Author: Hao Wenmin
Unit: Shanghai Donghai Geriatric Nursing Hospital
The kidney is one of the important organs of the human body, the basic function is to generate urine, in order to remove metabolites and waste products, poisons in the body, while through glomerular filtration and tubular reabsorption function to regulate water, electrolyte balance and maintain acid-base balance. In addition, the kidneys also have endocrine functions, producing renin, erythropoietin, active vitamin D3, prostaglandins, kinins and so on.
However, the early onset of kidney disease is hidden, the medium-term progression is rapid, and the late stage is very harmful, so early detection, early intervention, and early treatment of kidney disease are the key to the treatment or delay of the progression of kidney disease, and the effective application of kidney damage markers is a key part of the kidney disease prevention and control process.
The author is a five-year medical laboratory major, a bachelor's degree in medicine, with a clinical practitioner qualification certificate and a medical laboratory health qualification certificate, and has participated in the clinical and laboratory departments, and has some experience summaries and suggestions for the detection and clinical value of markers of common kidney diseases in clinical work. At the same time, the kidney-related indicators carried out by our hospital are becoming more and more comprehensive, in addition to the common kidney function, urine routine, urinary sediment, blood complement C3/C4, ASO, IgA, IgM, IgG and urine specific proteins (mALB, IgG, TRF, ɑ1-MG, β2-MG) have been added, and this year, the retinol-binding protein (RBP) detection index has been added.
What are the common tests for kidney disease and its common indicators?
Clinical kidney diseases are mainly divided into acute and chronic glomerulonephritis, acute and chronic pyelonephritis, kidney stones, kidney damage (blunt, iatrogenic, etc.), kidney tumors, secondary nephropathy (diabetic nephropathy, hypertensive nephropathy, etc.) and other categories.
(1) Acute glomerulonephritis
1. Common indicators of patient detection: blood routine, C-reactive protein, urine routine (urine sediment), urine trace protein, renal function (total protein, albumin, creatinine, urea nitrogen, uric acid), ASO, complement C3.
2. Clinical significance of index detection: blood routine and C-reactive protein are used to understand whether the patient has bacterial infection; urine routine or urine sediment is used to initially understand whether the kidney is infected or bleeding or proteinuria through red, white blood cells, casts, proteins, specific gravity, etc.; urine trace protein is used to supplement the qualitative results of protein in the urine routine; renal function test is used to initially exclude the degree of kidney damage; ASO is used to detect whether there is a streptococcal infection; complement C3 is due to the decrease in patients with acute glomerulonephritis. Supplementary proof can be made.
(2) Chronic glomerulonephritis
1. Common indicators of patient detection: In addition to the detection indicators of acute glomerulonephritis, the detection of specific proteins in blood and urine is increased.
2. Clinical significance of index detection: urine-specific protein can be found earlier in urine protein, glomerular damage or tubular damage.
(3) Acute and chronic pyelonephritis
1. Common indicators of patient detection: blood routine (erythrocyte sedimentation rate, CRP may be available or not), urine routine, renal function.
2. Clinical significance of index detection: blood routine (erythrocyte sediment rate, CRP) is used to detect whether infection, urine routine microscopy of pus cells and red blood cells, cell casts, etc. is the most easily found. In chronic pyelonephritis, serum creatinine and urea nitrogen are normal and elevated in the late stages.
(4) Kidney stones
1. Common indicators of patient detection: urinary routine.
2. Clinical significance of index detection: microscopic examination of red blood cells, white blood cells, etc., need to be confirmed by ultrasonic testing.
(5) Chronic kidney diseases such as kidney failure and uremia
1. Common indicators for patient detection: renal function, urine-specific proteins, and urinary routine.
2. Clinical significance of index detection: monitoring the progress of kidneys.
(6) Secondary nephropathy (diabetic nephropathy, hypertensive nephropathy)
Due to the long-term glucose metabolism abnormalities in diabetic patients, hypertensive renal blood flow perfusion abnormalities, easy to lead to the occurrence of kidney disease, so early detection of urine trace protein or urine-specific protein will find out whether the kidney is damaged as soon as possible, and early intervention and treatment will reduce a large amount of treatment costs for patients with severe kidney damage in the later stages that require dialysis.
Because the kidney is a very important human organ, early onset is hidden, medium-term rapid progression, late stage of the harm is huge, so it is recommended that people with underlying diseases or chronic kidney diseases, once a year for renal function, urine routine and urine-specific protein testing is more appropriate, if there are basal metabolic diseases recommended to detect once a quarter, there are patients with kidney disease monitoring and treatment according to the doctor's advice.
In summary, in addition to the common urinalysis routine, renal function, etc., urine-specific proteins (mALB, IgG, TRF, ɑ1-MG, β2-MG, retinol-binding protein RBP) and blood complement C3/C4 and ASO and other indicators need to be used as indicators for early screening of kidney disease, early detection and early treatment, so as not to develop into chronic diseases and increase physical and economic burden. Specific protein instruments are commonly seen in Siemens BNII, Guosai Omnipo automatic specific protein analyzer or Aristo orbital automatic specific protein analyzer, AS-600 and so on.
Figure: Our hospital urine specific proteins, blood specific proteins and complement, etc., can see the scope and unit of reference materials, will find that the implementation of these projects as screening can be carried out earlier and in time to find out whether the kidney has inflammatory infection or damage.
Editor: Ren Mileage Reviewer: Xiao Ran