Normally, 100-150 mg of protein per day is lost in the urine, some of which is albumin. The daily loss of albumin in the urine is below 30 milligrams. Protein loss in the urine is often detected incidentally by simple urine examination. Normal urine tests are expressed with values such as negative, trace, +, ++, +++… or no protein in the urine, 30, 100, 300, 500. It should be noted that simple urine examination is a screening test.
Further investigation is required when protein is detected in the urine. First of all, the amount of protein loss in the urine is determined, and if the protein loss is serious, the cause is investigated.
In order to understand the amount of protein loss in urine, either urine is collected for 24 hours or the protein/creatinine ratio is checked in a urine sample.
If there is severe proteinuria, it is of kidney origin. It may be directly related to kidney disease, or it may be the result of another disease affecting the kidney. For example, diabetes can cause proteinuria by affecting the kidney.
If proteinuria is severe, albumin may decrease in the blood and swelling (edema) begins in the body.
It may be necessary to take a piece of the kidney (kidney biopsy) to detect kidney disease causing proteinuria.
Microalbuminuria is defined as a daily loss of 30-300 mg of albumin in the urine.
There are different types of proteinuria. By looking at the type of protein lost in the urine, information about the cause of kidney disease can be obtained. Proteinuria can be transient or positional.
When proteinuria is detected, it should be evaluated by a nephrologist.
EDEMA (BODY Swelling)
Edema is fluid accumulation in the body and is a common problem. The swelling is noticeable on the feet, legs, hands, fingers (the ring cannot be removed) and around the eyelids. Kidney disease comes to mind immediately. Water can accumulate in the lungs. It can be a sign of a serious illness.
Diseases that cause edema can be examined under 6 headings:
1. Kidney diseases
2. Liver diseases
3. Heart diseases
4. Hormonal diseases
5. Vascular occlusions
6. Other diseases.
In kidney diseases, darkening of the color of the urine and high blood pressure can be observed. There may be a history of jaundice in liver diseases. In heart diseases, the patient cannot lie on his back, there is shortness of breath. If he sleeps on one pillow at night, he will have shortness of breath. The patient cannot climb stairs, shortness of breath can be observed even with the smallest movement. Edema may occur in under- or over-functioning of the thyroid gland, adrenal gland diseases.
Swelling in kidney, liver, heart and hormonal diseases is usually diffuse and bilateral. In vascular diseases, swelling may be unilateral and varies according to the location of the involved vessel; For example, if there is a problem in the right leg veins, the swelling is only in the right leg.
In patients with edema, these diseases are primarily investigated. For this purpose, various laboratory investigations are necessary. In some cases, a disease causing edema cannot be detected. This condition is called idiopathic (unknown cause) edema.
Idiopathic edema is usually seen in young-middle-aged women. As the name suggests, the cause is not clear, but causes such as tension, excess weight, carbohydrate consumption, and a high salt diet can lead to edema. The diagnosis of idiopathic edema is made by excluding other diseases causing edema.
Before starting edema treatment, the disease causing edema is investigated and the treatment is planned according to the underlying disease. Salt restriction is the first condition of treatment in most of the edematous patients. Diuretic drugs can reduce swelling, but these drugs should definitely be used under the supervision of a doctor.
Nephritis: GENERAL INFORMATION
One of the basic functions of the kidney is to produce urine. There are about 2 million small units (nephrons) in both kidneys that lead to urine production. A nephron basically consists of 2 parts.
1. The filter (glomerule) through which the blood coming to the kidney is filtered
2. The long, locally coiled pipes (tubule) through which the filtered blood turns into urine
Inflammatory diseases of the kidney are called nephritis. The causes of nephritis are divided into two as microbial and non-microbial:
1. Microbial nephritis (pyelonephritis): Another name for pyelonephritis is upper urinary tract infection.
2.Non-microbial nephritis: Non-microbial inflammatory diseases of the kidney are divided into two.
A.Glomerulonephritis
B.Tubular nephritis (Tubulointerstitial nephritis)
NEPHRITIS: GLOMERULONEPHRITH
There is inflammation in the nephron, predominantly in the glomeruli. One of the common causes of chronic renal failure in Turkey is glomerulonephritis. Signs and symptoms vary according to the type of glomerulonephritis.
It is usually very easy to diagnose glomerulonephritis by examining the patient, measuring urea and creatinine in the blood, and simple urine analysis. On examination, signs of glomulonephritis are swelling of the hands, feet and eyelids, darkening of the urine color (the urine may turn into tea), and high blood pressure. Bleeding (hematuria) and protein loss (proteinuria) in urine examination are findings in favor of glomerulonephritis.
The main difficulty in the diagnosis of glomerulonephritis is the detection of the disease causing glomerulonephritis. To understand the type of glomerulonephritis, a kidney biopsy should be performed, that is, a piece of the kidney should be taken for microscopic examination. Many patients think of cancer when they think of biopsy, but the purpose of kidney biopsy is not to look for cancer, but to understand the type of glomerulonephritis.
What kind of problems does glomerulonephritis cause?
In practice, glomerulonephritis occurs in 5 forms. The patient may not have any complaints or may have advanced kidney failure.
1. Abnormalities in urine examination: The patient has no signs or symptoms. Bleeding or protein loss is detected in the urine examination of the patient who goes to the doctor for another reason.
2.Nephrotic syndrome: There is a loss of more than 3-3.5 grams of protein in the urine per day. There are swellings on the hands, feet, face and other parts of the patient that leave traces when pressed. In addition, the level of albumin in the blood decreases, the level of cholesterol increases.
3. Sudden onset glomerulonephritis: The main problems in these patients are bleeding in the urine, high blood pressure and fluid accumulation in the body. Most nephritis developing following streptococcal infections in children fall into this group.
4.Chronic (chronic, long-term) glomerulonephritis: These patients have urinary bleeding, protein loss, high blood pressure and swelling. The disease is long-lasting and may be insidious. For this reason, urinalysis is important in patients with hypertension.
5. Rapidly progressive nephritis: In a short time, kidney failure develops and the patient needs dialysis treatment.
Causes
The causes of glomerulonephritis can be divided into 2 groups:
1. Cause of unknown
2. Due to a known disease: For example, respiratory tract infection in the past , rheumatic diseases, hepatitis can be given
Treatment
It is different for each patient. Treatment is planned according to the results of the kidney biopsy and the problems present in the patient. Only in children, if nephrotic syndrome is present, treatment is given first and then if it does not improve/if necessary, kidney biopsy can be performed. The treatment of glomerulonephritis should be under the supervision of a nephrologist. Hypertension treatment, if any, should not be neglected. Failure in treatment may lead to permanent renal failure and the patient may require continuous dialysis treatment.
NEPHRITIS: TUBULAR NEPHRITIS
In the nephron, there is predominantly inflammation in the tubules. With the progression of the disease, damage also occurs in the glomeruli. They can lead to both sudden and permanent kidney failure. The majority of tubular nephritis is preventable. In tubular nephritis, as the name suggests, tubular functions are impaired. It is usually not difficult to distinguish tubular nephritis from glomerulonephritis.
Major signs and symptoms in patients
Frequent urination
Waking up at night to urinate
High blood pressure
Salt, sugar in the urine, amino acid, protein loss
decrease in vitamin D and blood production hormone (erythropoietin) production
Anemia
Deterioration in water and salt balance
Kidney failure.
Causes
1. Medicines: Especially long-term, high-dose, unconscious use of painkillers.
2.Infectious diseases
3.Some cancers
4.Sickle cell anemia
5.Gout disease
6. Immune system diseases
7. Urinary tract obstructions, leaks
8. Other causes.
Treatment
First of all, the disease causing tubular nephritis is investigated and this disease is treated. If the cause cannot be found, treatment is planned according to the signs and symptoms found in the patient.
RECOVERY OF THE KIDAL (BIOPSY)
It may be necessary to take a piece of the kidney to understand the cause of kidney disease. When it comes to buying parts, the patient usually thinks of cancer. In nephrology practice, the purpose of taking a piece is not cancer most of the time. Today, taking a piece of the kidney with the help of ultrasonography is a very easy procedure and its risks are greatly reduced. In special cases, kidney biopsy can be performed open or laparoscopically.
The main risks of kidney biopsy are bleeding and pain, but biopsy with the help of ultrasonography with the necessary preliminary preparation and close follow-up after the procedure has minimized these risks. It is true that a biopsy has risks, but there are also risks to not having a biopsy. Biopsy is already on the agenda when there is a treatment option that may be beneficial to the patient.
Conditions for biopsy:
1. Loss of protein in the urine, changes according to age and amount
2. Unexplained bleeding in the urine
3. Unexplained rapid in progressive renal failure
4. In unexplained kidney failures with normal kidney sizes
5. In long-lasting sudden kidney failures
6. In some cases in diabetic patients
7. Some systemic diseases
8. Some familial kidney diseases
9. Other conditions where the cause of kidney disease cannot be understood
10. Transplanted kidney (if necessary)
