1 , medical history and symptoms
There are a variety of multi previous history of glomerulonephritis , pyelonephritis , hypertension , diabetes and gout disease. Early often anorexia, nausea, vomiting , headache , fatigue and nocturnal enuresis, gradually oliguria , edema or high blood pressure . Most patients have mouth odor , mouth ulcers , nasal bleeding or gastrointestinal bleeding , may have concentration or unresponsive , numbness , drowsiness or restlessness , anxiety and other neuropsychiatric symptoms, severe incontinence and even coma ; chest tightness , shortness of breath, precordial discomfort , suggesting concurrent uremic cardiomyopathy, cough, expectoration or hemoptysis , night can not be supine , suggesting uremic pulmonary edema or pneumonia ; small number of patients , chest tightness , persistent chest pain , or with varying degrees of fever , may be pericardial effusion ; such as itching, pain or muscle twitching , or even walking inconvenience , suggesting concurrent secondary hyperparathyroidism or renal osteodystrophy ; patients prone to suffer from various infections, such as respiratory tract infections , urinary tract infections or skin infections.
2 , physical examination
Most high blood pressure, anemia or a dark complexion , facial or lower extremity edema. Spiritual consciousness may have abnormal systemic or local bleeding, rapid shallow breathing or orthopnea , jugular vein distention , lung wet rales , heart community to expand , pleural or pericardial friction rub , changes in heart rate or rhythm , hepatomegaly and ascites and other symptoms.
3 , laboratory tests
( 1 ) Urine:
Decreased urine specific gravity or fixed , urinary protein , there are different degrees of hematuria and casts.
( 2 ) blood:
Reduction of hemoglobin and red blood cell count , hematocrit and reticulocyte count is reduced , some patients blood cells decreased three lines .
( 3 ) biochemical tests , nuclear medicine (ECT)
American Medical Quality nephropathy guide : GFR90ml/min above normal renal function ; GFR90-60ml/min, slightly decreased kidney function ; GFR60-30ml/min, moderately decreased kidney function ; GFR30-15ml/min, severe kidney function decline ; GFR15ml/min less, kidney failure.
Domestic chronic renal failure stages : GFR50 ~ 80ml/min, blood urea nitrogen, creatinine normal renal insufficiency compensated ; GFR50 ~ 25ml/min, serum creatinine 186 ~ 442μmol / L, urea nitrogen than 7.1mmol / L, as decompensated renal insufficiency ; GFR25 ~ 10ml/min, serum creatinine 451 ~ 707μmol / L, urea nitrogen 17.9 ~ 28.6mmol / L of renal failure ;
GFR is less than 10ml/min, serum creatinine greater than 707μmol / L, urea nitrogen 28.6mmol / L or more, renal failure and uremia . When renal failure, often accompanied by hypocalcemia hyperphosphatemia , metabolic acidosis .
4 , imaging examination
B ultrasound showed renal volume is reduced, renal cortical echogenicity ; radionuclide renal dynamic developing shows decline in glomerular filtration rate and renal excretory dysfunction ; radionuclide bone scan showed signs of renal osteodystrophy ; chest X- ray shows pulmonary congestion or pulmonary edema, increased cardiothoracic ratio or pericardial effusion , pleural effusions.
5 , biopsy
Renal biopsy may help diagnose early chronic renal insufficiency primary disease .
6 , the differential diagnosis
When the kidneys no significant history of sudden onset of acute renal failure should be differentiated . Severe anemia should gastrointestinal cancer, hematological diseases. It should also attach importance to the primary disease and the identification of predisposing factors to determine the degree of renal impairment .
7 Determination of renal function
① glomerular filtration rate , creatinine clearance decreased . ② phenol red excretion test and urine tests were concentrated diluted loss . ③ water clearance measurement anomalies. ④ radionuclide renography and renal scintigraphy scan and also helps to understand kidney function.
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