Such a disease as nephrosclerosis, for a long time remained without the attention of doctors. Until the 19th century, there was no complete description of it. It began to be considered an independent disease only three decades later, when information about the etiology appeared. The disease was associated with damage to arterial vessels against the background of damage to their cholesterol. His prognosis is not always favorable. Many patients after a course of therapy have to deal with complications such as blindness, dysfunction of the ventricles of the heart. In order to maintain the viability of the body, in such cases, urgent blood purification is required by artificial means.
Anatomical background: kidney nephrosclerosis
What is this? This is a disease in which the active elements of the organ (parenchyma) are replaced by connective tissue. The latter plays the role of a kind of neutral filler, but does not take over the main functions. To understand the essence of the pathological process, it is necessary to refer to the anatomical reference.
The kidneys are a paired organ withbean shape. Its main part is the parenchyma, where urine is formed. Cups and pelvises are also considered an important component, which represent a whole system for the accumulation and subsequent excretion of urine. Filtration is carried out by the nephrons of the parenchyma. All renal bodies are united by an extensive network of tiny vessels extending from the main artery.
The kidneys perform many functions, including:
- synthesis of renin - a substance that affects the state of the walls of blood vessels;
- remove harmful substances from the body;
- maintaining a certain level of acid;
- production of erythropoietin, on which the process of hematopoiesis directly depends.
Such versatility of the kidneys leaves no doubt about their importance in the work of the whole organism. Therefore, any pathological processes in this area can negatively affect the state of human he alth.
Renal nephrosclerosis - what is it?
This is a process of successive replacement of the kidney parenchyma with connective tissue, which leads to a decrease (shrinkage) in the size of the organ and a decrease in its functionality. If left untreated, a complete cessation of performance may occur.
Previously it was believed that the main cause of the disease is glomerulonephritis. Today, doctors have revised this point of view, identifying diabetes mellitus and arterial hypertension as its main provocateurs.
According to the mechanism of development, primary and secondary nephrosclerosis of the kidneys are distinguished. Each of the forms of the disease has its own prerequisites for the occurrence, andalso characteristic features. It is advisable to dwell on this issue in more detail.
Primary nephrosclerosis
The primary form of the disease develops against the background of a violation in the work of blood vessels, narrowing of the working section of the artery. The consequence of ischemia are numerous heart attacks and scars. Another cause of the pathological process can be considered age-related changes if they lead to venous blood stagnation.
Primary nephrosclerosis can be of several types: atherosclerotic, hypertensive, involutive. In the first case, the main cause of vasoconstriction is the deposition of fatty plaques on their walls. As a result, the lumen decreases, which leads to ischemia of the kidney. At the same time, the surface of the organ becomes knotty, irregularly shaped scars are easily discernible on it. This type of illness is considered the safest.
Hypertensive nephrosclerosis is a manifestation of severe vasospasm, which is caused by the disease of the same name. The consequence of the pathological process is the narrowing of the arteries and severe ischemia. Hypertensive kidney nephrosclerosis can be benign or malignant.
The involutive form of the disease is associated with age-related changes. For example, after the age of 50, in most people, calcium begins to accumulate on the walls of the arteries, which helps to reduce the lumen. On the other hand, it is with age that atrophy of the elements of the urinary tubules is observed. Therefore, the functionality of the body falls.
Secondary nephrosclerosis
Secondarynephrosclerosis develops against the background of inflammatory and / or dystrophic processes occurring in the kidneys. The causes of the pathological process can be various conditions and disorders:
- Diabetes. An increase in blood sugar levels provokes changes in the walls of blood vessels. They thicken and swell, but the permeability increases. As a result, the protein enters the blood, which, to compensate for the violation, increases clotting. At the same time, the current slows down, which entails damage not only to the kidneys, but also to other organs.
- Chronic glomerulonephritis. With this pathology, immune complexes are not destroyed, but go directly to the kidneys. They damage the membranes of blood vessels in the glomeruli. To compensate for ongoing processes, the synthesis of substances that increase thrombus formation begins.
- Pyelonephritis. This disease is accompanied by the penetration of bacterial flora into the renal glomeruli and tubules, where blood clots form. Around them sequentially accumulate leukocytes. After recovery, scars or ulcers form on the damaged areas.
- Urolithiasis. When the urine stagnates, bacteria begin to actively multiply in it. In the case of reverse reflux of urine, pathogenic flora can damage the inner walls of the urinary tubules.
- Lupus erythematosus. This systemic disease is characterized by the synthesis of immune complexes that can launch an attack on their own organs.
- Nephropathy of pregnancy. During the bearing of a baby, the hormonal system of a woman undergoes changes, this leads to variousfailures. One such disorder is capillary spasm. As a result, blood pressure rises, and the blood supply to the kidneys is impaired. The woman develops edema, and the nephrons begin to actively die.
Given the information presented, several conclusions can be drawn. Primary nephrosclerosis of the kidneys most often develops against the background of impaired blood circulation in the organ. The secondary form of the pathological process is usually preceded by inflammatory-destructive disorders.
Separately, it should be noted a group of provocative factors, from the impact of which the likelihood of developing the disease increases significantly. First of all, it is the abuse of alcoholic beverages and food additives, smoking, uncontrolled use of drugs. A sedentary lifestyle and infectious diseases also increase the risk of nephrosclerosis. Therefore, the main measure of its prevention is the elimination of these factors.
Stages of disease progression
Elements of kidney tissue die gradually, so the disease itself develops in stages. In the first phase, a picture is observed due to a specific disease that provoked the sclerotic process. This is an early stage of kidney nephrosclerosis. It is difficult to predict what it threatens for the patient if you ignore the therapy prescribed by the doctor.
The next stage is the death of nephrons, their replacement with connective tissue. The pathological process contributes to the occurrence of renal failure, which also develops in stages.
First, there is a decrease in performance and a deterioration in overall well-being after exercise. Sometimes polyuria develops. The patient may be tormented by intense thirst, a feeling of dry mouth. At the next stage, high blood pressure remains, which is not even amenable to drug exposure. Patients are worried about severe headaches, nausea. If the patient is promptly prescribed a strict diet for kidney nephrosclerosis, as well as drug therapy, all unpleasant symptoms will quickly disappear.
The third stage of the pathological process is characterized by lack of appetite, severe weakness. Such a person has a tendency to viral diseases. Against the background of constant thirst, the volume of urine excreted is greatly reduced. The skin acquires a characteristic yellowish tint. In the fourth stage, urine is practically not excreted. Intoxication develops at a rapid pace, the process of blood clotting is disrupted. At this stage, the above changes are irreversible.
Clinical picture
Nephrosclerosis, also known as "shrunken kidney", is quite difficult to identify at the initial stages, since there are no characteristic symptoms. The patient does not experience any discomfort. Only when contacting a doctor with other complaints and after a diagnostic examination, it becomes possible to identify abnormal processes.
When the disease becomes stable, the following symptoms appear:
- swelling of the face and limbs;
- the number of urges to urinate increases, but the amount of excretedurine output is reduced;
- pain in the lumbar area;
- intense thirst;
- high BP;
- fatigue, weakness;
- itching of the skin.
The listed symptoms of kidney nephrosclerosis should be the reason for a deeper medical examination. Only after receiving its results, you can start therapy.
Comprehensive diagnosis of kidney disease
The non-specificity of the signs of the disease significantly complicates the diagnosis. Usually such issues are de alt with in specialized nephrological centers. Organ transplants of varying degrees of complexity are also performed here.
If you suspect an illness, you should seek help from such a center or a local therapist. The latter, after studying the clinical picture, can give a referral to a narrow specialist.
Diagnosis of the disease begins with the study of the patient's complaints, his medical history and physical examination. During the consultation, the nephrologist can also palpate the abdominal cavity. These manipulations allow us to assume a preliminary diagnosis and outline further examination tactics.
At the next stage, laboratory tests are scheduled for the patient. For example, blood chemistry may indicate the following symptoms of kidney dysfunction:
- increased levels of urea, creatinine;
- reducing the amount of protein;
- decrease in potassium, and increase in phosphorus and magnesium.
In the analysis of urineprotein and erythrocytes are detected, but its density is significantly reduced. When examining a blood test, it turns out that the level of platelets and hemoglobin falls, and the quantitative content of leukocytes increases.
For a more accurate assessment of the work of the organs, instrumental methods of examining patients with a diagnosis of "nephrosclerosis" are used. Ultrasound of the kidneys, for example, allows you to assess their size and the state of the cortical substance. Urography is mandatory. Angiography gives a complete picture of the state of the vessels in the affected organ.
Based on the results of the examination, the doctor confirms or refutes the preliminary diagnosis, gives recommendations for further treatment.
Medication use
Therapy of this disease is carried out in specialized nephrological centers. It boils down to eliminating the main provocateur factor. Attempts to restore lost kidney function without a first step are usually unsuccessful.
Treatment is always complex and long-term. Depending on the clinical picture and the general condition of the patient, the following medications may be required:
- Anticoagulants ("Heparin") to prevent blood clots.
- Drugs to lower blood pressure.
- ACE inhibitors ("Diroton", "Berlipril") to dilate the blood vessels of the kidneys.
- Diuretics that remove excess fluid from the body.
- Arterial dilating calcium antagonists(“Falipamil”).
- Multivitamin complexes.
For other disorders due to kidney dysfunction, drugs are selected individually.
Surgery
At the 3-4th stage of the pathological process, drug treatment is usually ineffective. In such cases, the patient is shown hemodialysis or transplantation of a donor kidney. The essence of the first procedure is to cleanse the blood of toxic substances. For this, a special artificial kidney filter is used. The frequency of hemodialysis is determined by the patient's condition, the severity of the pathological process. The procedure must be accompanied by drug therapy.
Surgical treatment involves transplantation of a donor kidney. This is one of the few types of operations when an organ can be removed from both a living person and a corpse. During the recovery period, the patient is prescribed serious medical support and complete rest.
Features of food
An excellent addition to the course of treatment is a fairly strict diet. Nutrition for kidney nephrosclerosis is selected by the doctor for each patient individually. The following principles are usually followed:
- Restrict protein intake. At the same time, it cannot be completely abandoned. When choosing protein foods, preference should be given to poultry, fish and dairy products. It is important to completely exclude potatoes, cereals and bread from the diet.
- The diet must necessarily include seafood, butthey should not be abused due to the high content of phosphorus.
- Restricting s alt intake. At any consultation, the nephrologist will say that at stages 1-2, up to 15 g of s alt per day is allowed, and at the 3-4th, this amount is halved. It is impossible to completely refuse this spice, as the likelihood of dehydration increases.
- Be sure to include potassium-rich foods in your diet. For example, bananas, dried apricots, raisins.
- Food should be as balanced as possible, contain the required amount of calories and vitamins.
This is the diet most patients are forced to adhere to for the rest of their lives.
Forecast
Kidney nephrosclerosis is a chronic disease. At the initial stages of its development, it is possible to maintain the functions of the organs, but for this it is necessary to follow the recommendations of the doctor and adhere to some restrictions. For example, for patients with such a diagnosis, it is important to minimize the consumption of s alt, constantly monitor the levels of calcium and phosphorus in the blood. With each exacerbation of the pathology, it is necessary to seek medical help and each time undergo a course of therapy.
Identified at the 3-4th stage, the "wrinkled kidney" requires a slightly different approach. In this case, all restrictions are much stricter. It is no longer possible to restore lost organ tissues. Therefore, in such situations, therapy is reduced to ensuring the functionality of the remaining nephrons. Sometimes even this is not enough.
