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IgA nephropathy diagnosis, syndrome differentiation

  IgA nephropathy diagnosis, syndrome differentiation

  1, diagnosis

  1.1, the incidence of IgA nephropathy is the most common of a primary glomerular disease, is a diagnosis of immune pathology is a group of patients with no systemic disease, renal histopathological characteristics of mesangial cells and matrix hyperplasia Mainly immunopathological features of the mesangial area is mainly IgA deposition, clinical hematuria as the main performance of primary glomerulonephritis.

  1.2, IgA kidney disease urine test features 1, simple hematuria (microscopic hematuria or gross hematuria); 2, hematuria with mild to moderate proteinuria; 3, simple proteinuria, even for nephrotic syndrome. Clinically, the first two cases more common.

  IgA nephropathy in the early onset of blood pressure and renal function were normal. Part of the progress of patients late hypertension and renal dysfunction may occur, serum IgA value of about 50% of patients increased.

  1.3, diagnosis points

  1, the incidence of children or young people.

  2, the clinical manifestations of renal damage: hematuria, and even gross hematuria and / or varying degrees of proteinuria, with / without impatient, chronic renal failure.

  3, with pharyngitis synchronous hematuria characteristics, and by the detection of glomerular hematuria.

  4, must have renal biopsy results of immunopathology: IgA mainly in the glomerular mesangial area was lumps or scattered coarse particles distribution.

  5, must be followed by secondary IgA deposition-based glomerular disease.

  2, renal pathology

  2.1, light microscopy mainly in the mesangial area, showing varying degrees of mesangial cells and matrix hyperplasia. Common mesangial area. Some may be associated with varying degrees of renal tubular - interstitial damage.

  2.2, immunopathology IgA-based immunoglobulin and C3 in the mesangial area into a massive deposition. Some cases can be seen capillary wall IgA deposition, with IgM, IgG and other immune complex deposition.

  2.3, electron microscopy

  1, the typical features: glomerular mesangial cell proliferation, mesangial matrix increased and accompanied by high density density of electron dense particles deposition. Part of the cases can be seen under the endothelial cells of electron dense material deposition.

  2, pathological grade: Lee / Haans classification

  3, differential diagnosis

  IgA nephropathy should be mainly associated with allergic purpura nephritis, cirrhosis of the kidney, lupus nephritis and other secondary glomerular disease phase identification. Hematuria should also be thin basement membrane nephropathy and nutcracker phenomenon occurs by the identification of hematuria.

  4, dialectical classification

  4.1, lung Wei Feng hot, blood under the main symptoms: fever micro-evil cold, headache cough, sore throat, red urine or microscopic hematuria. Tongue side sharp red, thin white or thin yellow fur, pulse floating number.

  4.2, under the coke hot and humid, forced blood under the main symptoms: abdominal pain that diarrhea, upset thirst, or urinary frequency, burning astringent pain, waist pain, dry stool, red urine or microscopic hematuria. Red tongue, yellow greasy moss, slippery pulse number.

  4.3, Qi and Yin Deficiency Syndrome: microscopic hematuria or see with proteinuria, Shenpi weakness, waist and knee pain, hand, foot or warm or hand, foot and heart heat, sweating or night sweats, easy to cold, palpitations, mouth thirst or pharynx Dry pain, dry stool dry or loose pond thin. Pale red tongue with teeth or tongue fat, thin white or thin yellow fur, pulse breakdown and powerless.

  4.4, liver and kidney deficiency syndrome: microscopic hematuria or see with proteinuria, five upset hot, throat and pain, head dizziness, tinnitus, low back pain, dry stool. Red tongue, moss dry, pulse breakdown or string breakdown.

  4.5, spleen and kidney qi deficiency syndrome: microscopic hematuria or see with proteinuria, Shenpi fatigue, Yaoxisuanruan, nocturia, loose stools thin or diarrhea, mouth light is not thirsty, pale tongue, Thin white fur, pulse weak.