Hematuria with proteinuria

Introduction Renal hematuria refers to hematuria derived from glomeruli, clinical manifestations of simple hematuria, or hematuria with proteinuria. If the treatment is not thorough, repeated attacks or treatment failure, the condition can not be effectively controlled, and eventually lead to uremia.

Cause

The cause of hematuria with proteinuria

More common in primary glomerular diseases, such as IgA nephropathy, mesangial proliferative nephritis, focal glomerulosclerosis, renal cysts, polycystic kidney disease, also seen in secondary glomerular diseases such as purpuric nephritis , lupus nephritis.

When the glomerulus is diseased, the basement membrane is damaged, so that the mesh pores are enlarged and the electric charge is changed, so that the permeability is increased, so that proteins having a larger molecular weight such as albumin are leaked from the basement membrane. At the same time, red blood cells in the blood can also be squeezed out from the broken capillary wall, resulting in hematuria with proteinuria in the urine.

The pathogenesis of renal hematuria is currently considered by the medical community to be related to immunity. The antigen-antibody complex is deposited in the glomerular basement membrane and mesangial area, destroying the filtration barrier of the glomerular basement membrane, and causing mesangial cells and mesangial cells. Matrix hyperplasia, causing renal hematuria.

an examination

Related inspection

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Hematuria with proteinuria examination

Generally moderate gross hematuria, the protein in the urine will not exceed 300 mg / liter; if the protein in the urine of patients with hematuria exceeds 300 mg / liter, it is accompanied by proteinuria. Proteinuria is the result of increased permeability of the basement membrane after glomerular damage. If hematuria is accompanied by proteinuria, hematuria can be considered as glomerular hemorrhage, which belongs to the category of nephritis and hematuria.

Red blood cells and proteins do not appear in the urine of normal people because the basement membrane (filter membrane) of the glomerulus has a dual role of physical barrier and charge barrier. The so-called physical barrier refers to the three-layer structure of the glomerular capillary wall, that is, the fissure between the porous endothelial cells, the basement membrane and the epithelial cells. Such a structure is like a molecular sieve. Blocking red blood cells so that they do not leak out of the blood vessels. On the other hand, the permeability of the basement membrane only allows some small molecules of proteins in the plasma, such as microglobulin, to be filtered, while proteins with larger molecular weights such as albumin are difficult to filter. by. The so-called charge barrier refers to albumin with a negative charge, while the normal basement membrane also carries a negative charge, which is repelled to prevent albumin from filtering through the basement membrane. Based on the above reasons, the total amount of protein in the normal human glomerular filtrate, ie, the original urine, is about 2 g to 4 g, but more than 95% is absorbed by the renal tubules, so the excretion of urine protein is extremely small, qualitative. Check for negative, quantitative examination, <300 mg per day.

Differential diagnosis

Hematuria with proteinuria confusing symptoms

Abdominal pain with hematuria: abdominal pain with hematuria is one of the clinical manifestations of kidney and ureteral calculi.

Hemoglobinuria: The urine contains free hemoglobin called hemoglobinuria. It is one of the evidences for diagnosing intravascular hemolysis. Because the urine content is not equal to the urine color can be red, rich brown, serious soy sauce color.

Edema with proteinuria: edema with proteinuria edema with severe proteinuria is mostly renal edema. Mild proteinuria can also be seen in cardiogenic edema in addition to nephrotic edema. Edema during pregnancy, proteinuria is more common in gestational poisoning edema.

Generally moderate gross hematuria, the protein in the urine will not exceed 300 mg / liter; if the protein in the urine of patients with hematuria exceeds 300 mg / liter, it is accompanied by proteinuria. Proteinuria is the result of increased permeability of the basement membrane after glomerular damage. If hematuria is accompanied by proteinuria, hematuria can be considered as glomerular hemorrhage, which belongs to the category of nephritis and hematuria.

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