Nephritis
Introduction
Introduction to nephritis Nephritis is a non-suppurative inflammatory lesion on both sides of the kidney. Kidney due to damage to the renal corpuscle, edema, hypertension, proteinuria and other phenomena, is the most common type of kidney disease. There are many types of nephritis, acute (glomerular) nephritis, chronic (glomerular) nephritis, pyelonephritis, occult nephritis, allergic purpura nephritis (purpuric nephritis), lupus nephritis (lupus nephritis). Nephritis is an immune disease that is inflammatory response mediated by kidney immunity. It is a different antigen that infects humans and produces different antibodies, which are combined into different immune complexes. The Institute of Nephrology, Chinese Academy of Sciences believes that deposition in the kidneys Pathological damage caused by different parts forms different types of nephritis. Most patients have a history of pioneer infection one month before the onset of the disease, and the onset is sudden, but it can also occur slowly and slowly. Most of the onset begins with oliguria, or gradually oliguria or even no urine. Can be accompanied by gross hematuria, duration, but microscopic hematuria persists, urine changes are basically the same as acute glomerulonephritis. basic knowledge The proportion of illness: 0.1--0.2% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia, high blood pressure, respiratory infection
Cause
Cause of nephritis
Nephritis is an immune disease that is inflammatory response mediated by kidney immunity. It is a different antigen that infects humans and produces different antibodies, which are combined into different immune complexes. The Institute of Nephrology, Chinese Academy of Sciences believes that deposition in the kidneys Pathological damage caused by different parts forms different types of nephritis.
Diabetes (10%):
Diabetes can also cause nephritis, diabetes can cause complications - diabetic nephropathy, early symptoms of diabetic nephropathy are proteinuria, edema, high blood pressure, etc., renal damage will occur in the late stage.
Digestive system lesions (14%):
Some patients suffer from long-term digestive tract disease, nausea and vomiting, and were found to have nephritis. Therefore, if there is a bad appetite, taste disorder, nausea and vomiting, extreme thirst and other symptoms, be more vigilant and timely check to rule out kidney function diseases.
High blood pressure (10%):
Hypertension and kidney disease are a vicious circle, high blood pressure can cause nephritis, and nephritis can cause high blood pressure. High blood pressure is not treated promptly and correctly, it can damage kidney blood vessels, cause damage to kidney function, and even cause kidney failure. At this point, the kidneys are not working properly and the blood pressure will be higher on the original basis.
Lupus erythematosus (20%):
Lupus erythematosus is also a type of nephritis, indicating that lupus can cause nephritis. Because the kidney is the most commonly invaded organ of lupus erythematosus, the production of large amounts of autoantibodies in the blood is the causative factor of systemic lupus erythematosus. When there is a rash after sun exposure, or repeated oral ulcers, severe hair loss, fever that cannot be treated with anti-inflammatory, anti-viral therapy, etc., the possibility of lupus nephritis should also be considered.
Family history (14%):
Some patients with nephritis have a family history, and their family members also have nephritis. Therefore, if there are relatives in the family who have had nephritis, they need to be vigilant. It is best to go to the hospital for regular checkups.
Other diseases (10%):
When the skin has an allergic purpura-like rash, pay attention to check the urine. A person infected with hepatitis B virus, whether it is a hepatitis B virus carrier or a patient, if hematuria or proteinuria occurs, it is necessary to check whether he has hepatitis B virus-associated glomerulonephritis. People who are overweight or obese may have obesity-related glomerular disease.
Prevention
Nephritis prevention
First, control the diet structure, avoid excessive intake of acidic substances, and exacerbate acidic constitution. The acid-base balance of diet is a very important part of the treatment of diabetes and the prevention and treatment of complications. For food, eat more foods rich in plant organic active base, eat less meat, and eat more vegetables.
Second, participate in aerobic exercise, exercise properly, exercise more sweat in the sun, help eliminate excess acidic substances in the body, thus preventing the occurrence of kidney disease.
Third, maintain a good mood, do not have excessive psychological pressure, excessive pressure will lead to the deposition of acidic substances, affecting the normal conduct of metabolism. Proper adjustment of mood and self-stress can maintain a weak alkaline constitution, thereby preventing the occurrence of kidney disease.
Fourth, people who have regular life and irregular living habits, such as singing karaoke, playing mahjong, and not returning home at night, will have aggravated physical acidification.
Fifth, stay away from smoke and alcohol. Smoke and alcohol are typical acidic foods. Uncontrolled smoking and drinking can easily lead to acidification of the human body, making kidney disease organic. In daily life, in addition to preventing and improving the treatment of nephritis, tea can also regulate the balance of body mechanism, anti-inflammatory and antibacterial, clearing away heat and detoxifying, and enhancing human body resistance. Such Chinese herbal teas mainly include honeysuckle, wild chrysanthemum, and cordyceps.
Sixth, do not eat contaminated food, such as contaminated water, crops, poultry, eggs, etc., to eat some green organic food, to prevent disease from mouth.
Complication
Nephritis complications Complications, anemia, high blood pressure, respiratory infection
1. Anemia: Anemia is the most common complication. Renal parenchymal damage occurs in the late stage of chronic nephritis, which can be complicated by various abnormalities in the blood system, such as anemia, abnormal platelet function, abnormal lymphocyte function and coagulation mechanism. The main causes of anemia are: decreased red blood cell production, increased destruction of red blood cells, and increased blood loss.
2. Hypertension: According to incomplete statistics, the incidence of hypertension in patients with chronic nephritis is 80%. Chronic nephritis renal dysfunction, often with serious cardiovascular complications, such as hypertension, atherosclerosis, cardiomyopathy, pericarditis and renal insufficiency. Patients who need renal replacement therapy have almost all hypertension. Hypertension in patients with chronic nephritis has its own characteristics, which is characterized by loss of physiologic blood pressure at night, and some can be divided into simple systolic hypertension.
3. Infection: As a malignant stimulator, infection often induces an acute onset of chronic nephritis, which makes the condition progressively worse. Professor Li Li, a kidney disease expert, pointed out that long-term proteinuria leads to a large loss of protein, malnutrition, immune dysfunction and easy infection. Such as respiratory infections, urinary tract and skin infections.
Symptom
Symptoms of nephritis Common symptoms oliguria no urinary foamy kidney pain lower extremity edema legs and feet edema mucinous edema face vigorous exercise or strong body... hematuria with proteinuria facial edema
1. Prodromal symptoms: Most patients have a history of pioneer infection one month before the onset of the disease. The onset is sudden, but it can also occur slowly and slowly.
2, onset: mostly start with oliguria, or gradually oliguria, or even no urine. Can be accompanied by gross hematuria, duration, but microscopic hematuria persists, urine changes are basically the same as acute glomerulonephritis.
3. Edema: About half of the patients develop edema at the beginning of oliguria, with the face and lower limbs as the weight. Once the edema appears, it is difficult to subside.
4, high blood pressure: some patients with high blood pressure at the onset, there are also high blood pressure in the process after the onset, once the blood pressure is increased, it is persistent, not easy to decline on its own.
5, renal dysfunction: a persistent increase is the characteristics of this disease. Significant reduction in glomerular filtration rate and renal tubular dysfunction.
Examine
Nephritis check
(1) Urine routine examination.
(2) Blood routine examination.
Acute nephritis may have mild anemia, hemoglobin is generally not less than 10 g / 100 ml, white blood cells are generally normal. However, white blood cells may increase in the early stage of streptococcal infection or in the stage of bacterial infection, and the neutral classification is elevated. ESR increases up to 30-60 mm/hr.
(3) Renal function test.
Most patients have a decrease in transient creatinine clearance, elevated creatinine and urea nitrogen. After treatment, it usually returns to normal quickly.
(4) B-ultrasound or CT examination.
Some patients may see an increase in kidney volume.
(5) Other special inspections.
In some patients with acute nephritis, the anti-streptolysin "o" titer is increased, serum circulating immune complexes are elevated, and fibrin degradation products (PDP) are elevated in blood or urine. Serum total complement (cH, o) and complement C were reduced.
Diagnosis
Diagnostic diagnosis of nephritis
Diagnosis of acute nephritis
(1) Identification of acute nephritis and urinary tract infection.
Symptoms of atypical acute nephritis sometimes only have changes in urine, such as a small amount of protein, red blood cells, white blood cells without high blood pressure, edema, oliguria and other clinical signs and symptoms, and urinary tract infections have similar performance.
However, urinary tract infections generally have urinary tract irritation such as frequent urination, urgency, and dysuria. More routine white blood cells can be found in urine routine examination, and pathogenic bacteria can be found by urinary bacterial culture or smear microscopy. The use of antibiotic treatment has a good effect.
(2) Identification of acute nephritis and acute glomerulonephritis.
Chronic glomerulonephritis usually has a history of chronic nephritis such as edema and persistent hypertension, similar to the performance of acute nephritis. However, the urine density is generally not high, often fixed at about 1.010, and often occurs in red blood cell casts and granular casts. Kidney volume does not increase or even shrink.
Diagnosis of chronic nephritis
1. Identification of chronic nephritis and chronic pyelonephritis
The clinical manifestations of chronic pyelonephritis can be similar to chronic nephritis, but a detailed history of urinary tract infections (especially in women), more white blood cells in the urine, white blood cell cast, positive urine culture, intravenous pyelography and nuclear kidney map Check the performance of the two sides of the kidney damage. These are all conducive to the diagnosis of chronic pyelonephritis.
2. Identification of chronic nephritis and lupus nephritis
The clinical manifestations and renal histological changes of lupus nephritis are similar to those of chronic nephritis. However, systemic lupus erythematosus is more common in women and is a systemic disease that can be associated with multiple systemic manifestations such as fever, rash, and arthritis. Blood cells are reduced, immunoglobulins are increased, lupus cells can be found, antinuclear antibodies are positive, and serum complement levels are decreased. Renal histology showed that the immune complex was extensively deposited in various parts of the glomerulus. Immunofluorescence is often a "full hall" performance.
3. Identification of chronic nephritis and essential hypertension with renal damage
Chronic nephritis with increasing blood pressure should be differentiated from primary hypertension with renal damage. The latter age is usually 40 years old. Hypertension occurs before urine changes. Urinary protein is often not serious and tubular damage is obvious. Cardiac, cerebrovascular and retinal vascular sclerosis changes are often more pronounced. Some patients with chronic nephritis have refractory hypertension. The higher the blood pressure, the longer the duration, the more serious the condition and the poor prognosis. Malignant hypertension is more common in middle-aged people with hypertension, often causing renal insufficiency in a short period of time, so it is easy to be confused with chronic nephritis complicated by hypertension. The blood pressure of malignant hypertension is higher than that of chronic nephritis, often at 29/17kP (200/130mmHg) or higher. However, the initial changes in urine were not obvious, the amount of urine protein was small, there was no hypoproteinemia, and there was no obvious edema. Because small arteriosclerosis and necrosis in malignant hypertension is systemic, common retinal arterioles are highly constricted, with sclerosis accompanied by hemorrhage and oozing, papilledema, enlarged heart, and cardiac dysfunction. The basis for making a test.
4. Other primary glomerular diseases
(1) occult glomerulonephritis: clinically mild chronic nephritis should be differentiated from occult glomerulonephritis, the latter mainly manifested as asymptomatic hematuria and proteinuria, edema, hypertension and renal dysfunction. (2) Acute nephritis after infection: Chronic nephritis with a pre-infection worker with acute onset needs to be differentiated from this disease. The incubation period of the two is different, and the dynamic changes of serum C3 can help identify. In addition, the disease has different outcomes. Chronic nephritis has no self-healing tendency and is chronically progressive and can be distinguished.
