Nephrogenic edema

Introduction Edema is the most common symptom in the clinic and one of the common symptoms of kidney disease. Edema can be caused by many causes, and different edema has different characteristics. Edema caused by heart disease is called cardiogenic edema or cardiac edema. Edema caused by liver disease is called hepatic edema or hepatic edema. Similarly, edema caused by kidney disease is called nephrogenic edema. Nephrogenic edema is a kind of systemic edema. It is a common symptom of glomerular disease. It is caused by kidney disease, which causes water and sodium retention in the body, causing edema in different degrees of tissue loosening.

Cause

1 glomerular filtration rate decreased, sodium retention.

2 The increase in systemic capillary permeability makes it easy for fluid to enter the interstitial space from the blood vessels.

3 plasma protein levels are reduced, especially albumin levels are reduced, causing a decrease in plasma colloid osmotic pressure and easy migration of water to the interstitial space.

4 The effective blood volume is reduced, resulting in an increase in secondary aldosterone, which aggravates the retention of sodium and water.

an examination

Related inspection

Lysis lysozyme urinary cyclic guanosine monophosphate hepatobiliary imaging triiodothyronine inhibition test urinary dehydroepiandrosterone

The characteristics of nephrogenic edema mainly occur in the loose areas of the tissues, such as the eyelids or the face and the ankles. It is obvious in the morning, and can be related to the lower limbs and the whole body in severe cases. The nature of nephrotic edema is soft and easy to move, and it is clinically depressed edema, that is, depression can be caused by pressing a local skin with a finger. Diagnosis can be based on the above clinical manifestations.

Differential diagnosis

(1) Cardiac edema: In the case of right heart dysfunction, exudative or constrictive pericarditis, edema is caused by increased venous pressure in the systemic circulation and increased capillary filtration pressure. Cardiac edema is characterized by edema that first occurs in the ptosis, often throughout the body from the lower extremities, and ascites or pleural effusion can occur in severe cases. Edema is formed at a slower rate. The edema is solid and less mobile. The main basis for the diagnosis of cardiogenic edema is the history and signs of heart disease. Determination of a significant increase in venous pressure is an important indication for diagnosis.

(2) Hepatogenic edema: cirrhosis often has mild edema of the lower extremities before the appearance of ascites, which first occurs in the ankle and gradually spreads upward. The head and face and upper limbs are often edema. Ascites and pleural effusion occur in severe cases. A variety of chronic liver disease history and signs of liver damage and laboratory indicators are the basis for diagnosis.

(3) dystrophic edema: chronic consuming disease, chronic nutritional deficiency, protein loss gastrointestinal disease, severe burns caused by hypoproteinemia, vitamin B1 deficiency, etc. can produce edema. Tissue relaxation caused by a decrease in subcutaneous fat and a decrease in tissue pressure increase the retention of water. Edema often spreads from the foot to the whole body.

(4) Systemic edema for other reasons: 1 mucinous edema: hypothyroidism, when the condition is severe, due to skin infiltration by mucin and mucopolysaccharide, producing characteristic non-depressed edema, called mucinous edema. Often occurs in front of the face and cheekbones. 2 drug edema: the application of certain drugs can cause edema, which is characterized by mild edema after medication, gradually disappear after stopping the drug. The more common drugs are adrenocortical hormone, testosterone, estrogen, insulin, etc., and the dose of Rauvolfia, thiourea and licorice can also cause edema. 3 premenstrual tension syndrome is also one of the common causes of edema, which is characterized by mild edema of the eyelids, ankles and hands 7 to 14 days before menstruation, which may be accompanied by breast tenderness and pelvic heaviness, urinating after menstruation. As the amount increases, edema and other neurological symptoms gradually subsides. 4 idiopathic edema: mainly in the sagging part of the body, more common in adult obese women, often associated with emotional and mental changes, accompanied by fatigue, dizziness, headache, anxiety, insomnia and other neurasthenia manifestations, vertical position water test is positive .

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