Acute renal failure - This is a condition in which there is a sudden cessation or a very sharp decrease in the function of both kidneys or a single kidney. Due to the development of such a condition, it manifests itself azotemia, which is rapidly growing, and severe water-electrolyte disturbances are also noted.
In the same time anuria is a serious condition of the body, in which the flow of urine into the bladder completely stops, or no more than 50 ml of it arrives during the day. A person suffering from anuria lacks urination and urges to him.
In the pathogenesis of the disease, the leading one is a violation of blood circulation in the kidneys and a decrease in the level of oxygen delivered to them. As a result, there is a violation of all important kidney functions - filtration, excretory, secretory. As a result of this, the content of nitrogen metabolism products in the body rises sharply, and metabolism is seriously impaired.
In approximately 60% of cases, signs of acute renal failure are observed after surgery or injury. About 40% of cases are manifested in the treatment of patients in a hospital. In rare cases (approximately 1-2%), this syndrome develops in women during of pregnancy.
Distinguish sharp and chronic stages of renal failure. A clinic of acute renal failure can develop over several hours. If the diagnosis is carried out in a timely manner, and all measures have been taken to prevent this condition, then the kidney functions are fully restored. The presentation of treatment methods is carried out only by a specialist.
Several types of acute renal failure are determined. Prerenalrenal failure develops as a result of acute impaired blood flow in the kidneys. Renal renal failure is the result of damage to the renal parenchyma. Postrenal renal failure is a consequence of a sharp violation of the outflow of urine.
The development of acute renal failure occurs during traumatic shock, in which tissue is damaged. Also, this condition develops under the influence of reflex shock, a decrease in the amount of circulating blood due to burns, and a large loss of blood. In this case, the state is defined as shock kidney. This happens in case of serious accidents, severe surgical interventions, injuries, myocardial infarctionwhen transfusing incompatible blood.
Condition called toxic kidney, manifested as a result of poisoning by poisons, intoxication of the body with medications, alcohol abuse, substance abuse, radiation.
Acute Infectious Kidney - consequence of serious infectious diseases - hemorrhagic fever, leptospirosis. It can also occur during the severe course of infectious diseases, in which dehydration quickly develops.
Acute renal failure also develops due to obstruction of the urinary tract. This happens if the patient has a tumor, stones, thrombosis, embolism of the renal arteries, and an ureter injury. In addition, anuria sometimes becomes a complication of acute pyelonephritis and sharp glomerulonephritis.
During pregnancy, acute renal failure is most often observed in the first and third trimesters. In the first trimester, this condition may develop after abortionespecially carried out under non-sterile conditions.
Renal failure also develops as a result of postpartum hemorrhage, as well as preeclampsia in the last weeks of pregnancy.
A number of cases are also highlighted when it is not possible to clearly determine the reasons why the patient develops acute renal failure. Sometimes this situation is observed when several different factors influence the development of the disease at once.
Initially, the patient does not manifest directly the symptoms of renal failure, but signs of the disease that leads to the development of anuria. These can be signs of shock, poisoning, directly the symptoms of the disease. Further, symptoms in children and adults are manifested by a decrease in the amount of urine excreted. Initially, its amount decreases to 400 ml daily (this condition is called oligouria), later the patient is allocated no more than 50 ml of urine per day (determined anuria) The patient complains of nausea, he also has vomiting, appetite disappears.
A person becomes lethargic, drowsy, he has inhibition of consciousness, and sometimes convulsions and hallucinations appear.
The condition of the skin also changes. It becomes very dry, turns pale, swelling and hemorrhage may appear. A person breathes often and deeply; tachycardia, the rhythm of the heart is disturbed and blood pressure rises. Loose stools and bloating.
Anuria is cured if the treatment of anuria was started in a timely manner and carried out correctly. For this, the doctor must clearly identify the causes of anuria. If the therapy is carried out correctly, then the symptoms of anuria gradually disappear and the period begins when the diuresis is restored. In the period of improvement of the patient's condition, anuria is characterized by daily diuresis of 3-5 liters. However, in order for health to fully recover, you need from 6 to 18 months.
Thus, the course of the disease is divided into four stages. At the initial stage, a person’s condition directly depends on the reason that provoked renal failure. At the second, oligoanuric stage, the amount of urine decreases sharply, or it may be completely absent. This stage is the most dangerous, and if it lasts too long, then a coma and even death are possible. In the third, diuretic stage, the patient gradually increases the amount of urine that is excreted. Next comes the fourth stage - recovery.
A patient with a suspected renal failure or with signs of anuria is assigned a series of examinations. First of all, this is a consultation of a urologist, biochemical and clinical blood tests, ultrasound, intravenous urography. It is easy to diagnose anuria, since according to a survey of the patient it can be understood that for a long time he did not have urination and urges to him. To differentiate this condition from acute urinary retention, catheterization of the bladder is performed to confirm the absence of urine in it.
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All patients who have symptoms of acute renal failure should be urgently taken to a hospital where diagnosis and subsequent treatment are carried out in the intensive care unit or in the nephrology department. Of primary importance in this case is the beginning of treatment of the underlying disease as early as possible in order to eliminate all the causes that led to kidney damage. Given the fact that the pathogenesis of the disease is most often determined by the effect on the body of shock, it is necessary to promptly conduct anti-shock measures. The decisive importance in the choice of treatment methods is the classification of types of disease. So, with renal failure caused by blood loss, its compensation is carried out by the introduction of blood substitutes. If poisoning initially occurred, gastric lavage is mandatory to remove toxic substances. In severe renal failure, hemodialysis or peritoneal dialysis is necessary.
An especially serious condition is caused by the terminal stage of chronic renal failure. In this case, kidney function is completely lost, and toxins accumulate in the body. As a result, this condition leads to serious complications. Therefore, chronic renal failure in children and adults should be properly treated.
The treatment of renal failure is carried out gradually, taking into account certain stages. Initially, the doctor determines the causes that led to the fact that the patient had signs of renal failure. Next, it is necessary to take measures in order to achieve a relatively normal volume of urine that is excreted in humans.
Conservative treatment is performed depending on the stage of renal failure. Its goal is to reduce the amount of nitrogen, water and electrolytes that enter the body so that this amount matches the amount that is excreted from the body. In addition, an important point in the restoration of the body is kidney failure diet, constant monitoring of his condition, as well as monitoring of biochemical parameters. Especially careful treatment should be if renal failure in children is observed.
The next important step in the treatment of anuria is dialysis therapy. In some cases, dialysis therapy is used to prevent complications in the early stages of the disease.
The absolute indication for dialysis treatment is symptomatic uremia, the accumulation of fluid in the patient's body, which cannot be excreted using conservative methods.
Particular importance is given to the nutrition of patients. The fact is that both hunger and thirst can dramatically worsen a person’s condition. In this case, it is shown low protein diet, that is, fats, carbohydrates should dominate in the diet. If a person cannot eat on his own, glucose and nutrient mixtures must be administered intravenously.
In order to prevent the development of such a dangerous state of the body, first of all, it is necessary to provide qualified care to those patients who have a high risk of developing acute renal failure. These are people with severe injuries, burns; those who have just undergone a serious operation, patients with sepsis, eclampsia, etc. Very carefully use those medications that are nephrotoxic.
In order to prevent the development of chronic renal failure, which develops as a consequence of a number of kidney diseases, it is necessary to prevent exacerbation of pyelonephritis, glomerulonephritis. It is important for chronic forms of these diseases to follow a strict diet prescribed by a doctor. Patients with chronic kidney disease should be monitored regularly by a physician.
The course of acute renal failure is often complicated by infectious diseases. It is with such a course that the disease can be fatal.
As complications of the cardiovascular system is circulatory failure, arrhythmias, hypertension, pericarditis. Often with acute renal failure, a manifestation of neurological disorders is noted. Those patients who are not on dialysis may report severe drowsiness, impaired consciousness, trembling and other disorders of the nervous system. More often, such disorders develop in older people.
By Gastrointestinal tract complications also develop often. This may be nausea, anorexia, bowel obstruction.
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List of sources
- Ermolenko V.M. Chronic renal failure / V.M. Ermolenko; ed. prof. I.E. Tareeva.-M .: Medicine, 2000;
- Chizh A.S. Nephrology in therapeutic practice / A.S. Siskin. - M .: Medicine, 2001;
- Nephrology / ed. I.E. Tareeva I.E. - M: "Medicine". - 2000;
- Treatment of chronic renal failure / Under. ed. S.I. Ryabova. - SPb .; 1997;
- Guide to Nephrology: Per. from English / Ed. J.A. Whitworth, J.R. Lawrence, - M.: Medicine, 2000.