Shock kidney: micropreparation and macro preparation, symptoms, diagnosis, treatment

To date, the concept of "shock organs" is widely used, which is most often characterized by kidneys and lungs. This concept is associated with multiple necrotic changes at the tissue and cellular level of vital organs as a result of shock conditions.

Shock kidney - a description of

Shock kidney is one of the most common types of acute kidney failure. Necrobiotic changes in the kidneys in 80% of cases are the cause of uremia( violation of the nitrogen balance of the body).Changes in renal tissue develop as a result of septic conditions, significant blood loss or severe injuries.

• Microscopically determined thinning of the cortical layer of the kidney and a decrease in the amount of blood in it. In the brain substance, everything happens on the contrary - it determines the fullness.
Micropreparation( plethora of the juxtaglomerular zone and pyramids of the medulla)

• Dystrophic changes in the tubular epithelium are detected under a microscope, which leads to a violation of the absorption of trace elements from the primary urine.
instagram viewer
• Macroscopically the kidney has a swollen appearance, a cortical layer of gray color, on the incision there is fullness in the pyramids of the medulla, the kidney is slightly enlarged.

Reasons for the development of

pathology Possible causes of kidney failure and shock kidney:

1. Operative interventions or trauma accompanied by a septic inflammatory process;
2. Severe injuries and prolonged squeezing;
3. Abundant blood loss and disseminated intravascular coagulation syndrome;
4. Severe exsycosis( state of dehydration of the body) with diarrhea syndrome or repeated vomiting;
5. Severe shock state as a result of thermal burns, thermal shock;
6. When transfusing blood products.

All the above conditions in certain conditions cause a shock reaction of the body, in which, primarily, the lungs and kidneys suffer. Due to a sharp drop in arterial blood pressure, the perfusion pressure in the glomerular apparatus of the kidneys decreases, which reduces the blood filtration rate. The volume of primary and secondary urine decreases. Develops oligo and anuria( a rare and complete absence of urination).

Clinical manifestations of

The first symptom of the disease is most often a gradual decrease in the amount of urine released, the volume of diuresis daily can be reduced to 500 ml. In this period, there are signs: weakness, a feeling of nausea, vomiting, dizziness, uremic coma( unconsciousness).These symptoms occur as a result of delayed products of nitrogen metabolism in the body. Because of the increase in the level of potassium, patients often complain of the sensation of crawling on the palms and feet( so-called paresthesia), periodic muscle twitching, convulsive syndrome. Weak tendon reflexes are noted. Quite often, patients develop edema. The duration of the stage is about 7 to 10 days.

After the oligoanuric stage, the function of urine formation and excretion is gradually restored. The stage of polyuria comes, the amount of urine per day can be up to 9 liters. In this case, the discharge is poorly colored, with a low specific gravity. This period lasts about 14 days.

The final stage is the recovery stage. Gradually restored the ability of the kidneys to concentrate urine, the removal of nitrogen metabolites. The stage can last up to 6 months or more.

The course of the disease

Four stages of development of the shock kidney can be distinguished:

1. Initial stage or stage of primary manifestations;
2. Oligoanuric stage( decrease in daily diuresis);
3. Polyuric stage( recovery of 24-hour urine volume);
4. The stage of recovery of kidney function.

The outcome of the disease is in most cases unfavorable, since the shock kidney causes many complications from other systems and organs. The most common cause of death in a shock kidney is the fluttering of the ventricles of the heart. The activity of the heart muscle increases as a result of an increase in the concentration of potassium in the blood.

Diagnosis

Diagnostic criteria for shock kidney:

1. In the general analysis of urine, an increased number of leukocytes and erythrocytes is detected, hyaline and granular cylinders are present in the urinary sediment( cells of the desquamated epithelium of the renal tubules);
2. Significant proteinuria( protein excretion in the urine) is recorded: more than 0.066 grams of protein per liter of urine per day;
3. In the stage of polyuria, there is a decrease in the relative density of urine( the concentration ability of the kidneys is impaired);
4. When carrying out a biochemical blood test, an increase in the level of potassium, sodium, nitrous products of metabolism is revealed, in parallel, the level of ALAT and ASAT can change( in case of liver damage);
5. When detecting blood pressure, hypertension can be detected;
6. In the general analysis of blood, leukocytosis, anemia, and an increase in ESR are recorded.
7. Ultrasound scanning of the renal parenchyma allows to establish the dimensions of the cortical and cerebral layers, increasing the size of the kidney.

Treatment of

For the treatment of kidney failure due to the development of a shock kidney, the cause of the development of this condition should be eliminated. For this purpose, antidotes are administered( in case of acute poisoning with toxic substances), anti-shock therapy( stimulate the heart, increase blood pressure), and detoxification.

In case of significant blood loss, the blood or its components are transfused:

• Replenishes the body's water balance by intravenous drip fluids in combination with diuretics. A 5% solution of glucose in a volume of 400 ml and a high molecular weight solution of Rheopolyglucin are used.
• In the presence of severe trauma and pain syndrome, analgesics are injected intravenously: promedol or fentanyl.
• To stimulate cardiac activity and increase vascular resistance, subcutaneous administration of caffeine and cordiamine is used.
• For the removal of nitrogenous bases from the body during the formation of a shock kidney, it is recommended to carry out artificial hardware hemodialysis.
• With the development of hyperkalemia( potassium level more than 6.5 mmol / l) immediately injected intravenously with a jet solution of calcium chloride( 10%) in a volume of 5-10 ml.
• It is mandatory to ensure daily monitoring of changes in laboratory parameters of the patient's blood, with registration of the level of blood electrolytes, creatinine and urea.

Warning! Timely diagnosis of the condition and timely treatment started increase the chances of the patient recovering.