renal edema
Introduction
Introduction to renal edema Renaledema refers to the pathological process in which excessive fluid accumulates in the interstitial space or body cavity, called edema. According to the cause of the disease, edema can be divided into renal edema, hepatic edema, cardiac edema, dystrophic edema, lymphedema and so on. Body edema due to dysfunction of the kidney is called renal edema. basic knowledge The proportion of illness: 0.025% Susceptible people: no specific population Mode of infection: non-infectious Complications: proteinuria glomerulonephritis
Cause
Cause of renal edema
First, the glomerular filtration is decreased, and the renal tubules are reabsorbed by sodium and water, which leads to the retention of sodium and water. At this time, the capillary permeability of the whole body is often increased, so the water in the interstitial space is retained. This condition is more common in nephritis. .
Second, due to the large amount of proteinuria in the patient, resulting in renal edema caused by low plasma protein.
Prevention
Renal edema prevention
There is edema, and the diet should pay attention to the following points:
Limit water, sodium and protein intake.
1, protein intake
Patients with severe edema and hypoproteinemia can give protein 1g per kilogram of body weight per day, of which more than 60% are high-quality protein, mild to moderate edema, 0.5-0.6g protein per kilogram of body weight per day, must be given protein Adequate calorie intake, daily 125.5 ~ 146.4kJ / kg (30 ~ 35kcal / kg).
2, water and salt intake
Mild edema urine volume >1000ml / d, no excessive water limit, sodium salt is limited to 3g / d, including sodium foods and beverages. Severe edema with oliguria should be limited to 1000ml of daily water intake, and a salt-free diet (sodium content of main and non-staple foods <700mg per day).
Complication
Renal edema complications Complications, proteinuria, glomerulonephritis
1. The bilateral limb edema should first be distinguished by lymphedema caused by accumulation of lymph with high protein content, or edema caused by accumulation of body fluid with low protein content such as cardiac hepatic, renal, dystrophic and other systemic edema. And localized venous or neurovascular edema, which can generally be identified by medical history, physical examination and laboratory tests.
2. Unilateral limb edema should be distinguished from venous disease. Limb edema caused by venous disease is usually characteristic.
Symptom
Symptoms of renal edema Common symptoms Older calf edema edema nephropathy edema face edema of the legs and feet edema eyelid edema edema and edema of the back of the foot edema after standing for a long time
The characteristics of renal edema are: first occur in the loose areas of the tissue, such as the eyelids or facial, foot and ankle, which is obvious in the morning, and can involve the lower limbs and the whole body in severe cases. The nature of renal edema is soft and easy to move, and it is clinically depressed edema, that is, depression can be caused by pressing a local skin with a finger.
Examine
Renal edema examination
24-hour urine protein quantification, blood routine, erythrocyte sedimentation rate, plasma albumin, blood urea nitrogen, creatinine, humoral immunity, electrocardiogram, cardiac function test, kidney B-ultrasound and other laboratory tests are helpful for diagnosis and differential diagnosis.
1. Determination of plasma protein and albumin, such as plasma protein below 55/gL or albumin below 23 g/L, indicating a decrease in plasma colloid osmotic pressure. Among them, the reduction of albumin is particularly important. Plasma protein and albumin reduction are common in cirrhosis, nephrotic syndrome, and malnutrition.
2. Urine examination and renal function test When there is systemic edema, it should be checked whether there is edema protein, red blood cells and tube type in the urine. If there is no proteinuria, it is likely that edema is not caused by heart or kidney disease. Patients with heart failure often have mild or moderate proteinuria, while persistent severe proteinuria is characteristic of nephrotic syndrome. Persistent proteinuria, increased red blood cells and casts in the urine, accompanied by a significant decrease in renal function often suggest edema caused by kidney disease; heart failure patients may have the above performance, but urine test and renal function changes to a degree Generally lighter. In renal function tests related to edema, phenol sulfonate, also known as phenolsul-fonphthalein test, urine concentration and dilution test, urea clarification test, etc., are used to determine the excretory function of the kidney.
3. Determination of red blood cell count and hemoglobin content
If the red blood cell count and hemoglobin content are significantly reduced, it should be considered that this edema may be related to anemia.
4. Calculate the daily intake and discharge of water and sodium salt. Calculate the intake and discharge of daily water and sodium salt. If necessary, determine the plasma sodium chloride content, which helps to understand the retention of water and salt in the body. Happening.
Diagnosis
Diagnosis and diagnosis of renal edema
Detailed systemic examinations should be performed on patients with edema, as many systems, organs, and tissue disorders can cause edema. A systemic examination helps to understand the source and characteristics of edema and is helpful in diagnosis and differential diagnosis.
Differential diagnosis:
(1) Cardiac edema: In the case of right heart dysfunction, exudative or constrictive pericarditis, edema is caused by increased venous pressure in the systemic circulation and increased capillary filtration pressure. Cardiac edema is characterized by edema that first occurs in the ptosis, often throughout the body from the lower extremities, and ascites or pleural effusion can occur in severe cases. Edema is formed at a slower rate. The edema is solid and less mobile. The main basis for the diagnosis of cardiogenic edema is the history and signs of heart disease. Determination of a significant increase in venous pressure is an important indication for diagnosis.
(2) Hepatogenic edema: cirrhosis often has mild edema of the lower extremities before the appearance of ascites, which first occurs in the ankle and gradually spreads upward. The head and face and upper limbs are often edema. Ascites and pleural effusion occur in severe cases. A variety of chronic liver disease history and signs of liver damage and laboratory indicators are the basis for diagnosis.
(3) dystrophic edema: chronic consuming disease, chronic nutritional deficiency, protein loss gastrointestinal disease, severe burns caused by hypoproteinemia, vitamin B1 deficiency, etc. can produce edema. Tissue relaxation caused by a decrease in subcutaneous fat and a decrease in tissue pressure increase the retention of water. Edema often spreads from the foot to the whole body.
(4) Systemic edema for other reasons: 1 mucinous edema: hypothyroidism, when the condition is severe, due to skin infiltration by mucin and mucopolysaccharide, producing characteristic non-depressed edema, called mucinous edema. Often occurs in front of the face and cheekbones. 2 drug edema: the application of certain drugs can cause edema, which is characterized by mild edema after medication, gradually disappear after stopping the drug. The more common drugs are adrenocortical hormone, testosterone, estrogen, insulin, etc., and the dose of Rauvolfia, thiourea and licorice can also cause edema. 3 premenstrual tension syndrome is also one of the common causes of edema, which is characterized by mild edema of the eyelids, ankles and hands 7 to 14 days before menstruation, which may be accompanied by breast tenderness and pelvic heaviness, urinating after menstruation. As the amount increases, edema and other neurological symptoms gradually subsides. 4 idiopathic edema: mainly in the sagging part of the body, more common in adult obese women, often associated with emotional and mental changes, accompanied by fatigue, dizziness, headache, anxiety, insomnia and other neurasthenia manifestations, vertical position water test is positive .
