August 17, 2022

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Will a kidney disease patient with a little proteinuria develop to uremia?

Will a kidney disease patient with a little proteinuria develop to uremia?

 

 

Will a kidney disease patient with a little proteinuria develop to uremia?  After the partial remission of nephrotic syndrome, urine protein excretion in patients with nephropathy is usually divided into three levels, namely, a small amount of proteinuria, a moderate amount of proteinuria, and a large amount of proteinuria.

 

Will a kidney disease patient with a little proteinuria develop to uremia?

Among them, a 24-hour urine protein quantitative greater than 3.5 grams belongs to the category of large proteinuria; a 24-hour urine protein quantitative between 1.0-3.5 grams belongs to the category of moderate proteinuria; and a 24-hour urine protein less than 1.0 grams belongs to the category of small proteinuria. Years of research and clinical observations have shown that persistent uncontrolled kidney disease with moderate or large proteinuria is more likely to progress, and it is more likely to develop into renal failure and uremia. However, it is generally the case that nephropathy with only a small amount of proteinuria is relatively safe, and its progression rate is very slow or hardly developing. If the 24-hour urine protein quantitative is less than 0.3-0.5 grams, it is safer.


In view of the above reasons, some patients with kidney disease may think that no matter what kind of kidney disease, as long as the 24-hour urine protein is less than 1.0 g or even 0.3-0.5 g, everything will be fine. No longer worry about the development of kidney disease, they think that chronic renal failure is related to chronic renal failure. Uremia has absolutely nothing to do with you! Is this really the case?


Before discussing this topic, let’s take a look at this case. The patient is a middle-aged female with a medical history of more than 13 years. When nephropathy was first discovered, the patient mainly showed slight swelling of both lower limbs and no other discomfort. After the hospital examination, the urine protein was ±-1+, the 24-hour urine protein was 0.48 g (ie 480 mg), and the blood pressure was basically normal (blood pressure). Fluctuations between 110/70-140/90mmHg), renal function is completely normal. At that time, it was clinically diagnosed as “chronic glomerulonephritis”, and only general conventional treatment was given.

Later, although regular review was also frequent, the urine protein was between 0.3 and 0.7 grams, and there was no abnormality in kidney function after repeated examinations. The patient underwent a renal puncture pathological examination 3 years ago, and the result showed “IgA nephropathy”. Since I have been sick for a long time, I often hear doctors say, “Your condition is mild, don’t worry about uremia!” Later, I gradually didn’t take it seriously. In the last 3 years, patients have basically ignored it. Until the day 2 weeks ago, the patient felt obviously uncomfortable, complained of dizziness, fatigue and increased nocturia. After another examination, it was found that the renal function was obviously abnormal, showing that the blood creatinine was 272.5 μmol/L, and the patient’s urine protein was still only 1+. The 24-hour urine protein quantitative was 0.53 g.


As can be seen from the above case, it is not that kidney disease that is not too high in urine protein will not progress. It just means that kidney disease with high urine protein is more likely to progress, and kidney disease with low urine protein is not that it will not progress. Generally speaking, renal diseases caused by glomerular diseases, such as membranous nephropathy and IgA nephropathy, have relatively high urine protein excretion; while renal diseases mainly caused by renal tubulointerstitial damage, such as hypertensive renal damage and chronic drug-induced renal disease Interstitial nephritis, etc., the urine protein excretion is relatively low. In addition, due to the many types of kidney diseases, the factors affecting the final outcome of different kidney diseases not only depend on the indicator of urine protein, but may also be related to other indicators.


Therefore, the truth is-it is not that kidney disease with a small amount of proteinuria does not progress. The following seven types of kidney diseases have only a small amount of proteinuria, and they may also progress to chronic renal failure and uremia.

 

 


1. After partial remission of nephrotic syndrome

After the treatment of nephrotic syndrome, the condition was partially relieved, the patient’s edema completely subsided, and the plasma protein and blood lipids returned to normal. However, the urine protein dropped to a small amount of proteinuria, and the 24-hour urine protein quantitative did not drop below 0.3 grams. Although the curative effect is also very good, it is still possible to develop gradually. Subsequent regular review and follow-up treatment are still necessary to avoid the occurrence of chronic renal failure and uremia.

 

2. Abnormal urine test type IgA nephropathy

Because the incidence of IgA nephropathy is very high, accounting for about one-third of primary glomerular diseases, the absolute number of uremia caused by IgA nephropathy is also very high. In uremia caused by IgA nephropathy, only a small amount of proteinuria also accounts for a certain proportion. Therefore, regardless of whether the urine protein of patients with IgA nephropathy is high or not, it is still very important and necessary to give corresponding treatment and monitor changes in the condition.

 

3. Mild chronic glomerulonephritis

This is similar to the above abnormal urine test IgA nephropathy, the difference is that this is a clinical diagnosis, and the abnormal urine test IgA nephropathy is a pathological diagnosis. Similarly, mild chronic glomerulonephritis with only a small amount of proteinuria may also develop into uremia. It is also necessary to pay close attention to changes in the disease and give corresponding treatment and management.

 

4. Hypertensive renal damage

This is easily confused with hypertension caused by chronic nephritis. Under normal circumstances, the urine protein excretion of patients with hypertensive renal damage is relatively small, and the 24-hour urine protein quantitative is mostly less than 1.0 g, and the tubulointerstitial damage is the main one. However, it is also one of the causes of uremia. In other words, hypertensive kidney damage with low urine protein can also progress to uremia.

 

5. Chronic Interstitial Nephritis

Generally speaking, the urine protein of patients with chronic interstitial nephritis is not too high, and the 24-hour urine protein quantitative is about 1.0 g or less than 1.0 g, which is related to the main damage to the characteristics of the renal interstitial. Urinary tract infections or certain nephrotoxic drugs are the pathogenic factors of chronic interstitial nephritis. This disease also accounts for a certain proportion of the causes of chronic renal failure and uremia.

 

6. Polycystic kidney disease

In some cases of polycystic kidney disease, if you do not do kidney color Doppler ultrasound and renal function tests, but only check the urine routine, sometimes the kidney disease may not be found. The reason is that in the absence of urinary tract infection or cyst bleeding, urine routine is normal and urine protein is negative. Even if the patient’s blood creatinine is significantly abnormal, urine protein can still be negative. However, polycystic kidney disease will eventually be chronic renal failure and uremia.

 

7. Lupus nephritis

There is a type of lupus nephritis of “not tepid”, the patient has no special manifestations at all: no facial erythema, no edema, low urine protein, and no joint pain. Unfortunately, some patients are only diagnosed when they develop chronic renal failure or uremia. In other words, lupus nephritis with only a small amount of urine protein will also progress.
Nephropathy that can progress with only a small amount of proteinuria is far more than the above 7 types. Don’t think that kidney disease will not progress if the urine protein is not too high. Those with a 24-hour urine protein quantitative of less than 1.0 g or even less than 0.5 g may also end up Progression to uremia also requires attention and management.

 

(source:internet, reference only)


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