Toxic nephropathy: ICD-10 code, causes, symptoms, diagnosis, treatment

In severe poisoning and intoxications, the kidneys can be affected primarily by the development of toxic nephropathy. Only timely treatment will help a person avoid the most serious complication of such phenomena - renal failure.

Toxic nephropathy

By toxic nephropathy is meant the defeat of the kidney parenchyma, their glomerular apparatus, which occurs against the background of exposure to exogenous and endogenous toxic products and metabolites( ICD-10 code is N14.4).

The classification of pathology includes such types:

1. Specific nephropathy. It is associated with acute external toxicoses, which occur during poisoning with various nephrotoxic substances. Often the developing disorder of kidney function is preceded by toxicogenic liver damage.
2. Nonspecific Nephropathy. It is caused by disorders of hemodynamics of different etiology, provoked by various severe poisonings.

Causes and pathogenesis of

Kidney damage can occur due to the pathogenic effect on their tissues of the poisonous substances themselves, the products of their decomposition, and also against the background of the development of an autoimmune reaction.

The most common disease is caused by such substances:

• Heavy metals, their salts;
• Ethylene glycol;
• Oxalic, acetic acid;
• Pesticides, herbicides;
• Arsenic;
• Solvents;
• Copper vitriol;
• Poisons of animals, insects;
• Toxins of fungi;
• Nitrogen-containing compounds;
• Volatile ethers;Low-quality alcohol.

Often, toxic nephropathy is recorded in people engaged in harmful production, where work is associated with poisons, chemicals, rubber, polymers. All substances can enter the body both through the respiratory system, and through the blood, through the skin( with bites).

After the effects on the kidneys of toxins and metabolites, the swelling of parenchyma cells is observed, as well as the disruption of the functioning of the renal glomeruli, which causes malfunctions in the cellular respiration and results in the precipitation of protein fractions. If the body is affected by hemothoxic poisons, they destroy the red blood cells in parallel, as a result of which hemoglobin clogs the structural units of the kidneys - nephrons. In some cases, kidney damage occurs against the background of their inhibition by free amino acids. Whatever the pathogenesis, ultimately, there is oxygen starvation of the kidney tissue, its ischemia, which without treatment leads to necrosis of the tubules and glomeruli.

Symptoms of

The severity of organ damage will largely depend on the type of substance that has entered the body, on its quantity, on the way it hits. A certain role is played by the health of the urinary system before the onset of pathology - in the presence of chronic kidney diseases, nephropathy can develop even from small doses of toxic agents.

The clinical picture resembles that of acute glomerulonephritis. First, there are general symptoms - weakness, weakness, inhibition, the temperature may rise. Next, the person notes swelling of the legs, puffiness of the face. The parameters of the urine composition change: the amount of protein in it grows, blood appears( erythrocytes).

Other common signs of a pathology:

• Increase in blood pressure up to very high digits.
• Decreased urine output, frequency of urination( sometimes complete anuria).
• Back pain due to kidney edema.
• Convulsions.
• Decreased heart rate.
• Arrhythmia.
• Chryps in the lungs.

Depending on the type of toxic substance, specific symptoms may also be associated with the clinical signs described above. For example, if a person is poisoned with an excessive amount of sulfonamides, then in toxic nephropathy, he has pain in the joints, hemorrhages on the skin and mucous membranes, febrile state.

In terms of severity, the disease is differentiated as follows:

1. The first is a moderate increase in protein, hemoglobin and red blood cells in the blood, mild symptomatology.
2. The second - diuresis falls, the amount of urea, potassium, creatinine in the blood greatly increases, the symptoms increase.
3. Third - due to edema of the kidneys and a sharp decrease in the parameters of glomerular filtration, it is possible to develop acute renal failure - a deadly complication.

In the progression of renal failure in toxic nephropathy, several stages are also distinguished:

1. Initial( up to 3 days).The actual poisoning of the body by nephrotoxic agents occurs.
2. Oligoanus( 1-2 weeks).Because of the fluid retention, urinary excretion decreases, which leads to heart overload and development of edema, dyspnea, wheezing in the lungs. At this stage, cerebral edema is also possible. There is a death from suffocation with pulmonary edema, from cardiac arrest, DIC syndrome. Often joins secondary vasculitis, anemia, thrombocytopenia.
3. The stage of polyuria( up to several months and years).This stage occurs with a favorable course of the disease. Diuresis builds up, which can also lead to dehydration.
4. Recovery. All indicators of urine and kidney work come back to normal, but full recovery is probably not all patients.

Diagnostics

Usually, diagnostic activities are already conducted in the nephrology department, where the patient is brought with suspicion of acute kidney damage. In addition to the characteristic clinical picture, the doctor draws attention to the history of pathology, finds out the possible nature of poisoning.

Methods of examination for toxic nephropathy are as follows:

• General analysis of blood, urine;
• Blood test for pH, electrolytes;
• Biochemical blood test for renal function;
• kidney ultrasound;
• If necessary - MRI of the kidneys.

With nephropathy, ESR, the number of leukocytes in the blood, anemia is most often increased. In the urine, the amount of protein, nitrogen compounds grows, hemoglobin and erythrocytes, and cylinders appear. The specific gravity of urine is increased, and in the peripheral blood, there is an increase in creatinine, urea, uric acid, and potassium.

Treatment of

Treatment of toxic nephropathy is often performed in the intensive care unit, especially in acute kidney failure. In a less serious situation, the treatment is performed in the standard ward of the Nephrology Department( urology).Start a set of measures for the treatment of the disease should be immediately, preferably - under the supervision of a toxicologist.

The most important are measures to remove toxins, poisons from the body. This is achieved by performing such techniques:

• Plasmapheresis;
• Hemodialysis;
• Hemofiltration;
• Hemosorbtion;
• Gastrointestinal tract flushing.

Forced diuresis is carried out by the introduction of euphyllin, mannitol, and lasix. To wash the stomach, it injects vaseline oil or a large amount of liquid. Hemodialysis is recommended in the first 6 hours of the disease, then another 48 hours make peritoneal dialysis( purification of blood through the peritoneum).

Of drugs with toxic kidney nephropathy, sorbents, diuretics, glucocorticosteroids, and abundant alkaline drinking can be recommended. Supplement the treatment with the introduction of glucose with vitamin C, insulin, sodium bicarbonate, calcium chloride, vitamins. If necessary, transfusion of albumin and plasma is performed.

Complications and Forecast

The prognosis for toxic nephropathy depends on the type of poison and the severity of the disease, the lethality ranges between 20-70%.The prognosis is favorable only with the adequacy of therapy and its timeliness. The worst forecast is when cadmium, silicon, hydrogen arsenate enters the body.

Complications most often develop with a high concentration of toxins and poisons in the body, with their introduction not through the respiratory tract, but through the blood. Complications include hemolytic-uremic syndrome, interstitial nephritis, acute renal failure. The last indicated complication often leads to death due to kidney necrosis and complete failure of their function.