prerenal renal insufficiency
Introduction
Introduction Prerenal acute renal insufficiency (Prerenal acute renal insufficiency) caused by any decrease in renal blood perfusion caused by urinary dysfunction, when the kidney has no organic disease, such as renal irrigation flow in time to restore kidney function It then returns to normal, also known as functional acute renal insufficiency. Acute renal insufficiency (ARI) refers to a syndrome in which the renal urinary function is rapidly reduced in a short period of time, so that the internal environment is not stable, resulting in water, electrolyte and acid-base balance disorders and accumulation of metabolic products. . The causes of acute renal insufficiency fall into three categories: pre-renal, renal, and post-renal.
Cause
Cause
Effective circulation of blood loss, massive loss of extracellular fluid, bleeding, trauma, surgery, gastrointestinal bleeding, postpartum hemorrhage, etc.; gastrointestinal loss: severe vomiting, diarrhea, gastrointestinal drainage, etc.; kidney loss, diabetes, diuretics Improper use, adrenal insufficiency, etc.
Examine
an examination
Related inspection
Renal function test kidney perfusion kidney dynamic imaging
1, urine protein qualitative test
Generally, three methods of protein test paper method, sulfosalic acid method, and heated acetic acid method are employed. Under normal circumstances, the urine protein qualitative test was negative. However, this method of inspection is susceptible to a number of factors, which can lead to false results. For example, when the urate content is high, the urine is acidic, the protein test paper results are lower than the actual situation, and the sulfosalic acid method is false positive; When a large amount of penicillin is used, the sulfosalic acid method is easy to be a false positive reaction; when a sulfonate contrast agent is used, a sulfosalic acid method and a heated acetic acid method can all have a false positive reaction; when the urine is strongly alkaline, the false result is more More, or a false negative reaction of the protein test paper, or a false negative reaction of the sulfosalic acid method and the heated acetic acid method.
When the urine protein is only some special proteins, the protein test paper method and the sulfosalic acid method are not sensitive. Therefore, when performing urinary protein characterization, various factors should be integrated, specific conditions should be analyzed, and appropriate methods should be selected. Although qualitative tests are convenient, it is sometimes difficult to reflect the actual situation of proteinuria. When conditions permit, it is best to perform quantitative tests.
2, blood routine examination
Obvious anemia, normal cell anemia, normal or increased white blood cell count. Decreased platelets and accelerated cell sedimentation rate.
Urine routine examination of renal insufficiency:
There are trapping differences depending on the primary disease. The commonalities are:
1Urine osmotic pressure is reduced, mostly below 450mOsm per kilogram, the weight is low, mostly below 1.018, and when it is severe, it is fixed between 1.010~1.012. When used for urine concentration dilution test, the night urine volume is greater than the daily urine volume, and the urine specific gravity Both exceed 1.020, the highest and lowest urine specific gravity difference is less than 0.008;
2 The amount of urine is reduced, mostly below 1000ml per day;
3 urinary protein quantitative increase, the majority of glomeruli have been destroyed in the late stage, and urine protein is reduced;
4 urine sediment examination, leukocytosis in urine sediment (usually full of vision in the acute phase, 5 / high power field in the chronic phase), sometimes white blood cell cast.
5 urine bacteria examination: this method of nephritis is relatively simple, when the urine contains a lot of bacteria, due to urinary sediment coating for Gram staining, 90% can find bacteria. The positive result of the test is high.
3, X-ray inspection
X-ray examination when the patient with nephritis repeated, or the patient's condition developed to the point of difficulty to control, at this time X-ray for nephritis examination, including abdominal X-ray, intravenous pyelography, urinary bladder urography. The purpose is to rule out the presence or absence of stones, congenital malformations of the urinary system, renal ptosis, and other pathological changes.
Diagnosis
Differential diagnosis
It needs to be distinguished from the following symptoms:
Chronic renal insufficiency: Chronic renal insufficiency is the final outcome of various progressive renal diseases.
Accompanied by nausea, vomiting, oliguria, edema, malignant hypertension, severe anemia, itchy skin, urinary odor in the mouth.
Renal failure: A pathological condition in which some or all of the kidney function is lost. According to the rapid onset of the attack, it is divided into acute and chronic.
