Correct understanding of proteinuriaProteinuriaDetermination of proteinuria (proteinuria), including proteinuria and urinary protein quantit
Correct understanding of proteinuria
Determination of proteinuria (proteinuria), including proteinuria and urinary protein quantitation.
Clinical significance of proteinuria (proteinuria):
Proteinuria (proteinuria) is qualitative and pathological, and its positive degree is not proportional to the degree of renal damage. Diabetic patients with persistent proteinuria in urine, except urinary tract infection, primary nephropathy, diabetic nephropathy should be considered. Some experts believe that the early phase of proteinuria in diabetic nephropathy is intermittent, only after labor or exercise positive reaction. Therefore, the detection of urine protein after exercise is of significance in the early diagnosis of diabetic nephropathy.
Clinical significance of proteinuria (proteinuria):
(1) the normal reference value of the 24 hour urine protein was from 10 to 150 mg. If the 150 ~ 500 mg, for microalbuminuria, + 500 mg for clinical proteinuria. Microalbuminuria in early diabetic nephropathy, the need for long-term control of blood sugar, reversing or delaying the development of nephropathy and retinopathy have a certain significance.
(2) the normal reference value of urinary albumin excretion rate (uAE) was less than 15 micrograms per minute. The early stage of diabetic nephropathy, glomerular basement membrane damaged lighter, so only a trace of albumin leakage. Early diabetic nephropathy uAE was 15 to 200 micrograms / min, clinical diabetic nephropathy > 200 micrograms / min. Some experts report that diabetic nephropathy has obvious proteinuria, almost 100% of diabetic retinopathy. When patients with diabetes uAE30 micrograms / minute, may be a critical juncture in the prevention and treatment of diabetic microvascular complications. After strict control of blood glucose, urinary albumin in early diabetic nephropathy can be reversed or partially reversed. At present, the commonly used method for the determination of trace proteinuria is radioimmunoassay.
What is albuminuria (albuminuria)? Is there any protein in the urine of normal people?
Proteinuria (proteinuria) is detected by acidification of urine by acidification. Normal daily urine output of the protein is generally 40 ~ 80 mg, an upper limit of 150 mg, called physiological proteinuria. Due to the small amount of routine laboratory tests were negative, more than 150 mg / day, that is, abnormal proteinuria. The human body in strenuous exercise, heavy labor, agitation, cold heat and stress status, the excretion of proteinuria, urinary protein can be increased, called transient proteinuria, returned to normal in a few hours or a few days.
What is the cause of proteinuria?
(1) renal proteinuria
1 glomerular proteinuria in acute glomerulonephritis, various types of chronic glomerulonephritis, IgA nephritis, latent nephritis. Secondary seen in lupus kidney and other autoimmune diseases, diabetic nephropathy, Henoch Schonlein purpura nephritis, renal arteriosclerosis, etc.. Proteinuria
Metabolic disorders in gout kidney. According to the degree of injury lesions filtration membrane and proteinuria were divided into two types: the selectivity of proteinuria to albumin, and a small amount of protein with small molecular weight, no high molecular weight proteinuria (IgG, IgA, IgM, C3, C4), semi quantitative in + + + + + + + ~, typical disease nephrotic syndrome of non selective proteinuria: glomerular capillary wall has serious damage, there is a high molecular weight protein in the urine, such as immune globulin, complement; molecular weight of albumin and small molecular weight protein, urine protein, immunoglobulin / albumin ratio of > 0.5, semi quantitative + ~ + + + +, quantitative between 0.5 ~ 3.0g/24h, more common in primary glomerular diseases, such as acute nephritis, chronic nephritis, membranous or membranoproliferative glomerulonephritis, and secondary glomerular diseases, such as diabetes, lupus nephritis renal Such inflammation. Non selective proteinuria appears to have a poor prognosis. Strenuous exercise, Long March, high temperature environment, fever, cold environment, mental stress, congestive heart failure can also occur proteinuria. 2 renal tubular proteinuria is the most common cause of interstitial nephritis, renal vein thrombosis, renal artery embolism, heavy metal poisoning, etc.. 3 renal tissue proteinuria, also known as secretory proteinuria. Due to the formation of urine, renal tubular metabolism of protein into the urine caused by.
(two) non renal proteinuria
1 humoral proteinuria is also called overflow proteinuria, such as multiple myeloma. 2 proteinuria, such as malignant tumors, urinary proteins, host proteins, etc.. 3 urinary tract protein mixed with urine causes proteinuria in urinary tract infection, urinary tract epithelial cell shedding and urinary secretory mucin.
Edit this section of diagnosis: Proteinuria should be checked?
Such as the history of edema, hypertension, history of diabetes, history of allergic purpura, the history of drug use, the history of heavy metal poisoning, proteinuria
History of connective tissue disease, metabolic disease and gout.
(two) physical examination of proteinuria
Pay attention to edema and serous cavity effusion, bone and joint examination, anemia and heart, liver and kidney signs. Fundus examination, normal or mild vascular spasm of acute nephritis, chronic nephritis fundus arteriosclerosis, bleeding, exudation, diabetic nephropathy, diabetic retinopathy.
(three) laboratory examination of proteinuria
Urine protein examination can be divided into qualitative, quantitative examination and special examination. 1 qualitative examination is best morning urine, morning urine is the most concentrated, and can exclude the position of proteinuria. Qualitative examination is just screening test, not as accurate urine protein content index. 2 urine protein quantitative examination of 3 urine protein special examination urine protein electrophoresis, can distinguish between selective proteinuria and non selective proteinuria. Multiple myeloma urine protein electrophoresis to examine the two types of help. The diagnosis of early renal tubular injury by radioimmunoassay is of great help.
Proteinuria and kidney disease
In the following cases, physiological postural proteinuria may be considered.
1 in healthy young adults or leptosome.
In the early morning when there is no protein in urine, after a period of time, urine protein can significantly increase
But, supine rest after 1 hours urine protein content decreased or disappeared.
24 hours urine protein content of less than 1 grams, mainly albumin. If the analysis of the composition of urinary protein, urine protein is not simply albumin, and other proteins, the greater the possibility of pathology. Because the physiological position of the main component of proteinuria is albumin.
4 no clinical manifestations, or only with the phenomenon of vascular imbalance.
The upright when dizziness, headache, palpitation, consciousness of vertigo, dizziness and fatigue,
But there was no sign of kidney disease.
The renal function tests were normal, general good health. The mechanism is mainly due to
Vertical displacement of the kidney, the renal vein distortion or by the protrusion of the spinal compression, resulting in renal blood circulation
In addition, when the urine pH value of 7.8, but also the phenomenon of increased urinary protein, but no clinical symptoms, urine examination is also within the normal range.
To give you a piece of advice, in the physical examination of proteinuria, do not because of the discovery of urine
Protein and jittery. Must not abuse health care products, or go to the hospital for medical treatment. If not
Consult a doctor on their own to pharmacies to buy drugs or kidney autotherapy, please quackery have treatment.
Capable of causing potentially irreparable harm to the body.
The relationship between foam urine, proteinuria and nephropathy
A bubble in urine is not necessarily proteinuria.
Under normal circumstances, fresh urine is transparent, light yellow, the surface tension of urine is very low, very few bubbles. Normal urine, such as containing some organic matter (glucose) and inorganic substances (mineral salts), can make the tension of urine becomes stronger, urine can be generated due to the impact of some foam. In this case, the size of the bubble, in a short time can disappear. Therefore, a bubble in urine does not necessarily mean that the urine contains protein
Two, there is not necessarily proteinuria nephropathy.
Proteinuria, as its name implies, is a protein in the urine. Healthy people can also have a small amount of urine protein, generally not more than 0.15 grams in twenty-four hours. Common clinical detection methods can not find these trace proteins, the results showed that urine protein negative. If the content of protein in urine increases, the surface tension of urine increases, and more bubbles appear in the urine. However, even if the subjects were examined for proteinuria, there was no evidence of a kidney disease. Some normal people in the following special circumstances, can also be detected in the urine protein: such as cold season, high fever, severe pain, emotional stress, intense activity, eating raw eggs too much, poisoning, etc..
Three, the occurrence of foam urine can not reflect the degree of renal damage.
The emergence of foam urine is a representation of the body, the appearance of this phenomenon may occur proteinuria. When this happens, doctors often ask these people to do urine protein testing to determine if they have kidney disease. And after the hospital to do routine urine examination after the occurrence of proteinuria, can explain the damage to the kidney. That is, by detection of urinary protein, can not explain the "+" must have kidney damage, but many times do a urine test combined with renal function tests, when necessary do renal biopsy to determine the degree of kidney damage.
From the medical point of view: the detection of proteinuria in patients with urinary foam often appear, however, patients with foam urine performance may not be able to detect proteinuria. In other words, there is no direct link between bubble urine and proteinuria, but can not be directly inferred symptoms of renal failure. Despite the performance of foam urine, but foam urine can not be equated with proteinuria, as an ordinary person, he will not because of foam urine on his own need to go to the hospital to check renal function.
Detection of urinary albumin, three specimens from the way of urine:
1.24 hours of urine retention of urine samples for 24 hours, can be calculated at the same time creatinine clearance rate and urinary albumin excretion rate of 24 hours.
2 urine samples were randomly taken randomly, and the concentration of albumin / creatinine in urine was measured. Research shows that the random urine albumin / creatinine ratio calculation method is better than single white protein determination more early diagnostic value.
3 timed urine collection method is usually done in urine sample to the next morning this time to check before going to sleep, calculate the urinary albumin excretion rate per unit time.
Normal value 24 hours urine albumin + 29 mg
Microalbuminuria 24 hours urine microalbuminuria 30~300 mg
Dominant albuminuria 24 hours urine micro albumin > > 300 mg
Several possible cases of false proteinuria
False proteinuria, as the name suggests, is not true proteinuria. A positive reaction was observed in urine routine examination for some reason. Proteinuria
Pseudo proteinuria generally occurs in the following situations, if any of the items leading to proteinuria, it is recommended to do in-depth examination.
Pseudo proteinuria occurs in the following situations: urine mixed with blood, pus, inflammation or tumor secretions, as well as menstrual blood, leucorrhea, etc., can be a positive test of conventional proteinuria. The urine sediment in large quantities of red and white blood cells and squamous epithelium seen without tube, urine centrifugation or filtration, protein qualitative examination will be significantly reduced or even negative; the urine for a long time or after cooling, precipitated salt crystals, the urine was cloudy white, confusing that proteinuria, but heat or add a little acetic acid make turbid urine turned clear, to help distinguish; mixed with prostatic fluid or in the urine, or the secretion of urethritis, urinary protein response was positive. In this case, patients with lower urinary tract or prostate disease, urine can be found in sperm, more flattened epithelial cells, can make the difference; the lymph urine protein containing less, not necessarily in the chyle shape; some drugs such as rifampicin, santonic etc. from the urine, the urine can color turbidity similar proteinuria, but protein qualitative negative response.
Proteinuria in patients with nephrotic syndrome (proteinuria)
The problems that should be paid attention to in urine test:
Urine collection time: any time to discharge urine can do routine laboratory tests. General nephropathy patients as the observation results before and after getting up in the morning, all the provisions of the first urine inspection.
Urine volume: 5 ~ 10ml, to measure the specific gravity of urine is not less than 50ml.
Urine urine specimens should be taken: the first part of the urine discharge drain to flush in the urethra and the anterior urethra bacteria, then the urine samples.
Attention should not be taken into the urine of non urine ingredients: such as women do not mix with vaginal bleeding and menstrual blood, male patients do not mix with prostate fluid, etc..
Normal values and changes of proteinuria (proteinuria)
In healthy people will discharge some protein in the urine (proteinuria)
Healthy people will also appear a small amount of urine protein, but in the qualitative examination as long as the test paper does not change color negative (a) is normal.
In addition, the quantitative examination of urinary protein content, as long as 100 mg or less are within the normal range.
In addition, even if the body does not have obstacles, as long as there is intense exercise, cold, mental excitement, strong pressure, also can appear urinary protein.
A disease suspected to be abnormal
Positive and positive anomaly is suspected,
Qualitative examination was positive (+ +) or positive (+) and was considered abnormal.
In addition, the quantitative examination, the value of more than 100 mg a day is abnormal.
Urine protein shows abnormal values of the disease, some of the kidney itself, some of which are caused by kidney disease.
What should happen when abnormal value of albumen of uric fluid (albumen)?
No one checks, in order to diagnose
For the first time when a protein (urine) is detected, it must be checked again. Check is abnormal, must accept urine sedimentation, the number of red blood cells, white blood cell count and other inspection, inspection precision but also the implementation of the kidney and urinary tract, and systemic symptoms to diagnose whether the kidney disease or other diseases. Kidney disease, but also to do other renal function tests, do a comprehensive diagnosis.
Is the basic treatment, diet therapy
A diagnosis of cystitis, pyelonephritis, urinary tract infection, nephritis, kidney disease, must be calm, take medicine physician instructions. Diagnosis of nephritis, kidney disease, renal function must be checked. When the test results are bad, it is necessary to limit the exercise, and the implementation of diet therapy. The treatment of renal disorders is based on diet therapy, which shows that diet therapy is very important, so we must follow the instructions of physicians to control the day of salt and protein intake.
When a large number of proteinuria, whether through dietary supplement protein?
A large number of proteinuria nephritis patients, usually through diet supplement, think nephritis patients can not eat protein containing foods is wrong, one-sided, even to the development of advanced chronic nephritis patients with uremia, also advocated to eat high quality low protein diet. Daily protein intake should be controlled at 0. 6~0. 8 g / kg body weight. In patients with uremia, the amount of daily protein intake should be increased by about 1 during dialysis treatment, especially during peritoneal dialysis. 2~1. 5 g / kg body weight. Patients with nephrotic syndrome, a large number of protein loss in the urine, such as normal renal function, advocated eating a high protein diet to correct hypoproteinemia, reduce edema and improve or enhance the body resistance. If patients with nephritic syndrome, or early renal insufficiency, should limit the intake of protein. Otherwise it will accelerate the deterioration of renal function. In short, different conditions, should adopt a different diet recipes. When a large amount of proteinuria in patients with nephropathy, do not have too much panic; when a small amount of proteinuria occurs, the severity of the disease can not be ignored, the best time to diagnose the disease, make corresponding treatment scheme of proteinuria. Complete recovery of renal function and elimination of proteinuria from the perspective of renal pathological damage.
Relationship between proteinuria and disease prognosis
The appearance of proteinuria in the exclusion of other causes such as physical factors, postural factors, the other kidney ultrasonography, renal function examination, urine routine examination, basically can determine the clinical symptoms caused by kidney damage. The clinical significance of proteinuria is very complex. Clinical observation of persistent proteinuria often means substantial damage to the kidney. When proteinuria is variable, it can not only reflect the improvement of renal disease, but also may be due to the majority of glomerular fibrosis, reduced filtration protein, deterioration of renal function, exacerbation of the disease. Therefore, to determine the severity of kidney disease damage can not be measured only by proteinuria, the amount of urine protein to be integrated and the duration of a comprehensive consideration, but also combined with systemic and renal function tests to determine.
A large number of clinical data indicate that patients with nephrotic syndrome and persistent proteinuria have poor prognosis. In focal glomerulosclerosis, membranoproliferative glomerulonephritis, membranous nephropathy, IGA nephropathy, diabetic nephropathy and chronic renal allograft rejection, proteinuria is significant because of the unique factors for progression and mortality rate increased kidney disease. In fact, the remission of these diseases, the reduction of urinary protein excretion, whether spontaneous or active treatment, can improve the survival rate.
Diet recuperation nephropathy patients
The concept and principle of diet 1, proteinuria
Every day 24h urinary protein more than 150mg, and can be detected by routine urine protein qualitative test, called proteinuria. Generally speaking, there are physiological and pathological characteristics of proteinuria, the former is the occurrence of some of the body in the absence of organic lesions of proteinuria, also known as functional proteinuria. There is a common cause of fever caused by waiting, strenuous exercise, erect, and were temporary, because after removal of proteinuria disappeared; the latter is composed of various primary and secondary renal disease caused by persistent proteinuria as the characteristic, general prerenal, kidney disease, kidney after. The urine protein, belonging to Chinese medicine "edema", "consumptive disease", "pain" and other areas, feasible syndrome differentiation, the principle of diet.
(1) should be based on the cause of proteinuria in patients with nephritis, generally according to the normal needs of the supply, adult 0.8~1.0g/kg. Should choose the high physiological value of protein, such as eggs, milk, fish, lean meat etc..
(2) nephrotic syndrome, urine in the loss of a large number of proteins, but also the loss of calcium, magnesium, zinc and protein combined with other minerals, should eat more fresh fruits and vegetables, supplement of calcium rich foods, such as milk and milk products, shrimp, sesame, seaweed, fish and green vegetables. Foods rich in magnesium, such as millet, wheat, barley, meat, animal offal, etc.. Zinc rich foods, such as millet, wheat, corn flour, cabbage, radish, carrots, eggplant, lentils, pumpkin, etc..
(3) because of the large number of purine bases in plant proteins, it can aggravate the burden of the metabolism of the kidney. Soy beans and soy products, although the high protein content, for the above reasons, the protein should also be used to avoid.
In 2, the treatment of proteinuria
(1) astragalus root, coix seed, red bean glutinous rice 30g, 15g, 9g at the end of chicken 2, kumquat cake (broken). Huangqi Decoction 20min 600ml water, juice, coix seed, red beans boiled into 30min, glutinous rice, chicken at the end of reentry of Zhu Chengyu, finally add chopped kumquat cake boiled slightly. Take 1 doses a day, take 2 times. With heat and dampness, invigorating spleen to promote digestion, elimination of proteinuria and other functions, suitable for spleen deficiency and dampness heat proteinuria etc..
(2) dogwood, lotus 15g, 60g glutinous rice, sugar amount. The first 3 flavors together boiled porridge, add sugar seasoning can. Daily 1~2 agent, take 1~2 times. With spleen and kidney, eliminating proteinuria and other functions, suitable for kidney qi deficiency of proteinuria.
(3) the 30g Gorgon, glutinous rice, white flesh 10. You can cook into a gruel. Daily 1~2 agent, take 1~2 times. It has the functions of invigorating spleen and kidney, eliminating proteinuria and so on.
(4) 30g 60g dodder, glutinous rice, sugar amount. Dodder mash decoction, glutinous rice congee, add sugar seasoning. Take 1 doses a day, take 2 times. With kidney, eliminating proteinuria, kidney qi deficiency for albuminuria.
(5) Gorgon fruit, Poria cocos 15g, rice 60g. Boiled together into gruel. 1 doses daily, taken in times. It has the functions of invigorating spleen and kidney, removing protein urine and so on.
(6) the Gorgon walnut, 30g, rice 60g. The former 2 kinds of mash, and rice cooked into porridge. Take 1 doses a day, take 2 times. It has the functions of tonifying kidney, removing protein and urine and so on.
(7) cinnamon, paeonol 10g, rice 100g. The first 2 flavors of water to extract juice, into the glutinous rice porridge can be boiled. Take one dose daily, 2 times. With warming kidney and eliminating proteinuria and other functions, suitable for kidney yang deficiency proteinuria.
Give you a suggestion:
1 all eligible healthy adults have a routine urine test every year;
2 people with diabetes, high blood pressure should pay more attention to urine examination, regular urine routine should be done every year, urine microalbumin;
There are 3 manifestations of kidney disease, such as early morning and afternoon swollen eyelids swollen legs, hypertension, anemia, backache and other symptoms, to repeatedly check the urine, 3 times a year the best check.
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