Patient Question: Disease:Primary nephritis Description:In December 15, the physical examination and hospital re-examination found that urine protein 2+ and occult blood 3+ red blood cells, occasionally wake up in the morning with facial edema quickly after the swelling, blood pressure is normal, normal kidney function, no hepatitis B, lupus erythematosus, etc., no medical history, no family nephritis, the diagnosis is primary chronic nephritis, pathology recommended to do a kidney puncture, not to do a kidney puncture, what else? I’d like to ask the doctor to give me some advice on treatment, whether it is necessary to do a kidney puncture to confirm the diagnosis, whether there are other ways to confirm the diagnosis and treatment recommendations The hospital department: The Third Affiliated Hospital of Sun Yat-sen University, Department of Nephrology Treatment: Hospital department: unfilled Unfilled Treatment process: none Medication: taking instructions: diagnosis, have not used drugs Hospital Department of Traditional Chinese Medicine: With the improvement of living standards, people are in a position to pay attention to their health, many units or individuals have regular health checkups, which allows early detection of many chronic diseases without obvious symptoms, including chronic kidney disease, one is the blood biochemistry has a test for blood creatinine level, which can initially determine the state of kidney function and can detect patients with renal insufficiency earlier (many patients with renal failure without any history and symptoms of kidney disease), and the other is the routine urine test with proteinuria and occult blood items can indicate the presence of chronic kidney disease. Whether or not a kidney biopsy is needed after the discovery of chronic kidney disease is something that patients or their families often struggle with, and may be advised differently by different doctors, which often leaves patients with nothing to go on. Some patients may maintain normal kidney function for a long time, while others will progress to uremia and require dialysis and other renal replacement therapy if left untreated. Therefore, it is very important to determine the severity of the patient’s disease to decide whether it is worth using these drugs with toxic side effects and the dosage and duration of treatment. There are two levels of diagnosis and severity of chronic kidney disease, one is clinical diagnosis and assessment, which is based on the amount of urine protein, the presence of hematuria, the status of renal function, the presence of renal hypertension, whether it is primary glomerular disease or secondary to other systemic diseases (e.g., allergic purpura nephritis, lupus nephritis, diabetic nephropathy, etc.) to make the diagnosis and severity determination The second level is the pathological diagnosis of renal penetration, which is relatively higher level than the clinical diagnosis and more accurate in assessing the severity of the disease, but the pathological diagnosis must also be combined with the clinical diagnosis to be more accurate, and in a few cases In a few cases, the judgment of pathological diagnosis on the severity of the disease is even wrong (after all, the kidney puncture is only a very small amount of kidney tissue extracted by the needle, which may not represent the whole lesion, for example, a patient I met clinically more than ten years ago, the pathological report of kidney puncture “sclerosing nephropathy”, the pathology at that time suggested that the disease was very serious and had a poor prognosis, but (The patient’s urinary routine is basically normal and renal function is still normal.) In addition, although renal puncture is generally a safer examination operation, it is after all an invasive examination, which can cause damage to the patient if there is an accident. Unless the patient and his family are willing to cooperate and face the possible risks together with the doctor after explaining the necessity of kidney biopsy, they will do it. Since this issue is so tangled, how can we as patients and their families make sense of it? First of all, the decision of whether to do renal puncture is mainly on the patient’s side. In the current environment, if the patient does not agree to renal puncture, the doctor will never do it for the patient, although it is a relatively safe test. If the patient wants to clarify the pathological diagnosis through renal puncture, so that the prognosis and treatment plan of the disease can be more accurate, as long as the patient does not have contraindications to renal puncture (such as single kidney patients, abnormal coagulation function, etc.) can do renal puncture. If patients have any concerns about nephroporation, I believe that nephroporation can be temporarily avoided in patients who do not have a large amount of urine protein (e.g., 24-hour urine protein quantification less than 1 gram), whose blood pressure is not high, whose renal function is normal, and whose clinical examination does not suggest that the disease is caused by other systemic diseases, but if there is a large amount of urine protein, abnormal renal function or acute progression, accompanied by renal hypertension, and suspected immune diseases, nephroporation is strongly recommended. However, if there is a large amount of urine protein, abnormal renal function or acute progression, with renal hypertension, suspected immune disease, it is strongly recommended to do a pathological diagnosis of renal puncture, because these conditions often suggest a serious disease and may require the use of hormones and immunosuppressive drugs.