Swelling on different parts of the body can occur for various reasons. These can be puffiness of the cardiovascular etiology, liver pathology, unhealthy lifestyle and diet, traumatic factors or allergic exacerbations. But more often the cause of puffiness is renal structures, i.e.edema associated with kidney pathologies.
Renal edema is a characteristic of
Renal edema is a kind of swelling that occurs with kidney diseases. Most often this sign indicates the development of kidney failure. Such edema is difficult to diagnose, in terms of the fact that you can make mistakes in determining their causes, and hence in the further treatment of the disease. Kidney pathologies in medical practice are often enough, therefore, the puffiness of such etiology is also not uncommon. Kidneys are a kind of body filter. If some pathology develops in them, the filtration function is violated, the balance of substances in the body is disrupted, which as a result leads to puffiness. Usually, the restoration of filtration activity and correction of the blood composition leads to the disappearance or a significant decrease in edema.
Reasons for
Renal edema occurs for various reasons, which are conventionally divided into two classes. The first class of causes is the pathological mechanisms that cause the exit and accumulation of fluid in the intercellular space. The second class is the causes caused by renal pathologies, under which the above mechanisms operate. Therefore, renal edema is most typical for such pathologies:
- Amyloidosis. With pathology in the kidney accumulates protein - amyloid, it gradually clogs the membranes, preventing normal blood flow. All this reduces the filtration capacity of the kidneys, leading to the accumulation of toxins in the blood and fluid in the tissues.
- Glomerulonephritis. This is an immune lesion of the glomerular renal apparatus. Immune complexes that provoke pathology are usually formed in the blood on the background of autoimmune and infectious pathologies like streptococcal angina, etc. The glomerular apparatus becomes inflamed under the influence of immune complexes, filtering is violated.
- Renal failure is a violation of all renal functions, including water-electrolyte equilibrium and filtration, which is the cause of edema.
- Tumor lesions. With some tumor formations there is a violation of renal activity, which negatively affects the filtration ability.
- Poisoning. Some heavy metals and toxic substances can accumulate in the body. Against the background of their toxic effects, normal cells die, replaced by connective tissue structures. As a result, kidney deficiency is formed, accompanied by edema.
In addition, the causes of puffiness can be caused by nephropathy on the background of diabetes or pregnancy, systemic connective tissue pathologies, etc.
Mechanism of development of
Edema is an excessive accumulation of water in the intercellular spaces.
In general, the pathogenesis of edema of kidney origin looks like this:
- Increased filtration of proteins through membrane structures of the glomerular system. When proteins enter the urine, they take some of the fluid. The proteins are not reabsorbed, since their molecules are too large to seep through the tubular walls.
- Decreased filtration activity of the kidneys. It occurs against a background of different conditions, for example, with hypotension, when the hormonal system activates, which increases the reverse absorption of sodium in the kidney structures, which leads to fluid retention.
- Deficiency of protein compounds in the blood. Usually, this condition occurs due to the loss of protein in the urine, although this may be caused by a violation of protein formation in the liver.
- Increased capillary permeability. With such a violation, the fluid and the blood components flow freely into the space between the cells. Elevated vascular permeability is observed with glomerulonephritis, infectious kidney damage, with renal failure and other pathologies. Excessive concentration of sodium ions in the blood. Such clusters are associated not only with sodium retention in the kidneys, but also with the excessive intake of this substance from the outside, for example, when salt is misused.
- Increased fluid intake. Many renal pathologies lead to slower filtration in the glomeruli. If the patient at the same time consumes excessive amounts of water, the liquid will inevitably accumulate in the tissues in the form of edema.
All mechanisms of development of renal edema are reduced to functional disorders in the kidneys.
Signs and symptoms
Initially, when the filtration activity of the kidneys is not significantly affected, swelling of the kidney origin appears on the areas with a thin, delicate skin and loose structure of the cellulose. Therefore, at the beginning of the pathology, puffiness predominates on the eyelids and face. They manifest themselves most in the morning, but soon pass. Similar symptoms can be considered the first signal indicating the development of pathology.
Then, with further development of the disease, the insufficiency progresses, the swelling spreads to other parts of the body, and the hands begin to swell. Characteristic for renal edema is a pitting - if you press on the swollen patch, then there is a dent that passes in a few seconds. In some patients, such swelling is accompanied by sensations of soreness, stiffness, stiffness or stiffness.
If, and with such symptoms, the patient continues to ignore the disease, the kidney pathologies progress, the swelling spreads to the feet. In other words, the sequence of progression of renal edema is as follows: first the face swells, then the hands, then the legs. Additional signs for renal edema may be neurologic manifestations( drowsiness, migraine, arthralgia, myalgia and bone pain), urination disorders and painful sensations in the kidney area.
Diagnosis
Not all kidney pathologies are accompanied by edema, as not all edemas speak of the development of kidney disease. Therefore, the appearance of puffiness requires a thorough differential diagnosis, in which the expert excludes other probable pathologies.
Studies
To identify renal edema and determine their causes, patients are assigned the following studies:
- Biochemistry and general laboratory blood tests. With edema, the overall picture of blood does not change, but biochemical analysis reports increased cholesterol and creatinine, uric acid and urea. Also, with the biochemistry of the blood, protein deficiency and electrolyte disturbances are revealed.
- Detection of rheumatic factor. Often glomerulonephritis occurs as a complication of angina of streptococcal origin. To confirm this diagnosis, you need to identify the rheumatic factor.
- Biochemistry and general urine research. A characteristic feature in renal edema is proteinuria - when there is an increased protein content in the urine. A similar sign is typical for a variety of renal pathologies. Biochemical examination of urine shows that it lacks uric acid, creatinine urea, etc.
- Dopplerography of renal vessels. A similar study is performed on an ultrasound machine. The specialist determines the presence of vascular pathologies and sclerotic zones, tumors in the kidney tissues, blood flow velocity, etc.
- Functional samples of the kidneys. To identify pathology, samples like urine density, creatinine clearance, or dilution test are performed. These samples help to determine the quality of filtration activity.
Difference from cardiac edema
The table distinguishes renal edema from edema of cardiac origin:
| Symptom | Renal edema | Cardiac edema |
|---|---|---|
| Localization of | Upper part of the face, face, eyelids. Distribute from top to bottom. | The tibia, the feet. In a supine position, lumbar swelling appears. |
| Palpation | Externally, edema is slightly paler, with palpation the temperature does not differ from other areas. | In the place of puffiness, the skin is cyanotic and cold. |
| Mobility | The site of the edema can move, that is, it is mobile. | Puffiness is immobile, and when you press it, you can feel pain. |
| Concomitant symptoms of | The presence of urinary disorders such as lumbar pain or decreased urine volume is characteristic. | Symptoms of cardiovascular problems such as chest pains and dyspnea, swelling of cervical localization, etc. are characteristic. |
| Urinalysis | Changes in urine composition( contains electrolytes and proteins). | Usually, there is no change in the urine. |
| The rate of disappearance of | Renal edema quickly disappear and quickly appear. | Characterized by the slow formation of edema and its resorption. |
Treatment
How to treat it can be said only after finding out the etiology of swelling. The primary task is to eliminate the provoking factor.
In general, the treatment involves the use of the following techniques:
- Treatment of the underlying pathology. It is necessary to eliminate the root cause of edema.
- Diuretics. They stimulate the removal of surplus fluids( Furosemide, Oxodolin, Ureit, Dichlorothiazide, Triamteren, Veroshpiron, etc.
- Diet Therapy is aimed at the most gentle mode for kidneys. In severe cases, bed rest is shown, at rest kidneys are easier to perform filtration, which helps to eliminate swelling. Patients are assigned a salt-free diet number 7 or a diet number 7A, limiting the intake of liquid and salt
- Vascular strengthening agents( Ascorutin, etc.) They are not prescribed to all patientss, and only those whose receptacles are characterized by high permeability.
- means for normalizing water and electrolyte balance. Used by intravenous infusion or drip infusions with solutions of certain salts.
These drugs are extremely important for maintaining normal cardiac activity and preventing the washing out of potassium. Controls the process of treatment of renal edema and their underlying cause of nephrology. The competent specialist in this case is extremely necessary to exclude all kinds of complications.