It is possible to accurately diagnose a disease only if there is an idea of the various existing pathologies and their nuances, differences, features. Determining the totality of syndromes is a key diagnostic point. The doctor’s task is to evaluate information, signs, make a preliminary diagnosis and identify the pathogenesis of manifestations. In addition, knowledge of symptoms and syndromes in nephrology is necessary for the correct determination of methods for clarifying the condition.
Relevance of the issue
Doctors knowingly make a list of syndromes in nephrology - it is the principle of diagnosis with the use of such a list that makes it possible to adequately assess the patient's condition. This is important to determine how significant patient care should be and what kind of treatment is needed right now. Perhaps the patient needs help in eliminating the pathogenesis, in other cases it is necessary to alleviate the symptoms or to deal with complications. The syndromic approach is the most effective method for assessing the nuances of a case; therefore, it is considered the most important way to determine the exact diagnosis and choose the optimal state correction program.
In propaedeutics of nephrology, syndromes are usually divided into several main groups. The key ones are hypertonic, acute nephritic, nephrotic and urinary, acute and chronic PN, tubular dysfunction. Certain varieties are a detailed picture of the condition with characteristic complaints and numerous symptoms. Others can only be determined as part of a laboratory or instrumental study.
The nuances of the question
There are known types of syndromes in nephrology that develop against the background of a unilateral renal pathological condition, whose manifestations are such that it is easy to confuse them with a bilateral lesion. One of the important tasks of the doctor dealing with the patient is to take into account the asymmetry of the renal lesion, which is not distinguished as an independent syndrome, but is often present in practice.
The description of the syndromes in nephrology requires clarification in a particular case whether the condition is a sign of a disease or exacerbation. In addition, the syndrome may indicate the onset of impaired renal function. A good example is high blood pressure, which makes it possible to suspect the development of chronic renal failure.
The complexity of the diagnosis of syndromes in nephrology is associated with some ephemerality of a number of phenomena. There are cases when the syndrome first occurs, at the beginning of the development of the disease, and in the future episodes of repetition are not observed. This is characteristic, in particular, of nephrotic syndrome. To establish the diagnosis very accurately, it is necessary not only to evaluate the current condition of the patient, but also his medical history. The periods of existence of the syndromes indicate the optimal format of treatment, allow you to give the correct prognosis.
More details. Urination disorders
Urinary disorders are the main syndromes in nephrology. Their reasons must be identified in each case individually. A healthy person releases almost 100% of the fluid consumed in the form of urine, that is, in total this is about one and a half liters. For a certain time period, diuresis can be estimated - urine excretion.
If more than two liters are released per day, we can talk about polyuria. Disruptions in the work of the kidneys and other organs can provoke it. It is not uncommon for polyuria to accompany diabetes and diabetes associated with impaired pituitary gland function. For this syndrome in nephrology, the causes are the convergence of edema, a decrease in the ability of the kidneys to function adequately. In this case, nitrogenous compounds are excreted from the body not due to the concentration function of the organ, but through increased volumes of urine. This allows you to diagnose forced, compensatory polyuria. In some cases, the amount of urine is significantly higher than normal, because a person drinks too much.
Oliguria and nocturia
Among the main syndromes in nephrology, it is necessary to consider oliguria. This state is established if tubular reabsorption is more active than the norm or urine generation processes are disturbed in the glomeruli of the kidneys. The term refers to a condition in which urine is excreted in smaller volumes than it should be. With the complete cessation of its generation, they speak of anuria. At the glomerular filtration stage, a secretory fluid is not formed, excretory fluid does not penetrate the bladder, which also prevents the secretion of the substance. However, anuria is not always explained by renal dysfunctions, sometimes mechanical reasons - spasm or stone, clogged the urinary ducts.
Nocturia is one of the main syndromes in nephrology, in which the person is characterized by the allocation of urine at night, that is, a disturbed rhythm, a process mode, is recorded. This is often the case with heart disease. Too frequent urge to urine is possible, this allows you to identify pollakiuria. If the renal adaptation function is impaired, establish isuria. The main manifestation of this condition is equal portions of secretions at different periods of the day and night.
Possible syndromes: what happens?
Among the syndromes in nephrology, hypostenuria is worth noting. This term refers to a state in which the specific gravity of urine is below normal. Isostenuria is also possible when for a long time the fluid released has approximately the same specific gravity below normal. Another possible syndrome is dysuria, in which the act of urine excretion is accompanied by pain, difficulties. The urge to urinate can be more than normal, and the channel for the fluid duct responds with a thread. Dysuria is more often detected in pathological conditions of the urinary tract, canal or bladder.
Edema as a syndrome
With renal diseases, edema is very common. The pathogenesis of the phenomenon can be explained in different ways: many factors have been identified that provoke the appearance of edema. This syndrome in nephrology in children and adults can be explained by improper filtration, re-absorption of components when passing through the kidneys, as a result of which organic tissues accumulate fluid, salts. In some cases, edema indicates an excessively high level of capillary permeability or a decrease in the content of protein structures in the circulatory system. Hypoproteinemia often leads to edema in violation of the concentration of albumin. This is usually accompanied by a decrease in oncotic pressure. The consequence of the phenomenon is that liquid fractions of blood from blood vessels penetrate into the surrounding tissue.
Speaking of edema as the causes of the syndrome in nephrology, it is worth remembering the connection of this condition with albuminuria. To clarify the diagnosis, protein metabolism should be evaluated. A situation is possible when a large amount of protein is excreted from the body with urine, and this continues for a rather long time. The result is hypoproteinemia, and in the first place there is a shortage of albumin. If analyzes confirm such processes, edema-albuminuric syndrome is diagnosed . Most often, it indicates renal dystrophy, nephrosis. This allowed us to introduce a new category of nephrotic syndromes in nephrology.
Swelling: nuances
Compared to cardiac, edema caused by impaired renal function appears quickly. First, the paraorbital region suffers. According to textbooks on nephrology, nephrotic syndrome can be seen by edema of the eyelids, gradually capturing the entire face. This is due to the saturation of loose fiber with small vessels. Gradually, swelling spreads throughout the body. They are most pronounced in serous cavities, in the brain.
The fluid that accumulates in the tissues when the kidneys are not functioning properly is poor in protein structures. Edema as a syndrome in nephrology has a number of specific signs: wateriness, mobility, softness. Additional studies show a lack of cyanosis and normal liver size. Renal edema does not provoke tachycardia.
Pressure and kidney function
Renal diseases are often accompanied by high blood pressure. The pathogenesis of this condition is complex, due to improper operation of the network of capillaries in the glomeruli of the kidneys. This is accompanied by disruptions in the humoral function of the organ. Activation of the juxtaglomerular system leads to the release of renin, which reacts with alpha globulin. The result is the formation of a pressor effect of angiotensin. Persistent high blood pressure is the cause of hypertension, which is quite important in nephrology: it is known that it is inherent in a wide range of kidney diseases.
Eclampsia
This syndrome in nephrology has also been studied for a long time and intently. It is known that more often it appears against the background of edema. The risks of this pathological condition are higher with glomerulonephritis in the acute form and with an exacerbation of the chronic. Eclampsia is frequent during the period of bearing a child. The syndrome is usually explained by vasospasm in the brain, a failure of permeability, an increase in pressure inside the skull and swelling of the brain substance. Eclampsia can be provoked by heavy drinking, an excess of salt in food.
For this syndrome in nephrology, treatment is chosen after a complete examination of the patient has been performed. Eclampsia in an impressive percentage of cases is observed with high pressure and very severe swelling. First, the patient becomes lethargic, sleepy, then he begins to hurt and is dizzy. The patient is sick and vomits, speech is disturbed, consciousness is fogging, paralysis is possible. Pressure rises, convulsions appear, before the next attack, a person cries out or sighs noisily. In the first 30–90 seconds of a seizure, muscle contractions are quite strong, then individual muscle groups twitch. Urine is involuntarily released, the contents of the intestine, the patient can bite his tongue. The face acquires a bluish tint, eyes roll up or mow, while the pupils are dilated.
Eclampsia: Nuances
Usually the duration of an attack with eclampsia is a couple of minutes, but longer episodes are possible. After 2-3 attacks, sedation, stupor, coma occur. As the condition stabilizes, amaurosis or aphasia is observed. Eclampsia can occur in an erased form. The condition can be fatal. With eclampsia, the patient needs urgent qualified help.
Uremia
This syndrome is also considered dangerous and severe. More often observed against a background of kidney failure. Uremia can accompany both an acute form of pathology and a chronicle. The pathogenesis is complex, the most significant aspect is the accumulation of nitrogen metabolites in the body, that is, urea, creatinine and uric acid. This leads to an imbalance in mineral metabolism, acidosis. The specific gravity of urine decreases, the content of residual nitrogen increases, a large percentage of acidic products are observed in the blood.
Uremia manifests itself as general weakness and apathy. The patient has a headache, appetite disappears, the skin turns pale, the integuments acquire a shade of wax or a gray earth color. There is practically no swelling, but the face is puffy, legs are pasty. The skin is flaky, the integument is dry, some parts itch, traces of scratching are visible. For some, the skin is as if sprinkled with talcum powder, covered with hoarfrost. This is due to the release of urea through the glands of sweat excretion. The examination shows dry tongue, mucous membranes of the oral cavity. It smells of urine from the patient’s mouth and body.
Uremia: intoxication
Mostly the symptomatology of the syndrome is explained by compensatory excretion of nitrogenous slag by various glands. The patient vomits and feels sick, which makes it possible to notice uremic gastritis. Colitis appears gradually, in some cases ulcerative. The stool is broken, the blood content in the feces is possible. The body is actively losing fluid, dehydration is observed, the patient is drawn to drink, and the state is exhausted. In some cases, urea crystals are deposited on the serous membranes, while the terminal stage can be determined by the friction noise in the heart. The general temperature decreases, little urine is generated, anuria is possible.
With uremia, poisoning of the body leads to inhibition of certain blood-forming structures. The content of hemoglobin, red blood cells in the circulatory system is reduced, anemia is observed, while leukocytes are contained in higher than normal concentrations. There are problems with blood coagulation, diathesis symptoms develop, examination shows the presence of skin hemorrhage. Patients are prone to nosebleeds, blood in the uterus, gastrointestinal tract, urinary tract. Unpredictable internal hemorrhages are possible.
Acute jade
Such a syndrome is more often observed against the background of an infection. To a greater extent, risks are inherent in infection with streptococci. Usually the disease appears 2-3 weeks after the infectious. From observation and research it was found that acute nephritis is allergic in nature, due to a violation of the body's sensitivity to the sending components generated by microbes. Toxins become the cause of the adjustment of the antigenic structure of various tissues, so the body activates the production of antibodies to its own cells. Antibodies are nephrotoxic compounds under the influence of which an autoimmune process with numerous foci of inflammation is observed.
Often the syndrome is preceded by general hypothermia, under the influence of which cramps occur in arterioles, an allergic reaction is activated.
Acute jade usually begins abruptly. Urinary syndrome indicates its appearance. In nephrology, it has been established that acute nephritis is accompanied by the content of blood and albumin in urine. The patient's blood pressure rises, swelling is observed. The most pronounced hematuria at the onset of the disease. Gradually, this syndrome weakens, becoming more active when edema subsides. In a severe case, there is a risk of anuria. The specific gravity of the liquid is quite large, and the protein structures are about 1% of the total liquid. Investigating urinary syndrome in nephrology, it was found that cylindrical structures and red blood cells dominate in the patient’s urine sediment. The presence of single leukocytes, kidney epithelial cells is possible.
Acute nephritis: features of the syndrome
First, the condition leads to the appearance of edema on the face, which gradually covers the body, arms, legs. There is a risk of dropsy. Pressure rises rapidly, systole reaches 200–220 units, diastole - 100–120 units or more. The patient has a headache, lower back, shortness of breath. Cardiac asthma is possible if the syndrome leads to insufficient ventricular function in the left ventricle in acute form. The skin turns pale, the temperature remains within normal limits.
Acute nephritis rarely leads to impaired renal excretory function. The specific gravity of urine is high. Diuresis is gradually increasing, edema disappears, the specific gravity of the fluid decreases. Residual nitrogen is estimated to be close to normal, with prolonged oliguria it can grow. After the restoration of stable standard diuresis, normalization of residual nitrogen occurs. In acute nephritis, uremia rarely develops, but the likelihood of eclampsia is high - this complication is considered one of the most severe.
Acute nephritis usually develops one to three months. An improvement in condition is indicated by stabilization of pressure, the disappearance of edema. The composition of urine gradually normalizes, blood fractions and albumin disappear. Perhaps a complete recovery. If four to six months of the course of the disease do not lead to a complete cure, a chronic form of nephritis is diagnosed.
Pyelonephritis
This is such a syndrome in nephrology, which is diagnosed with inflammatory processes in the kidneys associated with an ascending infection. The etiology and pathogenesis of the condition are significantly different from the syndromes discussed above. As a rule, at first the patient suffers from cystitis or pyelitis, and already against this background pyelonephritis appears. In the acute form, the disease is due to the spread of infection to the renal parenchyma. In a predominant percentage of cases, pathogens are conditionally pathogenic life forms.
The syndrome initially leads to a deterioration in the patient's condition. The lower back hurts, the pain is usually asymmetric, the temperature rises, the patient is in fever. If pyelonephritis accompanies cystitis, dysuria is observed. Urine is rich in white blood cells, the content of albumin is assessed as moderate.In a predominant percentage of cases, acute pyelonephritis results in a complete cure, but there is a risk of the disease becoming chronic. To a greater extent this is characteristic of cases with damage to the tubules and interstitial tissues of the kidneys. Chronic pyelonephritis can cause uremia and renal wrinkling.
The clinical manifestations of this renal syndrome are close to glomerulonephritis. Pressure rises, swelling appears, blood fractions appear in urine. An additional sign indicating pyelonephritis is purulent inclusions in the urine. For the diagnosis, it is important to analyze the fluid for the presence of Sterningamer-Melbin cells.