Urine protein
Introduction
Introduction Urine protein is a protein that is detected by turbidity of urine after heating by acidification. The 24-hour urine protein range of normal people is 0.15g, which is negative in routine laboratory tests. For example, when detecting urine protein 150 mg/day, that is, urine protein positive, it indicates that the amount of urine protein excreted by the human body is significantly increased, and it belongs to abnormal urine protein. Urine protein continues to be positive, often representing kidney disease, so the clinical basis can determine the degree of kidney disease damage and the effect of kidney disease treatment. Therefore, abnormal urine protein must be effectively controlled and eliminated to prevent the progression of the disease.
Cause
Cause
When glomerular and renal tubules develop lesions, such as nephritis, nephropathy, and hypertension, renal arteriosclerosis can occur; proteinuria can occur; various bacterial infections such as pyelonephritis, renal tuberculosis, sepsis, etc. can also occur Proteinuria; non-infectious diseases such as kidney stones, polycystic kidney disease, renal amyloidosis and shock, severe muscle damage, fever, jaundice, hyperthyroidism, hemolytic anemia and leukemia, etc., may also occur proteinuria.
Physiological proteinuria is common in high-protein diets, and it is possible to have transient proteinuria after mental agitation, strenuous exercise, prolonged exposure to cold, and pregnancy.
In general, persistent proteinuria often represents a disease in the kidneys. The amount of urine protein reflects the extent of the disease, and clinical observation can be made according to this. However, it should be specially pointed out that the glomerular lesions are advanced, and due to the loss of a large number of nephron, the protein filtration is reduced, and the urine protein examination is reduced or disappeared, which does not mean the reduction of renal lesions.
Examine
an examination
Related inspection
Urine routine renal dynamic imaging renal function test select protein index (SPI) renal angiography
The glomerular proteinuria is generally more abundant in urine protein, mainly albumin; the amount of renal tubular proteinuria is less, mainly lysozyme, 2 microglobulin, etc., renal tissue proteinuria is often not alone. Exist, mostly with glomerular or renal tubular proteinuria, spilled proteinuria has a primary disease, a special protein.
1. routine examination of proteinuria
Pay attention to edema and serous effusion, bone and joint examination, degree of anemia and examination of heart, liver and kidney signs.
Fundus examination, normal nephritis, normal or mild vasospasm, chronic nephritis, fundus arteriosclerosis, hemorrhage, exudation, etc. Diabetic nephropathy often has diabetic fundus.
2. Laboratory examination of proteinuria
Urine protein examination can be divided into qualitative, quantitative and special examinations.
Qualitative inspection
It is best to have morning urine, the morning urine is the strongest, and the orthostatic proteinuria can be ruled out. Qualitative examination is only a screening test, not as an accurate indicator of urine protein content.
Quantitative examination of urine protein.
Special examination of urine protein.
Diagnosis
Differential diagnosis
(1) Urine changes: 40% to 70% of patients have gross hematuria, urine color such as washing water samples or such as black tea and soy sauce, about 1 to 2 weeks into microscopic hematuria. Most of the hematuria under the microscope disappeared within 6 months, and it lasted for 1 to 3 years before it completely disappeared. In the early stage of the disease, the amount of urine is significantly reduced, even without urine (full-day urine volume is less than 100m1). If there is no urine for more than 3 days, the condition is severe, and azotemia (blood urea nitrogen >7.14mmol/L) often occurs at this time; Renal function is impaired. In the recovery period of the disease, the urine volume can be increased by more than 2000ml, and the renal function can gradually return to normal.
(2) proteinuria: almost all patients with acute nephritis have proteinuria, which is characterized by increased foam in the urine, usually with the severity of the lesions. The proteinuria disappears slowly compared with other symptoms. After the edema disappears, the proteinuria can still be 1 2 months, or even longer, will gradually fade away.
(3) edema: edema is often the first symptom of onset, seen in 70% to 90% of cases, ranging in weight. Light is only the eyelid edema, can be extended to the whole body in severe cases, some patients will also have symptoms such as pleural effusion, ascites. Edema usually begins to subside in 2 to 3 weeks, and the amount of urine will gradually increase.
(4) Hypertension: 80% of patients with acute nephritis may have high blood pressure, and the blood pressure is often moderately increased. Adults generally have 18.7-22.7 kPa/12.0-14.7 kPa. Occasionally, more serious can develop into a hypertensive crisis. However, the diastolic pressure rarely exceeds 16 kPa. If the blood pressure continues to rise, it is a harbinger of chronic nephritis, indicating that the kidney disease is more serious.
(5) systemic symptoms: In addition to the above clinical manifestations, patients often have symptoms such as general malaise, fatigue, low back pain, frequent urination, and poor appetite. Some patients may have pre-infections such as sore throat, body heat, skin ulcers and other symptoms.
