Symptom >> Internal Medicine >> Nephrology

Chronic renal insufficiency

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Chronic renal insufficiency refers to the clinical syndrome of a series of symptoms and metabolic disorders caused by various kidney diseases leading to the progressive irreversible decline of the three major functions of the kidney until the function is lost, referred to as chronic renal failure. In the 21st century, chronic renal failure has become a major public hazard in the world after cardiovascular and cerebrovascular diseases, cancer and diabetes. Chronic kidney disease is very common and harmful, but it can be treated. Therefore, the International Kidney Disease Association and the International Kidney Disease Foundation will set the second Thursday of March every year as World Kidney Day, aiming to awaken people to the kidneys and care for life. . Chronic renal insufficiency is the final outcome of various progressive renal diseases.

Cause

Cause

There are many causes of chronic renal insufficiency, the most common of which are the following:

1, chronic glomerulonephritis: such as IGA nephropathy, membrane proliferative glomerulonephritis; focal segmental sclerosing glomerulonephritis and mesangial proliferative glomerulonephritis.

2, kidney damage caused by abnormal metabolism, such as diabetic nephropathy, gouty nephropathy and amyloidosis nephropathy;

3, vascular nephropathy, such as hypertension, renal vascular hypertension, renal arteriosclerosis, etc.;

4, hereditary kidney disease, such as polycystic kidney disease, Alport syndrome, etc.;

5, infectious kidney disease, such as chronic pyelonephritis, kidney tuberculosis, etc.;

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

7, toxic nephropathy, such as analgesic nephropathy, heavy metal toxic kidney disease, etc.;

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

Examine

an examination

Nausea, vomiting, oliguria, edema, malignant hypertension, severe anemia, itchy skin, urinary odor in the mouth.

I. Laboratory inspection

Urine check

The urine routine protein is generally >2.0g/L, and the urine protein is reduced when the renal function damage is obvious. The morning urine specific gravity is reduced to below 1.018, or fixed at around 1.010.

Because of anemia in CRF, blood routine examination has an important role in CRF. Other tests include plasma total protein, albumin, globulin and their ratio determination; blood electrolytes (HCO3--, K, Na, Ca, Mg2, P3, etc.) levels.

Serum creatinine (Scr), urea nitrogen (BUN) increased, urine concentration-dilution function measurement showed a decrease in endogenous creatinine clearance (Ccr).

4. Liver function and hepatitis B two-and-a-half check

5. Serum immunological examination

Including serum IgA, IgM, IgG, complement C3, complement C4, T lymphocyte subsets, B lymphocyte group CD4 / CD8 ratio and so on.

6. Malnutrition index detection

Serum total protein, serum albumin, serum transferrin white and low molecular weight proteins were determined. Very low levels of cholesterol are also considered indicators of malnutrition.

Second, imaging examination

Kidney B ultrasound

The thickness of the renal cortex is <1.5 cm, and the CRF is judged to be superior to the size of the kidney. Such as kidney atrophy, support end-stage diagnosis.

2. Other

Conventional electrocardiogram, X-ray, bone and gastroscopy, as well as some special examinations such as X-ray, radionuclide kidney scan, CT and magnetic resonance to determine the shape and size of the kidney and the presence or absence of urinary tract obstruction, Water, stones, cysts and tumors are helpful.

Diagnosis

Differential diagnosis

Renal insufficiency in the first phase, renal insufficiency compensatory period, serum creatinine (Scr) 133 ~ 177umol / L, due to the large renal compensatory capacity, so the clinical renal function has decreased, but its excretion of metabolites and regulating water The electrolyte balance ability can still meet the normal needs, clinical symptoms do not appear, renal function tests are also in the normal range or occasionally slightly higher.

Renal insufficiency in the second phase, renal insufficiency decompensation period (also known as renal insufficiency azotemia period), serum creatinine (Scr) 177 ~ 443umol / L, glomerular sclerosis fibrosis increased, about 60 damage %-75%, there are certain obstacles in the kidney excretion of metabolic waste, and the serum creatinine urea nitrogen is higher or exceeds the normal value. The patient has anemia, fatigue, weight loss, difficulty in concentration, etc., but is often overlooked. If there is a situation such as loss of water, infection, or bleeding, the progress of the disease will accelerate.

Renal insufficiency in the third stage, renal failure, serum creatinine (Scr) 443-707umol / L, glomerular sclerosis, renal tubulointerstitial fibrosis, renal vascular fibrosis, leading to severe renal impairment, anemia, Nocturia increased, serum creatinine, blood urea nitrogen increased significantly, and often acidosis, this period without formal treatment, will develop into end-stage renal disease, treatment is more difficult.

Renal insufficiency, stage 4, uremia or renal insufficiency, serum creatinine (Scr) > 707umoll / L. Patients with renal insufficiency in uremia are more than 95% of glomerular lesions, with severe clinical symptoms such as severe nausea, vomiting, oliguria, edema, malignant hypertension, severe anemia, itchy skin, and urinary odor.