive rate or titer is higher, the positive probability is 100%, and it is strongly positive. If it is negative, it indicates the patient's resistance. Low, non-responsive, poor prognosis, secondary syphilis positive rate of 60% to 100%, and high titer (at least 1:60), the earlier the recurrence, the higher the positive rate.
3 late syphilis: the positive rate decreased, the untreated serotonin test was 70% to 80%, the specific antibody test was 93% to 100%, the cardiovascular syphilis positive rate was 80% to 96%, the positive rate of paralytic dementia Up to 100%, in general, the longer the infection, the lower the positive rate.
(3) Cerebrospinal fluid examination: After the pallidum invades the central nervous system, the cell count, protein assay, spirochete test, spirochete DNA, responsive hormone test and specific antibody test can be checked by examining the cerebrospinal fluid. If the condition permits, the feasible cerebrospinal fluid VDRL (CSF- VDRL) test, CSF-FTA-ABS test or CSF-TPHA test, can also check P. pallidum DNA, use immunoblotting test, 19s-IgM-FTA-ABS test, IgM-SPHA test, IgM-Captia test and CSF monoclonal IgM antibody test, etc., the specificity is very high, the indication is for early syphilis 1 year after the treatment of meimei; syphilis or advanced syphilis with unknown disease; recurrent syphilis (regardless of clinical recurrence or serum recurrence); the course of disease is more than 2 years and Untreated syphilis; all patients with latent syphilis.
2. Syphilis-related kidney disease test
Hematuria, severe proteinuria, and mild renal insufficiency can be seen.
In addition to the typical pathological changes of syphilis, the degree of glomerular lesions varies from mild lesions to severe proliferative lesions. The main pathological changes are diffuse mesangial proliferation and epithelial immunoprecipitation. Some patients have renal biopsy. Interstitial mononuclear cell infiltration was found. Immunofluorescence microscopy showed granule deposition of IgG and C3 under the glomerular epithelium. In addition to IgG and C3 in the mesangial area, there was deposition of IgM.
Diagnosis
Diagnosis and diagnosis of syphilis nephropathy
Patients diagnosed with syphilis may be diagnosed with syphilis-related nephropathy if they have abnormal urine (proteinuria, hematuria), edema and renal dysfunction, and exclude primary kidney disease and other secondary kidney diseases.
There are many diseases that must be differentiated from syphilis. The syphilis-related kidney disease is mainly differentiated from nephritis caused by other causes.
