Urine-colored sauce red or soy sauce color
Introduction
Introduction Diagnosis of malaria nephropathy, urinary examination can be seen in urine red sauce or soy sauce color, and some patients who have not healed for a long time may have nephrotic syndrome. Plasmodium infection is the only cause of the disease. It has been found that the incidence of kidney disease in malaria endemic areas is much higher than that in non-endemic areas during the same period.
Cause
Cause
(1) Causes of the disease
Humans are generally susceptible to several human malaria parasites. Plasmodium infection is the only cause of the disease. It has been found that the incidence of kidney disease in malaria endemic areas is much higher than that in non-endemic areas during the same period. In recent years, clinical and histological studies have been found to have Plasmodium antigenic substances in the glomerular immune complexes of patients, further confirming that malaria is an important cause of kidney disease.
(two) pathogenesis
Kidney damage caused by malaria can be divided into acute renal failure, acute reversible renal damage and chronic progressive renal damage. Acute renal failure is one of the serious complications of falciparum malaria, with an incidence of about 0.45%. Its incidence is related to acute intravascular hemolysis, decreased blood volume, increased blood viscosity and diffuse intravascular coagulation. The latter two are closely related to the immune response.
1. Acute renal failure: acute renal failure caused by malaria, the pathological changes are mainly distal tubule degeneration and necrosis, hemoglobin tube type and granular tube type in the lumen, renal interstitial edema. Acute renal failure in falciparum malaria is often non-oliguric, so it is easily overlooked clinically. Common causes are acute intravascular hemolysis (black water fever), common in falciparum malaria, congenital glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is an important factor, malaria parasitic toxin release And the application of antimalarial drugs (such as quinine and primaquine), antipyretic analgesics, etc. are all incentives. In severe cases, patients may develop acute renal failure.
2. Acute reversible renal damage: Under immunofluorescence, IgM (mainly), IgG and C3 were deposited in the basement membrane and mesangial areas. Electron microscopy shows electron dense deposits, and part of the Plasmodium antigen can be found. It has been found that after implantation of the falciparum malaria antigen, the circulating antibody binds to it and forms an immune complex in situ. It is indicated that kidney damage in humans and experimental animals is caused by immune complexes. This type of kidney damage (such as proteinuria, glomerulonephritis, and nephrotic syndrome) is effective against malaria treatment in most malaria patients.
Renal biopsy showed thickening of the mesangial membrane, proliferation and hypertrophy of the endothelial cells, and irregular thickening of the basement membrane.
3. Chronic progressive renal damage: Chronic progressive renal damage caused by malaria, can also detect Plasmodium antigen in kidney tissue. In the 1960s, renal damage was confirmed to be due to immune abnormalities induced by Plasmodium infection, resulting in immune complex nephritis. In recent years, it is believed that the three-day malaria nephropathy may be an autoimmune reaction. In the early stage, the immune complex is formed by the circulating three-day malaria antigen, or the antigen is implanted into the renal capillary wall, and the immune complex is formed in situ by binding with the antibody. The initial damage of the kidney occurs, and the damaged kidney tissue protein can act as an autoantigen to promote the production of autoantibodies and cause immune complex nephritis. The anti-nuclear antibody of the residents of the three-day malaria endemic area has a cross-immunological reaction with the anti-nuclear antibody of Plasmodium vivax.
Examine
an examination
Related inspection
Adrenal MRI examination of kidney CT
The main clinical manifestations of malaria nephropathy are hypertension, proteinuria, hematuria and edema. All four malaria cases can be complicated by this disease, but it is more common in three-day malaria. Patients with acute renal failure caused by malaria may have high fever, excessive sweating, insufficient intake of water, resulting in decreased blood volume, followed by increased compensatory sympathetic activity, increased secretion of catecholamines, and strong contraction of renal blood vessels, leading to renal blood flow. Significantly reduced, can cause or aggravate renal insufficiency.
Chronic progressive renal damage caused by malaria, the main clinical manifestation is nephrotic syndrome. Most patients die within 1 year and the mortality rate is high (about 13%). It is usually a three-day malaria complicated with nephrotic syndrome, which is more common in children. Typical renal edema occurred within 3 weeks after the control of malaria, and even pleural effusion and ascites were produced, accompanied by liver, splenomegaly and anemia. After the edema subsides, proteinuria can persist and renal function damage and hypertension can occur. A small number of progressive renal failure.
1. Diagnosis of malaria: Four kinds of malaria in the human body have many commonalities in clinical manifestations, course of disease, response to drugs, etc., and each has certain special characteristics. Therefore, the diagnosis should identify the type of malaria in the patient. The main points of clinical diagnosis are:
(1) Most cases have chills or chills of varying lengths before fever.
(2) The body temperature rises rapidly in a short period of time, lasts for several hours, then falls quickly, and then there are varying degrees of sweating. When the body temperature is measured once every 2 to 4 hours, and the body temperature curve is analyzed, it can be found that the body temperature at night tends to fall to normal or below normal temperature.
(3) There is a timing of seizures, and the fever period and the non-heat period overlap, and there is a certain regularity.
(4) The patient feels good in addition to fatigue, weakness and slight discomfort during the intermittent period.
(5) The incidence is more common around noon and afternoon, and fewer authors start at night.
(6) The clinical symptoms are more serious than once, and after repeated attacks, they gradually reduce, and there is a tendency of self-healing.
(7) The clinical manifestations of hemolytic anemia, the degree of which is consistent with the number of episodes.
(8) Splenomegaly, the degree is related to the course of the disease, and some cases also see liver enlargement.
The first and second episodes of infants, falciparum malaria, and new infections are often atypical. In addition, some patients with high immunity have a large number of protozoa in the blood, but the clinical symptoms are not obvious or completely absent. In particular, the diagnosis can be confirmed by reference to physical examination and laboratory examination. If the laboratory examination can detect the malaria parasite in the surrounding blood, the diagnosis can be confirmed.
2. Diagnosis of malaria nephropathy: Malaria is complicated by glomerulonephritis, acute renal failure or nephrotic syndrome during the attack. It is generally considered to be an immunopathological phenomenon and is a type III allergic reaction. Nephropathy caused by acute malaria is a temporary reversible disease. Patients may have hemolytic anemia, jaundice, backache, frequent urination, and urgency. Urine examination can be seen in urine red or soy sauce color, and some patients who have not healed for a long time may have nephrotic syndrome. Malaria nephropathy is more common in patients with falciparum malaria and three-day malaria. Combined with the diagnosis of clinical malaria, as well as the clinical manifestations of kidney disease, comprehensive analysis of laboratory tests can confirm the diagnosis.
Diagnosis
Differential diagnosis
Pediatric urine blue: is a complication of pediatric blue diaper syndrome. General performance, may have anorexia, vomiting, constipation, irritability, weight loss, visual loss and other symptoms. The child was pale, pygmy, flattened in the nose, with internal epithelium, nystagmus, squinting, optic disc edema, and optic atrophy.
Green urine: Green urine is discharged when a large number of anti-inflammatory drugs or Pseudomonas aeruginosa are born in the urine.
Black urine: black urine is relatively rare, often occurs in patients with acute intravascular hemolysis, such as falciparum malaria, medically known as black urine fever, is one of the most serious complications of falciparum malaria. The patient's plasma contains a large amount of free oxygen, hemoglobin and oxyhemoglobin, which are dark red or black in urine. A small number of patients who take levodopa, cresol, benzoquinone, etc., will also cause black urine, which will disappear after stopping the drug. According to foreign reports, patients with paroxysmal myoglobinuria will also explode brown-black urine after exercise, accompanied by muscle weakness, which can gradually develop into dysentery. In addition, black urine can also be seen in phenol poisoning, black tumor, and urinary acidosis.
Brown urine (like soy sauce color): can be seen in acute nephritis, acute jaundice hepatitis, kidney crush injury, extensive burns, hemolytic anemia, mistype blood transfusion, even after intense exercise, urine can also be like soy sauce color. Sometimes the urine is brown after sleep, which is characteristic of paroxysmal nocturnal hemoglobinuria. If this kind of urination occurs after eating green broad beans, you should be alert to faba disease. The patient's red blood cells lack a substance called phosphoglucose dehydrogenase, which is somewhat heritable. Therefore, when eating broad beans, brown urine will appear, and fatigue, dizziness, nausea, skin, and yellow eyes should be sent to the hospital for treatment in case of any accident.
Colorless urine: may be a signal of diabetes, chronic interstitial nephritis, diabetes insipidus, if not drinking too much, should pay attention to identification.
White urine: White urine is common in purulent urine, chyluria, and salt urine.
Purulent urine: caused by severe urinary purulent infection, urine is milky white. Purulent urine is common in pyelonephritis, cystitis, renal abscess, urethritis, or severe renal tuberculosis. Chyluria is one of the main symptoms of filariasis, white urine like milk. Because the intestinal absorption of the chyle (the liquid after the saponification of fat) can not be drained from the normal lymphatics to the blood circulation, it can only flow back into the lymphatics of the urinary system, causing the lymphatic pressure in the urinary system to increase, varicose and rupture. The chyle is spilled into the urine, and chyluria appears. Chyluria is generally paroxysmal. When there are red blood cells in the chyluria, it is called chyluria. Microfilaments (ie, young silkworms) can sometimes be found in the blood and urine of patients with chyluria.
Salt-type urine: Most children are common in winter, and the urine is rice-like. Most of them contain a large amount of phosphate or uric acid in the original. It is easy to precipitate after being placed. If the urine is placed in the bottle, it will be immediately cleared. Salt urine is a normal physiological phenomenon. Can be cured without drugs, the key is to drink more boiled water.
Yellow urine: refers to urine that is yellow or dark yellow. The reasons are:
1 When eating carrots, taking riboflavin, , , rhubarb and other Chinese and Western medicines, the urine may turn yellow. Once you stop taking it, it will disappear and you don't have to worry about it. Common fever or vomiting and diarrhea patients are discharged with sweat or feces, urine will be concentrated and reduced, and urine pigments will not change, so the color of urine will appear very yellow.
2 Another type of urinary yellow like strong tea is not due to the above reasons, but the liver or sac has lesions. It turns out that there are usually two paths for bile to go out: one out of the urine and one out of the intestines. When the liver or gallbladder is sick, the path of bile to the intestine is cut off, it can only be discharged from the urine, and the urine is dark yellow due to the increase in bile content. In the early stages of hepatitis, jaundice has not yet appeared. We can often see the color of urination like strong tea, which is often a sign of hepatitis.
In addition, yellow turbid pyuria is a manifestation of urinary organ purulence.
Red urine: urine color turns red, mostly red blood cells in the urine, medically called hematuria. The cause of hematuria is very complicated. There are hundreds of diseases that can cause hematuria. It is not so easy to diagnose correctly.
