Nephrotic syndrome (NS) by a variety of causes, in order to increase the permeability of the glomerular basement membrane, showed massive proteinuria, hypoalbuminemia, severe edema, a clinical syndrome of hyperlipidemia.
Diagnosis
1. nephrotic syndrome (NS) diagnostic criteria are:
(1) greater than 3.5g / d proteinuria.
(2) serum albumin less than 30 g / L.
(3) Edema.
(4) Hyperlipidemia.
2 DK diagnosis should include three aspects.
(1) Diagnosed NS.
(2) Confirm the cause: First rule out secondary and inherited diseases can be diagnosed with primary NS, better renal biopsy for pathological diagnosis.
(3) Judgment uncomplicated.
Differential Diagnosis
1. Purple allergic nephritis
Especially in young, with typical purple skin, often in symmetrical distal extremities, 1 to 4 weeks hematuria and (o) proteinuria after more than a rash.
2. Systemic lupus nephritis
Most often in middle-aged women and youth. Immunological examination showed a variety of autoantibodies and multiple system damage, can confirm the diagnosis.
3. Hepatitis B virus associated glomerulonephritis
It is more common in children and adolescents, the main clinical manifestations of proteinuria or NS, common pathologic type of membranous nephropathy. The diagnosis is based on ① HBV antigen positive serum. ② The suffering of glomerulonephritis, and excludes secondary glomerulonephritis. ③ biopsy slice HBV antigens found.
4. Diabetic nephropathy
Occur in the elderly, is common in patients with diabetes duration of more than 10 years. Early can be found in urinary albumin excretion increased, then gradually became a massive proteinuria, NS. History of diabetes and fund changes characteristic eye contribute to the differential diagnosis.
5. Renal amyloidosis
Occur in the elderly, renal amyloidosis is a part of the involvement of multiple organs. Primary amyloidosis primarily involving the heart, kidneys, gastrointestinal tract (including language), skin and nerves; secondary amyloidosis often secondary to chronic suppurative infections, tuberculosis, cancer and other diseases, which mainly involves the kidneys, liver and spleen and other organs. Volume increases renal involvement, often NS. Renal amyloidosis often require biopsy confirmed.
6. Myeloma nephropathy
It occurs most commonly in men middle-aged patients may have clinical features of multiple myeloma, such as bone pain, elevated serum monoclonal immunoglobulin protein electrophoresis and urine with the M protein positive this week, shows plasma cells bone marrow dysplasia (occupy more than 15% of the nucleated cells), and accompanied by a qualitative change. Multiple myeloma can occur when the glomerular involvement of NS. Demonstrations myeloma above features for the differential diagnosis.
Above mentioned are the diagnosis of nephrotic syndrome? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and fitness features all the information? If you have any problem, you can consult our experts online or leave a message below!
2015年1月2日星期五
Long-term complications of renal dialysis
Technology makes hemodialysis patient survival significantly prolonged with chronic renal failure, however, is not entirely hemodialysis renal replacement therapy, can not completely eliminate toxins body disease urea, can not completely eliminate uremia caused by metabolic disorders, can not replace the endocrine function of the kidney. With prolonged dialysis, toxins accumulate, metabolic disorders and endocrine disorders caused by problems gradually worsened, can cause a number of complications, which seriously affects the quality of life and survival of patients.
1. Hypertension: Mainly due to sodium retention, increased activity of the renin-angiotensin system, increased excitability of the sympathetic nervous system and other causes.
First, the treatment should be limited intake of water and sodium, keep dry weight, 75% of patients can control blood pressure. Invalid can increase with antihypertensive drugs, the class of ACEIs channel blockers and calcium are first choice. 3% to 5% of patients are refractory hypertension, peritoneal dialysis or hemofiltration may be effective.
2. The left ventricular dysfunction: the etiology addition of hypertension, sodium retention, but also with anemia, acidosis, fistula, electrolyte imbalance, malnutrition etc. Dehydration adequate dialysis, keeping the dry weight is the main treatment, the other must correct the anemia, blood pressure control and nutritional therapy.
3. Coronary Artery Disease: More by the original based on ultrafiltration excessive causing coronary atherosclerosis coronary ischemia caused. Controlling high blood pressure, high cholesterol, correct anemia, weight maintenance among dialysis, prevent excessive dehydration etc., can effectively prevent its occurrence. The same treatment and patients not on dialysis. Angina occurred in dialysis treatment of kidney disease should slow blood flow ultrafiltration stop and breathe oxygen and sublingual nitroglycerin, you should be expanded low blood pressure. Patients ineffective treatment should cease hemodialysis treatment again. Done repeatedly can make peritoneal dialysis or hemofiltration.
4. Pericarditis: After two weeks start dialysis pericarditis occur, early pericarditis is called, after two weeks, late pericarditis is called, pathogenesis were unclear. Patients with early symptoms of pericarditis most have chest tightness, chest pain and pericardial rub, strengthens dialysis to treat effectively. Pericarditis most asymptomatic late, only in recurrent dialysis hypotension occur, in part to strengthen effective dialysis, peritoneal dialysis some needed.
5. Pulmonary edema: More due to overload caused by water, other causes of congestive heart failure, hypoalbuminemia and pulmonary capillary permeability etc. Adequate water ultrafiltration can rapidly improve symptoms. Restricted water intake, adequate dialysis and hypoproteinemia can be prevented effectively.
6. The pleural effusion: Exudative base. More in heart failure, sodium retention, renal syndrome, infection and other causes, in part explained uremic idiopathic pleural effusion. Treatment should be enhanced dialysis and ultrafiltration, hypoproteinemia, improve the general condition, if necessary, keep a breast pump fluid therapy.
7. Gastrointestinal diseases: including esophagitis, gastritis, ulcers, delayed gastric emptying and gastrointestinal bleeding. More urinary retention urinary toxins cause damage to the autonomic nervous disorders gastrointestinal motility, gastrin metabolic abnormalities lead to increased gastric acid secretion, anemia, malnutrition weaken mucosal protecting factors and other causes. Most effective treatment to strengthen dialysis, can also used drugs promote gastrointestinal motility, excluding protective agents gastrointestinal mucosa magnesium antacid agents. Gastrointestinal bleeding should pay attention to the choice of methods of anticoagulation.
8. The intestinal ischemia, intestinal infarction: High blood pressure, high cholesterol, heart failure, diabetes and other common diseases in hemodialysis patients and metoprolol, etc vasodilators, commonly used drugs may reduce the intestinal blood flow, once excessive ultrafiltration, and intestinal bowel can induce myocardial ischemia. It manifests as severe abdominal pain, nausea, vomiting, diarrhea, abdominal distension, shock. Early quick to add volume can relieve intestinal ischemia, such as intestinal infarction without suspicion effect, once the diagnosis to be treated surgically.
9. Liver disease: Since hemodialysis patients with renal anemia and repeated blood transfusions, increasing infection with hepatitis B and C, can cause deposition of iron in dirty, causing cirrhosis, silicone and silicone dialysis tube also can be deposited in cuasa liver damage. When Hemodialysis patients liver damage, rare jaundice, gastrointestinal symptoms were masked by uremia and early detection difficult. Treatment focuses on prevention, as the use of erythropoietin to reduce blood transfusions, avoid using aluminum agents etc.
10. Ascites dialysis-related: Most occurred in patients who had undergone dialysis, the reasons include sodium retention, peritoneal permeability increase, infection, hypoalbuminemia, heart failure, pericardial disease, cirrhosis etc. Should be excluded before treatment tuberculosis, liver cancer and ascites. Treatment includes limiting intake of sodium and water, adequate dialysis ultrafiltration, ascites reinfusion and download abdominal fluid, local glucocorticoid therapy department etc. Kidney transplantation is the fundamental solution of the method of refractory ascites.
11. Anemia: renal hormone erythropoietin (EPO) produces insufficient is the main reason. Other factors include: blood shortage of raw materials, the loss of blood dialysis, increased destruction of red blood cells, bone marrow fibrosis and aluminum intoxication. EPO is the primary means of dealing renal anemia, general subcutaneous 3000u of 2-3 times / week, HCT reach 30-33% of the dose can be reduced and maintained at this value HCT, other treatments, including strengthening dialysis, raw materials of supplemental blood dialysis reduce blood loss, severe anemia can be a small amount of blood transfusion.
12. The secondary hyperparathyroidism and renal osteodystrophy: Generally regarded hemodialysis patients as calcium and phosphorus metabolism, deficiency of active vitamin D3 and acidosis can cause secondary hyperparathyroidism (2-HPT), and 2-HPT is increased osteoclast , decreased synthesis of collagen fibers in bone, bone mineralization disorders etc, cause renal osteodystrophy. The clinical manifestations are bone pain, fractures, bone deformation, joint swelling and deformation, muscle strength, muscle tone decreases, metastatic calcification and tendon rupture etc. Further diagnosis based on clinical symptoms, serum calcium, phosphorus, I-PTH concentration and X ray bone etc. Bone biopsy is the gold standard for the diagnosis of renal osteodystrophy. The primary treatment is active vitamin D3 supplement, the other can also hemoperfusion and parathyroid surgery etc.
13. Urogenital: Urinary stones in hemodialysis patients, infections, cancer and impotence, loss of libido and other incidence rate was significantly higher. Kidney cysts also acquired common, which is caused by the same kidney disease has nothing to do with dialysis, can be complicated by bleeding, infection and malignancy. Treatment is symptomatic, severe nephrectomy.
14. Nervous System: Mainly aluminum intoxication, uremic toxins, retention of parathyroid hormone, vitamin, micronutrient deficiencies, water and electrolyte disturbance caused by other factors. Central lesions showed inattention, short films, paranoia, mental impairment, severe cases there is a language and movement disorders, and even seizures, dementia. Peripheral neuropathy showed the depth of feeling important obstacles small number of patients with dyskinesia advanced flaccid even paralysis. Autonomic neuropathy manifests as hypotension, sexual dysfunction, disorders of sweat secretion, gastrointestinal disorders. Treatment includes avoiding contact with the aluminum to improve dialysis, improve nutritional status, to correct anemia, hemofiltration or peritoneal dialysis diverted if necessary. Kidney transplantation is the most effective method.
15. Skin: Mainly for color changes of the skin, dryness, hair, nail changes itching and oral lesions. Some of strengthening effective dialysis, most only symptomatic treatment, no special treatment.
Above mentioned are the long-term complications of kidney dialysis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and the gym has all the information? If you have any problem, you can consult our experts online or leave a message below!
1. Hypertension: Mainly due to sodium retention, increased activity of the renin-angiotensin system, increased excitability of the sympathetic nervous system and other causes.
First, the treatment should be limited intake of water and sodium, keep dry weight, 75% of patients can control blood pressure. Invalid can increase with antihypertensive drugs, the class of ACEIs channel blockers and calcium are first choice. 3% to 5% of patients are refractory hypertension, peritoneal dialysis or hemofiltration may be effective.
2. The left ventricular dysfunction: the etiology addition of hypertension, sodium retention, but also with anemia, acidosis, fistula, electrolyte imbalance, malnutrition etc. Dehydration adequate dialysis, keeping the dry weight is the main treatment, the other must correct the anemia, blood pressure control and nutritional therapy.
3. Coronary Artery Disease: More by the original based on ultrafiltration excessive causing coronary atherosclerosis coronary ischemia caused. Controlling high blood pressure, high cholesterol, correct anemia, weight maintenance among dialysis, prevent excessive dehydration etc., can effectively prevent its occurrence. The same treatment and patients not on dialysis. Angina occurred in dialysis treatment of kidney disease should slow blood flow ultrafiltration stop and breathe oxygen and sublingual nitroglycerin, you should be expanded low blood pressure. Patients ineffective treatment should cease hemodialysis treatment again. Done repeatedly can make peritoneal dialysis or hemofiltration.
4. Pericarditis: After two weeks start dialysis pericarditis occur, early pericarditis is called, after two weeks, late pericarditis is called, pathogenesis were unclear. Patients with early symptoms of pericarditis most have chest tightness, chest pain and pericardial rub, strengthens dialysis to treat effectively. Pericarditis most asymptomatic late, only in recurrent dialysis hypotension occur, in part to strengthen effective dialysis, peritoneal dialysis some needed.
5. Pulmonary edema: More due to overload caused by water, other causes of congestive heart failure, hypoalbuminemia and pulmonary capillary permeability etc. Adequate water ultrafiltration can rapidly improve symptoms. Restricted water intake, adequate dialysis and hypoproteinemia can be prevented effectively.
6. The pleural effusion: Exudative base. More in heart failure, sodium retention, renal syndrome, infection and other causes, in part explained uremic idiopathic pleural effusion. Treatment should be enhanced dialysis and ultrafiltration, hypoproteinemia, improve the general condition, if necessary, keep a breast pump fluid therapy.
7. Gastrointestinal diseases: including esophagitis, gastritis, ulcers, delayed gastric emptying and gastrointestinal bleeding. More urinary retention urinary toxins cause damage to the autonomic nervous disorders gastrointestinal motility, gastrin metabolic abnormalities lead to increased gastric acid secretion, anemia, malnutrition weaken mucosal protecting factors and other causes. Most effective treatment to strengthen dialysis, can also used drugs promote gastrointestinal motility, excluding protective agents gastrointestinal mucosa magnesium antacid agents. Gastrointestinal bleeding should pay attention to the choice of methods of anticoagulation.
8. The intestinal ischemia, intestinal infarction: High blood pressure, high cholesterol, heart failure, diabetes and other common diseases in hemodialysis patients and metoprolol, etc vasodilators, commonly used drugs may reduce the intestinal blood flow, once excessive ultrafiltration, and intestinal bowel can induce myocardial ischemia. It manifests as severe abdominal pain, nausea, vomiting, diarrhea, abdominal distension, shock. Early quick to add volume can relieve intestinal ischemia, such as intestinal infarction without suspicion effect, once the diagnosis to be treated surgically.
9. Liver disease: Since hemodialysis patients with renal anemia and repeated blood transfusions, increasing infection with hepatitis B and C, can cause deposition of iron in dirty, causing cirrhosis, silicone and silicone dialysis tube also can be deposited in cuasa liver damage. When Hemodialysis patients liver damage, rare jaundice, gastrointestinal symptoms were masked by uremia and early detection difficult. Treatment focuses on prevention, as the use of erythropoietin to reduce blood transfusions, avoid using aluminum agents etc.
10. Ascites dialysis-related: Most occurred in patients who had undergone dialysis, the reasons include sodium retention, peritoneal permeability increase, infection, hypoalbuminemia, heart failure, pericardial disease, cirrhosis etc. Should be excluded before treatment tuberculosis, liver cancer and ascites. Treatment includes limiting intake of sodium and water, adequate dialysis ultrafiltration, ascites reinfusion and download abdominal fluid, local glucocorticoid therapy department etc. Kidney transplantation is the fundamental solution of the method of refractory ascites.
11. Anemia: renal hormone erythropoietin (EPO) produces insufficient is the main reason. Other factors include: blood shortage of raw materials, the loss of blood dialysis, increased destruction of red blood cells, bone marrow fibrosis and aluminum intoxication. EPO is the primary means of dealing renal anemia, general subcutaneous 3000u of 2-3 times / week, HCT reach 30-33% of the dose can be reduced and maintained at this value HCT, other treatments, including strengthening dialysis, raw materials of supplemental blood dialysis reduce blood loss, severe anemia can be a small amount of blood transfusion.
12. The secondary hyperparathyroidism and renal osteodystrophy: Generally regarded hemodialysis patients as calcium and phosphorus metabolism, deficiency of active vitamin D3 and acidosis can cause secondary hyperparathyroidism (2-HPT), and 2-HPT is increased osteoclast , decreased synthesis of collagen fibers in bone, bone mineralization disorders etc, cause renal osteodystrophy. The clinical manifestations are bone pain, fractures, bone deformation, joint swelling and deformation, muscle strength, muscle tone decreases, metastatic calcification and tendon rupture etc. Further diagnosis based on clinical symptoms, serum calcium, phosphorus, I-PTH concentration and X ray bone etc. Bone biopsy is the gold standard for the diagnosis of renal osteodystrophy. The primary treatment is active vitamin D3 supplement, the other can also hemoperfusion and parathyroid surgery etc.
13. Urogenital: Urinary stones in hemodialysis patients, infections, cancer and impotence, loss of libido and other incidence rate was significantly higher. Kidney cysts also acquired common, which is caused by the same kidney disease has nothing to do with dialysis, can be complicated by bleeding, infection and malignancy. Treatment is symptomatic, severe nephrectomy.
14. Nervous System: Mainly aluminum intoxication, uremic toxins, retention of parathyroid hormone, vitamin, micronutrient deficiencies, water and electrolyte disturbance caused by other factors. Central lesions showed inattention, short films, paranoia, mental impairment, severe cases there is a language and movement disorders, and even seizures, dementia. Peripheral neuropathy showed the depth of feeling important obstacles small number of patients with dyskinesia advanced flaccid even paralysis. Autonomic neuropathy manifests as hypotension, sexual dysfunction, disorders of sweat secretion, gastrointestinal disorders. Treatment includes avoiding contact with the aluminum to improve dialysis, improve nutritional status, to correct anemia, hemofiltration or peritoneal dialysis diverted if necessary. Kidney transplantation is the most effective method.
15. Skin: Mainly for color changes of the skin, dryness, hair, nail changes itching and oral lesions. Some of strengthening effective dialysis, most only symptomatic treatment, no special treatment.
Above mentioned are the long-term complications of kidney dialysis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and the gym has all the information? If you have any problem, you can consult our experts online or leave a message below!
Recent complications of renal dialysis
Each process dialysis or hemodialysis end after a few hours, the complications associated to the dialysis itself.
(1) imbalance Syndrome: Common in high levels of urea nitrogen and creatinine, patients with uremia obvious symptoms, especially prevalent in initial induction of dialysis and dialysis period. The main reason is primarily through urea after some of the substances in the blood and brain tissue between the unequal distribution, the pH balance uneven cause brain edema and cerebral hypoxia, showing through in and through the pain headache, fatigue, malaise, nausea, vomiting, high blood pressure, sleep disorders, severe cases may have psychosis, epileptic seizures, coma and even death.
(2) Hypotension:
The most common complication of hemodialysis. Causes include effective hypovolemia, ultrafiltration too much too fast, autonomic neuropathy, vasoconstriction decreases levels of atrial natriuretic peptides are too high and the impact of antihypertensive drugs. It is manifested as dizziness, sweating, amaurosis, nausea, vomiting, cramps, pale muscle and even loss of consciousness. The treatment is quick to add volume, while slowing of blood flow, reduction or suspension of ultrafiltration. Preventive measures include pre-dialyzer, blood flow gradually from small to large, using sequential dialysis or dialysis of high sodium, and asked the patient to control weight gain between dialysis to reduce the amount of ultrafiltration.
(3) Hypoxemia: More common in acetate dialysis, its causes and acetate metabolism in the body and lower blood CO2 and HCO3- concentration. Dialysis membrane biocompatibility differences may lead to aggregation of leukocytes affects pulmonary capillary ventilatory function, but also produces a major cause of hypoxemia. But no obvious clinical manifestations, patients original heart and lung disease or the elderly may be symptoms of hypoxia, or even induced angina and myocardial infarction. Treatment nasal cannula can. Preventive measures include: Use dialysis with bicarbonate dialysate with good biocompatibility.
(4) Hemolysis: More dialysate by disorders and malfunction of the dialysis machine caused if permeability low dialysate highest temperature, chlorine and chloramines or nitrate content is too high, the other also is common in the profiled transfusion, etc. residual disinfectant Acute hemolysis in patients with pain of venous blood back, chest tightness, palpitations, shortness of breath, irritability, may be associated with severe to spasm of the waist and abdomen, severe chills, chills, hypotension, arrhythmia, hemoglobinuria and even coma. Hypotonic dialysate caused by water intoxication can occur simultaneously or cerebral edema. Performance of small and slow for hemolytic anemia will only increase.
(5) Air embolism: As a dialysis machine measures are in perfect control, air embolism occurs rarely, and much more for malfunction or damage pipe.
Once air is over 5 ml may cause symptoms of obvious embolism, the leading cause of stroke when sitting, Supine major cause of acute pulmonary hypertension and right heart failure, coronary thrombosis may occur or stroke, physical examination, listening to the sounds of stirring the heart.
(6) Cerebral hemorrhage: Hemodialysis patients with major causes of death. Mainly caused by high blood pressure and anticoagulants patients not on dialysis with similar clinical manifestations of cerebral hemorrhage, treatment is the same.
(7) subdural hematoma: The most common reasons are: Head trauma, anticoagulation, excessive ultrafiltration, high blood pressure etc. The most durable clinical syndrome similar imbalance, but. CT of the head can confirm the diagnosis. Treatment is conservative medical treatment, patients in 7-10 days should continue dialysis must dialysis without heparin or peritoneal dialysis.
Above mentioned are recent complications of kidney dialysis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and fitness has all the information? If you have any problem, you can consult our experts online or leave a message below!
(1) imbalance Syndrome: Common in high levels of urea nitrogen and creatinine, patients with uremia obvious symptoms, especially prevalent in initial induction of dialysis and dialysis period. The main reason is primarily through urea after some of the substances in the blood and brain tissue between the unequal distribution, the pH balance uneven cause brain edema and cerebral hypoxia, showing through in and through the pain headache, fatigue, malaise, nausea, vomiting, high blood pressure, sleep disorders, severe cases may have psychosis, epileptic seizures, coma and even death.
(2) Hypotension:
The most common complication of hemodialysis. Causes include effective hypovolemia, ultrafiltration too much too fast, autonomic neuropathy, vasoconstriction decreases levels of atrial natriuretic peptides are too high and the impact of antihypertensive drugs. It is manifested as dizziness, sweating, amaurosis, nausea, vomiting, cramps, pale muscle and even loss of consciousness. The treatment is quick to add volume, while slowing of blood flow, reduction or suspension of ultrafiltration. Preventive measures include pre-dialyzer, blood flow gradually from small to large, using sequential dialysis or dialysis of high sodium, and asked the patient to control weight gain between dialysis to reduce the amount of ultrafiltration.
(3) Hypoxemia: More common in acetate dialysis, its causes and acetate metabolism in the body and lower blood CO2 and HCO3- concentration. Dialysis membrane biocompatibility differences may lead to aggregation of leukocytes affects pulmonary capillary ventilatory function, but also produces a major cause of hypoxemia. But no obvious clinical manifestations, patients original heart and lung disease or the elderly may be symptoms of hypoxia, or even induced angina and myocardial infarction. Treatment nasal cannula can. Preventive measures include: Use dialysis with bicarbonate dialysate with good biocompatibility.
(4) Hemolysis: More dialysate by disorders and malfunction of the dialysis machine caused if permeability low dialysate highest temperature, chlorine and chloramines or nitrate content is too high, the other also is common in the profiled transfusion, etc. residual disinfectant Acute hemolysis in patients with pain of venous blood back, chest tightness, palpitations, shortness of breath, irritability, may be associated with severe to spasm of the waist and abdomen, severe chills, chills, hypotension, arrhythmia, hemoglobinuria and even coma. Hypotonic dialysate caused by water intoxication can occur simultaneously or cerebral edema. Performance of small and slow for hemolytic anemia will only increase.
(5) Air embolism: As a dialysis machine measures are in perfect control, air embolism occurs rarely, and much more for malfunction or damage pipe.
Once air is over 5 ml may cause symptoms of obvious embolism, the leading cause of stroke when sitting, Supine major cause of acute pulmonary hypertension and right heart failure, coronary thrombosis may occur or stroke, physical examination, listening to the sounds of stirring the heart.
(6) Cerebral hemorrhage: Hemodialysis patients with major causes of death. Mainly caused by high blood pressure and anticoagulants patients not on dialysis with similar clinical manifestations of cerebral hemorrhage, treatment is the same.
(7) subdural hematoma: The most common reasons are: Head trauma, anticoagulation, excessive ultrafiltration, high blood pressure etc. The most durable clinical syndrome similar imbalance, but. CT of the head can confirm the diagnosis. Treatment is conservative medical treatment, patients in 7-10 days should continue dialysis must dialysis without heparin or peritoneal dialysis.
Above mentioned are recent complications of kidney dialysis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and fitness has all the information? If you have any problem, you can consult our experts online or leave a message below!
2014年12月31日星期三
The cause of renal cyst
It will happen within the kidney renal cysts of various sizes do not communicate with the outside world cystic mass in general, common renal cysts can be divided in diseases of adult polycystic kidney simple renal cysts and acquired renal cysts.
1. Congenital dysplasia bad
Bad congenital dysplasia can productar long illness. For cystic renal disease, the leading cause medullary sponge kidney, polycystic kidney disease, etc dysplasia, congenital anomalies of genes in general, is no exception, so it is with gene or gene mutation is the difference.
2. Genetic Mutation (non-genetic)
For polycystic kidney disease, which mostly through genetic parents, and is divided into autosomal dominant and autosomal recessive, but some patients with polycystic kidney disease and the genetic parents, not in the polycystic renal dysplasia, but the mutations in embryogenesis. In the process of embryo formation, due to various factors, the role of the mutated form of the gene for polycystic kidney disease, although these cases are rare, but may occur, so some patients with polycystic renal parents can no history genetic.
3. Various infections
The infection can abnormal changes of the internal environment, and therefore produce a beneficial gene cystic changing environmental conditions, the cyst activity increased internal factors, as may facilitate the formation of cysts, grow; But any infection anywhere in the body, through the blood to the kidneys which affects cysts, such as cyst infection, in addition to the clinical symptoms intensified, but also promote further accelerate the growth rate of the cyst, and to aggravate renal dysfunction and so on. The most common infections were infections of the upper respiratory tract (including cold), urinary tract infections, gastrointestinal tract, skin infections, trauma, infections, etc. equipment, ie if a bacterial infection or infection viral, which can have a significant impact on the cyst.
4. Toxin
The toxins in the human body, can cause a variety of cellular tissue and organ damage, which occurred in sickness, even death, and also produce mutations, congenital anomalies, as one of the main phenomena. Toxins such as pesticides in common, certain chemicals, radiation, pollution, etc. Interestingly, some drugs also have kidney toxicity if used incorrectly could easily lead to kidney damage, these drugs include: kanamycin, gentamicin, sulfonamides, rifampicin, indomethacin and other drugs, and Marchand son and other traditional Chinese medicine.
If you are other problems, please leave a message at the bottom or free with our customer communication online part. Our mailbox is enfermedad-renal@hotmail.com.
1. Congenital dysplasia bad
Bad congenital dysplasia can productar long illness. For cystic renal disease, the leading cause medullary sponge kidney, polycystic kidney disease, etc dysplasia, congenital anomalies of genes in general, is no exception, so it is with gene or gene mutation is the difference.
2. Genetic Mutation (non-genetic)
For polycystic kidney disease, which mostly through genetic parents, and is divided into autosomal dominant and autosomal recessive, but some patients with polycystic kidney disease and the genetic parents, not in the polycystic renal dysplasia, but the mutations in embryogenesis. In the process of embryo formation, due to various factors, the role of the mutated form of the gene for polycystic kidney disease, although these cases are rare, but may occur, so some patients with polycystic renal parents can no history genetic.
3. Various infections
The infection can abnormal changes of the internal environment, and therefore produce a beneficial gene cystic changing environmental conditions, the cyst activity increased internal factors, as may facilitate the formation of cysts, grow; But any infection anywhere in the body, through the blood to the kidneys which affects cysts, such as cyst infection, in addition to the clinical symptoms intensified, but also promote further accelerate the growth rate of the cyst, and to aggravate renal dysfunction and so on. The most common infections were infections of the upper respiratory tract (including cold), urinary tract infections, gastrointestinal tract, skin infections, trauma, infections, etc. equipment, ie if a bacterial infection or infection viral, which can have a significant impact on the cyst.
4. Toxin
The toxins in the human body, can cause a variety of cellular tissue and organ damage, which occurred in sickness, even death, and also produce mutations, congenital anomalies, as one of the main phenomena. Toxins such as pesticides in common, certain chemicals, radiation, pollution, etc. Interestingly, some drugs also have kidney toxicity if used incorrectly could easily lead to kidney damage, these drugs include: kanamycin, gentamicin, sulfonamides, rifampicin, indomethacin and other drugs, and Marchand son and other traditional Chinese medicine.
If you are other problems, please leave a message at the bottom or free with our customer communication online part. Our mailbox is enfermedad-renal@hotmail.com.
Classification and symptoms of kidney dialysis
The kidneys filter the blood to remove waste substances. If kidney failure, waste accumulation in the body, eventually poison the body. Also known as artificial kidney dialysis, hemodialysis (referred to hemodialysis) or also called dialysis. English Hemodialysis hemodialysis, hemo means blood, dialysis Greek, meaning the release of certain substances, the English meaning of dialysis. This is a technology of purifying the blood. In worldwide rely on dialysis to sustain life most 500,000 hemodialysis patients. Hemodialysis patients to relieve symptoms and prolong survival have some meaning.
For medical dialysis divided into two categories: hemodialysis, peritoneal dialysis
Hemodialysis
Hemodialysis (Hemodialysis), popular argument, also known as artificial kidney, renal washing, is a technology for purifying the blood. Your use of the theory of semipermeable membrane, diffusion, convection and body of harmful metabolic waste products and excess excess electrolytes from the body, to achieve the purpose of purifying the blood and absorb water and electrolyte and acid-base remedial purposes balance.
Peritoneal dialysis
Peritoneal dialysis is peritoneal use as a semi-permeable membrane, using gravity action through the dialysate prepared from the patient's peritoneal cavity dumping, so that the two sides of the difference in concentration gradient peritoneal solute, a high concentration side of low solute concentration side of the mobile (diffuse action) .The part moisture from hypotonic to hypertonic lateral movement (osmosis) .A via fluid replacement continuous peritoneal dialysis, with in order to achieve clear metabolites, toxins and water correction, disorders of electrolyte balance purposes.
The disadvantage of peritoneal dialysis
1. induce infection: As a dedicated peritoneal dialysis catheter is required dialysis bag to replace the liquid, therefore, the possibility of intra-abdominal infection, so priate do anything and peritoneal dialysis related steps, one should thoroughly wash your hands first. For new technologies, the appearance of peritonitis has been greatly reduced.
2. Body weight and triglycerides in the blood increase: Since glucose dialysate used to remove excess water, which can absorb when dialysis of glucose, do patient weight gain, blood triglycerides and other lipids high, so they need proper exercise and reducing sugar intake.
3. Excessive loss of proteins: In the dialysis process leaks some proteins and vitamins, so that the need for dietary supplement. Besides keeping the original normal eating habits, it may be more consumption of some fish, meat, eggs, milk and other high-quality protein, the best source of vitamin are fruits and vegetables supply the body's needs.
Symptoms
1. Arrhythmia: by hypokalemia often cause, the cause of hypokalemia is used mainly potassium dialysate little or no potassium. when hemolysis can produce hyperkalemia and induce arrhythmia, but quite rare. Predialysis patients with digitalis medicines by decreased serum potassium and pH changes, arrhythmias may occur digitalis intoxication.
The prevention and control are: Food controlled potassium diet to prevent hyperkalemia predialysis, dialysis patients stringent restrictions use of digitalis drugs, and the use of potassium> 3.0 mmol / L dialysate. when arrhythmia, can be used when antiarrhythmic drugs, but it is necessary to adjust the dose according to the situation of drug metabolism.
2. pericardial tamponade: In hemodialysis and after penetration occur in a short time hemorrhagic pericardial tamponade is most often based on the original uremic pericarditis, caused due to the application of pericardial bleeding heparin.
The clinical manifestations are: ① Progressive decrease in blood pressure, with signs of shock. ② open jugular vein thick, large liver, rare pulse, elevated central venous pressure. Community ③ heart expand, distant heart sounds. ④ B ultrasound can see a lot of pericardial effusion etc.
Treatment measures: Dialysis dialysis occurred must stop in protamine and heparin, to bridge the observation of changes in condition. Severe symptoms can tamponade pericardiocentesis for drainage or direct surgical decompression decompression drainage. Preventive measures are primarily in patients with suspected uremic pericarditis, pericardial especially precordial sound heard and patients, the use of low molecular weight heparin or heparin-free hemodialysis.
Above mentioned are classifications and symptoms of kidney dialysis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and Fitness has all the information? If you have any problem, you can consult our experts online or leave a message below!
For medical dialysis divided into two categories: hemodialysis, peritoneal dialysis
Hemodialysis
Hemodialysis (Hemodialysis), popular argument, also known as artificial kidney, renal washing, is a technology for purifying the blood. Your use of the theory of semipermeable membrane, diffusion, convection and body of harmful metabolic waste products and excess excess electrolytes from the body, to achieve the purpose of purifying the blood and absorb water and electrolyte and acid-base remedial purposes balance.
Peritoneal dialysis
Peritoneal dialysis is peritoneal use as a semi-permeable membrane, using gravity action through the dialysate prepared from the patient's peritoneal cavity dumping, so that the two sides of the difference in concentration gradient peritoneal solute, a high concentration side of low solute concentration side of the mobile (diffuse action) .The part moisture from hypotonic to hypertonic lateral movement (osmosis) .A via fluid replacement continuous peritoneal dialysis, with in order to achieve clear metabolites, toxins and water correction, disorders of electrolyte balance purposes.
The disadvantage of peritoneal dialysis
1. induce infection: As a dedicated peritoneal dialysis catheter is required dialysis bag to replace the liquid, therefore, the possibility of intra-abdominal infection, so priate do anything and peritoneal dialysis related steps, one should thoroughly wash your hands first. For new technologies, the appearance of peritonitis has been greatly reduced.
2. Body weight and triglycerides in the blood increase: Since glucose dialysate used to remove excess water, which can absorb when dialysis of glucose, do patient weight gain, blood triglycerides and other lipids high, so they need proper exercise and reducing sugar intake.
3. Excessive loss of proteins: In the dialysis process leaks some proteins and vitamins, so that the need for dietary supplement. Besides keeping the original normal eating habits, it may be more consumption of some fish, meat, eggs, milk and other high-quality protein, the best source of vitamin are fruits and vegetables supply the body's needs.
Symptoms
1. Arrhythmia: by hypokalemia often cause, the cause of hypokalemia is used mainly potassium dialysate little or no potassium. when hemolysis can produce hyperkalemia and induce arrhythmia, but quite rare. Predialysis patients with digitalis medicines by decreased serum potassium and pH changes, arrhythmias may occur digitalis intoxication.
The prevention and control are: Food controlled potassium diet to prevent hyperkalemia predialysis, dialysis patients stringent restrictions use of digitalis drugs, and the use of potassium> 3.0 mmol / L dialysate. when arrhythmia, can be used when antiarrhythmic drugs, but it is necessary to adjust the dose according to the situation of drug metabolism.
2. pericardial tamponade: In hemodialysis and after penetration occur in a short time hemorrhagic pericardial tamponade is most often based on the original uremic pericarditis, caused due to the application of pericardial bleeding heparin.
The clinical manifestations are: ① Progressive decrease in blood pressure, with signs of shock. ② open jugular vein thick, large liver, rare pulse, elevated central venous pressure. Community ③ heart expand, distant heart sounds. ④ B ultrasound can see a lot of pericardial effusion etc.
Treatment measures: Dialysis dialysis occurred must stop in protamine and heparin, to bridge the observation of changes in condition. Severe symptoms can tamponade pericardiocentesis for drainage or direct surgical decompression decompression drainage. Preventive measures are primarily in patients with suspected uremic pericarditis, pericardial especially precordial sound heard and patients, the use of low molecular weight heparin or heparin-free hemodialysis.
Above mentioned are classifications and symptoms of kidney dialysis? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and Fitness has all the information? If you have any problem, you can consult our experts online or leave a message below!
The dangers of proteinuria
(1) Proteinuria mesangial toxicity:
In the model of renal failure, can be observed in the whey proteins in glomerular mesangial accumulation in mesangial macromolecules that can cause buildup cell injury, matrix synthesis powers hyperplasia membrane, resulting in glomerulosclerosis. Proteinuria, glomerular nephropathy model density lipoprotein low density lipoprotein (LDL) and very low (VLDL), apolipoprotein B and apolipoprotein A deposition of these aggregates over time can lead to glomerulosclerosis.
(2) The cell toxicity action of proximal tubular proteinuria:
When proteinuria, renal tubular epithelial cells in the amount of protein increased, increased lysosomal activity, suggesting that the protein causes lysosomal overflow tubular cell suspension, cell injury can stimulate further inflammation and the formation of scars.
(3) Changes induced tubular proteinuria in cell biology:
Many kidney disease with excessive cell proliferation are proteinuria represents a non-adaptive response, leading to kidney failure. More and more evidence that the protein can be directly conditioned tubule cell function, changing the growth characteristics of cytokines and matrix proteins and their phenotypic expression can lead to a small tube basolateral PDGF release, FN, and MCP-1 induced fibrosis.
(4) The tubulointerstitial hypoxia-induced proteinuria emphasis:
Resorption proteinuria extra energy to digest large quantities of protein, which can cause hypoxia tubule cells, resulting in cellular damage caused by a small tube.
Above mentioned are the dangers of proteinuria,? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and fitness features all the information? If you have any problem, you can consult our experts online or leave a message below!
In the model of renal failure, can be observed in the whey proteins in glomerular mesangial accumulation in mesangial macromolecules that can cause buildup cell injury, matrix synthesis powers hyperplasia membrane, resulting in glomerulosclerosis. Proteinuria, glomerular nephropathy model density lipoprotein low density lipoprotein (LDL) and very low (VLDL), apolipoprotein B and apolipoprotein A deposition of these aggregates over time can lead to glomerulosclerosis.
(2) The cell toxicity action of proximal tubular proteinuria:
When proteinuria, renal tubular epithelial cells in the amount of protein increased, increased lysosomal activity, suggesting that the protein causes lysosomal overflow tubular cell suspension, cell injury can stimulate further inflammation and the formation of scars.
(3) Changes induced tubular proteinuria in cell biology:
Many kidney disease with excessive cell proliferation are proteinuria represents a non-adaptive response, leading to kidney failure. More and more evidence that the protein can be directly conditioned tubule cell function, changing the growth characteristics of cytokines and matrix proteins and their phenotypic expression can lead to a small tube basolateral PDGF release, FN, and MCP-1 induced fibrosis.
(4) The tubulointerstitial hypoxia-induced proteinuria emphasis:
Resorption proteinuria extra energy to digest large quantities of protein, which can cause hypoxia tubule cells, resulting in cellular damage caused by a small tube.
Above mentioned are the dangers of proteinuria,? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and fitness features all the information? If you have any problem, you can consult our experts online or leave a message below!
2014年12月30日星期二
General treatment and symptomatic treatment of nephrotic syndrome
General treatment
Patients have severe edema, hypoalbuminemia require bed rest. The edema disappeared, the general situation improves, can receive up activities.
Given the normal amount of 0.8 ~ 1.0 g / (kg · d) high-quality protein (rich in essential amino acids based animal protein) diet. To ensure adequate per day per kilogram of body weight calories should be less than 30 ~ 35kcal. Despite the large number of patients with urinary protein loss, but because of the diet increased glomerular filtration high in protein, may aggravate kidney disease proteinuria and promote progress, it is now generally do not advocate the application.
When edema should be low in salt (<3 g / d) diet. To reduce hyperlipidemia, feed rich in saturated fatty acids should be less (animal fat) diet and eating foods rich in polyunsaturated fatty acids (such as vegetable oil, fish oil), and rich in soluble fiber (such as beans) diet .
Symptomatic treatment
1. Diuretic swelling
(1) thiazide diuretics: Important role in medullary thick ascending limb loop segment and anterior distal convoluted tubule, by inhibiting the reabsorption of sodium and chloride, potassium excretion increased diuresis. The long-term use should prevent hypokalemia, hyponatremia.
(2) Retention of potassium-sparing diuretics: Important role in the distal convoluted tubule of the posterior segment, natriuresis, row of chlorine, but retain potassium for patients with hypokalemia. When used alone, a diuretic effect was not significant, with thiazide diuretics. Common triamterene or aldosterone antagonist spironolactone. The long-term use is necessary to prevent hyperkalemia should be used with caution in patients with renal insufficiency.
(3) Loop diuretics: lMPORTANT role in the ascending limb of the loop core sodium, potassium and chloride reabsorption has a potent inhibitory effect. Common furosemide (Lasix) and bumetanide (d urinary amine) (equivalent to the dose of furosemide role more than 40 times), sorted by mouth or intravenously. Osmotic diuretics administered in immediately after application, the better. Application of loop diuretics is required to protect against hyponatremia and hypokalemia, hypochloremic alkalosis occurs.
(4) Osmotic Diuretics: Through a transient increase in plasma colloid osmotic pressure, can cause tissue moisture into the bloodstream. They are also through glomerular filtration, resulting in a tubular inner solution hyperosmolar state, reduce water and sodium reabsorption and diuretic. 40 used without dextran sodium (low molecular weight dextran) or starch plasma generation (plasma 706) (molecular weight was 25000 ~ 45000) intravenously. Followed by the addition of loop diuretics may enhance the diuretic effect. But for oliguria (urine output <400 mL / d) should be used with caution in patients with these drugs, because of its easy and tubular secretion Tamm-Horsfall protein and glomerular filtration of albumin to form tubes, tubular obstruction and for his leadership role in hypertonic degeneration of renal tubular epithelial cells and induced necrosis "osmotic nephrosis", leading to acute renal failure.
(5) Increase the plasma colloid osmotic pressure of plasma or plasma albumin infusion: All may increase the plasma colloid osmotic pressure, and promote tissue back to the absorption of moisture and a diuretic such as furosemide glucose solution and then intravenously slowly, sometimes you can get a good diuretic effect. But because of the entry of the protein are within 24 to 48 hours is excreted in the urine, can cause glomerular and tubular filtration high metabolism, resulting in visceral glomerular lesion of tubular epithelial cells, promote renal interstitial fibrosis technology, light effect of glucocorticoid treatment, delaying remission, severe cases can damage kidney function. Should be strictly controlled, severe hypoproteinemia, edema, but very oliguria (urine output <400 mL / d) of NS patients, the case must be considered diuretic use, but also to avoid the too frequent excessive. Use cautiously in patients with heart failure.
NS patients on diuretics principle is not too much too fast to avoid hypovolemia, increased blood clotting tends to induce thrombosis, embolism complications.
Reduce urinary protein
persistent proteinuria itself can cause high glomerular filtration, tubular aggravation - interstitial injury, promote glomerular sclerosis, glomerular disease, affects an important prognostic factor. Has been shown to reduce urinary protein can effectively retard deterioration of renal function.
Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor blockers (ARB) plus effectively control hypertension, but may be by reducing glomerular pressure and glomerular basement membrane to the direct impact of high permeability molecule, can not rely on systemic blood pressure lowering effect of reducing urinary protein. Or ARB with ACEI reduce urinary protein, usually the dose should be used in large doses than conventional blood pressure in order to obtain a good effect.
Above mentioned are general treatment and symptomatic treatment of nephrotic syndrome? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and the gym has all the information? If you have any problem, you can consult our experts online or leave a message below!
Patients have severe edema, hypoalbuminemia require bed rest. The edema disappeared, the general situation improves, can receive up activities.
Given the normal amount of 0.8 ~ 1.0 g / (kg · d) high-quality protein (rich in essential amino acids based animal protein) diet. To ensure adequate per day per kilogram of body weight calories should be less than 30 ~ 35kcal. Despite the large number of patients with urinary protein loss, but because of the diet increased glomerular filtration high in protein, may aggravate kidney disease proteinuria and promote progress, it is now generally do not advocate the application.
When edema should be low in salt (<3 g / d) diet. To reduce hyperlipidemia, feed rich in saturated fatty acids should be less (animal fat) diet and eating foods rich in polyunsaturated fatty acids (such as vegetable oil, fish oil), and rich in soluble fiber (such as beans) diet .
Symptomatic treatment
1. Diuretic swelling
(1) thiazide diuretics: Important role in medullary thick ascending limb loop segment and anterior distal convoluted tubule, by inhibiting the reabsorption of sodium and chloride, potassium excretion increased diuresis. The long-term use should prevent hypokalemia, hyponatremia.
(2) Retention of potassium-sparing diuretics: Important role in the distal convoluted tubule of the posterior segment, natriuresis, row of chlorine, but retain potassium for patients with hypokalemia. When used alone, a diuretic effect was not significant, with thiazide diuretics. Common triamterene or aldosterone antagonist spironolactone. The long-term use is necessary to prevent hyperkalemia should be used with caution in patients with renal insufficiency.
(3) Loop diuretics: lMPORTANT role in the ascending limb of the loop core sodium, potassium and chloride reabsorption has a potent inhibitory effect. Common furosemide (Lasix) and bumetanide (d urinary amine) (equivalent to the dose of furosemide role more than 40 times), sorted by mouth or intravenously. Osmotic diuretics administered in immediately after application, the better. Application of loop diuretics is required to protect against hyponatremia and hypokalemia, hypochloremic alkalosis occurs.
(4) Osmotic Diuretics: Through a transient increase in plasma colloid osmotic pressure, can cause tissue moisture into the bloodstream. They are also through glomerular filtration, resulting in a tubular inner solution hyperosmolar state, reduce water and sodium reabsorption and diuretic. 40 used without dextran sodium (low molecular weight dextran) or starch plasma generation (plasma 706) (molecular weight was 25000 ~ 45000) intravenously. Followed by the addition of loop diuretics may enhance the diuretic effect. But for oliguria (urine output <400 mL / d) should be used with caution in patients with these drugs, because of its easy and tubular secretion Tamm-Horsfall protein and glomerular filtration of albumin to form tubes, tubular obstruction and for his leadership role in hypertonic degeneration of renal tubular epithelial cells and induced necrosis "osmotic nephrosis", leading to acute renal failure.
(5) Increase the plasma colloid osmotic pressure of plasma or plasma albumin infusion: All may increase the plasma colloid osmotic pressure, and promote tissue back to the absorption of moisture and a diuretic such as furosemide glucose solution and then intravenously slowly, sometimes you can get a good diuretic effect. But because of the entry of the protein are within 24 to 48 hours is excreted in the urine, can cause glomerular and tubular filtration high metabolism, resulting in visceral glomerular lesion of tubular epithelial cells, promote renal interstitial fibrosis technology, light effect of glucocorticoid treatment, delaying remission, severe cases can damage kidney function. Should be strictly controlled, severe hypoproteinemia, edema, but very oliguria (urine output <400 mL / d) of NS patients, the case must be considered diuretic use, but also to avoid the too frequent excessive. Use cautiously in patients with heart failure.
NS patients on diuretics principle is not too much too fast to avoid hypovolemia, increased blood clotting tends to induce thrombosis, embolism complications.
Reduce urinary protein
persistent proteinuria itself can cause high glomerular filtration, tubular aggravation - interstitial injury, promote glomerular sclerosis, glomerular disease, affects an important prognostic factor. Has been shown to reduce urinary protein can effectively retard deterioration of renal function.
Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor blockers (ARB) plus effectively control hypertension, but may be by reducing glomerular pressure and glomerular basement membrane to the direct impact of high permeability molecule, can not rely on systemic blood pressure lowering effect of reducing urinary protein. Or ARB with ACEI reduce urinary protein, usually the dose should be used in large doses than conventional blood pressure in order to obtain a good effect.
Above mentioned are general treatment and symptomatic treatment of nephrotic syndrome? If you are interested in our items, still pay attention to us please! We articles on various diseases of kidneys, include rudimetos, symptoms, treatment, diet and the gym has all the information? If you have any problem, you can consult our experts online or leave a message below!
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