mesangial capillary glomerulonephritis
Introduction
Introduction of mesangial capillary glomerulonephritis Mesangial capillary glomerulonephritis is caused by mesangial cell proliferation, mesangial matrix dilatation, thickening of the basement membrane, and expansion of the mesangial cells and matrix into adjacent capillary walls, resulting in light microscopic capillaries Wall thickening and glomerular disease characterized by pathology. Clinical manifestations of nephrotic syndrome with hematuria, hypertension and renal dysfunction, some patients with holding. The pathological changes are based on the glomerular basement membrane and mesentery. The disease is mainly seen in children and young people. Patients with chronic nephritis must establish confidence in the fight against the disease, because the condition of chronic nephritis is slowly extended, so it is necessary to maintain the determination and confidence of treatment; temper, worry will cause liver damage, affect the disorder of the secretion system, and directly Damage to kidney function. basic knowledge The proportion of illness: 0.0034% Susceptible people: no special people Mode of infection: non-infectious Complications: renal failure
Cause
Mesangial capillary glomerulonephritis etiology
According to the characteristics of the deposition site of the electron dense substance and the lesion of the basement membrane, it is divided into three types: type I: thickening of the basement membrane, and double-track phenomenon due to the growth of mesangial cells and matrix into the basement membrane and endothelial cells, and the formation of double rails It is caused by the formation of pseudo-basement membrane by the inserted mesangium. The mesangial proliferation of this type is the most serious. It can separate the glomeruli into small leaflets. In addition to the mesangial insertion phenomenon, electron microscopic examination can see fine irregular electronic dense matter. In the mesangial area and under the endothelium, immunofluorescence showed that the IgG, IgM and C3 particles were distributed along the basement membrane and deposited on the mesangium. Type II: characterized by a large amount of large dense electron dense substance in the basement membrane, and immunofluorescence is mainly C3 deposition, and immunoglobulin deposition is less common. Type III: This type has a prominent subepithelial immune complex deposition in addition to the type I, and can be seen in the basement membrane nails like membranous nephropathy. The immunopathology is C3, with or without With IgG and IgM, mainly distributed in the basement membrane, also deposited in the mesangium.
Prevention
Mesangial capillary glomerulonephritis prevention
Work and rest
In daily work, whether it is physical or mental work, patients with nephritis should not be excessively tired, and should rest more, otherwise it will increase the abnormal metabolism, increase the burden of kidney function, and even damage the kidney.
2. Pay attention to the regulation of emotions
Patients with chronic nephritis must establish confidence in the fight against the disease, because the condition of chronic nephritis is slowly extended, so it is necessary to maintain the determination and confidence of treatment; temper, worry will cause liver damage, affect the disorder of the secretion system, and directly Damage to kidney function.
3. Pay attention to diet
Unreasonable diets tend to exacerbate the kidney burden of patients with chronic nephritis, leading to further damage to kidney function, leading to continued deterioration of the disease. According to the characteristics of chronic nephritis, patients should be asked to have a reasonable diet for kidney disease.
4. Couples should live regularly
For husband and wife life, patients with chronic nephritis should not be too frequent, generally not more than twice a month, if it exceeds, it will easily lead to relapse and deterioration of the disease.
5. Forbidden to take anti-inflammatory analgesics
For example, cold medicines and antibiotics must be taken under the guidance of relevant doctors before using anti-inflammatory analgesics, because improper use of these drugs directly damages kidney function, leading to abnormal kidney function.
Complication
Mesangial capillary glomerulonephritis complications Complications, renal failure
Infection, thrombosis and embolism complications, renal failure, protein and fat metabolism disorders.
Symptom
Mesangial capillary glomerular nephritis symptoms common symptoms low back pain with renal sputum pain proteinuria chronic renal insufficiency edema with proteinuria hematuria with proteinuria hematuria hypertension
About 20% to 30% of patients can start from upper respiratory tract infection, and its clinical manifestations and characteristics are:
(1) About 50% of patients showed obvious nephrotic syndrome, about 30% showed asymptomatic proteinuria, and about 20% to 30% of the initial manifestations were acute nephritic syndrome.
(2) Regardless of the above-mentioned syndrome or asymptomatic proteinuria, there are almost proteinuria and hematuria, proteinuria is non-selective, hematuria is often persistent microscopic hematuria, and about 15% is paroxysmal gross hematuria. About 80% to 90% of patients are associated with high blood pressure. Often there is more severe anemia after onset, the extent of which is not proportional to the degree of renal dysfunction. Half of the patients had renal dysfunction.
(3) CH50 and C3 in patients with 30% to 50% were persistently low, and circulating immune complexes and cryoglobulin were positive.
Examine
Mesangial capillary glomerulonephritis
1, through urine protein qualitative, urine sediment microscopic examination, you can initially determine whether there is glomerular lesions.
2, urine routine examination: urine color is generally no abnormality, urine protein is generally not much, urinary sediment increased leukocytosis (acute period often full of vision, chronic phase in 5 / high power field), sometimes can produce white blood cell cast.
3, urine bacteria check: When the urine contains a large number of bacteria, due to urinary sediment coating for Gram stain test, about 90% can find bacteria. This method is simple and has a high positive rate.
4, urine cell count: in recent years, the use of 1 hour counting method, it is considered that the 12-hour urine sediment count is accurate and simple. The standard is that the number of white blood cells is more than 300,000 / hour is positive, less than 200,000 / hour can be considered as a normal range, between 200,000 and 300,000 / hour should be combined with clinical judgment; red blood cells greater than 100,000 / hour is positive.
Diagnosis
Diagnosis and diagnosis of mesangial capillary glomerulonephritis
diagnosis
The patient almost always has hematuria, including microscopic or gross hematuria. Proteinuria can be mild, about 30% of patients with asymptomatic proteinuria, but half of patients with urinary protein >3.5g/24h, more than 90% of patients with poor proteinuria selectivity. Urine FDP and C3 can be elevated.
Differential diagnosis:
(1) acute exacerbation of chronic nephritis: most chronic nephritis, often insidious onset, acute attacks often secondary to acute infection, the prodromal period is often shorter, 1 to 2 days of edema, oliguria, [1] nitrogen Symptoms such as blood, serious cases can be accompanied by anemia, high blood pressure, poor renal function, usually with nocturia, urine specific gravity or fixed low specific gravity urine.
(2) Rapid progressive nephritis: It is difficult to identify acute onset of acute nephritis at the beginning of the disease; the progressive renal insufficiency can help identify the disease within a few weeks, and if necessary, renal pathological examination, such as crescentic nephritis can be identified.
(3) acute urinary tract infection: urinary routine can appear red blood cells, but often accompanied by white blood cells and pus cells, some patients have fever and urinary tract irritation, middle urine culture can be diagnosed, often complement normal.
(4) Membrane proliferative nephritis: often with acute nephritis onset, but often proteinuria is obvious, serum complement continues to decline (more than 8 weeks), the disease recovery is not as good as acute nephritis, if necessary, a renal biopsy to confirm the diagnosis.
(5) IgA nephropathy: mainly with recurrent hematuria as the main manifestation, ASO and C3 are often normal, and renal biopsy can confirm the diagnosis.
(6) secondary nephritis: such as sensitized purpura nephritis, lupus nephritis, hepatitis B virus-associated nephritis.
