Necrotic nephrosis: etiology, pathogenesis, clinical picture, treatment

The nephrosis group includes diseases accompanied by dystrophic changes in the kidneys. The clinical picture of such pathologies includes various abnormalities on the part of the excretory function of the body, as well as signs of fluid stagnation in the tissues. Necrotic nephrosis belongs to the acute form and without treatment can end in serious complications.

Necrotic nephrosis

Necronephrosis, or necrotic nephrosis - is an acute toxic or infectious shockogenic condition, accompanied by impaired blood supply and renal ischemia. Subsequently, against the backdrop of pathology, necrosis( death) of the epithelium of renal tubules occurs, which leads to the development of acute renal failure( uremia).

With necrotic nephrosis, there are phenomena of nephrogenic shock, because the degree of violation of blood supply and lymph flow can be very severe. A person has various phenomena of intoxication, in connection with which pathology is also called a "toxic infectious kidney."

Causes of

The etiology of nephronecrosis is diverse, but most often this disease causes poisoning and infections. Intoxication can cause rapid progression of kidney damage.

Immediate causes of necrotic nephrosis include the ingestion of large quantities of substances such as:

• Uranium;
• Chrome;
• Mercury;
• Lead;
• Gold;
• Bismuth nitrate;
• Organic acids( sulfuric, hydrochloric, etc.);
• Drugs;
• Chloroform;
• Antifreeze;
• Vinegar;
• Barbiturates;
• Ethylene glycol;
• Arsenic and other poisons;
• Some medicines( sulfonamides, etc.).

Violation of blood circulation in the kidneys can also lead to serious injuries, which are often accompanied by multiple organ failure, acute dehydration of the body, extensive burns, and severe intestinal obstruction. A separate line is necronemphrosis due to acute intravascular hemolysis against a background of transfusion of incompatible blood.

Pathogenesis of

Toxins of poisons, bacteria or other factors can directly affect the epithelium of the renal tubules and lead to the phenomena of coagulation necrosis. Since the inner layer of the tubules has a reabsorption capacity, when the toxins penetrate, their concentration in the kidneys increases manifold. This is the cause of acute circulatory disorders and ischemia of the kidneys. The depth of damage to renal nephrons strongly depends on the type of toxic substance, its volume and duration of exposure. Various changes on the part of the excretory function of the kidneys are due to the clogging of the glomerular lumen with depleted epithelium, as well as the products of the decay of blood cells. For this reason, the rapid development of acute renal failure is characteristic of necronemphrosis.

During the pathology several stages are distinguished:

1. Initial( up to 1-2 days).Signs of shock, poisoning and intoxication predominate.
2. Oligoinuric( up to 6 days).The amount of excreted urine drops sharply to 400 ml / day, later anuria occurs( discontinuation of urine output).Myoglobinuria, proteinuria syndrome( protein in the urine) is attached. Renal insufficiency grows, blood is slagged with nitrogenous substances, acidosis, hyperkalemia develops.
3. Polyuric( up to 2 weeks).The amount of urine released increases to 3 liters / day, urine is low in density, light. In the absence of complications, the kidney function begins to gradually recover, the blood composition is normalized.
4. Rehabilitation( 3-12 months).The patient recovers, the kidneys start working again without failures.

Clinical picture of

In an acute period against a background of progressive renal failure and acidosis, the patient may have symptoms such as severe vomiting, weakness, stupor and apathy. Appear edema on the body and face, some increase blood pressure. The temperature of the body falls, the work of the heart is disrupted. Respiratory cycles become uneven( deep breath, increased exhalation).Often there are pleurisy, pericarditis.

With hyperkalaemia against a background of delayed potassium, the body develops characteristic symptoms, the cause of which is intoxication of the nervous system and heart:

• Paresthesia.
• Decreased reflexes of tendons.
• Paracls, pareses.
• Arrhythmia.
• Bradycardia.

The recovery period can be prolonged for many months, and during this period all signs gradually decrease in severity. If necrotic nephrosis is severe, death from acute renal failure is possible.

Diagnosis

In the course of clarifying the anamnesis and taking into account the characteristic clinical picture, the diagnosis of "necrotic nephritis" is usually made without difficulty. The general analysis of blood, the general analysis of urine, Zimnitsky's test, Nechiporenko are necessarily carried out. On the oligoanuric stage in urine there is an increase in protein, hyaline and granular cylinders, a small number of erythrocytes, white blood cells are absent or single. In the blood, the content of nitrogenous compounds can be off scale, the retention of potassium is observed, the ESR increases. In polyuria, urine may contain a small amount of protein, in the blood, the ESR decreases.

In addition to assessing the condition of the kidneys and analyzing the complications that occur, diagnostic tests are performed, such as:

1. Coprogram.
2. Biochemistry of blood.
3. The test of Reberg-Tarayev to determine the level of glomerular filtration.
4. ultrasound or MRI of kidney.
5. ECG.
6. Instrumental studies of the heart, fundus, lungs, etc.(according to indications).

Treatment of

Early onset of treatment is the key to success in recovering the patient. The main goal is as soon as possible to eliminate the causes that led to the development of the disease. To remove from the body toxins and toxins, the rinsing of the digestive tract is urgently performed, the introduction of saline solutions, laxatives, sorbents. For example, when poisoning with mercury or lead, special antidotes are introduced.

In the development of acute renal failure, the goal of therapy is to support kidney function and eliminate slag and nitrogen compounds from the blood. For this, hemodialysis and intraperitoneal dialysis are recommended, as well as hemosorption and exchange blood transfusion. With massive loss of blood, infusion of erythrocytic mass, colloidal solutions, blood substitutes is urgently performed.

In nutrition, the products containing animal protein are reduced or completely eliminated, salt volume is reduced. Under the supervision of a doctor in a hospital, patients with acute necrotic nephrosis may stay for several weeks or months.

Forecast

The prognosis will depend on the severity of the cause, which led to the appearance of nephrosis, as well as the speed and quality of the medical care provided. Conduction of hemodialysis greatly facilitates the prognosis. Lethal outcome often occurs at the stage of shock or at the stage of anuria from acute uremia. Often even the severe course of the disease ends in complete recovery. The transition of the disease to the chronic stage is practically not observed, but the disturbances in kidney function can be quite long.