All causes due to which a disease may appear can be divided into three groups: renal; prerenal; postrenal. Each group of reasons has its own distinctive features. Methods of diagnosis, treatment and clinic of acute renal failure is determined only by a specialist.
Renal Causes
Causes of renal renal failure include the following:
- various injuries: burns, trauma, severe skin damage;
- various illnesses that reduce the body's supply of s alt and water, such as diarrhea and vomiting;
- serious infections such as pneumonia.
Prerenal causes
Prerenal causes of kidney failure can be as follows:
- severe or pre-heavy form of glomerulonephritis, it also has its own varieties;
- anaphylactoid purpura;
- localized intravascular coagulation;
- presence of thrombosis in the renal vein;
- presence of necrosis on the adrenal medulla;
- hemolytic uremic syndrome;
- severe tubular necrosis;
- interaction with s alts of heavy metals, chemicals or drugs;
- developmental deviations;
- cystosis.
Postrenal causes
Postrenal form of renal failure can occur in the following cases:
- serious abnormalities in the urine (stones, tumors, blood in the urine);
- diseases of the spinal cord;
- pregnancy.
The basis of the disease is a variety of disorders that are characterized by the presence of disturbances in the renal blood flow, a decrease in the level of glomerular separation passing through the walls of disease-prone channels, squeezing these channels with edema, possible humoral effects, due to which biological substances become active, due to which may be damaged or damaged. Arterial spasms and thrombosis may occur. The resulting changes most strongly affect the tubular apparatus.
Key Factors
There are many causes that can lead to kidney failure, and one of the most common is traumatic shock, which can occur due to tissue damage that occurs when the amount of circulating blood decreases. Traumatic shock, in turn, can provoke extensive burns, abortions, andalso incompatible blood transfusions, large blood loss, severe toxicosis in the early stages of pregnancy, as well as exhausting uncontrollable vomiting.
Another cause of acute kidney failure is exposure to neurotropic poisons, such as mercury, snakebite, fungi or arsenic. Severe intoxication can lead to acute renal failure with an overdose of drugs, alcoholic beverages, certain medications, such as antibiotics.
Another common cause of this condition can be infectious diseases such as dysentery or cholera, as well as leptospirosis or hemorrhagic fever. Acute renal failure can be caused by uncontrolled intake of medical diuretic drugs, as well as dehydration, decreased vascular tone.
Symptoms
In the early stages of the disease, it is quite difficult to detect. In this case, the differential diagnosis of acute renal failure will come to the rescue. Criteria (leading and additional) are determined by the attending doctor. With the further development of this disease, there may be a significant decrease in the volume of urine excreted, in rare cases, urination stops completely. This stage of acute renal failure is considered the most dangerous, and it can last for about three weeks.
At this time, other signs of the disease appear, such as a decrease in blood pressure, severe swelling on the hands and face,there is general restlessness or lethargy. In addition, the patient may begin to feel nausea with vomiting, shortness of breath will appear, due to the appearance of swelling in the lung tissues. All of the above symptoms may be accompanied by the appearance of severe retrosternal pain, heart rhythm disturbance, pain in the lumbar region.
At the same time, severe intoxication begins in the body, which leads to the development of ulcers, both in the intestines and in the stomach. With the further development of acute renal failure, an increase in the liver is observed, shortness of breath increases, and edema appears already on the legs. The patient may complain of complete loss of appetite, severe weakness, growing pain in the lumbar region, and drowsiness. In especially severe cases, drowsiness can also turn into a uremic coma.
In addition, the patient's stomach is gradually growing due to constant flatulence, the skin becomes pale and dry, there is a specific bad breath. After about three weeks, the last stage of acute renal failure occurs, in which the volume of urine released gradually increases, and this leads to the appearance of a condition such as polyuria. In this condition, the amount of urine excreted can reach two liters per day, and this leads to severe dehydration. At this stage, the patient also has general weakness, periodically pains in the heart, intense thirst is observed, the skin becomes very dry due to dehydration.
Diagnosis
The main factor is considered to be an increase in potassium and nitrogenous combinations in the blood against the background of a significant decrease in the amount of urine given by the body and the state of anuria. The volume of daily urine, and the concentration functioning of the kidneys are evaluated using the Zimnitsky test. Monitoring of such characteristics of blood biochemistry as urea, creatinine and electrolytes plays a significant role. These characteristics make it possible to assess the severity of acute renal failure and the result after the necessary therapeutic actions.
The main problem in the diagnosis of acute renal failure is the establishment of its form. For this purpose, ultrasound of the kidneys and bladder is done, which makes it possible to identify or exclude obstruction of the urinary tract. In some cases, bilateral catheterization of the pelvis is performed. If, at the same time, two catheters easily passed into the pelvis, but urine output is not traced through them, it is possible to eliminate the postrenal form of acute renal failure with complete confidence.
At a later stage, acute renal failure is diagnosed according to test criteria, which are determined by a specialist after a comprehensive examination.
If it is necessary to evaluate the renal blood flow, ultrasound of the renal vessels is performed. Suspicion of tubular necrosis, acute glomerulonephritis, or systemic disease is considered an indication for a kidney biopsy.
After laboratory diagnosis of acute renal failure - emergency treatment - the first thing to do in order tothe patient did not worsen.
Treatment
Therapy of acute renal failure is carried out depending on the cause, form and stage of the disease. As the pathology progresses, both the prerenal and postrenal forms are necessarily transformed into the renal form. In the treatment of acute renal failure, it is very important: early diagnosis, finding the cause and timely initiation of therapy. After receiving answers on the criteria for diagnosing acute renal failure, treatment begins.
Therapy for ORF includes the following:
- treatment of the cause - the main pathology that provoked acute renal failure;
- normalization of water-electrolyte and acid-base balance;
- providing adequate nutrition;
- treatment of comorbidities;
- temporary replacement of kidney function.
Depending on the cause of AKI, you may need:
- antibacterials for infection;
- compensation for lack of fluid (with a decrease in blood circulation volume);
- diuretics and fluid restriction to reduce edema and stimulate urination;
- cardiac means for heart failure;
- antihypertensive drugs to lower blood pressure;
- surgeries to restore kidney function or remove obstructions in the path of urine;
- stimulators of blood supply and blood flow in the kidneys;
- gastric lavage, antidotes and other measures for poisoning.
Do I need hospitalization?
If acute renal failure is suspected and the diagnosis is confirmed, patients are urgently hospitalized in a multidisciplinary hospital with a hemodialysis unit. When moving the patient, keep him calm, warm, and keep his body in a horizontal position. It is wiser to go by ambulance, then qualified doctors will be able to take all the necessary measures in a timely manner.
Indications for hospitalization:
- AKI with a sharp deterioration in kidney function, requiring intensive treatment.
- Need for hemodialysis.
- With an uncontrolled increase in pressure, multiple organ failure requires hospitalization in the intensive care unit.
After discharge, a patient with acute renal failure is prescribed a long-term (at least 3 months) outpatient observation and treatment by a nephrologist at the place of residence.
Non-drug treatment of AKI
Treatment of prerenal and renal ARF differs in the volume of infusions. With a lack of blood circulation, an urgent restoration of the volume of fluid in the vascular system is required. Whereas with renal acute renal failure, intensive infusion, on the contrary, is prohibited, since pulmonary and cerebral edema may begin. For proper infusion therapy, it is necessary to determine the degree of fluid retention in the patient, daily diuresis and blood pressure.
Prerenal form of acute renal failure requires urgent restoration of circulating blood volume and bringing blood pressure back to normal. With acute renal failure caused by poisoning with drugs and other substances, an early detoxification is necessary (plasmapheresis, hemosorption, hemodiafiltration orhemodialysis), and give the antidote as early as possible.
Postrenal form involves the early drainage of the urinary tract to restore the normal outflow of urine through them. Bladder catheterization, urinary tract surgery, epicystostomy may be required. It is necessary to control the balance of fluid in the body. In the case of parenchymal AKI, it is necessary to limit the intake of fluid, potassium, sodium and phosphates in the body.
Drug treatment of acute renal failure
If the patient does not need to eat on his own, the need for nutrients is replenished with the help of droppers. In this case, it is necessary to control the amount of incoming nutrients and fluids. Loop diuretics are prescribed as drugs that stimulate the excretory function of the kidneys, for example, Furosemide up to 200-300 mg / day in several doses. Anabolic steroids are prescribed to compensate for the breakdown process in the body.
In case of hyperkalemia, glucose (5% solution) is administered intravenously with insulin and calcium gluconate solution. If hyperkalemia cannot be corrected, emergency hemodialysis is indicated. Drugs to stimulate blood flow and energy metabolism in the kidneys:
- "Dopamine";
- "No-shpa" or "Papaverine";
- "Eufillin";
- glucose (20% solution) with insulin.
What is hemodialysis for?
At different stages of the clinic of acute renal failurea hemodialysis method can be prescribed - this is the processing of blood in a mass-exchange apparatus - a dialyzer (hemofilter). Other types of procedure:
- plasmapheresis;
- hemosorption;
- peritoneal dialysis.
These procedures are used until the kidneys are restored. The water-electrolyte and acid-base balance of the body is regulated by the introduction of solutions of s alts of potassium, sodium, calcium and others. Indications for emergency hemodialysis or other varieties of this procedure is the threat of cardiac arrest, pulmonary edema or brain. In chronic and acute PN, the approach to the procedure is different. The doctor calculates the duration of blood dialysis, dialysis load, filtration value and qualitative composition of dialysate individually before starting treatment. At the same time, it is monitored that the concentration of urea in the blood does not rise above 30 mmol / l. A positive prognosis is given when the content of creatinine in the blood decreases earlier than the concentration of urea in it.
With timely started and correctly performed therapy of acute renal failure, we can talk about a favorable prognosis. The combination of acute renal failure with urosepsis is the most difficult to treat. Two types of intoxication - uremic and purulent - at the same time significantly complicate the treatment process and worsen the prognosis for recovery.
Prevention
Timely preventive measures will help to avoid the onset of acute renal failure, and the very first and most important step is the maximum elimination of various factors that can lead to this condition. In addition, timely preventive measures will help maintain normal kidney function and avoid serious consequences.
So, for the purpose of prevention, it is necessary to undergo a regular annual examination, in which the doctor can prescribe an x-ray. Those who have previously been diagnosed with chronic kidney disease are advised to gradually reduce the dose of drugs previously prescribed by physicians. Naturally, you should not reduce the dosage of drugs on your own without first consulting a doctor and diagnosing.
Prevention of acute kidney failure will also help to treat existing chronic diseases such as urolithiasis or pyelonephritis.
Forecast
Doctors say that the kidneys are a unique internal organ, they are able to recover, which means that it is correct, and most importantly, timely measures taken to prevent acute renal failure will help the patient recover fully.
