Minimal pathological nephropathy

Introduction

Introduction to minimally pathological nephropathy

Minimalchangenephropathy, also known as lipid-induced nephropathy, is one of the most common diseases leading to nephrotic syndrome. It accounts for about 75% of children with primary nephrotic syndrome, accounting for 70% to 80% of nephrotic syndrome in children under 8 years old, and is not uncommon in adults, accounting for 15% of patients with primary nephrotic syndrome over 16 years old. ~20%. The pathogenesis of minimally pathological nephropathy is unknown, characterized by the loss of the negative charge of the glomerular capillary wall, which can also occur in the transplanted kidney.

basic knowledge

The proportion of illness: 0.001%

Susceptible people: children

Mode of infection: non-infectious

Complications: focal glomerulosclerosis

Pathogen

Causes of minimally pathological nephropathy

The pathogenesis of minimally pathological nephropathy is unknown. It is characterized by the loss of the negative charge of the glomerular capillary wall. This disease can also occur in the transplanted kidney. Therefore, it supports the possibility that the circulating blood may have a body fluid factor that depletes the glomerular charge. The latter damages the glomerular charge barrier and produces selective proteinuria. In addition, the minimally pathological nephropathy associated with Hodgkin's disease is effective against steroids and alkylating agents. Renal disease can be quickly relieved after removal of the affected lymph nodes. Some patients have complicated viral infections such as measles, and the disease is also relieved. These all suggest that T lymphocyte dysfunction, some lymphokines produced by it, increase the permeability of glomerular capillary wall, but this substance has been Not yet confirmed clearly.

Prevention

Minimally pathological nephropathy prevention

Unfortunately, you have kidney disease, please go to the nephrology hospital to see the kidney specialist to do the most appropriate treatment, otherwise chaos to find Jianghu Langzhong to eat herbal remedies, mistake the timing of treatment, more complications, and even become uremia in the short term.

Appropriate (sufficient) drink water, do not urinate, urine in the bladder for too long is easy to breed bacteria, bacteria are likely to be infected to the kidney through the ureter, drink plenty of water every day to urinate at any time, the kidney is not easy to stone.

Control high blood pressure, if you have high blood pressure, please seek medical advice immediately to control your blood pressure within a safe range. Because long-term high blood pressure will continue to destroy the tiny blood vessels of the kidney, the kidney is made up of 2 million kidney bodies ( Composed of microvessels.

Control diabetes Because the blood vessels of diabetic patients slowly harden, especially at the end of a small blood vessel, the kidney is composed of millions of tiny blood vessels. When the diabetes is severe, the function of the kidney may also be damaged. According to statistics, one quarter of the blood is One-fifth of the dialysis patients are caused by the end of diabetes.

Regular kidney function tests must be done once every six months. Urine screening tests, blood pressure testing, almost half of the kidney patients kidney damage process is carried out unconsciously, so it is likely to have arrived when the body feels uncomfortable The end of kidney disease - the time to survive by dialysis.

Complication

Minimal pathological nephropathy Complications focal glomerulosclerosis

Minimally diseased nephropathy In general, the prognosis is good. Cameron reports a 10-year survival rate of >95%. Most of the deaths are in adults (especially in the elderly). The main cause of death is cardiovascular disease and infection, while the latter is often Inadequate use of the side effects of hormones and cytotoxic drugs, long-term follow-up found that the development of chronic renal failure is rare, adult development of chronic renal failure, about 3%, children are more rare, chronic renal failure often occurs in anti-hormone The drug is accompanied by focal glomerular sclerosis.

Symptom

Symptoms of minimally pathological nephropathy Common symptoms Renal failure Renal tubular necrosis, hematuria, renal interstitial edema, decreased glomerular filtration rate, proteinuria, vascular sclerosis, nephrotic syndrome, hypoproteinemia, hypertension

The peak age of children is 2 to 6 years old, adults are more common in 30 to 40 years old, and the incidence of minimal pathological nephropathy is also high in nephrotic syndrome in patients over 60 years old. Basically similar, about 1/3 of patients may have upper respiratory tract or other infections before the disease, most of the onset is more urgent, the typical symptoms of the first case are more obvious nephrotic syndrome, accounting for 90% of children with nephrotic syndrome, 20% of adults, The blood pressure is normal.

20% of patients can see different degrees of microscopic hematuria. With the increase of age, the incidence of microscopic hematuria also increases. Especially in patients over 60 years old, the incidence of microscopic hematuria due to renal interstitial fibrosis and vascular disease. Higher, but gross hematuria is rare, due to hypovolemia and renal perfusion decreased, about 1/3 of patients may have a decrease in glomerular filtration rate when first seen, urine sediment examination without cells or casts, in severe cases 24 hours Urine protein can exceed 40g.

Urine protein is a typical high-selective proteinuria in children, mainly including albumin and a very small amount of high molecular weight proteins such as IgG, 2-macroglobulin, C3, adults, and small lesions in elderly patients over 60 years old. Renal nephropathy can be characterized by non-selective proteinuria, and often accompanied by hypertension and decreased glomerular filtration rate. In recent years, the transferrin with a molecular weight of 88,000 has been found, and due to its spherical structural characteristics, it also leaks to the kidney with albumin. In the small tube solution, in the urine with pH 4.5-5.5, the iron in transferrin will be released into the renal tubule fluid. Fe3+ can produce many oxygen free radicals to damage the renal interstitial tubules. Fe3+ can also directly damage the renal tubules and interstitial cells. There is no fibrin cleavage product in urine and C3. The blood complement component is normal, but there may be a slight decrease in C1q. The IgG concentration in the attack period is generally low, while IgM is slightly elevated in the attack period and remission period. Minimal lesion nephropathy The medium histocompatibility antigen HLA-B12 is more common, suggesting that the disease may have a certain relationship with heredity, and the anti-"O" antibody titer often decreases significantly.

Minimally diseased nephropathy should be noted for the exclusion of the combined Hodgkin's disease. In addition, nephrotic syndrome caused by allergic reactions to non-steroidal anti-inflammatory drugs, histology can be similar to minimally pathological nephropathy, but usually accompanied by interstitial nephritis and renal dysfunction.

In rare cases, acute renal failure can occur without significant hypovolemia, due to hypoproteinemia leading to a decrease in blood colloid osmotic pressure, pre-renal azotemia caused by severe hypovolemia is only seen in 7%. 38% of patients, if there is no clinical manifestation of typical hypovolemia, urinary enrichment function declines, urinary sodium excretion increases, especially in the case of renal products or albumin, the amount of urine does not increase should consider renal acute renal failure, At this time, in addition to taking into account acute tubular necrosis caused by drugs (neurotoxic drugs such as aminoglycoside gentamicin, etc.) or acute interstitial nephritis (antibiotics, non-steroidal anti-inflammatory drugs, etc.), it should also recognize another Special acute kidney failure.

The basic glomerular disease of nephrotic syndrome with idiopathic oliguric acute renal failure is often minimal change disease or mesangial proliferative GN, which is more common in older age. Nephrotic syndrome is heavier, blood pressure, especially systolic blood pressure with vascular sclerosis, pathological changes in addition to the performance of minimally pathological nephropathy, proximal renal tubular epithelial cells are flat, brush margins fall off, and (or) renal interstitial edema, However, there is no typical renal tubular necrosis or interstitial nephritis. Because the pathological changes in minimally pathological nephropathy complicated with acute renal failure are mild and mostly reversible, it is a hemodynamic change. The main lesion, although the blood volume and renal blood flow is generally normal, but the glomerular filtration rate is transiently decreased, so the filtration index (FF) decreases, and the two components of the single nephron glomerular filtration rate There is a significant change: the ultrafiltration coeffecient is reduced by more than 50%; due to the decrease in intravascular colloid osmotic pressure, the net driving force (net driving force) The vascular membrane hydrostatic pressure P-intravascular and extraluminal colloidal pressure difference ) increased, and renal interstitial edema aggravated.

Examine

Examination of minimal pathological nephropathy

There are many items for examining kidney disease. In addition to general investigations, there are some inspection items. Here are some examples:

1. Urine routine examination: the urine is best to be the first mid-stage urine in the morning, and should be tested within 1 hour. Women's menstrual period generally does not test urine. The purpose of urine examination is mainly to understand the presence or absence of protein in urine, red blood cells. , tube type, specific gravity and pH.

2. Urine protein quantification: can accurately reflect the amount of urinary protein excretion in the body by taking 24 hours of urine (recorded total amount), taking a part of the test, if the protein per 100 ml of urine exceeds 0.5 g, in the urine Proteins in routine examinations are often characterized by (4+.

3. Serum immunoglobulin (IgG, IgA, IgM, IgD, IgE): The increase or decrease of each value has a greater significance for the identification of various kidney diseases and the evaluation of prognosis.

4. Serum complement (total complement, C3, C4, C19): The change in its value helps to identify different types of nephritis, and regular examination can estimate the prognosis of nephritis.

5. The main items to understand the severity of kidney disease and the estimated prognosis are: serum creatinine clearance (Ccr), serum creatinine (Scr), blood urea nitrogen (BUN), urine creatinine, phenol red excretion test (PSP), urine sugar, " B "super scan, pyelography, renal biopsy, etc., these items do not have to be done, can achieve the purpose of diagnosis, the starting point is to reduce the patient's pain and reduce the economic burden of the patient, in addition, the generation of the kidney The repayment ability is very strong. Once the renal function such as Ccr, Scr, BUN, etc. is abnormal, it indicates that the kidney disease has been severe.

Diagnosis

Diagnosis and diagnosis of minimal pathological nephropathy

Differential diagnosis

Differentiation from nephrotic syndrome

The urine protein is qualitatively positive in the blood test, the urine specific gravity is greater than 1.030, the 24-hour urine protein is more than 150 mg, the plasma protein is less than 6 percent, the albumin is less than 3 percent, and the blood cholesterol is more than 6.7 per litre. Millipls, renal function tests suggest a decrease in function. Blood routine, blood viscosity, serum complement determination, fundus change examination, thyroid function measurement, etc., can also help the diagnosis of this disease and understand the progress of the disease.