Nephrotic acidosis symptoms?

summary

Metabolic acidosis nephropathy is a kind of metabolic acidosis which is caused by congenital genetic defects and various secondary factors, such as sodium bicarbonate reabsorption in proximal renal tubules and / or acid excretion dysfunction in distal renal tubules. According to different clinical manifestations, it can be divided into four types: complete and incomplete. Complete distal tubular acidosis (complete type I tubular acidosis) is the most common type. Nephrotic acidosis symptoms? I'd like to share my views with you.

Nephrotic acidosis symptoms?

History and symptoms 1. Women aged 20-40 are more common. Some patients may have chronic pyelonephritis and have a long history of taking analgesics, antibiotics and cottonseed oil; Some suffer from diffuse liver disease, systemic disease, congenital or acquired kidney disease. 2. Most of them have the symptoms of polydipsia, polyuria, nocturia, emaciation and weight loss. 3. The majority of skeletal muscle weakness, especially in both lower limbs, some showed periodic paralysis, even respiratory muscle paralysis. 4. Often have joint, bone ache, whole body ache. 5. A few patients were accompanied with deafness, sudden fracture, renal colic, hematuria and tooth loosening. 6. There may be primary symptoms.

Physical examination 1. More thin, thick and dry skin. Adolescent growth and development disorders. 2. Some lower limb deformity, muscle atrophy, dysfunction, fracture or pelvic pain, loose teeth. 3. The physiological tendon reflex was weakened and disappeared, and the muscle strength was obviously decreased. 4. There may be signs of primary disease.

Auxiliary examination 1. Different degrees of hypokalemia, hyponatremia, hypocalcemia, hyperchloremia, hypocarbonate, low blood pH, urine pH more than 5.5\ 2. Acid loading test (ammonium chloride loading test, urine carbon dioxide partial pressure test, sodium sulfate loading test, etc.) and urine pH value greater than 5.5 are positive results. 3. The urine routine changed slightly or normal. When there are primary diseases or other renal lesions, changes may occur. 4. Bun and Cr in blood were normal or slightly increased. 5. B-mode ultrasound examination varies according to different lesions, some showed renal calculi, calcification, some no abnormalities. 6. Blood gas analysis mainly showed metabolic acidosis, which may be accompanied by compensatory respiratory alkalosis. 7. X-ray bone examination: obvious osteoporosis and softening, especially in lower limbs and pelvis. Some showed fracture. Radionuclide bone scan showed that radionuclide absorption was sparse and uneven.

matters needing attention

(1) Lactic acidosis: it is necessary to correct tissue hypoxia or glucose metabolism disorder in order to reduce the production of lactic acid and promote the oxidation of lactic acid（ 2) Diabetic ketoacidosis: ketoacidosis is caused by too much ketoacids rather than loss of HCO3 ~. It is necessary to correct the water loss and give a small dose of insulin to promote the oxidation of ketoacids to HCO3 ~. When the blood pH is less than 7.1, NaHCO3 should be given（ 3) Acute and chronic renal failure complicated with acidosis: at the same time of alkali supplement, less dialysis should be considered. Attention should be paid to the imbalance of water and electrolyte, especially the occurrence of hypokalemia; 10% calcium gluconate 10-20ml should be given in advance; The compensatory hyperventilation caused by acidosis can still exist after the patient corrects the acidosis, which can cause respiratory alkalosis.