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The diagnosis of infectious acute tubulointerstitial nephrit

2017-05-13 11:33
The diagnosis is mainly based on the clinical manifestations that determine urinary tract infection or systemic infection, such as fever, chills, white blood cells increased, nuclear left shift of symptoms of systemic infection, and tubular proteinuria, hematuria, urinary leukocytes, urinary tube, urine specific gravity and urine osmotic pressure performance significantly the decline of renal damage, serious sudden acute renal failure syndrome, laboratory support on urinary tract infection, ultrasound, KUB, IVP showed no morphological changes of kidney, renal biopsy in renal interstitium of focal or diffuse inflammation, mononuclear cells, plasma cells and polymorphonuclear cell infiltration, renal tubular epithelial cell degeneration, sometimes visible immune deposition and other characteristics, can consider the disease diagnosis.
The infection of acute interstitial nephritis occurred in acute renal failure and renal vasculitis, acute tubular necrosis, acute nephritis, atherosclerotic nephropathy embolism and acute nephritis after streptococcal infection were identified.
These diseases can occur due to kidney failure, but the clinical features of primary disease, acute tubular necrosis, oliguria or anuria long time, urine filtration fraction of >1 sodium, urine sodium concentration >40 >2, renal failure index, urine osmotic pressure <250mOsm/L, acute glomerulonephritis usually after infection in 1 ~ 3 weeks after onset, hematuria and in 90% cases with hypertension, nephritis edema, transient hypocomplementemia, rapidly progressive glomerulonephritis usually subacute onset, progressive disease, are difficult to identify when renal biopsy can clarify the diagnosis of acute nephritis in more than half of all kidney small ball with crescent formation, some scholars report 167Ga scanning in recent years acute interstitial nephritis, renal uptake showed high density shadow, and acute renal tubular necrosis is not uptake, is helpful in differential diagnosis. In addition, should be identified with renal tuberculosis, kidney tuberculosis may have pulmonary or extrapulmonary tuberculosis; urinary can be found in Mycobacterium tuberculosis; urine culture of Mycobacterium tuberculosis growth; IVP has a special image changes in tuberculosis.

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