Kidneys perform very important functions in the human body: concentration and metabolic, excretory and ion-regulating, endocrine and hematopoietic, osmotoregulatory, etc. During the day, all the blood of our body passes through the kidneys and cleanses. Against the backdrop of impaired purine metabolism, vascular and metabolic abnormalities in the presence of gout in the kidneys, gouty nephropathy can develop.
Gouty nephropathy
So, gouty nephropathy is a kidney lesion that occurs against the backdrop of progressive gout, which is characterized by the deposition of uric acid salts in the body. Gout is more common for men and about half of them later become ill with gouty nephropathy.
If uric acid concentration exceeds 8 mg / l against the background of pathology, then the probability of kidney failure increases five to tenfold.
Causes of
At the heart of the pathology is the increased production of uric acid salts and their slow release from the body. As a result, the concentration of uric acid in the blood rises, urate accumulates in the kidneys, which provokes the development of urate nephrolithiasis, when stones form in the cup-and-pelvis structures.
Predisposing factors of gouty nephropathy are:
- Affiliation to the male sex;
- Presence in a history of diabetes;
- Alcohol abuse;
- Elderly age;
- Long-term treatment with salicylates or diuretics, anti-inflammatory therapy;
- Excess weight;
- Treatment with cytostatics( antitumor agents).
Actually, the cause of the gouty kidney is gout, which leads to metabolic and circulatory disorders. Due to the complex effects of the above factors, damage to the renal parenchyma occurs.
Symptoms and Diagnosis
Clinical manifestations of pathology consist in the bright manifestations of acute arthritis and metabolic syndrome, signs of abdominal obesity. The specific symptomatology depends on the variant of the gouty kidney. There are three variants of development of the pathological process: urate nephrolithiasis, tubulointerstitial nephritis of chronic type and acute urinary nephropathy. Each of the variants differs in the features of clinical manifestations, and therefore it is necessary to consider them as separate pathologies.
Urate nephrolithiasis
Urinary-type nephrolithiasis is detected in the presence of concrements in the kidneys. Usually this process has a two-sided nature, and after the removal of stones is characterized by a recurrent formation. Quite common in urate nephrolithiasis are coral-shaped stones, which completely fill the tubular cavity. Such stones are often accompanied by pyelonephritis and kidney bleeding.
Ultrasound diagnosis is the method of choice in detecting this pathology. Also for urate nephrolithiasis is the presence of renal colic, which is manifested by a sudden attack of pain accompanied by a delay in urine and obstructed by the patency of the urinary tract. There is such a complication of hematuria, which occurs due to damage to the walls of the urinary tract by concrements.
In general, urate nephrolithiasis is characterized by such manifestations:
- Persistent noisy intense soreness in the lumbar region;
- Presence of renal colic;
- Fever;
- Chills;
- The admixture of blood in the urine.
At laboratory research in urine bacteria and the raised maintenance of leucocytes can be found out that speaks about development of a pyelonephritis of the secondary form. If this condition is not treated, then hydronephrosis may develop, representing an enlargement of the pelvis against the background of an impossible urinary excretion. The lack of treatment is fraught with the development of pyelonephritis, leading to terminal failure of kidney structures.
If there is no inflammatory process in the kidneys and does not disturb renal colic, then in the results of laboratory tests no changes are observed.
On video characteristics of urate nephrolithiasis:
Chronic tubulointerstitial nephritis
Gouty kidney can develop in the form of tubulointerstitial jade of chronic form. It is an inflammatory lesion of the renal tubules, accompanied by a toxic, allergic or infectious genesis and leads to a significant deterioration in the functionality of the kidneys. Tubulointerstitial nephritis is characterized by a symptomatic pattern like:
- Fever;
- Organometallic weakness;
- Hyperthermia;
- Hives;
- Painful urination;
- Increases in renal size;
- Painful manifestations in the sides and lumbar region;
- Decreased physical activity due to rapid fatigue;
- Purulent impurities or bloody component in the urine that is visible to the naked eye;
- Lack of appetite.
Often it happens that the symptomatology for a long time is practically not manifested. Sometimes there is a fluid retention in the body. Patients note a persistent increase in pressure, which is controlled only by taking special medications. If you do not manage to control hypertension with medicines, then this indicates a large-scale damage and replacement of renal tissues with cicatricial.
Acute uric acid nephropathy
Development of this variant of the gouty kidney occurs abruptly and unexpectedly:
- Suddenly, the volume of urine released decreases;
- Patients report the emergence of severe pain in the lower back;
- A pronounced macroscopic hematuria is observed when urine becomes bright red due to a large amount of blood;
- Periodically disturbed by hypertensive crises;
- There are renal colic.
Against the background of these symptoms, renal excretory functions are not violated in any way. Over time, urine disappears altogether, a rapid development of the body's inadequacy begins, accompanied by a pronounced intoxication of the body with harmful products of its vital activity.
Treatment of
Treatment of gouty nephropathy with exacerbation of pathology requires intensive infusion therapy. The patient is poured polyionic, crystalloid, physiological solutions. For relief of pain symptoms, Colchicine or anti-inflammatory therapy is indicated. If gouty nephropathy is characterized by a stable course, then diet therapy and maintenance therapy is conducted.
The daily diet for gouty kidneys is based on the following principles:
- Low protein intake;
- Frequent drinking( alkaline);
- Minimum caloric content required.
In parallel, it is recommended to take antidotal drugs like Allopurinol. To excrete small fractional concrements, patients are assigned citrate mixtures. The pressure is controlled by antihypertensive drugs. Patients are categorically contraindicated in taking thiazide and loop diuretics, since these drugs only contribute to an increase in the urinary concentration. But the reception of uroantiseptics and phytopreparations will only benefit.
If large enough concretions have formed in the kidneys, then the intervention of the surgeon, which will remove the stones through nephrotomy, remote or contact lithotripsy, is indicated. In acute renal failure, urgent hospitalization in the intensive care unit is indicated.
Forecasts
Gouty kidney can lead to a number of complications such as:
- Chronic or acute renal failure;
- Chronic glomerulonephritis;
- Hypertonic disease;
- Stone formation in the pelvis;
- Hydronephrosis;
- Secondary pyelonephritis;
- Amyloidosis;
- Renal cyst formation;
- Renal colic;
- Pionephrosis and even death.
Urate nephrolithiasis or tubulointerstitial nephritis develops against the backdrop of a prolonged ongoing chronic gout. Urinary nephrolithiasis is often characterized by a recurrent course, and uric acid nephropathy is a cyclic reversible course.
If the pathology is chronic, the organ failure is formed over about 10-15 years after the disease is detected. Every fourth patient with gout as a result receives the terminal stage of kidney failure. The final predictions are determined by the activity of the development of the pathological process, as well as the timeliness and correctness of the prescribed treatment.