Department of Nephrology, Peking Union Medical College Hospital
Chronic interstitial nephritis is a group of diseases characterized by tubular atrophy, interstitial fibrosis and cell infiltration of different degrees.The mechanism of renal interstitial damage may involve immune injury, infection, poisoning, metabolic disorder, urinary mechanical obstruction and genetic factors.The main clinical manifestation is the impairment of renal tubular function, and the later stage of the disease isChronic renal failure。
TCM disease name
Chronic interstitial nephritis
Foreign name
Chronic interstitial nephritis
Visiting department
Department of Nephrology
Common location
kidney
Common causes
Chronic infection, drugs or chemical poisons, chronic rejection of transplanted kidney, etc
Chronic interstitial nephritis usually causes chronic interstitial nephritis by occult onset, which can also be the continuation of acute interstitial nephritis.Common clinical manifestations: some cases may have no symptoms.Often found during physical examination or medical treatment due to other diseasesanemia、hypertensionAnd slight changes in routine urine tests. In severe cases, renal dysfunction and renal osteopathy can be found.Urine examination often shows mild proteinuria (usually low molecular proteinuria), with a small amount of white blood cells in the urine sediment, occasionally red blood cells and casts.
In the early stage of the disease, renal tubular function is damaged. When the glomerular filtration rate (GFR) is normal or only slightly reduced, nocturia, low specific gravity urine, decreased urine osmotic pressure, and sometimes polydipsia, polyuria and other symptoms can occur.Hyperchloremia can be caused by the dysfunction of bicarbonate absorption in proximal tubules or the dysfunction of uric acidification in distal renal tubulesMetabolic acidosis, i.eRenal tubular acidosis。The function of proximal renal tubules is damaged, with decreased absorption and increased excretion of bicarbonate, sugar, uric acid, phosphate and amino acidFanconi syndrome。Some distal renal tubules are dysfunctional, resulting in loss of salt and potassium storage. In severe cases, insufficient capacity and/orHyperkalemia。
In the late stage of renal insufficiency, fatigue, anorexia, nausea, vomiting, anemia and other symptoms may occur. Anemia is often serious, which is not parallel to the degree of renal dysfunction.More than half of patients can develop hypertension.When some patients have acute renal papillary necrosis, they often have chills, high fever, and naked eyeshematuriaLow back pain, necrotic tissue fragments can be found in urine sediment.
diagnosis
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Due to the lack of specificity in the clinical manifestations of this disease, the diagnosis is often very untimely.In order to prevent missed diagnosis, the medical history should be inquired in detail to try to find the cause.The specific gravity of urine is low, and there are few changes in urine sediment inspection. There are usually only a few cells, and generally there is no cell tube type.The proteinuria is generally light, and the urine protein ration is<1.5g/24h, often<0.5g/24h.Proteinuria is generally low molecular proteinuria of renal tubule, such as urinary lysozyme, β 2-microglobulin, lysozyme, TH protein, retinol binding protein, etc. It can also occur in diabetes and amino acid urine.Electrolyte disorder and metabolic acidosis are common.During the acute attack of urinary system infection, urine examination can find more leukocytes and leukocyte casts.The glomerular filtration function may be normal, but many patients have reduced the glomerular filtration function to varying degrees when they visited the hospital.
Imaging (B ultrasound, X-ray, radionuclide, etc.) examination showed that the volume of both kidneys was normal or reduced.Renal biopsy showed interstitial fibrosis, tubular atrophy, diffuse lymphocyte and monocyte infiltration in different degrees;In some patients, the intima of renal arterioles was thickened, the lumen was narrowed, and the glomerulus was ischemic shrunken and sclerotic.
treatment
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First of all, we should emphasize early prevention, early diagnosis and early treatment. Third, we should pay attention to the combination of etiological treatment and symptomatic treatment, and try to control and eliminate the causes.For infectious or systemic diseases involving the kidney, it is necessary to actively treat the primary disease in a timely manner to prevent the renal interstitial disease from lingering or developing;Strictly grasp the clinical medication evidence, avoid the abuse of Chinese and western drugs, avoid excessive medication and long course of medication, to prevent drug induced interstitial nephritis.
In terms of etiological treatment, it is necessary to emphasize active control of infection, timely removal of urinary tract obstruction and reflux, cessation of the application of nephrotoxic drugs (analgesics, Guanmutong, etc.), and active treatment of systemic diseases involving the kidney.
In terms of symptomatic treatment, first of all, attention should be paid to correcting water, electrolyte and acid-base balance disorders, including water sodium retention, insufficient capacityMetabolic acidosis、HypokalemiaorHyperkalemiaEtc.
Patients with chronic renal failure should be treated according to the principle of chronic renal failure treatment, and actively treat anemia, hypertension, renal bone disease, cardiovascular disease, infection and other complications.For advanced chronic renal failure（uremia）Patients need to be treated in time (dialysis andrenal transplant）。
