Most patients with chronic kidney disease have no symptoms or mild symptoms in the early stage, so early laboratory tests are very important. To achieve early detection, the key is to insist on regular screening every year. Even if there are no symptoms, it is usually necessary to screen urine routine and kidney function once a year. If you have hypertension, diabetes, etc., you should regularly check urine routine, kidney function and other items twice or more per year (depending on the condition); if you already have certain symptoms, you should go to the hospital for a more comprehensive examination as soon as possible.
1.Urinary routine
Urine routine is the easiest way to check whether there are lesions in the urinary system, the nature and degree of lesions. Among them.
Urine protein (Pro): Positive urine protein is often caused by kidney disease, but excessive plasma protein, strenuous exercise, fever, heart failure, pericardial effusion and drugs may also cause positive urine protein.
Glucose (Glu): Positive urine glucose indicates decreased renal tubular reabsorption or diabetes mellitus. When blood glucose is normal and urine glucose is positive, it is called “renal diabetes”, which indicates abnormal renal tubular reabsorption of glucose (glucose leaks out of the renal tubules), not diabetes.
Erythrocytes (Ery): Positive urine red blood cells is called “hematuria”. In mild cases, hematuria cannot be detected by the naked eye and can only be determined by microscopic examination, called “microscopic hematuria”; in severe cases, the urine is the color of washed water or even blood, called “carnal hematuria”. “Hematuria is commonly seen in glomerulonephritis, urinary tract infection, urinary stones, and sometimes in tumors, cysts, malformations, and trauma of the urinary tract.
Leukocytes (LEU): The presence of leukocytes (1+ to 4+) in fresh mid-stage urine examination is often indicative of urinary tract infection, or sometimes non-infectious interstitial renal tubular lesions.
Other influencing factors: drugs or food can change the color and pH of urine; dilution of urine after drinking a lot of water can affect urine specific gravity and other items; urinalysis during menstruation and within 2-3 days before and after menstruation in female patients can affect urine results.
2, urine sediment phase contrast microscopy (urine red blood cell morphology examination)
If urinary anomalous red blood cells >80% are found, hematuria should be considered to be from the glomerulus.
3.Serum creatinine concentration (sCr).
4.Myohepatic clearance (Ccr).
5.24-hour urine protein quantification
Normal value <0.2g/24hour urine. If the 24-hour urine protein quantification increases, it can reflect the degree of glomerular or tubular lesions. This test is more accurate than the urine routine urine protein test, and thus better reflects the condition. However, urine retention of less than 24 hours; mixed with foreign bodies in the urine; eating a large amount of protein on the same day will affect the test results.
6.Quantitative urine microalbumin
The normal value is <20 mg/min or <30 mg/24 h. If the result is 20-200 mg/min or 30-300 mg/24 h, it can be determined as microalbuminuria. This test is a sensitive measure of microalbumin in urine and is one of the sensitive indicators of early kidney damage. For patients with hypertension, diabetes, recurrent long-term urinary tract infections, drug intoxication, etc., urine microalbumin should be tested regularly for early detection of disease damage.
7.Urine low molecular protein: β2-microglobulin, a1-microglobulin, transferrin, light chain protein, etc.
Urinary low molecular weight protein is a group of proteins that can be freely filtered by the glomerulus, but all reabsorbed in the proximal tubule. The increased urinary excretion of this group of proteins is a sign of impaired tubular function. It is commonly found in various tubulointerstitial nephritis, such as chronic pyelonephritis, hypertensive kidney damage, uric acid nephropathy, renal tubular acidosis, drug-related kidney damage, etc.
8, urine osmolality.
Normal value 600 ~ 1400 (mOsm/kg?H2O). Urine osmolality measurement value is more reliable than urine specific gravity, and its level decreases indicates that the renal tubular concentration function is reduced.
9.Bacterial culture and drug sensitivity test of clean middle urine
To understand the types of pathogenic bacteria of urinary tract infection and provide a basis for clinical selection of antibiotics.
10.Urinary cytology pathology examination
To understand the presence or absence of urinary tumors and the classification of tumor cells.
11.B-type ultrasound examinationÂ
It can understand the size and shape of kidney, and the presence of stones, tumors, cysts, hydronephrosis, urinary tract obstruction, congenital malformation and other lesions.
12.Nephrogram and renal dynamic imaging
To understand the renal blood flow, glomerular filtration function, renal excretion function of each of the left and right kidneys, and to indicate the presence of renal artery stenosis.
13.Intravenous pyelogram
To observe the structure and function of the organs of the urinary system and to understand the characteristics and nature of the lesions in the urinary tract.
14.Renal puncture biopsy pathological examination
It is the only way to clearly diagnose acute and chronic nephritis, but it is risky.
15.Kidney CT and magnetic resonance imaging (MRI)
CT and MRI. can detect fine calcifications and stones that cannot be detected by ordinary X-rays. It can also determine the location and nature of kidney lesions or congenital developmental abnormalities. MRI has higher resolution and minimal damage to the body, which are its main advantages