Sevel methods of acute nephritis check2017-03-06 14:35
1, urine analysis
Common gross hematuria, massive proteinuria, white blood cell and tubular urine, urine specific gravity and osmotic pressure decreased. The blood more severe anemia, white blood cells and platelets can be normal or increased. The concentration of renal insufficiency as blood urea nitrogen and creatinine were increased, creatinine clearance decreased significantly, significantly reduced the excretion of phenol red in experiment. The high level of immunoglobulin increased with the increase of gamma globulin, IgG and C3, which could be seen in the patients with lupus nephritis and acute glomerulonephritis. The positive of anti glomerular basement membrane antibody in blood was mainly seen in Goodpasture syndrome, and the concentration of anti glomerular basement membrane antibody could be detected by ELISA. Generally, the complement C3 was normal, and the decrease was seen in patients with streptococcal infection nephritis, lupus nephritis and membranous proliferative glomerulonephritis. Antineutrophil cytoplasmic antibodies (ANCA) were positive in ANCA positive RPGN. ANCA can be divided into C-ANCA and p-ANCA, the former was mainly seen in Wegener granulomatosis, which was mainly seen in polyarteritis nodosa under the microscope, the so-called idiopathic RPGN.
2, imaging examination
The results showed that the renal perfusion and filtration of the kidney were reduced with the digital subtraction angiography (DSA). Abdominal plain film examination showed that the kidneys were enlarged or normal in size, but the border between cortex and medulla was unclear. Intravenous pyelography (IVP) showed a poor, but the renal artery angiography normal blood vessels, blood flow is not reduced, even in systemic vasculitis as well. Renal ultrasound showed that the kidneys were enlarged or normal in size, but the skin and medulla were not clearly defined.
3, pathology and biopsy
(1) light microscope
In the normal kidney, the small balloon wall epithelial cells were monolayer cells, and in the pathological condition, the parietal epithelial cells proliferated and increased the number of cells (more than three layers). The pathological features of acute nephritis is widely crescent formation. The new moon volume of rapidly progressive glomerulonephritis is large, often involving the above glomerular cysts of 50%, and more widely, usually more than 50% of the glomerular crescent. Crescent formation is a serious damage to glomerular capillary loop results in crescentic and adjacent glomerular capillary loop loop necrosis can often be seen. The crescent of different subtypes of acute nephritis is slightly different. Crescentic anti basement membrane glomerulonephritis is consistent, in the early stage of disease, all were crescentic cellular crescents; in the later stage of cellular crescents into cellular fibrous crescents. This disease is quite fast, 4 weeks after the onset of renal biopsy can be seen in fibrous crescents and glomerular sclerosis.
Immune pathology is the main basis for the distinction between 3 kinds of acute nephritis. IgG is the most characteristic expression of anti GBM nephritis along the glomerular capillary basement membrane. Almost all glomerular IgG staining was moderately positive to strongly positive, and other immunoglobulins were generally negative. It has been reported that IgA type anti GBM nephritis is mainly manifested by the linear deposition of IgA along the basement membrane. This type of visible C3 along the basement membrane was continuous or discontinuous linear or fine granular deposition, but only 2/3 of patients with C3 positive. IgG can also be seen along the basement membrane. In diabetic nephropathy, sometimes showing a linear deposition of IgG along the basement membrane, but their clinical manifestations and light characteristics of easy identification, IgG deposition in diabetic nephropathy is due to the increase of vascular permeability to plasma proteins (including IgG and albumin) nonspecific deposition of exudation, because while the former albumin staining.
(3) electron microscopy
With the light microscope and electron microscope showed that the immune pathological acute nephritis corresponding. Anti GBM nephritis and non immune complex type of acute nephritis were no electron dense material (immune complex deposition). The basement membrane of the capillary and the basement membrane of the small renal balloon were observed, with the infiltration of neutrophils and monocytes. The electron microscopic features of immune complex type of acute nephritis is the deposition of immune complexes was seen with electron dense, mainly deposits in the mesangial area. Depending on the rapidly progressive glomerulonephritis electron dense deposits secondary to immune complex nephritis in primary glomerulonephritis type, visible in the mesangial area, epithelial or endothelial cells. Sometimes broken capillaries and visible glomerular basement membrane gap, but other than rare subtype of acute nephritis.
It is a rapidly progressive glomerulonephritis through some scientific means to check out all of our patients, not sure if he is not suffering from the acute nephritis, is to go to the hospital to check.