Kidney disease diagnosis gold indicator – kidney puncture
Renal puncture is kidney biopsy, also known as renal puncture biopsy. After the kidney tissue is removed and analyzed by pathology, the type of pathology can be determined and clinical treatment can be guided. Therefore, the results of kidney pathology examination have become the golden indicator for the diagnosis of kidney diseases.
The histopathological changes of kidney disease are not consistent in different periods of development. For example, the same IgA nephropathy can manifest pathologically in almost all stages of development from near normal kidney tissue to majority glomerulosclerosis. Therefore, understanding the histomorphological alterations of the kidney provides an important basis for clinicians in judging the condition, treating the disease and estimating the prognosis.
Clinical significance of renal puncture examination
1.Define the diagnosis: the clinical diagnosis of more than one third of patients can be corrected by renal puncture biopsy.
2.Guidance of treatment: The clinical treatment plan of nearly one third of patients can be modified by renal puncture biopsy.
3.Estimating prognosis: Renal puncture biopsy can be used to more accurately evaluate the prognosis of patients with kidney disease.
In addition, repeat renal pathology is sometimes required to understand the effectiveness of treatment or to understand the progression of pathology (e.g., crescentic nephritis, lupus nephritis, and IgA nephropathy).
Indications for renal puncture examination
1.Nephrogenic acute renal failure who cannot be diagnosed clinically with a clear etiology.
2.Acute nephritis syndrome: acute nephritis is suspected to be a rapid deterioration of renal function or the condition does not improve after 1-2 months of treatment for acute nephritis.
3.Nephrotic syndrome:
When regular glucocorticoid treatment for 8 weeks is ineffective.
When the clinical need for differentiated treatment according to the type of pathology.
Patients older than 50 years of age without contraindications to renal biopsy
4. Chronic glomerulonephritis
5. When secondary or hereditary or familial kidney disease is suspected
6, Asymptomatic proteinuria >1g/24h or proteinuria combined with hematuria
7.Suspected tubular interstitial damage but clinical diagnosis cannot be confirmed.
8.Transplanted kidney: when the cause of obvious renal decompensation is unclear, or severe rejection to decide whether to remove the transplanted kidney or suspected recurrence of the original kidney disease in the transplanted kidney.
9.When repeat kidney biopsy is needed to guide further clinical treatment.
Preparation before renal puncture
1. Explain the significance of renal puncture biopsy to the patient, relieve the patient’s worries and tension, teach the patient to hold his breath (more than 15 seconds), and ask the patient to practice urination lying flat on the bed.
2. Explain clearly to the patient and family the purpose of renal puncture and the possible complications, and have the patient and family sign the application form if they agree and understand.
3. Improve the preoperative examination. Before the kidney puncture, blood should be drawn to check liver function, hepatitis B and half, blood and urine routine, blood type, kidney function, coagulation function, ultrasound to understand the size and location of bilateral kidneys, and urine retention to check urine routine.
4. Blood pressure was controlled.
Work after kidney puncture
1. Blood pressure and pulse were measured immediately after the patient returned to the ward, and then once at half an hour, one hour and three hours after the operation. If the patient is stable, the blood pressure will be measured once a day. If the condition is unstable, monitor at any time according to the situation.
2.After returning to the ward, let the patient lie flat on the bed with pillows, upper and lower limbs can be moved, but the waist should never be moved; after 6 hours, if the condition permits, the patient can turn over with the help of others, and get out of bed after 24 hours of lying flat, and avoid strenuous activities and vibration for two weeks.
3, should encourage drinking water, three consecutive urine routine plus sediment microscopy, pay attention to the number of red blood cells in the urine.
4.Patients with bleeding tendency, those with bleeding after renal puncture, and those with more puncture needles should be prolonged in bed and given active hemostatic medication, and if necessary, other resuscitation measures should be taken.
5, the application of antibiotics after renal puncture should be decided at your discretion.
Hormone and cytotoxic drug therapy
According to the results of renal puncture to clarify the pathological type of kidney disease, according to the individual situation to develop the corresponding treatment plan. Some patients need to take hormonal and cytotoxic drugs under the guidance of doctors.
1.Pay attention to drug withdrawal reaction and rebound phenomenon
2.Adverse reactions
Centripetal obesity, full-moon face; inducing or aggravating various infections such as bacteria, virus and fungus; affecting fertility, leading to menopause, infertility and sterility; osteoporosis; bleeding tendency; metabolic disorders: such as steroidal diabetes (or aggravation of existing diabetes), hyperlipidemia, etc.; mental symptoms such as anxiety, excitement, euphoria or depression, insomnia; gastrointestinal reactions, etc.
Although some patients may have the above-mentioned adverse reactions, only hormonal drugs and cytotoxic drugs can curb the progress of the disease and slow down the deterioration of the patient’s condition according to the nephropathy.
Advantages of Traditional Chinese Medicine
Many patients with nephrotic syndrome often develop severe dependence on western prednisone, cyclophosphamide and other drugs during long-term treatment, which reduces drug sensitivity, reduces patients’ resistance, makes them susceptible to colds and recurrent attacks. Long-term treatment, and because of the toxic side effects of such drugs, long-term use, the patient also caused some damage. In the course of long-term clinical practice, it was found that Chinese medicine has great advantages in the treatment of this disease.
The pharmacological study of urine protein removal proves that many Chinese medicines such as Cordyceps sinensis and Astragalus have the function of improving cellular and humoral immunity, and a large number of clinical observations also found that such drugs can improve the body’s clearance of antigens and have a repairing effect on the damage of glomerular basement membrane, in addition to increasing renal flow and promoting the absorption of fibrous tissue, which can reduce urine protein and improve renal function. Spleen and kidney tonics such as Atractylodes and yam can enhance the body’s resistance to microbial invasion and have a significant effect on the repair of diseased epithelial tissues. Blood-activating and softening drugs can relax the smooth muscle of renal blood vessels, release vascular spasm, improve blood flow, and achieve the purpose of protecting renal function.
Patients with nephrotic syndrome are treated with hormones and immune preparations, which often lead to immune dysfunction, decreased resistance, recurrent attacks and gastrointestinal reactions and bone marrow suppression, and can be treated with piglet soup with astragalus and danshen to nourish blood and vitalize qi. It can eliminate the side effects of hormones and immune preparations, regulate immune function and reduce the incidence of hormone rebound.
At the stage of hormone reduction, because the suppressed renal cortical function is difficult to be restored within a short period of time, the patient often shows the corticosteroid withdrawal syndrome, and the symptoms change from yin deficiency and yang hyperactivity to qi and yin deficiency, at this time, pigling soup should be combined with ginseng and white atractylodes to strengthen the function of benefiting qi and nourishing yin. With the reduction of hormones to the maintenance amount, the exogenous hormones are withdrawn in large quantities, making the suppression of the adrenal-thymus axis more prominent, and the symptoms change from deficiency of both qi and yin to deficiency of both yin and yang.