Before doing kidney puncture, how to infer kidney disease type?

In the case of nephrotic patients who are not suitable for renal puncture, and in patients with poor compliance, it is important to deduce the pathological types of nephropathy by laboratory tests.

Before doing kidney puncture, how to infer kidney disease type?

The kidney is composed of two parts: glomerulus and tubulointerstitial. Most patients with nephropathy are mainly located in glomeruli. Glomerular diseases have two distinct characteristics: proteinuria and hematuria. When the kidney is damaged, red blood cells are squeezed and deformed during leakage, forming hematuria.

Proteinuria is a typical feature of nephrotic syndrome. However, a large amount of proteinuria (> 3.5 g) is not necessarily a nephrotic syndrome.

In the absence of a renal biopsy, the diagnosis can be narrowed by occult blood, protein levels, and age of onset.

Hematuria (may be accompanied by a small amount of proteinuria, active urine sediment. Younger than 15 years old: postinfectious glomerulonephritis, IgA nephropathy, thin basement membrane nephropathy, Alport syndrome, purpura nephritis, Mesangial proliferative glomerulonephritis. Thin basement membrane nephropathy, lupus nephritis, hereditary glomerulonephritis, Mesangial proliferative glomerulonephritis. Over 4. years old : IgA nephropathy.

Large proteinuria (may be accompanied by a small amount of hematuria), urine sediment is not active. Younger than 15 years old: minimal change, focal segmental glomerulosclerosis, Mesangial proliferative glomerulonephritis. Age 15-40 years: focal segmental glomerulosclerosis, minimal change, Membranous nephropathy, diabetic nephropathy, preeclampsia, post-infection glomerulonephritis.

Older than 40 years: membranous nephropathy, focal segmental glomerulosclerosis, diabetic nephropathy, minimal change IgA nephropathy, primary amyloidosis or light chain deposition disease, post-infectious glomerulonephritis. Renal dysfunction can also be used as a reference for judging the type of nephropathy.

Other tests can also provide evidence for the diagnosis of nephrotic types, such as PLA2R antibodies are usually positive in patients with primary membranous nephropathy, lupus nephritis, antinuclear antibodies, anti-double-stranded DNA antibodies, and so on.

Urine proteins are made up of many proteins. After we treat them with radioactivity, enzyme, antibody sandwich, we can examine the types of urine proteins, such as urinary transferrin, urinary NAG enzyme, retinol binding protein, α 2 macroglobulin, etc. Urine β 2 microglobulin, etc. Different proteins, indicating different nephropathy.

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