June 29, 2022

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Chronic kidney disease with low urine protein can also develop into uremia

Chronic kidney disease with low urine protein can also develop into uremia


Chronic kidney disease with low urine protein can also develop into uremia.  Some people may misunderstand that chronic kidney disease with low urine protein will not develop into uremia.

Chronic kidney disease with low urine protein can also develop into uremia

It is known that if the urine protein of chronic kidney disease (CKD) patients is at a high (medium proteinuria) or high (large proteinuria) level for a long time, they are more likely to develop uremia. Some people may misunderstand that chronic kidney disease with low urine protein will not develop into uremia. In fact, this is not always the case.

Some glomerulonephritis, such as IgA nephropathy, minimal change nephropathy, membranous nephropathy and allergic purpura nephritis, etc., originally have high urine protein. After the urine protein drops after treatment, the kidney disease is not easy to develop into uremia. However, there are still many chronic kidney diseases with low urine protein that can also develop into chronic renal failure and uremia.

The following five types of chronic kidney disease are prone to develop in the direction of uremia, so let nephrologists understand.


1. Diabetic nephropathy

Diabetic nephropathy (DN) complicated by diabetes (DM), in DN I-III, the patient’s urine protein is not high or not too high, it is difficult to find kidney disease without special or specialized laboratory tests.

When DN Ⅳ is the clinical stage of diabetic nephropathy, the patient’s urine protein gradually increases. The 24-hour urine protein quantitative is only> 0.5 g, and the urine albumin excretion rate (UAER)> 200 μg/min, but the patient’s glomerulus The disease is already very serious. Some glomeruli have sclerosis, renal tubule atrophy and renal interstitial fibrosis will also appear, and the glomerular filtration rate begins to decrease. At this time, it is often accompanied by hypertension or edema. If effective measures are not taken, the patient is more likely to develop uremia.


2. Hypertensive renal damage

In hypertensive renal damage caused by essential hypertension, most of the urine protein is not too high. Normally, the patient’s 24-hour urine protein quantity is less than 1.0 g, which is mainly because the renal tubule damage is earlier than the glomerulus Damage, that is, early renal tubular interstitial damage is dominant, and glomerular damage is relatively mild. Patients with a history of hypertension for more than 5-10 years can have hypertensive renal damage. If it is not detected in time or effective measures are not taken, the patient is also likely to develop chronic renal failure and uremia.


3. Polycystic kidney disease

Polycystic kidney disease is a genetic disease, mainly autosomal dominant polycystic kidney disease. The patient’s urine protein is not too high, and even the urine protein test results are negative (-) through urine routines. If you do not pass the kidney color ultrasonography or CT and other imaging examinations, polycystic kidney disease will not be found at the beginning of the disease.

Even after the development of chronic kidney disease 2-3 stages, the patient’s urine protein will not be high, but the patient’s kidneys are often significantly enlarged, accompanied by high blood pressure, abnormal increase in red blood cells in the urine, and even gross hematuria. Check the 24-hour urine protein quantitative may only be 0.3-0.5 grams, or even below the normal 0.15 grams. Nevertheless, the result is still mostly uremia.


4. Alport syndrome

This is commonly referred to as hereditary nephritis. 80% of Alport syndrome is X-linked dominant inheritance, which is a disease caused by mutations in the IV collagen gene encoding the glomerular basement membrane. In the patient’s urine examination, hematuria is the main manifestation, and proteinuria is also present. The urine protein of most patients is not too high. Only one-third of hereditary nephritis has proteinuria at the level of nephrotic syndrome. Even if the patient’s urine protein is not too high, male patients with X-linked dominant genetic Alport syndrome have a poor kidney prognosis, and almost all develop uremia.


5. Chronic tubulointerstitial nephritis

This is a large group of diseases. Chronic tubulointerstitial nephritis is a group of kidney diseases with renal tubule atrophy and renal interstitial fibrosis as the main manifestations. It is different from glomerular disease, and the patient’s urine protein is not too high. Generally speaking, the 24-hour urine protein quantitative is not more than 1.0 grams. The causes and mechanisms of chronic tubulointerstitial diseases are many, such as infection, drugs, metabolism, genetics, heavy metals, immune damage, and urinary tract obstruction.

Chronic pyelonephritis, antipyretic analgesic nephropathy, aluminum poisoning-related renal damage, aristolochic acid nephropathy, hyperuricemia nephropathy, hypokalemic nephropathy, Sjogren’s syndrome renal damage, and obstructive nephropathy can all cause chronic tubulointerstitial Nephritis. In the early stage of the disease, the patient’s glomerular filtration rate may be normal or slightly decreased. As the disease progresses, chronic tubulointerstitial nephritis will gradually develop into chronic renal failure and uremia.

 

In summary, do not think that patients with kidney disease who have low or low urine protein will not develop in the direction of chronic renal failure and uremia. If the treatment is actively regulated, there is hope to prevent or delay the condition; if the treatment is given up or randomized, its development speed will be accelerated.

(source:internet, reference only)


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