What to do if renal tubules are damaged

The main function of the renal tubules is to reabsorb water, glucose, protein, and excrete metabolites, etc., which plays a very important role in the body. This means that if the renal tubules are damaged due to one's own lack of restraint, it will cause great harm to one's body, resulting in the inability to excrete waste and obstruction of circulation in the body. This will cause symptoms such as edema and hematuria. When the renal tubules are damaged, early detection and early treatment can be achieved through the following examinations.

1. Condition analysis

The glomerular filtration function is generally evaluated by creatinine clearance as a routine indicator. The determination of selective urinary albumin is a synergistic indicator of creatinine clearance. The application of these two indicators has been relatively complete in the evaluation of early damage to the glomerular filtration function. The determination of blood urea nitrogen, blood creatinine and blood uric acid is still a commonly used clinical marker of glomerular function. Since the kidneys can excrete creatinine through the renal tubules, serum creatinine is usually not high in the early stages of kidney disease. It is not until the renal function is substantially damaged that serum creatinine values ​​increase. Therefore, blood creatinine measurement is of great clinical significance for late-stage kidney disease. Simultaneous determination of urea nitrogen and creatinine is helpful for clinical diagnosis.

Under normal circumstances, the ratio of urea nitrogen to creatinine is (15-24):1. In renal disease, serum urea nitrogen increases more significantly than creatinine, and prerenal causes (especially severe intestinal bleeding) cause significantly increased urea nitrogen values. Due to urethral obstruction, non-protein nitrogenous compounds are retained, and the urea nitrogen and creatinine values ​​will increase proportionally at the same time. In severe renal tubular damage, the ratio of urea nitrogen to creatinine can be reduced to 10:1.

2. Inspection method :

The most basic tests include urine specific gravity, urine osmotic pressure, urine volume, urine electrolytes, urine creatinine, and urine urea nitrogen.

1. Renal tubular acidification function test

Ammonium chloride test, urine titratable acid and urine ammonium determination, urine anion gap determination, etc.

2. Impaired renal concentrating function

The 24-hour Mosenthal test (urine specific density test) is now commonly used: fast after 8 pm the day before the test, eat normally on the day of the test, each meal contains about 500 ml of water, and no other liquids are consumed. Urine should be discarded at 8 am, and urine should be retained once at 10 am and 12 pm, 2, 4, 6, and 8 pm (daytime urine), and 8 am the next morning (nighttime urine). All urine should be discharged. Accurately measure each urine volume and density. When renal concentrating function decreases, urine volume is high, often exceeding 2500mL in 24 hours; urine volume is not much different between day and night, but increases at night, often exceeding 750mL (early manifestation); urine specific gravity is close between each urination, with the highest being <1.018, and the urine specific gravity difference is <0.009, and in severe cases it may even be only 0.001-0.002, and is often fixed at around 1.010, indicating that the concentrating function of the distal renal unit has been lost. It occurs in the late stages of chronic glomerulonephritis and chronic pyelonephritis, and the decompensated stage of hypertensive kidney disease.

3. Defective tubular reabsorption

Urine CO2, urine potassium, deionized water clearance rate, ammonium chloride load test, HCO3- reabsorption test, urine amino acid nitrogen, urine sodium, xylose determination, urine dilution test, etc.

4. Blood test

Blood tests to check potassium, sodium, calcium, and magnesium levels can help to understand renal tubular reabsorption function.

5. Electrocardiogram

Patients with hypokalemia have a downward shift of the ST segment, inverted T waves, and the appearance of U waves.

6. X -ray skeletal examination