wary! Every year, the index of physical examination exceeds the standard but does not care, and the 34-year-old woman is diagnosed with kidney failure!

Over the years, physical examinations have found that the urine protein index is abnormal

But because I didn't feel any discomfort

A 34-year-old woman in Guangzhou did not take this matter to heart

Never reviewed

It turned out to be a big problem!

This year's examination found that the kidney function was only 30% normal!

Diagnosed with chronic renal failure

The abnormality of the physical examination index was not taken to heart

34-year-old woman diagnosed with chronic renal failure!

A 34-year-old woman in Guangzhou was admitted to the hospital with elevated serum creatinine during the physical examination, and the re-examination indicators after admission showed that the patient's kidney function was only 30% normal! Is it acute kidney injury or chronic renal failure? After the contraindications were ruled out, the doctor performed a renal puncture examination, which suggested IgA nephropathy (focal hyperplasia sclerosing glomerulonephritis), tubular and interstitial atrophy, fibrosis of 60%, and chronic renal failure.

Further questioning the patient's medical history, it was learned that the patient unit carried out physical examination every year, and since 2018, the patient's annual physical examination can see urine protein 1 + ~ 2 +, urine occult blood 2 +, but because there is no discomfort, it does not affect work and life, the patient has never been re-examined, until the blood creatinine is elevated. Wang Lixin, director of the Department of Nephrology of Fangcun Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine, reminded that attention should be paid to urine protein in physical examination, detected as soon as possible, and actively treated as soon as possible to avoid missing the best treatment time.

Do proteinuria have to be processed?

Wang Lixin introduced that urine protein is one of the important components in urine. Normal people excrete very little protein from the urine every day, mainly low molecular weight protein and a small amount of albumin, generally less than 150 mg in 24 hours. Then, if the 24-hour urine protein quantification exceeds 150 mg or urine protein/creatinine > 200 mg/g, or a positive urine protein qualitative test is called proteinuria.

However, proteinuria also has physiological and pathological differences. Adolescents are prone to physiological proteinuria when they are stressed by strenuous exercise, fever, and nervousness, and proteinuria is also prone to occur in the upright and kyphosis positions of adolescent children, and the protein in the urine disappears when lying down. Physiological proteinuria is often transient, short duration, low protein content, therefore, occasional detection of urine protein slight abnormalities, can not confirm the diagnosis of kidney disease, need to repeat multiple times to be more clinical significance.

Pathological proteinuria is proteinuria caused by organic lesions of the kidneys, generally persistent proteinuria, and the following conditions are common:

(1) Glomerular proteinuria, such as acute nephritis, rapidly progressive nephritis, chronic nephritis, IgA nephropathy, nephrotic syndrome, lupus nephritis, etc.

(2) Renal tubular proteinuria, such as pyelonephritis, interstitial nephritis, renal tubular acidosis, etc.

(3) Overflow proteinuria, mostly seen in multiple myeloma, but also seen in macroglobulinemia, severe chain disease and light chain disease, amyloidosis and so on.

(4) Secretory proteinuria, which is related to immune response and urinary tract infection.

(5) Mixed proteinuria, clinically two kinds of proteinuria, such as glomerular proteinuria and renal tubular proteinuria coexist, called mixed proteinuria.

For these diseases, proteinuria is an early signal, which means that some kind of abnormality has appeared in the body, and if the cause cannot be found and removed, the abnormality may persist, continue to damage the kidneys, and eventually affect kidney function, and even develop uremia. At the same time, proteinuria is not only a signal, no matter what the cause of proteinuria, persistent, is also a damage to the kidneys themselves, so it needs to be paid enough attention.

What is IgA nephropathy?

What is the IgA kidney disease that causes Ms. Chen's long-term proteinuria? This is the most common primary glomerular disease in China and a major cause of chronic renal failure. The disease is more common in young adults, 80% of patients have an age distribution of 16-35 years old at the time of kidney biopsy, more men than women, and the ratio of male to female incidence is about 2:1 to 6:1.

The exact pathogenesis of IgA nephropathy is not fully understood, but studies have shown that IgA nephropathy is a "mistaken injury" of the kidneys by the systemic immune system (defense system) when dealing with "foreign enemies" such as bacteria and viruses attacking the body. The occurrence of "accidental injury" can lead to kidney damage, the appearance of hematuria and proteinuria. Over time, it can affect kidney function and eventually lead to kidney failure. About 25% to 30% of patients will develop renal failure in 20 to 25 years of the course of the disease and require renal replacement therapy. Moreover, as a chronic disease, IgA nephropathy can often recur or worsen due to colds, fatigue, high-salt and high-protein diets, nephrotoxic drugs, etc.

For patients, there are four things that must be done daily:

1. Regular follow-up review of relevant indicators. Even if the indicators are normal, every 3-6 months of review must be adhered to for a long time, early detection of signs of disease progression, with doctors and timely intervention can better delay the progression of kidney disease, prevent or delay the occurrence of uremia.

2, pay attention to adjust the diet structure, to light mainly, in addition to limiting the intake of edible salt, try to avoid the intake of salt, high sodium food, such as soy sauce, bean paste, shrimp paste and other condiments and all kinds of canned, pickles and other pickled foods, should eat more fruits, vegetables and high-quality protein food, prohibit spicy, fat and thick taste, as well as mold products, pickled food, avoid tobacco and alcohol.

3. Avoid exertion and strenuous exercise, and pay attention to appropriate exercise to enhance physical fitness. Pay attention to the prevention of infection, increase the ability to resist the disease, once the emergence of various infections, should be timely use of strong antibiotics and early control of infection.

4, the use of drugs with caution, most of the drugs are metabolized by the kidneys, patients with kidney disease need to be vigilant against drug-induced kidney damage, to avoid the use of drugs with unclear composition, such as not sure whether the drugs taken are risky, it is best to consult a professional nephrologist before use.

Source: Guangzhou Daily Xinhuacheng Reporter: Zhou Jieying Correspondents: Song Liping, Zha Guanlin