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Renal insufficiency

  Renal insufficiency (renal insufficiency) is caused by a variety of causes, the glomerular serious damage to the body in the excretion of metabolic waste and regulate water and electrolyte, acid-base balance and other aspects of the disorder after the clinical syndrome group. Divided into acute renal insufficiency and chronic renal insufficiency. The prognosis is serious, is one of the main life-threatening illness.

  Etiology

  Causes of renal insufficiency can be summarized as follows:

  1. Kidney diseases: acute renal tubular degeneration, necrosis, kidney tumor and congenital kidney disease caused by acute, chronic glomerulonephritis, pyelonephritis, renal tuberculosis, chemical poison and biological poison.

  2. Extrarenal disease: systemic blood circulation disorders (shock, heart failure, hypertension), systemic metabolic disorders (such as diabetes) and urinary tract disease (urinary tract stones, tumor compression).

  Staging symptoms

  Renal insufficiency can be divided into the following four:

  Phase one

  Decompensated renal function reserve. Because the renal reserve capacity is large, so the clinical renal function, although the decline, but the excretion of metabolites and regulate water, electrolyte balance can still meet the normal needs, clinical symptoms do not appear, renal function tests are normal Range or occasionally slightly higher phenomenon.

  the second term

  Renal insufficiency. Glomerular have more damage, 60% -75%, renal excretion of metabolic waste has been a certain obstacle, creatinine urea nitrogen can be high or exceed the normal value. Patients can be anemia, fatigue, weakness, weight loss, mental concentration is not easy. But often overlooked, if there is water loss, infection, bleeding and other conditions, then soon apparent symptoms.

  The third period

  Renal failure period. Renal dysfunction has been very serious, 75% -95%, can not maintain the body's internal environment stability, patients with fatigue, fatigue, attention can not be concentrated and other symptoms intensified, anemia significantly increased nocturia, serum creatinine, And often acidosis. This period also known as azotemia.

  Fourth period

  Uremic phase or renal failure end-stage. This period of glomerular damage has more than 95%, with severe clinical symptoms, such as severe nausea, vomiting, oliguria, edema, malignant hypertension, severe anemia, skin itching, urine smell urine smell and so on.

  classification

  Kidney dysfunction according to the development of priorities by time classification can be divided into chronic renal insufficiency and acute renal insufficiency!

  Chronic renal insufficiency

  Chronic renal insufficiency is the ultimate outcome of various progressive nephropathy, resulting in a number of chronic renal failure causes, the most common are the following:

  1, chronic glomerulonephritis categories: such as IGA nephropathy, membranoproliferative glomerulonephritis; focal segmental sclerosing glomerulonephritis and mesangial proliferative glomerulonephritis and so on.

  2, metabolic abnormalities due to kidney damage, such as diabetic nephropathy, gouty nephropathy and amyloidosis nephropathy;

  3, vascular nephropathy, such as hypertension, renal vascular hypertension, renal arteriosclerosis and so on;

  4, hereditary nephropathy, such as polycystic kidney disease, Alport syndrome;

  5, infectious nephropathy, such as chronic pyelonephritis, renal tuberculosis;

  6, systemic systemic diseases, such as lupus nephritis, vasculitis, kidney damage, multiple myeloma;

  7, toxic nephropathy, such as analgesic-induced nephropathy, heavy metal toxic nephropathy;

  8, obstructive nephropathy, such as ureteral obstruction; reflux nephropathy, urinary tract stones and so on.

  Note: When the kidney disease in the early stage (inflammation), only hematuria, proteinuria stage is the best time to treat, by regulating the regular treatment of renal small-scale pathological damage can be quickly restored, normal renal function, indicators returned to normal, and Renal dysfunction, a large range of fibrosis, treatment more difficult, but this time, such as active treatment can reverse renal function, control of concurrent disease, complications occur at the same time increased blood urea nitrogen, serum creatinine into the renal dysfunction stage, Disease, lower blood urea nitrogen, to avoid dialysis, kidney transplantation.

  an examination

  Qualitative test for urine protein

  Usually using protein test paper, sulfonic acid method, acetic acid heating three methods. Under normal circumstances, urine protein qualitative test was negative. However, this method is susceptible to a number of factors, can cause false results, such as uric acid content is high, the urine acidic reaction, protein test paper results than the actual situation is low, sulphosalicylic acid method is prone to false positive; When the use of penicillin, sulphosalicylic acid method is easy to false-positive reaction; the use of sulfonyl contrast agent, the sulfonic acid method, acetic acid heating method can occur false-positive reaction; when the urine was strongly alkaline, the false results more More or false-test paper method false negative reaction, or the presence of sulphosalicylic acid and heating acetic acid method of false negative reaction.

  When the urinary protein is only some special proteins, the protein test paper method and sulfonic acid method are not sensitive. Therefore, during the qualitative urine protein, should be a variety of factors, the specific circumstances of specific analysis, select the appropriate method. Although the qualitative test more convenient, but sometimes difficult to reflect the actual situation of proteinuria, conditional, it is best to conduct quantitative examination.

  Blood routine examination

  Significant anemia, normal cell anemia, white blood cell count normal or increased. Platelet reduction, fine cell sedimentation rate.

  Renal dysfunction, urinary routine examination:

  With the original disease of different traps of difference. The common points are:

  ① decreased urinary osmolality, more than 450mOsm per kilogram in the following, the weight low, more than 1.018 in the following, fixed in between 1.010 to 1.012 between severe, urine dilution test for urinary nocturia is greater than the day urine Volume, the urine specific gravity of more than 1.020, the highest and lowest urine specific gravity is less than 0.008;

  ② decreased urine output, more than 1000ml daily in the following;

  ③ quantitative increase in urinary protein, the vast majority of glomerular damage has been late, but decreased urinary protein;

  ④ urine sediment examination, urinary sediment in leukocytosis (acute phase is often full of vision, the chronic phase in the 5 / high power field), and sometimes white blood cell tube.

  ⑤ urine bacterial examination: This nephritis examination method is relatively simple, when the urine contains a large number of bacteria, due to urinary sediment coating for Gram staining, 90% can be found in bacteria. Check the positive rate of high.

  X-ray examination

  [1] X-ray examination when patients with repeated episodes of nephritis, or the patient's condition developed to the point where the control is not easy, this time the application of X-ray nephritis, including abdominal X-ray, intravenous pyelography, urinary bladder urorography . The purpose is to exclude the presence of stones, urinary system congenital malformations, renal ptosis, and other lesions.

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