cloudy urine
Introduction
Introduction Patients with pyelonephritis have turbid urine, may have gross hematuria, and have a lot of white blood cells or pus cells in routine urine microscopy. The most common reason for urinary turbidity is that the urine is too alkaline, causing precipitation of phosphate crystals in the urine and making the urine turbid. If this kind of urine is added with acid, the white turbidity disappears, which is exactly the opposite of proteinuria. After eating or drinking a lot of milk, it is the cause of the increase of phosphate in the urine. Other causes of turbidity in the urine are serious infection of the urine. Rare chyluria is caused by the parasitic filamentous obstruction of the lymphatics. .
Cause
Cause
Pyelonephritis is an infection of the renal pelvis, renal tubules, renal tubules, and renal interstitial infection caused by direct invasion of various pathogenic microorganisms. In recent years, it has been found that there are pathogenic antigens in the renal scar tissue of some patients with pyelonephritis, indicating that in the pathogenesis of pyelonephritis, immune renal tissue damage may also be one of the causes of inflammation.
First, the pathogen:
Escherichia coli is the most common cause of pyelonephritis, followed by Escherichia coli, Proteus, Streptococcus faecalis.
Second, the route of infection:
1, ascending infection: ascending infection is the most common route. When the body's resistance is reduced and the urethral mucosa is slightly damaged, the bacteria are prone to invade the bladder and kidneys and cause infection. Because the female urethra is much shorter and wider than the male, the urethral opening of the baby girl is often contaminated by feces, which is easy to cause disease. Bacteria that go up to the kidneys first invade the renal pelvis mucosa, causing inflammation, and then invade the renal parenchyma through the renal pelvis, nipple, and renal tubules.
2, blood line infection: bacteria invade the bloodstream from the lesions in the body, reach the kidneys causing inflammation, causing inflammation, when the blood is infected, the bacteria first reach the renal cortex, and form most small abscesses there, and then spread down the renal tubules Kidney nipple and renal pelvis.
3. Lymphatic infection.
4. Direct infection: When an infection occurs in an organ that is traumatic or adjacent to the kidney, the bacteria can directly invade the kidney vein and cause inflammation.
Examine
an examination
Related inspection
Urine routine immunoglobulin light chain renal function test
1. History:
The history of acute pyelonephritis can be used as a reference for diagnosis, but it cannot be used as a basis. Because most patients with non-obstructive chronic pyelonephritis have no history of urinary infection or other history of kidney disease. Often occluded, the symptoms of azotemia can be the first symptom of the patient, should be noted at the time of diagnosis.
2. Clinical manifestations:
There are intermittent reactions of urinary tract irritation, generally lighter, not as acute as acute pyelonephritis, often accompanied by fatigue, loss of appetite, back pain, may have low fever or no fever. In the advanced stage, symptoms of uremia such as dizziness, headache, nausea, and vomiting may occur due to impaired renal function. There may also be polyuria, nocturia, hypokalemia, hyponatremia or chronic renal tubular acidosis. Some patients are insidious or atypical, and should be noted.
3. Auxiliary inspection:
(1) Urine routine: Urine protein is generally a small amount or a small amount. If the urine protein is >3.0/24 hours, it may indicate the possibility of non-infectious disease. There may be a small amount of red blood cells and white blood cells in the urine sediment. If the leukocyte cast is found to be helpful for diagnosis, it is not unique to this disease.
(2) Urine culture: same as acute pyelonephritis, but the positive rate is low, sometimes it is necessary to repeatedly check to obtain a positive result. About 20% of patients with negative urinary bacterial culture can find the original pulp type strain. Under the action of antibacterial drugs and antibodies, the pathogenic bacteria can obtain a variation ability to survive in order to adapt to the bad environment. But the original pulp is still there, and once the environment is favorable, it can reproduce. Urine culture and urine antibody-encapsulated bacteria test positive after bladder sterilization can help diagnose the disease, which can be differentiated from cystitis.
(3) renal function test: usually have renal tubular dysfunction (urinary concentrating function decreased, phenol red excretion rate decreased, etc.), may have urinary sodium, increased urinary potassium excretion, metabolic acidosis; blood potassium can be increased when urine is low. Late glomerular dysfunction, increased blood urea nitrogen and creatinine, and lead to uremia.
(4) X-ray angiography: visible renal pelvis and renal pelvis deformation, irregular shadows or even reduced.
Diagnosis
Differential diagnosis
There is a thick gelatinous substance in the urine:
Seminal vesicle malignancies are rare. Because bladder cancer in situ, prostate cancer, rectal cancer and lymphoma are easy to invade and seminal vesicles, it is clinically difficult to identify whether the tumor originated in the seminal vesicle. Histologically, the primary seminal vesicle malignant tumors are adenocarcinoma and sarcoma. Clinical symptoms, blood, intermittent hematuria, frequent urination, thick gelatin in urine. When the mass is large, it can cause difficulty in urinating and even urinary retention. Late in the urgency and secondary epididymitis. Blood in the stool suggests that the tumor has invaded the rectum.
The urine is black:
Black urine is one of the main symptoms of black urine fever. The urine of the patient is black, so it is called black urine heat. Black urine heat is an acute blood vessel hemolysis, and causes hemoglobin and hemolytic jaundice. Incomplete function.
Ketone urine:
Low blood sugar levels in severely starved or untreated diabetics lead to increased gluconeogenesis, fatty acid oxidation accelerates the production of large amounts of acetyl-CoA, and gluconeogenesis causes oxaloacetate to be depleted, while the latter is acetyl-CoA entering the citric acid cycle. Necessary, whereby acetyl-CoA is directed to the direction of the ketone body. A large number of ketone bodies appear in the blood and urine.
Urine odor:
If there is a urinary tract infection, the urine will become cloudy and stinking.
