chronic kidney damage
Introduction
Introduction Chronic renal failure (CRF) is not an independent disease. It is the end-stage manifestation of deterioration of renal damage caused by various causes. When the renal function is close to 10% of normal people, a series of syndromes appear. Generally, there is a relatively long course of disease, according to the degree of renal dysfunction, the degree of renal insufficiency is compensated; the decompensation period of renal insufficiency is also called azotemia; the stage of renal failure; the end stage is also called uremic stage. Clinical manifestations of clinical manifestations of retention of metabolites, imbalance of water, electrolytes, acid-base balance, and systemic involvement are the main manifestations.
Cause
Cause
First, the cause
1. Chronic glomerulonephritis: The progression of the disease to the advanced stage is the most common cause of chronic renal failure.
2. Interstitial Nephritis: is a group of diseases mainly involving the renal interstitial and renal tubules, so it is also known as tubulin-interstitial nephropathy (Tubulo-Interstitia Nephropa-thy). Its etiology is complex, it is clinical Common diseases account for 25% to 33% of urinary system diseases, ranking second in chronic renal failure.
(1) Infection: Bacteria, viruses, molds, malaria parasites, etc. invade the renal interstitial and renal tubules, which represent diseases such as chronic pyelonephritis. Malignant dysentery and so on.
(2) immune damage: common drug allergies such as penicillin, sulfonamide, autoimmune diseases such as systemic lupus erythematosus, scleroderma, dermatomyositis involving the kidneys.
(3) Toxic substance damage: such as aminoglycoside antibiotics, contrast agents damage the kidneys, heavy metal salts such as mercury, lead, arsenic, gold and other damage to the kidneys.
(4) renal blood supply disorders: such as renal arteriosclerosis, renal artery stenosis.
(5) Metabolic abnormalities: such as hyperuricemia, hypercalcemia, and long-term hypokalemia.
(6) Physical factors: long-term exposure to X-ray, X-ray radiotherapy for malignant tumors, etc.
(7) urinary tract obstruction: obstruction caused by bladder, ureteral urine reflux, renal pelvis, ureteral pressure increased damage to the renal interstitial, such as combined infection is more serious.
(8) Tumor directly infiltrating the renal interstitial: such as leukemia, lymphoma, cancer cell metastasis caused by renal interstitial damage.
(9) hereditary diseases: such as polycystic kidney disease, renal cysts.
(10) Balkan nephritis: a renal interstitial disease of unknown cause, mainly occurring in southern Europe.
3. Hypertensive arteriosclerosis: At this time, the renal tubule is damaged first and then the glomerulus is damaged. The glomerular nephritis first damages the glomerulus and then damages the renal tubule.
4. Secondary to metabolic diseases: such as diabetes, gout kidney, amyloidosis.
Examine
an examination
Related inspection
Renal function test kidney ultrasound
Protein electrophoresis : Serum proteins are colloidal substances that carry a charge under certain conditions and move in an electric field.
Growth hormone (GH): Growth hormone is an important hormone secreted by the pituitary gland and regulates the metabolism of substances. It promotes the growth of long bones in adulthood.
Trypsin : Trypsin is a hydrolase secreted by the pancreas. It can hydrolyze amino acid compounds linked by peptide chains and has esterase activity. The amount in normal serum is very small. Determination of serum trypsin has a certain significance in the diagnosis of acute pancreatitis.
Urine 2-microglobulin (2-MG): 2-microglobulin is produced in lymphocytes and has a small amount in urine. Because of its small molecular weight, it can freely pass through the glomerular filtration membrane. The 2 microglobulin filtered by glomerulus is almost completely reabsorbed through the renal tubule. If the excretion of urinary 2-microglobulin is increased, the renal tubular reabsorption disorder is called renal tubular proteinuria, which is different from Albumin-based glomerular proteinuria.
In clinical urinalysis, urinary 2 microglobulin is of great significance for the detection of nephropathy.
MRI examination of the kidney: MRI can identify the location, size, shape and extent of the tumor; the mass can be identified as cystic, substantial, fatty, more sensitive than CT, qualitative and accurate.
Ultrasound examination of the kidney: B-ultrasound is a medical examination item that patients often come into contact with at the time of treatment. Clinically, it is widely used in the diagnosis of cardiology, gastroenterology, urology and obstetrics and gynecology.
Serum 1 microglobulin (1-MG): 1 microglobulin is a glycoprotein that is mainly synthesized in liver and lymphoid tissues and is widely distributed on body fluids and lymphocyte membrane surfaces. Determination of 1 microglobulin has a certain significance in diagnosing kidney disease and evaluating renal function.
Serum 2 microglobulin (2-MG): 2 microglobulin is a -light chain of human leukocyte antigen molecules. Its main function is to participate in the surface recognition of lymphocytes and is related to the killing of cells. Almost all nucleated cells in the body can synthesize 2 microglobulin and attach to the cell surface. The amount of 2 microglobulin produced daily by the same individual remains constant and is secreted in various body fluids. Determination of 2 microglobulin in blood, urine, and cerebrospinal fluid is important for the diagnosis of various diseases.
Urine color (UCO): The color check of urine is to observe the color of urine with the naked eye. It is generally used to evaluate the concentration of urine, the content of urine pigment and the metabolism of the body. It can be used for physical examination of healthy people and other Routine laboratory tests for patients with abnormal urine, dysuria, or fever. Specific Gravity (SG) -- Urine specific gravity (SG) is the ratio of urine to the same volume of pure water at 4 degrees Celsius. Because the urine contains 3-5% solid matter, the urine is longer than pure water. The specific gravity of urine varies with the content of water, salt and organic matter in the urine. In the case of pathology, it is also affected by protein, urine sugar and cell components. For example, the imbalance of anhydrous metabolism, the urine specific gravity can roughly reflect the concentration and dilution function of renal tubules. . This test is suitable for people with kidney disease, dehydration or excess water, and suspected abnormal substance excretion.
Serum chloride (Cl): The total amount of chlorine in the body is about 100g, which is mainly present in the form of chloride ions in tissues and body fluids. It is the anion with the largest amount of extracellular fluid. It is closely related to the content of bicarbonate. Chloride plays an important role in regulating water, osmotic pressure and acid-base balance in the body. Chloride ions in the body are often absorbed and metabolized with sodium ions, and the changes are often consistent.
Blood aluminum (Al): Aluminum is a trace element in the body, and aluminum that is normally ingested into the body is mainly excreted by the kidneys. Patients with renal failure are prone to aluminum poisoning. The main source of aluminum in renal failure is dialysate during hemodialysis. Aluminum can be transferred across the membrane to the blood to increase blood aluminum. Determination of blood aluminum content plays an important role in the assessment of renal failure.
Diagnosis
Differential diagnosis
Prerenal acute renal failure
Due to pre-renal factors, the effective circulating blood volume is reduced, resulting in renal dysfunction caused by insufficient renal blood flow perfusion. The glomerular filtration rate is reduced, and the reabsorption of urea nitrogen, water and sodium by the renal tubules is relatively increased. The blood urea nitrogen is increased, the urine volume is decreased, and the urine specific gravity is increased. The glomerular and tubular structures of patients with pre-renal acute renal failure remain intact, and the renal glomerular filtration rate also recovers when renal blood perfusion returns to normal. However, severe or persistent renal hypoperfusion can lead to pre-renal acute renal failure to acute tubular necrosis.
(1) Effective blood volume reduction:
1 bleeding trauma, surgery, postpartum, digestive tract, etc.
2 digestive juice lost vomiting, diarrhea, gastrointestinal decompression and so on.
3 kidney loss using diuretics, diabetes acidosis and so on.
4 skin and mucous membrane loss, burns, high fever, etc.
5 The third cavity lost crush syndrome, pancreatitis, hypoalbuminemia and the like.
(2) Reduction of cardiac output: including congestive heart failure, cardiogenic shock, pericardial tamponade, severe arrhythmia, etc.
(3) systemic vasodilation: sepsis, liver failure, allergies, drugs (hypotensive drugs, anesthetics, etc.).
(4) renal vasoconstriction: the application of drugs such as norepinephrine, liver and kidney syndrome.
(5) Drugs that affect hemodynamic changes in the kidney: angiotensin-converting enzyme inhibitors, non-steroidal anti-inflammatory drugs.
2. Post-renal acute renal failure
(1) ureteral obstruction:
1 cavity obstructs crystals (uric acid, etc.), stones, blood clots, etc.
2 extraluminal obstruction of retroperitoneal fibrosis, tumor, hematoma and so on.
(2) bladder neck obstruction: prostatic hypertrophy, bladder neck fibrosis, neurogenic bladder, prostate cancer, etc.
(3) urethral obstruction and stenosis.
3. Renal acute renal failure
(1) renal tubular disease: acute tubular necrosis is the most common. The cause is divided into renal ischemia and renal poisoning.
1 Renal ischemia: The cause of prerenal acute renal failure was not relieved in time.
2 kidney poisoning: common nephrotoxic substances, such as drugs, contrast agents, heavy metals, biotoxins, organic solvents, myoglobinuria, hemoglobinuria, light chain protein, hypercalcemia.
(2) glomerular diseases: such as acute nephritis, lupus nephritis.
(3) Acute interstitial nephritis: acute (allergic) drug-induced interstitial nephritis, sepsis, severe infection, etc.
(4) renal microvascular disease: primary or secondary necrotizing vasculitis, malignant hypertensive kidney damage.
(5) Acute renal and macrovascular disease: bilateral or unilateral renal artery/renal vein thrombosis or cholesterol crystal embolization of the kidney; hemorrhage of the dissecting aneurysm and rupture of the renal artery.
(6) Certain chronic kidney diseases: The clinical manifestations of acute renal failure caused by acute exacerbation of chronic renal failure under the influence of factors that promote the exacerbation of chronic renal failure.
