Renal eclampsia: causes, pathogenesis, symptoms, emergency treatment, treatment

The term "eclampsia" is usually used to characterize the most complex form of gestosis in pregnant women - a condition with convulsive syndrome, pressure jumps and severe disabilities in the body. But the disease kidney eclampsia is found not only in pregnant women, but also in other categories of the population.

Renal eclampsia

By eclampsia renal is understood as encephalopathic syndrome, accompanied by convulsions, loss of consciousness against the background of cerebral arteriolar spasm and cerebral edema. It is a rare disease, in most cases becomes a complication of kidney pathologies.

In acute forms of nephritis, the disease occurs only in 0.3% of cases. More often renal eclampsia is registered at pregnant women on last terms. In children aged 1-3 years, it almost does not occur, in childhood is more typical for schoolchildren. It is necessary to distinguish eclampsia from azotemic uremia, which is a consequence of severe forms of chronic nephritis.

Causes of

Diseases against which such a complication may develop are:

• Pregnant nephropathy;
• Toxicosis of the second half of pregnancy;
• Acute diffuse glomerulonephritis;
• Exacerbation of chronic nephritis.

The pathogenesis of

The development of eclampsia comes from two equivalent factors - cerebral circulation disorder against the background of cerebral edema and microcirculation disorders with angiospasm. In acute forms of kidney damage, sodium and water molecules in the brain tissues are delayed. Increases intracranial pressure, as well as pressure in the cerebral vessels.

Because of the increase in arterial pressure and spasm of the walls of the vessels, ischemia( oxygen starvation) of brain tissues is observed, leading to significant disorders of brain functions. In parallel, acute renal( sometimes hepatic) deficiency develops, dysfunction of the spinal cord occurs.

In pregnant women, renal eclampsia is often associated with an increase in blood viscosity and the development of disseminated intravascular coagulation - with the massive appearance of thrombi. Blood flow is disturbed both in the brain and in vital organs, therefore the consequences for the organism are extremely serious.

Clinical picture

The main manifestation of renal eclampsia does not always occur - often the patient has seizures in full consciousness, or short-term loss of consciousness. And yet, more often the development of eclampsia is "standard" - it is preceded by sudden lethargy, drowsiness, headaches against the background of acute nephritis. The attack can last several minutes( prolonged seizures are not typical), often a series of seizures follows one another. Between them the patient is as if in a stunned state, can not come to himself, or( in case of severe illness) falls into a coma. The total duration of pathology without treatment can be a day or more.

The main symptoms of an acute attack of renal eclampsia are as follows:

• Severe headache;
• Nausea and vomiting;
• Syncope;
• Visual impairment, speech;
• Paresis and paralysis( reversible);
• Boost pressure to high digits;
• Vein swelling on the neck;
• Rolling the eyes up;
• Biting the tongue;
• Foam from the mouth;
• Pale skin;
• Randomness, intermittent breathing.

Seizures are an important symptom of renal eclampsia. They develop at the height of the attack during a sigh, scream. Seizures can be initially weak( tonic), but then amplified( clonic).In some patients, instead of typical seizures, individual muscles twitch. During seizures, involuntary urination, defecation often occurs. In severe cases, the pupils do not react to light, the eyes harden.

The development of the symptoms of the attack occurs in four periods:

1. The first, or predictive. Duration - up to a minute.
2. The second, or period of tonic seizures. Duration - up to 30 seconds.
3. The third, or period of clonic seizures. Duration - up to 2 minutes.
4. Fourth, or allowing. The patient comes to his senses.

Diagnosis

Patients in the hospital for treatment of acute nephritis, diagnosis usually does not cause difficulties.

But in those patients who enter the department during the development of renal eclampsia, differential diagnosis is required:

1. With epilepsy, there is no swelling, the disease has a long history, the tongue may have scars from earlier seizures.
2. With azotemic uremia - occurs only in patients with chronic nephritis, characterized by slow development, urine has a low specific gravity, there is a smell of urine in the exhaled air, anemia in the blood, and increased residual nitrogen.
3. With hemorrhagic stroke - there are no cramps, the face is not pale, but red, hyperemic, the phenomena of paralysis rapidly build up, the coma develops sharply.

To facilitate the diagnosis, an anamnesis can be collected from the patient or his loved ones, in particular, an indication of a sudden increase in pressure and the appearance of swelling before the attacks. Distinctive features of renal eclampsia by analysis - high specific gravity of urine, presence of blood in the urine, in pregnant women - increase of blood platelets.

On a video attack of renal eclampsia:

First aid for

The tasks of close and arrived ambulance brigades are to stop the current attack and prevent the development of a new one, eliminate existing acute disorders, and bring down the pressure to normal levels.

At home, emergency care is as follows:

1. Put the person on the bed, sofa, floor( no pillow).
2. Head to deflect to the side, fix the tongue so that it does not sink - insert a spoon wrapped in gauze in the mouth.
3. Open the window, provide air access.
4. Remove all crushing details of clothing from the neck.
5. If necessary, perform manipulations by mouth-to-mouth breathing.
6. Give a person a Nitroglycerin pill if he is conscious.

Specialists "ambulance" to restore self-breath apply oxygen masks, in the absence of the act of breathing - establish a permanent IVL.When the heart stops, an indirect massage is performed. Treatment of renal eclampsia is more effective under anesthesia, so in the ambulance the patient is often given a general anesthesia.

Treatment

For the removal of seizures in the hospital, anticonvulsant therapy is performed - solutions of Seduxen, Droperidol, Promedol, Fentanyl with glucose are administered. Parallel treatment of arterial hypertension with Clophelin, Dibazolum, Euphyllinum, etc. is performed.

Well proven in the treatment of renal eclampsia, bloodletting with a fence of up to 400 ml of blood and the subsequent administration of glucose solution. Another method for treating cerebral edema and reducing blood pressure is the introduction of Magnesium Sulfate, which quickly stops the spasm of the cerebral vessels and normalizes intracranial pressure.

After removal of acute renal eclampsia, the patient should remain in the department for treatment of nephritis. A strict diet with a restriction of salt and liquid is recommended. Unloading days on milk, sour-milk products, kissel are necessarily performed. Treatment with diuretics, Prednisolone, preparations for arterial hypertension, diathermy of the lumbar region is prescribed.

Complications of

Due to the development of medicine, deaths from this type of eclampsia are rare. Nevertheless, the lethal outcome of acute renal or heart failure, from massive hemorrhage to the brain is still possible. Weighted forecast for the addition of other forms of eclampsia - cerebral, hepatic. In pregnant women, death is possible from disseminated intravascular coagulation. Usually renal eclampsia does not complicate the course of acute nephritis - on the contrary, the pathology after the seizures is often not transferred to the chronic one.