2012年4月13日星期五
Lupus nephritis, kidney damage manifested
About 70% of patients with varying degrees of renal damage in the clinical manifestations of varying degrees of proteinuria, microscopic hematuria is more common, often accompanied by tubular urine and renal function impairment. The majority of patients with renal impairment to a lesser degree. Some patients although the clinical symptoms, but are not the development of renal insufficiency. Only a small number of renal damage in patients with renal failure. Hypertension is often associated with renal failure extent, become an important factor affecting prognosis. (A) asymptomatic proteinuria and (or) the hematuria type: This type is more common.Mainly for light - moderate proteinuria (<2.5g or (and) hematuria. (B) type of acute nephritic syndrome: rare, clinical manifestations resembles a post-streptococcal acute nephritis. (C) rapidly progressive glomerulonephritis syndrome type: rare, clinically resembles rapidly progressive glomerulonephritis. Characterized by three months, serum creatinine increased by ≥ 1 times. Uremia occurred within weeks to months. (D) The nephrotic syndrome: This type is common, accounting for about 2/3, but not necessarily with hyperlipidemia. When not in treatment, the majority of 2 to 3 years to uremia. This type is often confused with primary nephrotic syndrome, it is noteworthy. (E) chronic nephritic syndrome: the performance of sustained proteinuria, hematuria, urinary tube, and varying degrees of edema, hypertension, anemia and renal insufficiency. Course of a long, delayed healing, and thus occurrence of uremia. (F) a small number of patients can be manifested as chronic tubule interstitial nephritis clinical manifestations of patients with clinical manifestations of the specific gravity and (or) reduce the osmotic pressure, nocturnal enuresis, high or hypokalemia and other electrolyte disorders. End-stage lupus nephritis uremia, the patient's clinical activities (including serology) may disappear or become typical.
Systemic manifestations of lupus nephritis
The most common systemic manifestations of lupus nephritis with unexplained
fever, arthritis, and skin and mucous membrane damage. The system is accompanied
by involvement of the liver, heart, central nervous system and blood-forming
organs, more than 1/3 of patients with polyserositis (pleural and
pericardial).
(A) General symptoms: Most patients showed generalized weakness, weight loss, 90% of patients have fever, some more than 39 ° C.
(B) of the skin, mucous membrane damage: The majority of patients the skin is exposed at the skin lesions, about half of patients with facial butterfly erythema, or hair loss.Visible urticaria in some patients, discoid erythema, the palm of your hand, refers to nail week erythema, purpura. Some patients with oral ulcers. These hair loss as the main indicators of the SLE disease activity.
(C) of the joints and muscles: 90% of patients with joint pain, common to the small joints in the limbs. About 30% of patients with muscle pain. Large quantities of irregular use of hormones can lead to some patients with aseptic necrosis of femoral head.
(D) cardiovascular: some patients can occur in pericarditis, generally short and mild, a few may occur in patients myocarditis performance. About 1/4 patients, there may be Raynaud's phenomenon.
(Five lung and pleura: Some patients may have pleurisy or lupus pneumonitis. But a common clinical SLE complicated infection caused by pneumonia, rather than lupus pneumonitis, should be noted.
(F) the blood system: ① red blood cells: 50% ~ 75% of patients showed positive pigment cell anemia; ② The white blood cells: 60% of the patients white blood cell count <4.5 x 109 / L, in particular, is the lymph decreased more significantly; ③ platelet: general slightly lower, a few can be severely reduced. Approximately 50% of patients with lymph node enlargement.
(G) the gastrointestinal tract: abdominal pain, may be associated with abdominal organ lesions caused by vasculitis. Liver, splenomegaly were found in 30%, 20% of patients.The small number of patients with ascites.
(H) of the nervous system: clinical manifestations of complex and diverse, of varying severity. Often show mental disorders such as depression, mental confusion, pay attention to the spirit and hormone-induced abnormal differentiated. The most notable is the epilepsy (15% ~ 50%), and the occasional migraine, peripheral neuritis.
(A) General symptoms: Most patients showed generalized weakness, weight loss, 90% of patients have fever, some more than 39 ° C.
(B) of the skin, mucous membrane damage: The majority of patients the skin is exposed at the skin lesions, about half of patients with facial butterfly erythema, or hair loss.Visible urticaria in some patients, discoid erythema, the palm of your hand, refers to nail week erythema, purpura. Some patients with oral ulcers. These hair loss as the main indicators of the SLE disease activity.
(C) of the joints and muscles: 90% of patients with joint pain, common to the small joints in the limbs. About 30% of patients with muscle pain. Large quantities of irregular use of hormones can lead to some patients with aseptic necrosis of femoral head.
(D) cardiovascular: some patients can occur in pericarditis, generally short and mild, a few may occur in patients myocarditis performance. About 1/4 patients, there may be Raynaud's phenomenon.
(Five lung and pleura: Some patients may have pleurisy or lupus pneumonitis. But a common clinical SLE complicated infection caused by pneumonia, rather than lupus pneumonitis, should be noted.
(F) the blood system: ① red blood cells: 50% ~ 75% of patients showed positive pigment cell anemia; ② The white blood cells: 60% of the patients white blood cell count <4.5 x 109 / L, in particular, is the lymph decreased more significantly; ③ platelet: general slightly lower, a few can be severely reduced. Approximately 50% of patients with lymph node enlargement.
(G) the gastrointestinal tract: abdominal pain, may be associated with abdominal organ lesions caused by vasculitis. Liver, splenomegaly were found in 30%, 20% of patients.The small number of patients with ascites.
(H) of the nervous system: clinical manifestations of complex and diverse, of varying severity. Often show mental disorders such as depression, mental confusion, pay attention to the spirit and hormone-induced abnormal differentiated. The most notable is the epilepsy (15% ~ 50%), and the occasional migraine, peripheral neuritis.
2012年4月10日星期二
Lupus nephritis kidney damage performance
Symptoms of lupus erythematosus kidney damage is almost a series of symptoms, including glomerular, tubulointerstitial, renal vascular disease, can also be abrupt onset can be insidious, the course is generally longer, with or without symptoms, can also be kidney damage as the only clinical manifestations. Edema is a common clinical manifestations tend to be the main reason for patients attending. The increase in nocturnal enuresis is one of the early symptoms often reflect the urinary concentration of dysfunction. About 1/6 patients with varying degrees of renal insufficiency at the time of diagnosis. According to its clinical manifestations can be divided into the following type:
Asymptomatic proteinuria (1) or (and) the hematuria type: This type is more common, edema, hypertension, mild to moderate proteinuria (<2.5g / d) or (and) hematuria.
(2) type of acute nephritic syndrome: rare, clinically resembles streptococcal infection, acute nephritis, acute onset of hematuria, proteinuria, urinary tube, may have edema, hypertension, and even acute renal decline.
(3) rapidly progressive glomerulonephritis syndrome, type: rare, clinically resembles rapidly progressive glomerulonephritis, abrupt onset and rapid development of oliguria or anuria, hematuria, proteinuria, urinary tube, can be edema, often without high blood pressure or mild hypertension, rapidly deteriorating rapidly and the development of anemia and hypoproteinemia, renal function, uremia in the weeks and months.
(4) nephrotic syndrome: This type is common, about 60% of patients with renal impairment performance for this type. The clinical manifestations of massive proteinuria (3.5g / d) and hypoproteinemia, severe edema, but not necessarily have high cholesterol.If not treated, the majority of 2 to 3 years, the development of uremia. This type is easy to be confused with primary nephrotic syndrome, it is noteworthy.
(5) type of chronic nephritic syndrome: the performance of persistent proteinuria, hematuria, urinary tube, and varying degrees of edema, hypertension, anemia and renal insufficiency. Course of a long, delayed healing and poor prognosis.
(6) The type of renal tubular syndrome: a rare renal tubular acidosis, nocturia, edema, hypertension, increased urine β2-microglobulin, half of the patients with renal dysfunction.
(7) clinical "silence": the clinical symptoms and signs had no kidney involvement, performance, urine tests negative, but the pathological examination (particularly in the electron microscopy and immunofluorescence) positive.
Asymptomatic proteinuria (1) or (and) the hematuria type: This type is more common, edema, hypertension, mild to moderate proteinuria (<2.5g / d) or (and) hematuria.
(2) type of acute nephritic syndrome: rare, clinically resembles streptococcal infection, acute nephritis, acute onset of hematuria, proteinuria, urinary tube, may have edema, hypertension, and even acute renal decline.
(3) rapidly progressive glomerulonephritis syndrome, type: rare, clinically resembles rapidly progressive glomerulonephritis, abrupt onset and rapid development of oliguria or anuria, hematuria, proteinuria, urinary tube, can be edema, often without high blood pressure or mild hypertension, rapidly deteriorating rapidly and the development of anemia and hypoproteinemia, renal function, uremia in the weeks and months.
(4) nephrotic syndrome: This type is common, about 60% of patients with renal impairment performance for this type. The clinical manifestations of massive proteinuria (3.5g / d) and hypoproteinemia, severe edema, but not necessarily have high cholesterol.If not treated, the majority of 2 to 3 years, the development of uremia. This type is easy to be confused with primary nephrotic syndrome, it is noteworthy.
(5) type of chronic nephritic syndrome: the performance of persistent proteinuria, hematuria, urinary tube, and varying degrees of edema, hypertension, anemia and renal insufficiency. Course of a long, delayed healing and poor prognosis.
(6) The type of renal tubular syndrome: a rare renal tubular acidosis, nocturia, edema, hypertension, increased urine β2-microglobulin, half of the patients with renal dysfunction.
(7) clinical "silence": the clinical symptoms and signs had no kidney involvement, performance, urine tests negative, but the pathological examination (particularly in the electron microscopy and immunofluorescence) positive.
What are the extra-renal manifestations of lupus nephritis?
Systemic lupus erythematosus is a common disease can occur at any age and
sex, is common in young women, the most common 20 to 30 years. Extrarenal
manifestations are:
(1) General symptoms: Most patients showed generalized weakness, weight loss, 90% of patients have fever, heat-type variable, 40% more than 39 ℃.
(2) skin and mucous membranes: 50% of patients, there may be facial butterfly erythema, lesions confined to the two cheeks and the nose bridge, was mild edema and erythema, telangiectasia and scaly blisters, severe exudative inflammation and crusts, erythema subsided in general does not leave scars and pigmentation. The hair loss seen in 50% of patients, is a sensitive indicator of lupus activity. Livedo reticularis is common, is a typical characteristic of vasculitis. Many symptoms of the nervous system. In addition, also visible urticaria, Discoid erythema, A Zhou erythema, purpura, crack haemorrhage, oral and nasal ulcers.
(3) joint and muscle: 90% of patients with joint pain, common in the limbs, joints, about 10% of patients may have mild joint deformity, but generally no bone erosion signs.Long-term, large, irregular use of hormones, can lead to some patients with aseptic necrosis of femoral head. 1/3 of patients with muscle pain, and some even appear obvious symptoms of muscle weakness or muscle atrophy.
(4) cardiovascular: up to 2/3 of patients with active lupus erythematosus pericarditis cases, usually short and mild clinical manifestations. 10% of patients with myocarditis.Mitral and aortic valve may also be involved, generally at the apex and the heart at the bottom of smell and systolic murmur, which may also be related to anemia, tachycardia, or fever, diastolic murmur rare. There is also the Raynaud's phenomenon (25%), pulmonary hypertension and recurrent thrombophlebitis, which can be lupus erythematosus in the first symptom.
(5), lung and pleura: 40% ~ 46% of patients can occur in pleurisy, it is a reliable indicator of lupus erythematosus forthcoming involving the kidneys. Acute lupus pneumonitis and rare, difficulty breathing, chest pain and cough, and severe cases, massive hemoptysis, and some patients present with recurrent pulmonary atelectasis, a few may develop as diffuse interstitial pulmonary fibrosis.
(6) the blood system: 50% ~ 75% of the patients showed positive pigment cell anemia; 60% of patients with white blood cells <4.5 × 109 / L; platelet is generally slightly lower, a small number of <30 × 109 / L (approximately 50% ).
(7) of the gastrointestinal tract: some patients have nausea, vomiting, abdominal pain is common (approximately 50%) may be associated with peritonitis and abdominal viscera. Liver, splenomegaly were found in 30% and 20% of patients.
(8) of the nervous system: the incidence of symptoms and signs of about 50% to 60%, complex and diverse clinical manifestations, and manifests itself as mental disorders such as depression, mental confusion. Or epilepsy, migraine, paralysis, chorea, peripheral neuropathy and retinopathy.
(9) Other: menstrual irregularity, premenstrual symptoms increased, especially migraine. Some patients may occur painless lymph nodes, parotid gland swelling, conjunctivitis.
(1) General symptoms: Most patients showed generalized weakness, weight loss, 90% of patients have fever, heat-type variable, 40% more than 39 ℃.
(2) skin and mucous membranes: 50% of patients, there may be facial butterfly erythema, lesions confined to the two cheeks and the nose bridge, was mild edema and erythema, telangiectasia and scaly blisters, severe exudative inflammation and crusts, erythema subsided in general does not leave scars and pigmentation. The hair loss seen in 50% of patients, is a sensitive indicator of lupus activity. Livedo reticularis is common, is a typical characteristic of vasculitis. Many symptoms of the nervous system. In addition, also visible urticaria, Discoid erythema, A Zhou erythema, purpura, crack haemorrhage, oral and nasal ulcers.
(3) joint and muscle: 90% of patients with joint pain, common in the limbs, joints, about 10% of patients may have mild joint deformity, but generally no bone erosion signs.Long-term, large, irregular use of hormones, can lead to some patients with aseptic necrosis of femoral head. 1/3 of patients with muscle pain, and some even appear obvious symptoms of muscle weakness or muscle atrophy.
(4) cardiovascular: up to 2/3 of patients with active lupus erythematosus pericarditis cases, usually short and mild clinical manifestations. 10% of patients with myocarditis.Mitral and aortic valve may also be involved, generally at the apex and the heart at the bottom of smell and systolic murmur, which may also be related to anemia, tachycardia, or fever, diastolic murmur rare. There is also the Raynaud's phenomenon (25%), pulmonary hypertension and recurrent thrombophlebitis, which can be lupus erythematosus in the first symptom.
(5), lung and pleura: 40% ~ 46% of patients can occur in pleurisy, it is a reliable indicator of lupus erythematosus forthcoming involving the kidneys. Acute lupus pneumonitis and rare, difficulty breathing, chest pain and cough, and severe cases, massive hemoptysis, and some patients present with recurrent pulmonary atelectasis, a few may develop as diffuse interstitial pulmonary fibrosis.
(6) the blood system: 50% ~ 75% of the patients showed positive pigment cell anemia; 60% of patients with white blood cells <4.5 × 109 / L; platelet is generally slightly lower, a small number of <30 × 109 / L (approximately 50% ).
(7) of the gastrointestinal tract: some patients have nausea, vomiting, abdominal pain is common (approximately 50%) may be associated with peritonitis and abdominal viscera. Liver, splenomegaly were found in 30% and 20% of patients.
(8) of the nervous system: the incidence of symptoms and signs of about 50% to 60%, complex and diverse clinical manifestations, and manifests itself as mental disorders such as depression, mental confusion. Or epilepsy, migraine, paralysis, chorea, peripheral neuropathy and retinopathy.
(9) Other: menstrual irregularity, premenstrual symptoms increased, especially migraine. Some patients may occur painless lymph nodes, parotid gland swelling, conjunctivitis.
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