Abnormal urine routine

Introduction Urine routine examination is a clinically indispensable preliminary examination because urine routine examination is a general diagnostic method for doctors to discover kidney disease. It is found that most of the abnormal urine routine is the first indication of kidney or urinary tract disease, and is often an important clue to provide the nature of the pathological process. Urine routine examination mainly includes analysis of white blood cells, red blood cells, urine protein, urine sugar, urine specific gravity and pH. When getting the urine routine report, mainly look at "+" and "-". If all is "-", it means everything is normal, and "+" indicates that there is a problem. There is a certain relationship between the amount of + in the test report and the amount of protein in the urine. To determine the diagnosis, it is necessary to check the 24-hour urine protein quantitation to diagnose which kind of kidney disease belongs to, and to judge the severity of the disease.

Cause

1, white blood cell abnormalities:

If there is a large amount of urinary white blood cells, it suggests a urinary tract infection, or stones, tuberculosis, etc. If the patient has typical symptoms of urinary frequency, urgency, and dysuria, it can be judged as a urinary tract infection. For recurrent chronic urinary tract infections, it is best to have a urinary bacterial culture before administration. According to the results of the cultured pathogenic bacteria and drug susceptibility test, effective antibiotic treatment was selected.

2, red blood cell abnormalities:

There are no red blood cells (or occasional) in the urine of normal people. If there are red blood cells in the urine, and more than 3+, it suggests urinary inflammation, stones, tumors, nephritis and so on. It should be noted that women detect red blood cells in the urine, depending on whether they are in the menstrual period to avoid false positives.

3. Abnormal urine protein:

Urinary protein + is a hallmark of nephritis and nephrotic syndrome. Urinary protein can also occur in severe urinary tract infections and strenuous exercise.

an examination

Related inspection

Urine routine polarized light microscopy

Urine routine examination generally includes 10 items: PRO (protein), RLD or ERY (red blood cells), LEU (leukocyte) is mainly used to diagnose nephritis, kidney stones, urinary tract infection and other diseases, SG (specific gravity), PH (pH) To assess renal tubular function (concentration function and acidification function), GLU (glucose) is used to check renal tubular function and diabetes, NIT (nitrite) positive means bacterial infection in the urinary tract, and KET (ketone body) is used to find diabetic ketone. Acidosis and starvation, BIL (urinary bilirubin), UBG (urinary gallbladder quality) is an auxiliary examination of jaundice, used to identify hemolytic, hepatic and obstructive jaundice. It is necessary to pay special attention to the fact that there is an error in the RLD and LEU measured by the automatic urine tester. Generally, the municipal large hospitals are subject to manual microscopic examination.

Secondly, the urine routine examination also pays attention to: urine color: the color of normal urine is mainly caused by urine pigment, and its daily excretion is generally constant, so the depth of urine color changes with the amount of urine. Normal urine is grassy yellow, and abnormal urine color can be changed by factors such as food, drugs, pigments, and blood.

Transparency: Normal fresh urine, except for women's urine, which is slightly turbid, most of them are clear and transparent. If placed for too long, there will be mild turbidity. This is due to the change of pH in urine, mucus protein and nuclear protein in urine. Gradually precipitated. If there is an abnormality in the urine routine examination, it is necessary to pay attention to it in a timely manner, and actively seek medical treatment to check the possibility of kidney disease.

Differential diagnosis

1. Purpuric nephritis: The patient has the characteristics of rash, purpura, joint pain, abdominal pain and blood in the stool, and has the characteristics of hematuria such as hematuria, proteinuria, edema and hypertension. If the characteristics of purpura are not typical, it is easily misdiagnosed as primary nephrotic syndrome. The early stage of the disease is often accompanied by elevated serum IgA. Renal biopsy is a common pathological change in diffuse mesangial proliferation. IgA and C3 are the main deposits in immunopathology, so it is not difficult to identify.

2. Lupus nephritis: more common in women aged 20 to 40 years old, patients with fever, rash and joint pain, serum antinuclear antibodies, anti-ds-DNA, anti-SM antibody positive, complement C3 decreased, renal biopsy under the microscope In addition to membrane hyperplasia, lesions have diverse characteristics. The immunopathology is "full of halls".

3. Diabetic nephropathy occurs in patients with a history of diabetes for more than 10 years and can be characterized as nephrotic syndrome. Fundus examination has microvascular changes. Renal biopsy showed thickening of the glomerular basement membrane and mesangial matrix hyperplasia, with typical lesions being the formation of Kimmelstiel-Wilson nodules. A renal biopsy can confirm the diagnosis.

4. Hepatitis B: virus-associated nephritis can be manifested as nephrotic syndrome, viral serum test confirmed viremia, kidney disease-free pathological examination found hepatitis B virus antigen components.

5. Wegner granuloma: three characteristics of necrotic inflammation of the nose and sinus, pneumonia, and necrotic glomeruli. The clinical feature of renal damage is rapid glomerulonephritis or nephrotic syndrome. Serum gamma globulin, IgG, IgA increased.

6. Amyloid nephropathy: only proteinuria can be found in the early stage. Generally, nephrotic syndrome occurs in 3 to 5 years, serum gamma globulin is increased, heart, liver and spleen are large, and serum gamma globulin mossy mucin-like edema is found. The diagnosis depends on a kidney biopsy.

7. Nephrotic syndrome caused by malignant tumors: All malignant tumors can cause nephrotic syndrome through immune mechanism, and even nephrotic syndrome is an early clinical manifestation. Therefore, patients with nephrotic syndrome should be thoroughly examined to exclude malignant tumors.

8. Kidney recurrence after renal transplantation: The recurrence rate of nephrotic syndrome after renal transplantation is about 10%, usually 1 week to 25 months after surgery, proteinuria occurs, and the recipient often has severe nephrotic syndrome, and at 6 The kidney was lost between months and 10 years.

9. Drug-induced nephrotic syndrome Organic gold, mercury, D-penicillamine, captopril (captopril), non-steroidal anti-inflammatory drugs have caused nephrotic syndrome (such as membranous nephropathy). Should pay attention to the history of medication, timely withdrawal may ease the condition.

10. Human immunodeficiency virus-associated nephropathy: Human immunodeficiency virus-associated nephropathy (HIV-AN) is a kidney complication of AIDS patients, which is more common in the early stages of HIV infection, before other serious infections. Depending on whether the patient has HIV susceptibility factors (such as intravenous drug abuse, homosexuality, HIV-prone areas and populations), early HIV testing and detection of anti-HIV antibodies, combined with other clinical manifestations of HIV (eg, asymptomatic infections, persistent lymph nodes) Swollen, secondary tumors can contribute to the diagnosis of HIV-AN. In combination with patients with nephrotic syndrome and proteinuria in the range of nephrotic syndrome, especially in patients with focal segmental glomerulosclerosis with progressive deterioration of renal function in the short term, the possibility of this disease should be considered. The renal pathology of HIV-AN is characterized by global or segmental glomerular capillary wall contraction and collapse with marked podocyte proliferation; as long as any glomerulus is globally collapsed or 20% in light microscopy The above glomeruli are segmental collapse should be considered in this disease; under the electron microscope, there are a large number of tube network inclusions in the glomerular endothelial cells and interstitial leukocytes of HIV-AN (existing in 80% to 90% of HIV) -AN patients), help to establish a diagnosis.

11. Mixed connective tissue disease renal damage: the patient has a combination of systemic sclerosis, systemic lupus erythematosus and polymyositis or dermatomyositis, but can not diagnose one of the diseases, serum can be detected High titer anti-RNP antibody, anti-SM antibody negative, serum complement almost normal. Kidney damage is only about 5%, mainly manifested as proteinuria and hematuria, nephrotic syndrome can also occur, renal function is basically normal, and renal biopsy pathological changes are mostly mesangial proliferative glomerulonephritis or membranous nephropathy. Good response to glucocorticoids and good prognosis.

12. Rheumatoid arthritis Kidney damage: Rheumatoid arthritis occurs in women aged 20 to 50 years, the incidence of renal damage is low, the reasons for renal damage may be the following: rheumatoid arthritis town Painful kidney disease, rheumatoid arthritis complicated with renal amyloidosis, rheumatoid arthritis complicated with glomerulonephritis. Rheumatoid arthritis complicated with nephrotic syndrome is very rare, its rheumatoid factor is positive, renal biopsy is the most common mesangial glomerulonephritis, can be improved after treatment with corticosteroids.

13. cryoglobulinemia renal damage: clinically encountered purpura, joint pain, Raynaud's phenomenon, hepatosplenomegaly, lymphadenopathy, visual impairment, vascular syncope and cerebral thrombosis, and concurrent glomerulonephritis, The disease should be considered to further confirm the increase in blood cold globulin, and the diagnosis can be confirmed. Cryoglobulinemia can cause kidney damage. In the clinical one-third of patients with chronic glomerular disease, mainly manifested as proteinuria and microscopic hematuria, often with nephrotic syndrome and hypertension, the prognosis is poor. A small number of patients present with acute nephritic syndrome, and some may be acute progressive nephritic syndrome, which directly develops into end-stage failure.

14. Sarcoidosis Kidney damage: Sarcoidosis is a rare multi-system granulomatous disease with unknown etiology. Kidney involvement is rare, and clinical kidney damage accounts for about 1%. Kidney biopsy and autopsy found renal lesions up to 20 %, mostly in 30 to 50 years old, both men and women can be affected. The diagnosis depends mainly on laboratory examination and chest photos, lymph node, skin, liver and kidney biopsy, and elevated serum angiotensin-converting enzyme activity are helpful for diagnosis. Kidney damage of sarcoidosis can be divided into: granulomatosis directly invades the kidney, kidney damage caused by abnormal calcium metabolism, and glomerulonephritis.

15. Cellulose glomerulopathy: 40 to 60 years old is more common, more men, most patients have microscopic hematuria, almost all patients have proteinuria, 60% to 70% of patients with nephrotic syndrome proteinuria More than 50% of patients have high blood pressure, the vast majority have no systemic diseases, and a few cases have malignant tumors. Electron microscopy showed the presence of fiber-like substances similar to amyloid fibrils or hollow microtubule-like structures, but negative staining for Congo red staining and Thioflavin T. Currently, there is a tendency to treat both as the same disease.

16. Collagen III glomerulopathy: Both adults and children can develop the disease, which is more common in men. Autosomal recessive inheritance, often characterized by proteinuria and nephrotic syndrome, renal function is normal for a long period of time, and gradually progresses to chronic renal failure. Renal biopsy pathological examination is the only means to diagnose this disease, and the immunofluorescence can be broadened. Strong positive collagen III was seen in the mesangial area and throughout the capillaries.

17. Fibronectin glomerulopathy: the onset of 14 to 59 years old, more common in young people under the age of 30, both men and women can be affected, the disease is autosomal dominant inheritance. Proteinuria is a common clinical manifestation of this disease, and 50% of patients have high blood pressure. Renal biopsy pathological examination under the light microscope can be seen in the mesangial area and subendothelial homogeneous transparent material (PAS positive), Congo red staining negative, electron microscopy can be seen in the capillary sac cavity filled with fine granular electron dense, basement membrane The thickness of the Congo red-negative fiber is smaller than that of the immunotubular disease, and its distribution is consistent with the PAS-positive substance seen under the light microscope; the immunopathological examination is fibronectin staining glomerular strong positive, and Diffuse distribution in the mesangial area and under the endothelium helps to confirm the diagnosis.

18. Lipoprotein Kidney: Small ball disease is more common in men, most of them are sporadic, and a few are familial. Proteinuria exists in all patients, and some gradually progress to proteinuria in the range of nephropathy, and lipoproteins do not form embolism outside the kidney. Its pathological features are highly proliferating glomerular capillaries in the sacral cavity, which have lamellar changes in "lipoprotein emboli", histochemical staining for lipoprotein positive, electron microscopy confirmed "lipoprotein embolism", and abnormal blood lipid metabolism The diagnosis is not difficult to establish. There is no definitive and effective treatment for this disease.

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