To solve the problem of proteinuria, it is necessary to target the inflammatory response in patients with kidney disease. Based on the clinical practice of long-term treatment of kidney disease, hormones have powerful anti-inflammatory and immune response-suppressing effects, and can provide effective symptomatic treatment for the inflammatory response in patients with kidney disease. Therefore, hormones have become a good treatment method widely used in patients with kidney disease to eliminate proteinuria. Therapeutic drugs. Hormones and immunosuppressive drugs treat the inflammatory reaction in the kidneys symptomatically, suppressing the patient's immune response, thereby achieving the purpose of quickly eliminating proteinuria.
Proteinuria is the most common clinical symptom in patients with chronic kidney disease. The continuous loss of proteinuria will directly lead to the worsening of the disease and cause a series of clinical complications such as hypoalbuminemia, hyperlipidemia, endocrine disorders, malnutrition, and susceptibility to infection.
Proteinuria
Urine protein quantification in 24 hours exceeds 150mg or urine protein/creatinine gt; 200mg/g, or urine protein qualitative test is positive is called proteinuria. Proteinuria is the most common manifestation of kidney disease, but protein may also appear in the urine in extrarenal diseases. In most cases, patients develop proteinuria without any symptoms and are usually discovered through routine clinical urine examination.
Cause of symptoms
(1) Physiological proteinuria
Without organic disease, it is common in the following two situations:
1. Functional proteinuria is transient proteinuria caused by strenuous exercise, fever, stress and other stress conditions. It is more common in adolescents. The amount of urinary protein in qualitative tests does not exceed ( ).
2. Orthostatic proteinuria is common in adolescents during puberty. Proteinuria occurs in upright and lordotic postures, and disappears in the supine position. The general protein excretion amount is <1g/d.
(2) Glomerular proteinuria
The glomerular filtration membrane is damaged, the permeability is increased, and plasma proteins are filtered out and exceed the reabsorption capacity of the renal tubules. of proteinuria. The most common proteinuria in clinical practice is mostly seen in primary or secondary glomerular diseases, such as acute nephritis, rapidly progressive nephritis, chronic nephritis, IgA nephropathy, nephrotic syndrome, lupus nephritis, purpura nephritis, and diabetic nephritis. Kidney disease, hypertensive nephropathy, tumor nephropathy, renal amyloidosis, toxic nephropathy and kidney damage caused by infection, etc. are also seen in congenital nephritis, renal circulation disorders, renal hypoxia, accelerated renal blood flow, etc.
(3) Renal tubular proteinuria
When the structure or function of the renal tubules is damaged, the renal tubules fail to reabsorb normally filtered small molecular weight proteins, causing protein to be excreted from the urine. It is excreted in the body and is called renal tubular proteinuria. Commonly seen in tubulo-interstitial lesions caused by various causes, such as pyelonephritis, interstitial nephritis, reflux nephropathy, uric acid nephropathy, renal tubular acidosis, heavy metal poisoning, Fanconi syndrome, hypokalemic nephropathy, Renal medullary cystic degeneration, radiation nephritis, analgesic nephropathy, rejection after kidney transplantation, etc.
(4) Overflow proteinuria
An abnormal increase in small molecular weight proteins in the blood, such as multiple myeloma light chain protein, hemoglobin, myoglobin, etc., and is filtered out from the glomerulus , proteinuria caused by exceeding the renal tubular reabsorption threshold. Can be completely reabsorbed by renal tubules.
Bence Jones protein is more common in multiple myeloma, but also in macroglobulinemia, heavy chain disease and light chain disease, amyloidosis, and occasionally in monocytic leukemia; hemoglobin or myoglobin Seen in massive muscle tissue damage, excessive hemolysis, etc.; rejection of kidney transplantation and increased FDP in urine due to disseminated intravascular coagulation are also overflow proteinuria.
(5) Tissue proteinuria
Mainly refers to some soluble tissue catabolites secreted by the kidney tissue, and in pathological conditions such as poisoning, ischemia, inflammation or tumors, the kidney and Structural proteins released by urinary tract tissue necrosis. For example, in glomerulonephritis, glomerular basement membrane antigen, renal tubular brush border antigen and various enzymes are excreted in the urine; in tumors, specific antigenic substances related to tumors can be found in the urine.
How to treat proteinuria? Web link