RU2414705C2 - Diagnostic technique of chronic renal insufficiency - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: before and after noon, urine samples are collected for 5-6 hours. Thereafter, two native urine samples are collected, the second sample is mixed with 10% albumin in the ratio 4:1 respectively. The mixture is dropped on a transparent surface, dried to carry out microscopic analysis, and if observing in the middle of the native urine sample isotropic salt X-crystals and isotropic salt crystals in the mixture sample, chronic renal insufficiency is diagnosed.

EFFECT: use of the technique allows fast and demonstrative detection of insufficient renal function in screening examination of patients.

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Description

The invention relates to medicine, namely to nephrology, and can be used to diagnose mainly hidden stages of chronic renal failure.

Chronic renal failure (CRF) is a violation of homeostasis caused by an irreversible decrease in the mass of active nephrons. It occurs with all progressive kidney diseases and manifests itself as a multisymptomatic complex, reflecting the participation in this process of almost all organs and systems of the patient.

The kidneys have great compensatory capabilities. The loss of a significant amount of functioning nephrons, approaching 60-70%, begins to be accompanied by clinical symptoms of chronic renal failure.

The generally accepted diagnosis of chronic renal failure is carried out using biochemical research methods - Reberg breakdown, with which the glomerular filtration rate and serum creatinine level are calculated.

The disadvantage of this method is its complexity, invasiveness.

Currently, researchers offer a number of ways to increase the efficiency of determining the stages of chronic renal failure.

The method for determining the stage of chronic renal failure (RF patent for the invention No. 2269284, IPC A61B 3/10, publ. 2006) includes determining the state of the organs of vision, registering electroretinograms, conducting dopplerographic studies of blood flow in the extracranial segment of the internal carotid artery and orbital artery, determining the coefficient of chronic renal failure according to the proposed formula.

A known method for determining the stage of chronic renal failure in nephrological patients (RF patent No. 2195161, IPC A61B5 / 02, publ. 2002), including instrumental study of the functional state of the cardiovascular system, measurement of mass and isovolumis relaxation of the left ventricle, which is determined by the proposed formula coefficient of chronic renal failure.

The disadvantage of these methods is their high complexity, the presence of complex and expensive diagnostic equipment, which limits their use in widespread practice.

A known method for the diagnosis of chronic renal failure (RF patent No. 2070047, IPC A61K 35/14, publ. 1996), including carrying out bicycle ergometry against the background of an 18-hour fluid restriction and the assessment of biochemical parameters of blood serum and urine.

The disadvantage of this method is that the patient must observe fluid restriction for 18 hours, which is difficult for the elderly and children, and requires additional equipment.

A known method for the diagnosis of hidden stages of chronic renal failure (RF patent No. 2143700, IPC G01N 33/68, publ. 1999), including protein or amino acid loading test in combination with a submaximal load on a bicycle ergometer and oral administration of cimetidine, study of creatinine concentration in urine and blood samples.

The disadvantages of this method include the need for a submaximal load on a bicycle ergometer and taking cimetidine, which may be contraindicated for certain categories of patients.

The objective of the invention is to eliminate these drawbacks, increasing the accuracy and reliability of diagnosis due to the fact that diagnostic information is achieved by self-organization processes of the molecular structures of the urine of the examined patient.

To do this, in a method for the diagnosis of chronic renal failure, including a protein stress test, microscopic examination of a urine sample, it is proposed that a protein stress test be carried out in the morning, then in the afternoon to collect urine for 5-6 hours. After that, two samples of native urine are taken, the second sample is mixed with 10% albumin in a ratio of 4: 1, respectively, a drop of the mixture is applied to a transparent surface, dried and in the presence of isotropic X-shaped salt crystals and isotropic crystals in the central zone of the native urine sample salt crystals in the sample mixture diagnose chronic renal failure.

With preserved renal function, the protein load in the first half of the day will be reflected in the morphological picture of urine in the form of anisotropic salt crystals - products of nitrogen metabolism (protein metabolism). The first test (native urine) characterizes the accumulation of sodium chloride in the body, the second test (mixture with albumin) - the absence of excretion of nitrogen metabolism products in chronic renal failure.

With insufficient renal function, the products of protein metabolism are retained in the tissues of the body and are not excreted in the urine, which becomes visible by the absence of anisotropic salt crystals in the urine samples under study.

On figa, b presents the morphological picture of a sample of native urine: under normal lighting and the same in polarized light, respectively; isotropic X-shaped salt crystals are determined (example 1); figa, b - urine sample with a protein reagent: under normal lighting and the same in polarized light, respectively; isotropic salt crystals are determined (example 1); figa, b - sample of native urine: under normal lighting and the same in polarized light, respectively; anisotropic salt crystals are determined over the entire surface of the facies; on figa, b - urine sample with a protein reagent: under normal lighting and the same in polarized light, respectively; the isotropic edge protein zone and the central zone saturated with anisotropic salt crystals are determined (example 2); 5 is a micrograph of the central zone of a native urine sample of a patient with chronic renal failure with the determination of the spectrum of chemical elements in X-shaped structures (example 1).

The method is as follows.

The subject takes a protein load in the morning of 9.00-10.00, then ordinary food. All urine excreted from 15.00 to 21.00 is collected in one container, from which a sample is taken for examination in this way. Then, a drop of native urine and its mixture with a 10% albumin solution in a ratio of 4: 1 are respectively applied to a transparent plastic, dried, microscopic examination of urine samples is carried out in polarized light and in the presence of isotropic X-shaped salt crystals in the central zone of the native urine sample and the absence of anisotropic salt crystals in the sample mixture and the presence of isotropic crystals are diagnosed with CRF.

In the normal structure of the urine, everything gives anisotropy (birefringence), since the products of nitrogen metabolism (complex metabolites containing proteins, lipids, carbohydrates) are excreted in the urine.

In chronic renal failure, metabolites are retained in the body, and sodium chloride accumulates in the urine. They are excreted in the urine, but are isotropic. This was proved using x-ray microanalysis: figure 5 presents a micrograph of the central zone of the native urine sample of a patient with chronic renal failure with the determination of the spectrum of chemical elements in X-shaped structures (example 1). It is seen that 93.6-97.7% are crystals of sodium chloride.

Example 1

Patient A., 52 years old. Examination, including morphological analysis of dehydrated urine. The proposed method carried out a biological load and prepared urine samples.

In the morphological picture of urine in polarized light, the absence of anisotropic salt crystals in the central zone is revealed, isotropic X-shaped crystals are determined. In a urine sample with a protein reagent, the facies is isotropic, that is, anisotropic salt crystals are absent in it. Conclusion: there are signs of chronic renal failure.

A complete examination of the urinary system organs of this patient made it possible to establish a latent course of chronic glomerulonephritis with signs of chronic renal failure (decreased glomerular filtration rate and creatinine level at the upper limit of normal in blood serum). Conclusion: chronic glomerulonephritis. Signs of chronic renal failure.

Example 2

Patient S., 44 years old. Examination, including morphological analysis of dehydrated urine. According to the proposed method, urine samples were prepared.

In the morphological picture of urine in polarized light, anisotropic salt crystals were found over the entire surface of the facies, including the central zone. In a urine sample with a protein reagent, the facies is represented by an isotropic edge protein zone and a central zone saturated with anisotropic salt crystals.

Conclusion: signs of chronic renal failure were not detected.

A complete examination of the organs of the urinary system of this patient did not reveal pathological abnormalities. Conclusion: the patient is healthy.

Studies on the proposed method were performed in 78 patients, 9 of them showed signs of a latent form of chronic renal failure, which was further confirmed by generally accepted diagnostic methods.

The proposed method allows you to quickly and demonstratively detect insufficient kidney function during a screening examination of patients, can be used in laboratories of hospitals of any capacity, on-site examinations.

Claims (1)

A method for diagnosing chronic renal failure, including a protein load test, microscopic examination of a urine sample, characterized in that the protein load test is carried out in the morning, then in the afternoon, urine is collected for 5-6 hours, from which two native samples are taken urine, the second sample is mixed with 10% albumin in a ratio of 4: 1, respectively, a drop of the mixture is applied to a transparent surface, dried and in the presence of isotropic X-ray in the central zone of the sample of native urine GOVERNMENTAL salts and salts isotropic crystals crystals in the sample mixture diagnosed chronic renal failure.

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