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GBZ79-2013: Diagnosis of occupational acute toxic nephropathy
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Diagnosis of occupational acute toxic nephropathy
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GBZ 79-2013
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| GBZ 79-2002 | English | 319 |
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Diagnostic Criteria of Occupational Acute Toxic Nephropathy
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GBZ 79-2002
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PDF similar to GBZ79-2013
Standard similar to GBZ79-2013 GBZ 20 GBZ 57 GBZ 49 GBZ 82 GBZ 89 GBZ 77 Basic data | Standard ID | GBZ 79-2013 (GBZ79-2013) | | Description (Translated English) | Diagnosis of occupational acute toxic nephropathy | | Sector / Industry | National Standard | | Classification of Chinese Standard | C60 | | Classification of International Standard | 13.100 | | Word Count Estimation | 7,730 | | Older Standard (superseded by this standard) | GBZ 79-2002 | | Quoted Standard | GB/T 16180 | | Regulation (derived from) | Health-Communication (2013) 1 | | Issuing agency(ies) | Ministry of Health of the People's Republic of China | | Summary | This standard specifies the principles of diagnosis of occupational acute toxic nephropathy, diagnostic classification and principles. This standard applies to occupational acute toxic nephropathy diagnosis and treatment. | GBZ79-2002: Diagnostic Criteria of Occupational Acute Toxic Nephropathy---This is a DRAFT version for illustration, not a final translation. Full copy of true-PDF in English version (including equations, symbols, images, flow-chart, tables, and figures etc.) will be manually/carefully translated upon your order.
(Occupational acute toxic nephropathy diagnostic criteria)
ICS 13.100
C60
GBZ
People's Republic of China National Occupational Health Standards
Diagnostic criteria for occupational acute toxic nephropathy
Diagnostic Criteria of Occupational Acute Toxic Nephropathy
Released in.2002-04-08
2002-06-01 Implementation
Issued by the Ministry of Health of the People's Republic of China
Foreword
Article 6.1 of this standard is recommended and the remainder is mandatory.
According to the "People's Republic of China Occupational Disease Prevention Law" to develop this standard.
In a variety of professional activities, in a short period of time contact with some high concentrations and toxic chemicals can occur acute toxic kidney
disease. At present there is no clear at home and abroad for the correct diagnosis and treatment of medical units for reference. To protect the health of the contact person,
Effective prevention and treatment of occupational acute toxic kidney disease, according to recent clinical and laboratory research progress, the development of this standard.
Appendix A to this standard is an informative appendix.
This standard is proposed and centralized by the Ministry of Health of the People's Republic of China.
This standard by the Peking University Third Hospital Occupational Disease Research Center is responsible for the drafting, Shandong Provincial Hospital Occupational Diseases, Jilin
Industrial workers in the hospital workers Institute of Occupational Disease Prevention and Control to participate in the drafting.
This standard is interpreted by the Ministry of Health of the People's Republic of China.
Diagnostic criteria for occupational acute toxic nephropathy
Occupational acute toxic nephropathy refers to occupational activity, due to short-term exposure to large doses of chemical substances caused by
To the kidney damage as the main performance of acute poisoning.
1 Scope
This standard specifies the diagnostic criteria and principles of occupational acute toxic nephropathy.
This standard applies to occupational activity due to occupational chemicals caused by acute toxic kidney disease. In non - professional
Activities due to other toxic substances caused by acute toxic kidney disease, can also refer to the use of this standard.
2 normative reference documents
The terms of the following documents are hereby incorporated by reference into this standard. Any date that references the date of the document
All subsequent amendments (excluding corrigenda) or revisions do not apply to this standard, however,
The parties to the agreement are able to use the latest version of these documents. Those who do not mind the date of the reference file, its latest
The version applies to this standard.
GBZ 71 Occupational Acute Chemical Poisoning Diagnostic Criteria (General)
Rules for the diagnosis of occupational acute occult chemical poisoning
Identification of Occupational Injury and Occupational Disease Disability in Staff and Workers GB/T 16180
3 diagnostic principles
According to the occupational history of exposure to a large number of chemical substances in the short term, the typical clinical manifestations of acute kidney injury, the relevant experiments
Room inspection results and on-site labor hygiene investigation, excluding other causes of similar diseases, can be diagnosed.
4 observation object
A large number of exposure to a large number of kidney poison in a short time, there is a transient acute renal damage manifestations of acute toxic nephropathy
Object.
5 Diagnostic and grading standards
5.1 mildly toxic nephropathy
Any person who has any of the following two manifestations.
a) Urine continues to be positive;
b) soy sauce color urine, laboratory tests showed occult blood test positive;
c) hematuria, laboratory tests show a lot of red blood cells;
d) see a large number of urine tube, or white blood cells, or a large number of renal tubular epithelial cells;
e) Glomerular filtration rate (GFR) continued < 80 ml/min.
5.2 Moderate toxic nephropathy
Any person who has any of the following two manifestations.
a) urine output continued < 400ml/24h;
b) Urine specificity continued < 1.012, or urine osmolality (Uosm) continued < 350mOsm/kgH2O;
c) urinary sodium (UNa) sustained > 40 mmol/L, or filtered sodium excretion rate (FENa) sustained > 2%;
d) GFR continued < 50ml/min;
e) blood urea nitrogen (BUN) sustained > 7.0mmol/L ( > 20mg/dl), or daily increase > 3.5mmol/L ( >
10 mg/dl);
f > serum creatinine (Pcr) > 177μmol/L ( > 2mg/dl), or daily increase > 89μmol/L ( > 1 mg/dl).
5.3 severe toxic nephropathy
Any person who has any of the following two manifestations.
a) Urine continued < 200 ml/24h;
b) GFR continued < 30 ml/min;
c) BUN sustained > 21mmol/L ( > 60mg/dl), or daily increase > 7.0mmol/L ( > 20mg/dl);
d > Pcr sustained > 430μmol/L ( > 5 mg/dl), or daily increase > 177μmol/L ( > 2mg/dl);
e) serum potassium (SK) sustained > 6.0 mmol/L ( > 6.0 mEq/L);
f) symptoms of uremia such as nausea, vomiting, headache, drowsiness, trance, convulsions, coma, etc.
Congestive heart failure, acute pulmonary edema, metabolic acidosis, hyponatremia, sepsis and other complications.
6 Principles of handling
6.1 Principles of treatment
6.1.1 Observe objects
a) immediately from the toxic contact, the skin can be absorbed by the poison should be off the contaminated clothing, and washed with soap and water
Skin; patients with gastrointestinal invasion, should be immediately gastric lavage; and then need to rest warm rest.
b) patients with systemic poisoning, according to the treatment of poisonous poisoning conventional treatment; treatment should pay attention to careful
Drugs with greater toxicity of the kidneys.
c) carefully record the amount of liquid intake and close observation of urine routine examination results 2 to 3 days; abnormal need to be kidney
Dirty function for further examination.
6.1.2 mild and moderate toxic nephropathy
In addition to the above treatment, the following measures can be taken.
a) have a special detoxification drugs can be used early, but each dose should be small; can be cleared by blood purification measures,
Moderate poisoning patients can be used early this treatment.
b) should pay attention to early prevention of insufficient blood volume, the lifting of renal vasospasm, improve renal microcirculation.
c) early start diuretic therapy.
d) early use of adequate glucocorticoid.
e) the emergence of pigment proteinuria, should be early use of alkaline drugs.
f) Oxygen free radical scavengers, calcium channel blockers, angiotensin converting enzyme inhibitors and other cellular interventions help
Delay the progression of the disease, but need to be used early.
6.1.3 Severe Toxic Kidney Disease
In addition to the above treatment, should pay attention to the following points.
a) active use of blood purification therapy to prevent uremia, hyperkalemia, water poisoning, etc., and with the detoxification treatment
Accelerated toxic discharge.
b) active prevention of toxic organs caused by systemic damage to other organs, the protection of vital organs function.
c) active prevention and treatment of infection and other complications; attention to a reasonable nutritional supplement.
d) oliguria should limit the amount of liquid, proper diuretic; polyuria should pay attention to maintain the body of water and electrolyte balance.
6.2 Other treatments
6.2.l Observe the object
After observing no obvious kidney damage and systemic poisoning performance, can return to the original job.
6.2.2 mildly toxic nephropathy
After the cure can be engaged in the original job.
6.2.3 Moderate toxic nephropathy
After curing can be engaged in normal work, but should avoid kidney poison contact.
6.2.4 Severe Toxic Kidney Disease
After curing can be engaged in light work, and to avoid contact with kidney poison; if necessary, refer to GB/T 16180 treatment.
7 Correctly use the instructions in this standard
See Appendix A (informative).
Appendix A
(Informative)
Correctly use the instructions in this standard
A.1 This standard is mainly applicable to the use of working or productive contact, so that chemical substances in a relatively short period of time a greater amount of invasion of the body
Caused by the acute toxicity of kidney damage diagnosis and treatment; due to chemical substances caused by renal tubular mechanical blockage (such as pigment
Protein tube type, crystal, etc.), or by its immune mechanism caused by acute kidney damage (such as acute interstitial nephritis, pulmonary hemorrhage -
Nephritis syndrome, etc.) are also applicable. Acute toxic nephropathy caused by environmental factors or drugs can refer to the use of this standard.
This standard can also be used as other diseases caused by a variety of non-specific systemic pathology, such as hypoxia, shock, cardiopulmonary dysfunction
And other causes of secondary acute renal damage diagnosis of the reference.
A.2 Common occupational toxicities with direct kidney toxicity are. a. Heavy metals or metal-like compounds such as cadmium, mercury, chromium,
Lead, bismuth, uranium, platinum, arsenic, phosphorus, etc .; b. Hydrocarbon compounds such as chloroform, carbon tetrachloride, trichlorethylene, ethylbenzene, naphthalene,
Gasoline, etc .; c. Phenols such as phenol, cresol, resorcinol and the like; d. Pesticides, such as organic mercury, organic arsenic, organic chlorine, there are
Machine phosphorus, organic fluorine, paraquat, etc .; e. Other compounds, such as synthetic dyes, glycols, acrolein, oxalic acid, pyridine,
Morpholine and so on.
Common occupational toxicity caused by indirect renal toxicity is mainly caused by acute intravascular hemolysis or the formation of denatured globin
Body chemicals such as arsine, antimonide, tellurium, copper, nitro and amino compounds of benzene, insecticidal,
Chrysanthemum, phenylhydrazine, coal tar derivatives, resulting in hemoglobin tube block renal tubules; and some compounds in the renal tubules
The formation of crystalline or myoglobin tube type, can also cause renal tubular obstruction and even cause acute tubular necrosis.
Many environmental factors and drugs also have direct or indirect renal toxicity, should pay attention to differential diagnosis.
A.3 The incubation period of this disease is common for several hours to several tens of hours, so the observation period is at least two days.
A.4 observation items in addition to the general clinical manifestations, the main urine, urine routine examination (including color, specific gravity, pH, eggs
White and urine sediment examination, conditions can be used for urine osmotic pressure determination); the above check abnormalities, but after the review has been self-recovery
, Is a transient kidney damage; if the previous indicators continue to be abnormal, should be occult blood test or urinary sodium, sodium filtration rate,
Serum creatinine, urinary creatinine, glomerular filtration rate and other indicators of renal function for further examination.
A.5 mildly toxic nephropathy should be noted with the identification of urinary tract infection, in addition to symptoms and signs, the urine see bacteria often infected with
Important hints.
A.6 is currently the most commonly used and more sensitive kidney function indicators are.
(L) urine osmotic pressure (Uosm) urine osmotic pressure or osmotic concentration is the degree of urine concentration of the observed indicators, it can be anti-
Reflective capacity of renal tubular. Although the urine specific gravity measurement also has this function, but susceptible to solute properties and molecular weight of the shadow
Such as protein, sugar can exist in the proportion of urine increased; urinary osmotic pressure is only related to the number of solute particles, and its large
Small irrelevant, so the more specific to more accurately reflect the renal tubular function. At present, the use of freezing point osmometer, vapor pressure penetration
Pressure meter and other equipment for the determination, convenient and efficient, the results are more objective and reliable. Under normal circumstances Uosm more >
500mOsm/kgH2O, if Uosm < 350 mOsm/kgH2O, more suggestive of renal tubular dysfunction.
(2) urinary sodium (UNa) renal tubular function is normal, the discharge of hypertonic hyponatremia, so under normal circumstances UNa will not
More than 20mmol/L; when the renal tubular damage, the water absorption of sodium function was significantly reduced, so the discharge of low hypotonic high sodium, at this time
UNa more > 40 mmol/L. Therefore, urine sodium can reflect the renal tubular function and help to identify prenatal nitrogen
Hyperthyroidism and acute tubular necrosis.
(3) filtered sodium excretion rate (FENa) It is defined as the total amount of urinary excretion of sodium per unit of time within the period of time by the kidney
The percentage of total sodium filtered by the ball. This indicator not only contains urinary sodium factors, but also contains serum sodium, serum creatinine, muscle
Anhydride, glomerular filtration rate and other functions, so the results are more objective and reliable, is currently recognized to reflect the best indicators of renal tubular function.
The formula is.
Urinary sodium concentration (mmol/L) Urinary creatinine concentration (ml/dl or μmol/L)
FENa (%) = ---------- ÷ -------------
Serum sodium concentration (mmol/L) serum creatinine concentration (ml/dl or μmol/L)
Under normal circumstances, FENa < 1%, if this value> 2%, then prompted renal tubular dysfunction.
(4) Endogenous creatinine production rate (Ccr) This indicator is based on the body to produce a metabolite clearance to carry out
Glomerular filtration ability to determine the need for injection of exogenous reference material, it is more simple and easy. Creatinine is high energy phosphate creatinine
Dehydration dephosphoric acid products, the amount of production is very constant, normally completely through the urine, which in addition to a very small amount (< 5%) by the kidney
Tube excreted, the vast majority of the Department of glomerular filtration, and not for the renal tubular reabsorption, so the clearance rate can be better reflected
Glomerular filtration capacity. The formula is as follows.
Urine creatinine concentration (mg/dl or μmol/L) 24 hours urine output (ml) 1.73 (m2)
Ccr (ml/min) = -------------- × one by one ------ × --- one by one
Serum creatinine concentration (mg/dl or μmol/L) 24 × 60 (min) S (m2)
Where 1.73 is the body weight of adult body weight of 70kg
S for the subject surface area, according to height, weight lookup table obtained; can also be calculated according to the following formula.
S = [height (cm) x 0.0061 weight (kg) x 0.0128] -0.1529
1.73/S is roughly 1, the weight is too large This value is slightly less than 1, the weight is too light this value is slightly greater than 1.
Ccr normal value of 80ml/min ~ 120ml/min, this value if the value is lower than the normal value of more than 50%, consider the acute
Renal insufficiency of the possible; this value if not yet normal value of 25%, then prompted the emergence of acute renal failure.
A.7 The focus of this disease treatment is the prevention and treatment of acute renal failure, the key is the emergence of acute renal insufficiency,
That should be blocked early disease progression of the relevant ways. Clinical routine use of the measures are. a reasonable infusion and timely fill the blood volume,
Use of microvascular dilators to relieve renal vasospasm to improve renal microcirculation, full diuretic to poison and metabolic waste
Out, early enough to use glucocorticoids, active use of blood purification therapy, including blood purification therapy especially harmful to the blood
Substance clearance has a significant effect. In general, hemoperfusion (HP) is more effective in removing exogenous toxicants
For effective, plasma exchange (plasma exchange, PE) can also effectively remove the blood of harmful substances, but with too much blood,
Difficult to be widely used; and various dialysis techniques such as hemodialysis (hemodialysis, HD), peritoneal dialysis (peritoneodialysis,
PD) and so on the metabolic waste and molecular weight < 50kd exogenous harmful substances have a better clearance effect, for a variety of toxic
Kidney disease, in particular, has occurred in acute renal dysfunction, it is a specimen of the treatment of both.
This standard relaxes the conditions of blood purification therapy to promote early, that is, to determine the acute moderate toxic nephropathy
Can be used in time, so that in addition to the purpose for treatment, but also become a prophylactic means of delaying the occurrence of toxic renal damage, is expected
To improve the prognosis will play a good role.
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