What happened to my urine? Understanding of proteinuria and hematuria

        "Doctor! I have bubbles in my urine. Is there something wrong with my kidney function? " I believe many people have all kinds of myths about kidney and urinary system diseases. In this issue, Dr. Far Eastern Memorial Hospital is invited to explain how to judge your health status from urine.

        Generally, healthy adults excrete 40 to 80 mg of protein in their urine every day, up to 150 mg. Once the protein in their urine exceeds 150 mg per day, it is "proteinuria". Therefore, the presence of bubbles in urine is not necessarily a condition of renal and urinary system, which can be determined only through urine test.

        1、 Proteinuria is divided into "functional proteinuria" and "pathological proteinuria"

        Functional proteinuria: it is usually temporary and occurs under the conditions of intense exercise, fever, dehydration, use of painkillers or acute diseases; In addition, proteinuria often occurs in renal and urinary system infections (such as urethritis, cystitis, pyelonephritis, etc.), and most of them can disappear after appropriate antibiotic treatment.

        Postural proteinuria is also temporary, which is closely related to the change of body posture. It is common in young people. There is no proteinuria when I get up to urinate in the morning. After standing, walking and moving for a long time, proteinuria will appear. When I lie flat for a period of time, proteinuria will disappear again, which is a benign change.

          Pathological proteinuria: persistent proteinuria caused by renal lesions, which may be the primary glomerular disease of the kidney itself, such as acute or chronic glomerulonephritis; Or secondary renal glomerulonephritis caused by other systemic diseases, such as diabetic nephropathy, hypertensive nephropathy, lupus nephritis, etc. A few renal tubular diseases are caused by protein malabsorption in renal tubules. In addition, leukemia or malignant tumor produces excessive immunoglobulin, which exceeds the maximum reabsorption of the kidney and is discharged into the urine, which will also form pathological proteinuria.

        The examination of proteinuria is divided into "qualitative analysis" and "quantitative analysis". Qualitative analysis is to put the test paper into the urine and judge according to the change of the color of the test paper. The more "+" means the higher the concentration of urinary protein. If it is a trace (+ / -) or a small amount (1 +), it can be rechecked for 2 ~ 3 times, and it is better to get up in the morning and release the urine for the first time. If the retest result is negative, it may be only temporary functional proteinuria. If the retest continues to be positive or the urinary protein is medium and high, further examination should be arranged, such as quantitative analysis of urinary protein, blood examination, renal ultrasound or renal puncture section, so as to facilitate accurate diagnosis.

        2、 Hematuria is divided into "macroscopic hematuria" and "microscopic hematuria"

          Renal glomerular hematuria is caused by renal glomerulopathy, including primary diseases (such as IgA nephropathy), systemic diseases (such as diabetes, hypertension, rheumatic immune diseases) or genetic diseases. Poorly controlled diabetes or hypertension can cause chronic renal ball injury and hematuria. In addition, strenuous exercise may also cause temporary hematuria, which usually occurs 1 ~ 2 hours after exercise and may last for 72 hours. As for rheumatic immune connective tissue diseases, such as lupus erythematosus or vasculitis, they often invade renal filaments and cause hematuria; Hereditary diseases can also cause renal fibroglobular hematuria. If renal fibroglobular hematuria is complicated with proteinuria or abnormal renal function, renal puncture section must be considered for further pathological diagnosis.

          Non renal silk hematuria: caused by injury and bleeding in the kidney and urinary system, including urinary stones (such as bladder stones, ureteral calculi, kidney stones, etc.), hair coloring, inflammation (e.g. urethritis, cystitis, prostatitis, pyelonephritis, etc.), malignant tumors (such as cystadenocarcinoma, prostate cancer, ureteral cancer, renal cell carcinoma, and cervical cancer). Colorectal cancer and other organs around the renal and urinary system (cancer invasion), urinary catheter placement, polycystic kidney, renal infarction, interstitial cystitis, trauma (such as car accident or external impact, recent surgery on the renal and urinary system, etc.), abnormal coagulation function (such as taking anticoagulants, hemophilia, leukemia, liver cirrhosis, platelet deficiency, etc.) Hemorrhagic cystitis caused by chemotherapeutic drugs (such as cyclophosphamide, ifosfamide, etc.) and radioactive cystitis caused by pelvic electrotherapy for cancer.

          Diagnosis of hematuria

        First, routine urine tests can be carried out in conjunction with X-ray and ultrasound examinations of the renal and urinary system, as well as urine cytology, blood biochemistry and serum immunology. Men should consider the examination of the prostate. Then, it was evaluated by intravenous pyelography, computed tomography and magnetic resonance imaging. If necessary, renal biopsy or cystoscopy, ureteroscopy and other invasive examinations must be performed.

        Hematuria caused by urinary tract infection can generally be improved after appropriate antibiotic treatment. If repeated urinary tract infection occurs, pay attention to whether urinary tract stones or abnormal urinary tract structure should be subject to further examination and treatment. If it is a malignant tumor of the renal and urinary system, it should be fully evaluated and then the treatment method should be selected. Some primary glomerulonephritis will have good curative effect after being treated with steroids or immunosuppressive drugs. As for renal glomeruli diseases caused by systemic diseases such as diabetes, hypertension, rheumatic and immunodeficiency diseases, proper treatment and control should be directed at the disease itself.

        It is recommended that people pay attention to their health through urine regularly. If there are abnormalities and the cause is still not found after detailed inspection, they should be followed up and rechecked regularly every 3 ~ 6 months.