A nephrotic crisis is a life-threatening complication that arose against the background of an already existing nephrotic syndrome. This syndrome, in turn, is characterized by a significant decrease in protein content in the blood and an increase in its excretion along with urine. Against this background, fluid from the vascular cavity emerges into the tissues and develops widespread expressed swelling.
Nephrotic crisis - the mechanism of development of
Each manifestation of the critical state of a person suffering from renal pathology has its pathogenetic justification.
Initially, due to increased excretion of protein from the body with urine, the amount of protein in the blood decreases( the level of oncotic pressure changes).Then there is a decrease in blood circulating through the bloodstream. In order to compensate for the activity of vital organs for humans, the organism redistributes the blood flow in such a way that the peripheral vessels spasmodic and all blood enters the heart, kidne
ys, lungs and brain, while not going to the periphery. As a result of such processes, oxygen starvation of cells and acidification of blood develop.
Blood from the vessels passes into the surrounding tissues and develops edema and erythematous spots due to increased vascular permeability( their walls).
Particularly sensitive to lack of blood supply and hypoxia of human kidney tissue, therefore, kidney failure develops rapidly enough.
It is possible to single out such pathogenetic links in the development of nephrotic crisis:
- Decrease in protein concentration in the blood and increase its excretion with urinary fluid;
- Decreased oncotic blood pressure and its release from the vessels into surrounding tissues;
- The process of blood supply of vital organs( centralization of blood circulation);
- Redistribution of blood along the body with its primary deposition in peripheral vessels;
- Development of a sludge syndrome, which is characterized by gluing blood platelets inside the vessel( multiple thrombi);
- Necrosis of cells of organs in whose vessels thrombosis developed.
Symptoms and symptoms of
There are three specific symptom complexes characteristic of a nephrotic crisis:
Symptoms of nephrotic crisis
- Manifestes a nephrotic crisis with frequent cramping abdominal pains, the pain syndrome can be characterized by positive symptoms of irritation of the peritoneum. The occurrence of this symptom is associated with the fact that the vessels feeding the intestinal wall undergo spastic contraction and significantly limit the local circulation of blood.
- The development of the crisis continues with the appearance of erythematous spots on the surface of the skin of a migratory nature( move within 24 hours).This symptom can be explained by the fact that the blood increases the factors that increase the permeability of the vascular wall, so some of the blood goes into the interstices surrounding the vessels. The dimensions of such spots on the skin usually do not exceed the size of the palm of a person. If you touch the reddened areas, there is clearly a difference in temperature( the stain is hotter to the touch).
- Shock state due to pronounced hypovolemia( decrease in the volume of circulating blood).This condition is characterized by rapid heartbeat and breathing, lowering of the blood pressure level. A cyanotic shade appears first on the limbs, and then on other parts of the patient's body. The pulse is recorded frequently with a weak filling.
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With the sudden appearance of the first signs of a nephrotic crisis, it is urgent to take urgent measures to help a person:
- First of all, a jet intravenous injection of prednisolone in a dose of 150-250 mg( calculate the dose should be by weight of the victim, 5 mg of the drug per 1 kg).
- Replenishment of blood volume in the body, or more precisely - in the vascular bed, is carried out by administration of albumin or blood substitutes( reopoliglyukin) to 500 ml( also depends on body weight and the degree of deficiency of blood volume).
- To prevent the development of thrombosis, heparin preparations are prescribed, the route of administration is intravenous. Usually guided by a dose of 150 units per 1 kg per day. Assign tablets kurantil for oral administration. Sometimes they resort to plasma transfusion.
- Infusion therapy is selected individually according to the results of a blood test( electrolyte composition).
- At the end of the dropper, inject furosemide( a diuretic) in a dosage of 20 to 120 mg.
- If a patient has low blood pressure values, signs of disruption of normal brain function are necessary, it is urgent to begin dopamine infusion at a dosage of 5 mg per 1 kg of body weight.
- If the abovementioned methods of care are not effective and the concentration of blood products in the blood increases - hemodialysis is indicated.
Quite often the nephrotic crisis develops against the backdrop of improper treatment of renal pathology accompanied by nephrotic syndrome. In order to avoid this, it is necessary to contact a doctor immediately if any signs of the disease appear and comply with all the prescriptions.
Nephrotic crisis therapy should be aimed at restoring the volume of fluid in the vascular bed due to the infusion of blood products and its substitutes, care should be taken for the state of the blood coagulation system and the administration of heparin by injection. Necessarily, the regimen includes glucocorticoids and antibacterial agents.
Regularly measured body temperature rectally and in the armpit, a blood test for coagulation is taken.