Hematuria, edema, back pain, polyuria and frequent urination are common symptoms of kidney disease. However, the above symptoms do not indicate a kidney disease. Only if the above symptoms plus abnormal urine routine (proteinuria, hematuria, tubular urine, leukocyturia) or abnormal kidney function can be considered as kidney disease.
1.Hematuria
There are flesh-eye hematuria and microscopic hematuria. Carnal hematuria urine is blood-like or washed water-like or those with blood clots.
True hematuria and pseudo hematuria.
Microscopic hematuria: centrifugal residue RBC≥3/HPF; or bovine packet wah count disc count RBC≥8000/ml; or RBC excretion rate >100,000 per hour; or Addis’ count RBC>500,000/12h, any of the above is true hematuria. True hematuria is a lesion of the kidney, ureter, bladder, prostate and urethra, but pseudohematuria should be excluded.
Pseudohematuria.
① urine color like blood urine, not hematuria, such as paroxysmal sleep hemoglobinuria, the patient’s urine is soy sauce or coffee; certain foods (such as beets, tomato leaves, pigment) can make the urine red; certain drugs (rifampin, dalantin, phenothiazine, etc.) can also make the urine red, but check the urine without RBC for differentiation.
(2) Transient hematuria, such as those caused by pollen, chemicals or drugs, can also occur after strenuous exercise, viral infections (such as the flu, etc.), only one to two times to check the urine RBC ≥ 3 / HPF, repeatedly rechecked negative, usually no significant significance.
③Fake hematuria, someone intentionally mixes blood into the urine of fake hematuria, the method of exclusion is to pay attention to the retention of specimens.
④Contaminated hematuria: hematuria caused by a woman’s menstrual period contaminating the urine specimen. None of the above faked hematuria is a kidney disease. It is only true hematuria that is considered a kidney disease.
2.Oedema
In addition to floating edema seen in glomerulopathy, it is also seen in cardiac, hepatic, endocrine and malnutrition edema.
Cardiac edema should be distinguished by a history of heart disease, evidence of heart failure and swelling in the afternoon or evening, and reduced the next morning.
Hepatic edema has a history of liver disease, abnormal liver function, and edema that extends to the extremities after the appearance of ascites.
Endocrine edema is more common in women with endocrine disease, and the edema does not change significantly for 24 hours, and there is no obvious depression when pressed.
Malnutrition edema, there should be wasting and other signs of malnutrition, while plasma albumin is low.
Differentiation points: urine routine with or without proteinuria.
Nephrogenic edema is mostly caused by glomerular disease or other diseases that lead to glomerular damage. Edema is predominant in the lax tissues, obvious in the eyelids and lower extremities, and is worse in the morning and reduced in the afternoon or evening, accompanied by proteinuria, hematuria or granular tubular pattern. If the urine routine of edema patients is normal, basically kidney disease can be excluded.
3.Lower back pain
In addition to kidney diseases, lumbar muscle strain, lumbar transverse syndrome, lumbar disc protrusion, lumbar spine osteophytes and gynecological diseases can also be seen. Kidney diseases can be seen as renal calculi, obstructive nephropathy, giant pelvic effusion, pyelonephritis, acute and chronic glomerulonephritis, renal vein thrombosis, nephrotic syndrome, renal cell tumor and perinephric inflammation, but low back pain caused by kidney diseases should have the following characteristics.
① pressure pain at the pressure point of the spinal rib angle or the pressure point of the rib and waist or the pressure point of the upper ureter; ② significant abnormalities in urine routine; ③ positive findings in renal ultrasound and renal venography (IVP), and further feasible CT examination. If there is no pressure pain at the above three pressure points, urinary routine is normal, and further investigation of renal ultrasound and IVP is not abnormal, renal disease can be basically excluded.
4.Polyuria
It refers to 24-hour urine volume over 2500ml, caused by a variety of reasons, non-renal uremia, hyperglycemic diuresis, primary aldosteronism, primary hyperparathyroidism, psychiatric factors, recovery from heart failure, etc. Nephrogenic include chronic interstitial nephropathy, recovery from acute tubular necrosis, hypokalemic nephropathy, renal arteriosclerosis, hypercalcemic nephropathy, etc. Nephrogenic polyuria has more abnormal urine routine or increased urinary calcium or amino acid content for differentiation.