low back pain - hematuria syndrome
Introduction
Low back pain - introduction to hematuria syndrome The concept of low back pain-hematuria syndrome (loinpainandhaematuriasyndrome, LPHS) was first proposed by Little et al. in 1967. Its definition is still unclear, and its clinical definition refers to a patient with intermittent or persistent severe low back pain and intermittent or persistent hematuria, usually microscopic hematuria. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Low back pain - cause of hematuria syndrome
(1) Causes of the disease
The etiology of LPHS, some scholars believe that psychological factors play a role, recently Lucas et al reported that a group of LPHS patients compared with a group of patients with kidney stones, found that the incidence of medically unexplained somatic symptoms in the LPHS group is a control group 3 times (P<0.01), the proportion of routine analgesics was higher than that of the control group (P<0.01), and 15 cases of 8 cases of low back pain were related to the psychological effects of the patients' life, but the incidence of the control group. None of the patients were related to psychological factors (P<0.02). Patients with LPHS recalled more serious illnesses and disability in childhood than the control group (P<0.001), and felt that they should be responsible for causing or alleviating parental diseases or pains. Responsibility (P<0.05), Lueas et al believe that psychological factors play a major role in the etiology of LPHS.
(two) pathogenesis
The pathogenesis of LPHS is not fully understood at present, and may be caused by diseases affecting intrarenal blood vessels. The intrarenal blood vessels are the only tissues in the renal parenchyma that contain pain-sensitive nerve fibers. The nature of vascular lesions is unclear. The following evidence supports the regulation of intravascular coagulation. Pathological changes of hair and secondary: vascular pathological changes as described above, platelet activation, fibrin deposition and dissolution, endothelial cells do not have enough blood supply to produce prostacyclin, deficiency of factor XII, etc., Leaker et al. Twenty of the 20 lung biopsies of LPHS were found to have similar histological changes to renal biopsy in patients taking cyclosporine A, further suggesting that vasospasm may be a primary pathological change.
Many young women with LPHS have taken estrogen-containing contraceptives before onset. Estrogen can affect platelet function and fibrinolysis system. Each episode of an individual after ovariectomy is associated with estrogen replacement therapy. At one time, estrogen was considered to play a role in the pathogenesis of LPHS. Woolfson et al. studied ureteral motility in patients with LPHS, but did not find more urinary tract periasis. In short, the pathogenesis of LPHS still needs further Research, most scholars believe that it is related to abnormal renal blood coagulation mechanism and vasospasm.
Prevention
Low back pain - prevention of hematuria syndrome
Prevention is based on relaxation and adjustment of emotions. Active symptomatic treatment for patients with symptoms can alleviate symptoms and reduce patient suffering.
Complication
Low back pain - complications of hematuria syndrome Complication
Generally no complications.
Symptom
Low back pain - symptoms of hematuria syndrome Common symptoms Hematuria, back, back, sinus, lower back, soreness, anxiety, low back pain, frequent urination, urine... After a gross eye, hematuria, hemorrhage, low back pain, bedridden
It was originally reported that most of the patients with LPHS were young women, and they were often medical staff, such as nurses, clinicians, laboratory assistants, doctors' secretaries, etc., even children or relatives of these people, but recent reports of male patients have increased. The proportion of male and female patients has been basically equal, and its clinical manifestations are:
1. Low back pain The main symptom of LPHS is low back pain, which often occurs on one side. The low back pain can be very severe and unbearable. The patient even requires nephrectomy. However, after nephrectomy, low back pain will occur on the contralateral side. Unilateral low back pain develops to bilateral low back pain, radiates to the abdomen and perineum for several hours to several days, but there is no frequent urination, urgency, dysuria, and low back pain can also be intermittent, but the number of episodes will gradually decrease until Disappeared in middle age.
2. Hematuria Another important symptom of LPHS is hematuria, usually microscopic hematuria, and gross hematuria. Some patients have hematuria after many years of low back pain.
3. Psychiatric symptoms Some patients with LPHS may have anxiety, guilt and hope for medical care. Individual patients will make up the condition and pretend to be sick. Those who are not properly and effectively treated due to severe low back pain may have attitudes and behaviors. Abnormal, such as neurotic behavior.
4. Part of the patient's side of the patient has tenderness or sputum pain in the kidney area.
Examine
Low back pain - examination of hematuria syndrome
Urine check
(1) Urine routine: There may be microscopic hematuria, but no red blood cell cast.
(2) erythrocyte phase contrast microscopy: most of the red blood cells in normal form, a few are abnormal red blood cells.
(3) Urine protein: The secretion of urinary protein in some patients will exceed the normal range, but the 24-hour urine protein content will not exceed 1.5g.
(4) Urine bacterial culture: There is no bacterial growth in the middle urine culture of LPHS patients.
2. Blood test
(1) Coagulation function: Most patients are normal, some patients have thrombocytopenia, and a small number of patients have increased serum fibrin degradation products (FDP).
(2) Blood biochemistry: blood urea nitrogen (BUN), serum creatinine (SCr) is normal.
(3) ESR: Even if examined during the episode, the patient's erythrocyte sedimentation rate (ESR) is still within the normal range.
3. Urethral cystoscopy
Urinary cystoscopy in these patients is generally no abnormalities, but sometimes the ureteral spurting of the affected side can be observed.
4. Venous urography
Patients with LPHS have good renal function and normal urinary tract morphology.
5. Renal angiography
In most patients, moderately sized blood vessels can be seen with distortion, beaded changes and occlusion. Some patients with unilateral low back pain show vascular changes only on the low back side, and sometimes there is a wide range of perfused areas in the kidney, Berggroth Others also saw the sputum of the internal renal artery, but some patients have completely normal renal angiography.
6.B-ultrasound
Exclude urinary stones and tumors.
1. Renal biopsy light microscopy
(1) Renal blood vessels: The pathology of LPHS is mainly manifested in intrarenal blood vessels, which are common with arterial wall hyaline degeneration, similar to atherosclerotic lesions, intimal hyperplasia or onion skin-like changes, and individual cases have microaneurysms, veins. Denaturation can also be seen in the elastic fiber structure.
(2) Renal unit: mild glomerular mesangial hyperplasia, focal sclerosis, hypertrophy of the glomerular capsule, stroma-like fibrosis of the interstitial, mild atrophy of the renal tubule, and some patients except the intrarenal blood vessels, tissue The examination is normal.
2. Immunofluorescence examination showed significant C3 deposition in the invaded blood vessels. C4 depositors were also reported. Of course, the deposition of C3 in the vessel wall is a non-specific change, which can be seen in many arterial lesions. Miller et al. The aged LPHS female patient first found that the renal arterioles had properdin and complement C5b-9, C3 deposition, suggesting that complement was activated, and no immunoglobulin deposition was observed in the glomeruli.
3. Electron microscopy showed no specific pathological changes.
Diagnosis
Low back pain - diagnosis and identification of hematuria syndrome
diagnosis
According to the above clinical features and auxiliary examination, the clinical diagnosis of LPHS can be made. It is worth mentioning that the diagnosis of LPHS, renal angiography and renal biopsy are indispensable.
Differential diagnosis
1. Urinary calculi due to the clinical manifestations and laboratory tests of LPHS are similar to urinary calculi, so some patients with a history of urinary calculi should be noted in the differential diagnosis, suspected small stones or negative stones, but urinary tract B-ultrasound should be performed when there is no urinary tract effusion and the diagnosis is difficult.
2. Others should be differentiated from kidney tumors, polycystic kidney disease, IgA nephropathy, purpuric nephritis, and diseases that cause hematuria.
