Low back pain with renal percussion pain
Introduction
Introduction Acute membranous nephropathy is characterized by sudden onset of low back pain, often more intense, with pain in the kidney area.
Cause
Cause
The cause of low back pain with sputum pain in the kidney area:
(1) Causes of the disease: The exact cause of the disease is not clear, and the clinical classification can be divided into two categories: primary MN and secondary MN. The cause of the former is unknown, the latter is often associated with some autoimmune diseases such as systemic lupus erythematosus, hepatitis B and hepatitis C, it is generally believed that the disease has autoimmune abnormalities. The secondary causes of membranous nephropathy are:
1. Immune diseases: systemic lupus erythematosus, rheumatoid arthritis, diabetes, Hashimoto's thyroiditis, Graves' disease, mixed connective tissue disease, Sjogren's syndrome, primary biliary cirrhosis, ankylosing spine Inflammation and acute infectious polyneuritis.
2. Infection: Hepatitis B, hepatitis C, syphilis, leprosy, filariasis, schistosomiasis and malaria.
3. Drugs and poisons: organic gold, mercury, D-penicillamine, captopril and probenecid.
4. Tumor: lung cancer, colon cancer, breast cancer and lymphoma.
5. Others: sarcoidosis, transplanted kidney recurrence, sickle cell disease, and vascular lymphoid hyperplasia (Kimura disease). However, 75% of membranous nephropathy can not find the above reasons, that is, it belongs to primary membranous nephropathy.
(B) pathogenesis: Although the current understanding of the pathogenesis of primary membranous nephropathy is not much, but most scholars agree that immune damage is the basic mechanism of its pathogenesis. Membranous nephropathy is an autoantibody-mediated glomerular lesion that is produced by antigenic components on the membrane of normal glomerular epithelial cells. The immune complexes are isolated from the epithelial cells of the epithelial membrane to form typical immune complexes. calm. The calming immune complex activates complement, where C5b-9 is produced. The complement membrane attack complex causes proteinuria, and the activated cytokines during the pathological process cause changes in the extracellular matrix component of the basement membrane, causing thickening of the basement membrane and further development of the lesion. Its possible pathogenesis has the following points:
1. Potential pathogenic antigens: Although some scholars have reported finding a DNA, thyroglobulin, tumor-associated antigen, renal tubular epithelial antigen, hepatitis B virus, etc. in the glomerular subepithelial deposition complex in patients with membranous nephropathy. A series of antigens, but only the deposition of the above proteins does not necessarily cause disease. At present, the pathogenic antigens and antibodies that cause the deposition of subcutaneous immune complexes on the glomerular basement membrane of the disease are not clear.
2. Subepithelial immune complex formation:
(1) Circulating immune complex deposition: Dioxon and Germuth use small doses of heterologous protein (2.5mg/d) daily injection to cause chronic serum disease in rabbits. The renal lesions are similar to membranous nephropathy, and the immune complex is deposited under the epithelium. Only small immune complexes were found in the circulation. Conversely, if rabbits receive different doses and methods of heterologous protein, larger immune complexes will appear, with the deposition site being mesangial rather than subepithelial. Germuth emphasizes that the immune complex in the membranous nephropathy cycle should have the characteristics of small molecular weight and a large amount of negative charge. However, these two points are not easily available in the body at the same time, and there is still doubt about the reliability of the circulating immune complex theory.
(2) In situ formation of immune complexes caused by non-renal antigens: This theory indicates that lesions can be caused by the reaction of circulating antibodies with a glomerular innate antigen, which is due to certain basement membranes. Biochemical properties and electrostatic affinity are previously "implanted" into the glomerulus to form an in situ immune complex, thereby damaging the glomerulus.
(3) In situ formation of immune complexes caused by renal antigen: This is a local glomerular intrinsic antigen component that reacts with circulating antibodies to form an in situ immune complex. This is a generally credible doctrine since the 1980s.
3. Complement-mediated: In 1980, Salant and Couser proposed for the first time in the passive Heymann nephritis model that complement activation is a necessary condition for pathogenesis. Studies have confirmed that inflammatory cell infiltration is not found in the glomeruli of membranous nephropathy, and there is no cleavage product such as C5a produced by the classical activation pathway of complement. However, a membrane attack complex (C5b-9 mem-brane attack complex, MAC) containing the complement component Csb-9 was discovered.
The membrane attack complex (MAC) can be inserted into the phospholipid bilayer structure of the glomerular epithelial cell membrane, causing damage to the cell membrane structure, affecting the synthesis and repair of the glomerular basement membrane, and changing capillary permeability. Immunoelectron microscopy confirmed that the membrane attack complex can be transferred from the basement membrane side to the renal capsule side by epithelial cells, and discharged into the urine by exocytosis, so that the urine membrane attack complexes in the early stage of membranous nephropathy or during immune activity. The amount of excretion increased. The MAC also activates glomerular epithelial cells to locally release inflammatory mediators and oxygen free radicals that act directly on the basement membrane. The release of a large number of oxygen free radicals oxidizes lipids, causing the degradation of glomerular epithelial cells and basement membrane IV collagen and increasing the permeability of the basal membrane to proteins, causing proteinuria, plus probucol (probucol) Probucol) Proteinuria is reduced by 85% after this antioxidant.
The study found that glomerular epithelial cells are versatile, such as glomerular epithelial cell membrane contraction, can resist 4.76kPa (35mmHg) transmembrane hydrostatic pressure, epithelial cells are an important part of the glomerular filtration barrier; epithelial cells Reacts with the cell adhesion molecule integrin 31; releases a variety of cytokines and inflammatory mediators, including: 1 bioactive esters: such as arachidonic acid epoxidase products PGE2, TXA2, etc. and lipoxygenase product 12-hydroxy Decaenoic acid (12-HETE). 2 matrix metalloproteinase (MMP)-9 and a matrix metalloproteinase tissue inhibitor (TIMP). 3 fibrinolysis factor: is a tissue type and urokinase-type plasminogen activator and inhibitor. 4 growth factors and differentiation factors: transforming growth factor (TGF), platelet growth factor (PDGF), epidermal growth factor (EGF). 5 Cytokines related to inflammation, immune recognition, and chemotaxis: such as interleukins.
In addition, epithelial cells have receptors for complement and various growth factors on the surface. There are related antigens of membrane nephropathy on the surface of SD rats in experimental animals; glomerular epithelial cells play an important role in the synthesis and repair of basement membrane; cell culture proves that podocytes can synthesize matrix components such as IV collagen and fibronectin. Both animal models and clinical studies have suggested an increase in the synthesis of laminin, heparin sulfate proteoglycan, and IV collagen in membranous nephropathy. These TGF-2-mediated changes in the composition of the extracellular matrix are one of the causes of thickening of the basement membrane.
Examine
an examination
Related inspection
Renal percutaneous nephrolithotomy, lumbar back examination, urinary occult blood
Low back pain with examination and diagnosis of sputum pain in the kidney area:
It is characterized by a sudden onset of low back pain, often more intense, with pain in the kidney area. Urine protein suddenly increased, often with gross hematuria, leukocyteuria, hypertension and acute renal dysfunction. B-ultrasound increased kidney. Bilateral renal vein thrombosis can cause oliguria and acute renal failure.
Diagnosis
Differential diagnosis
Symptoms of low back pain associated with sputum pain in the kidney area:
Low back pain radiates to the lower extremities: low back pain is as painful as "explosion", and radiates to the back of the thigh, the armpit, the outside of the calf, and has a feeling of acupuncture or electric shock. After the low back pain, the lower extremity feels numb. After the patient lie down, the symptoms are relieved. Standing, walking, and even coughing and sneezing. When the bowel movement is forced, the back pain is aggravated, suggesting that it may be lumbar disc herniation. Low back pain, especially in the 4th to 5th lumbar vertebrae, and radiate to one side of the lower extremity, and even have obvious numbness. When lying down, the lower limbs of the affected side cannot lift straight legs, suggesting that it may be root sciatica.
One side of the waist and abdomen suddenly "knife cut" like colic: a side of the waist and abdomen suddenly "knife cut" like colic, along the direction of the ureter to the lower abdomen, perineum and inner thigh, can last from a few minutes to a few hours. During the onset of low back pain, the patient bends over the back, rests restlessly, pale, sweating. After the pain, there are many different degrees of hematuria, which are more common in urinary stones.
Low back pain with frequent urination, urgency, dysuria: low back pain accompanied by frequent urination, urinary urgency, dysuria, suggesting that it may be a urinary tract infection.
Back pain in bed is aggravated: low back pain is aggravated when lying in bed, but it is relieved after getting up, and lumbar fibrosis should be considered.
Low back pain with increased vaginal discharge: Many women with back pain, vaginal discharge more often, caused by inflammation of the reproductive system. Such as cervicitis, pelvic inflammatory disease, annex inflammation and so on. After the labor, excessive fertility, low back pain, excessive frequency of the child, excessive childbearing or excessive abortion, the waist is sore, other tests are normal, this is the Chinese medicine said kidney deficiency, caused by the loss of the waist . In summary, through the above discussion, we know that the causes of low back pain are various. In clinical practice, doctors must pass laboratory tests in addition to understanding symptoms and physical examinations to make a diagnosis. Therefore, when there is low back pain, you should go to the hospital for examination, symptomatic treatment, and do not abuse the supplement.
Diffuse low back pain: Clinically, patients with over 40 years of age may have skeletal or diffuse low back pain, fatigue, paleness, and mild weight loss. The possibility of myeloma should be suspected. Typical and advanced plasmacytoma are easy to diagnose, but early plasmacytoma is difficult to diagnose. Plasmacytoma can be painless in the early stages, with only minor or insignificant signs, which can last for months, even years.
Persistent low back pain with morning stiffness: non-ocular clinical manifestations of ankylosing spondylitis: the most typical early manifestation of persistent low back pain (at least 3 months), unilateral occult, blunt or intermittent, Accompanied by morning stiffness and reduced after activities.
Low back pain when bending over: When bending hard, lifting heavy objects or lifting heavy objects, sudden low back pain occurs, and the muscles on both sides of the lumbar vertebrae are cramped and tender, suggesting that it may be an acute lumbar sprain or lumbar muscle strain.
Low back pain: The pain point indicated by the patient is equivalent to the level of the buttocks area, and a few are in the lower half of the humerus, often accompanied by symptoms of lower abdominal pain. It is aggravated by premenstrual, long standing and sexual intercourse. It is a symptom of the pelvic blood stasis.
Chronic low back pain with lower limb numbness: Lumbar spondylolisthesis is prone to chronic low back pain and radioactive numbness in one or both lower extremities.
It is characterized by a sudden onset of low back pain, often more intense, with pain in the kidney area. Urine protein suddenly increased, often with gross hematuria, leukocyteuria, hypertension and acute renal dysfunction. B-ultrasound increased kidney. Bilateral renal vein thrombosis can cause oliguria and acute renal failure.
