Double renal cortical thinning

Introduction The renal cortex is a thinning of the cortex caused by a series of lesions produced by chronic glomerulonephritis. Chronic glomerulonephritis is the final stage of development of different types of glomerulonephritis. The lesion is characterized by a large number of glomerular glassy changes and sclerosis, also known as chronic sclerosing glomerulonephritis. From the naked eye, the kidneys are reduced in size and the surface is diffuse and fine-grained. The cut cortex is thinned and the boundary of the cortex is unclear. Increased fat around the renal pelvis. The gross lesion of chronic nephritis is called secondary granular pyknosis.

Cause

1 intrarenal arteriosclerosis caused by glomerular lesions, intrarenal arteriosclerosis can further aggravate ischemic damage of renal parenchyma;

2 renal hemodynamic compensatory changes cause glomerular damage. When part of the glomerulus is involved, the glomerular filtration rate of the healthy nephron is compensated. This hyperperfusion and high filtration state can cause glomerular sclerosis and eventually renal failure.

3 hypertension causes renal arteriosclerosis. Long-term hypertension causes ischemic changes, leading to narrowing and occlusion of renal arterioles, accelerating glomerular sclerosis, and hypertension can also increase glomerular capillary hydrostatic pressure, causing glomerular hyperfiltration and accelerating kidney Small ball hardening;

4 The overload state of the glomerular mesangium. Normal mesangial cells have the function of phagocytosis and clearance of immune complexes, but when the load is too heavy, it can cause mesangial matrix and cell proliferation, and finally to harden.

an examination

Related inspection

Kidney ultrasound examination of kidney CT

According to the clinical manifestations of chronic nephritis, diagnosis is not difficult. Slow onset, prolonged condition, abnormal urine test, often proteinuria, sometimes accompanied by hematuria, edema and high blood pressure. Different degrees of renal impairment occur as the disease progresses. Its diagnostic criteria are:

1 There is edema, hypertension and progressive deterioration of renal function, and there is proteinuria with or without hematuria.

2 The course of disease is extended for more than 1 year.

3 Except for secondary and hereditary nephritis.

Differential diagnosis

1. Chronic nephritis Kidney disease type and glomerular nephropathy identify the two points in common: large amount of proteinuria, high edema and hypoproteinemia. However, patients with glomerular nephropathy, no microscopic hematuria, generally no hypertension and renal insufficiency, unless temporary renal dysfunction or hypertension can occur due to severe edema, both of which should be very diuretic after swelling It will return to normal. Therefore, those who have microscopic or even gross hematuria, or persistent hypertension and renal dysfunction, are generally nephritis and cannot be diagnosed as kidney disease. If you can further analyze the urine protein, it is more helpful for diagnosis. Glomerular nephropathy is mostly highly selective proteinuria; patients with chronic nephritis and nephropathy are mostly non-selective proteinuria. Kidney disease rarely occurs in the urine and chronic nephritis is more common. In addition, most patients with glomerular nephropathy are sensitive to hormone and immunosuppressive drugs, while patients with chronic nephritis and kidney disease have poor response to this class of drugs.

2. Identification of chronic nephritis common type and chronic pyelonephritis: In the advanced stage of chronic pyelonephritis, there may be a large amount of proteinuria and hypertension, which is difficult to distinguish from chronic nephritis. The latter is more common in women, often with a history of urinary tract infections. Multiple urine sediment tests and positive urine cultures contribute to the diagnosis of active infectious chronic pyelonephritis. In patients with chronic pyelonephritis, renal function damage is mainly caused by renal tubular damage, which may be hyperchloric acid poisoning, low-phosphorus renal osteopathy, and azotemia and uremia are mild, and progress is very slow. Intravenous pyelography and radionuclide kidney and kidney scans, if there is asymmetrical renal damage, it is more helpful in the diagnosis of chronic pyelonephritis.

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