Shock kidney syndrome is a common occurrence among people who suffer from acute renal failure. The pathological condition is associated with necrotic changes in the structure of organ tissues. As a result of the trouble, deterioration of urine excretion from the body is observed. The occurrence of such a phenomenon as a shock kidney has a most negative effect on the functioning of vital organs and systems. Doctors note a low chance of recovery among people prone to the development of the syndrome. Let's consider it in more detail in the article.
Shock kidney: pathogenesis
The mechanism for the occurrence of a pathological syndrome is quite complex. In order to describe the shock kidney, a whole set of reasons should be noted. The ischemic factor is of decisive importance. Serious inhibition of the heart muscle leads to a decrease in stroke volumes of blood. The consequence is a decline in renal blood flow. Violation causes poor-quality filtration of fluids that pass through the body.
Often a shock kidney makes itself felt against the background of a spasm of local vessels under the influence of changes at the neurohormonal level. A similar pattern is observed when the blood ducts are exposed to excessive amounts of serotonin and histamine. The occurrence of the problem leads to the destruction of cellular structures.
Among the main troubles causing the development of shock kidney syndrome, it is worth noting the effect on nephrotoxins on local tissues. The accumulation of toxic substances occurs due to insufficient quality of the organ. Toxins, which are poorly excreted from the body, destroy beneficial enzymes and damage cell membranes. The result is often necrosis of the renal structures. Blockage of the tubules of the organ is noted. The kidneys partially lose the ability to remove urine from the body.
Provocative factors
The following factors can increase the risk of a shock kidney:
- severe traumatic effects;
- prolonged squeezing of the organ;
- infectious lesions of the kidney tissue as a result of negligence on the part of doctors during surgery;
- the occurrence of hemorrhages in the lumen of the organ against the background of mechanical damage to local tissues and poor blood coagulation;
- critical dehydration;
- serious poisoning by toxic substances.
Under the influence of these factors, structural changes often occur in the tissues of the kidneys. The cortical layer of the organ begins to suffer from a deficiency of oxygen and nutrients as a result of inhibition of blood flow. Without proper treatment, necrosis and critical impairment of kidney function occur.
Characteristic symptoms
The primary symptom in the development of the syndrome is a significant decrease in urine excreted from the body. The daily volume of the release of waste fluid is reduced to an indicator close to 400 ml. In the structure of urine, the appearance of protein elements is visually observed.
The patient begins to suffer from growing weakness. Apathy, loss of appetite, dizziness, drowsiness are manifested. A pronounced aroma of ammonia is heard from the oral cavity. A person prone to the development of the syndrome is worried by constant thirst. Periodic attacks of nausea and the urge to vomit.
Over time, certain parts of the body undergo puffiness. An increased concentration of potassium in the blood due to impaired renal function causes a tingling sensation in the limbs. Convulsive phenomena occur periodically. Tendon reflexes worsen. The concentration of toxins in the body leads to inhibition of the nervous system, the appearance of hallucinations, delirium.
Shock kidney: pathological anatomy
During the study of the organ under a microscope, dystrophy of the cortical layer is detected. There is a decrease in the amount of blood in local tissues. A micropreparation of a shock kidney during examination of a brain substance, on the contrary, shows plethora. The results of the study indicate a thinning of the epithelium of the tubules of the organ.
A macrodrug of a shock kidney shows a swollen appearance of an organ. The cortical layer acquires a grayish tint. In the section of the kidney, plethora is visible, which affects the pyramidal regions of the brain layer.
Syndrome stages
The shock state of an organ develops in several stages:
- The primary damage to the kidney tissue lasts several days. During the specified time, the patient is harassed by a set of symptoms characteristic of renal failure.
- The stage of oliguria is observed within a week and a half. During the day, only about 0.5 liters of urine are excreted from the body. There are signs of intoxication. The general well-being of a person noticeably worsens. An increase in potassium concentration is observed in the blood structure during analysis.
- The stage of polyuria proceeds within 15-20 days. The patient is gradually recovering. Kidney function is partially restored. The daily volume of urine excreted rises to 1.5 liters. A temporary transition of the syndrome to a state of remission is noted.
- Stage of recovery - the work of the kidneys is gradually returning to normal. If adequate treatment is used, the functions of the organ are restored within six months.
Diagnostics
In case of suspicion of the development of the syndrome, an ultrasound examination of the renal parenchyma is prescribed. The procedure allows you to determine the size of the cerebral and cortical layer of the organ, to reveal its increase in volumes.
The patient is sent for a urinalysis. Diagnostics examine a body fluid sample for a high concentration of red blood cells and white blood cells, the presence of dead kidney tissue cells in the sediment. Doctors record daily protein excretion with urine.
In addition, a biochemical blood test is performed. The technique makes it possible to identify an increase in the concentration in the structure of the sample of potassium, sodium, nitrogen compounds.
Treatment features
If during the diagnosis, the prerequisites for the development of a shock state of the organ are found, the patient is prescribed intravenous injection of the drug Mantinol. The use of non-concentrated solution improves blood flow in the kidney tissue. The result of therapy is an increase in glomerular filtration of urine. The medicine has the properties of diuretics. In other words, the product activates the elimination of water and salts from the body. Performing therapy in the presented way becomes effective in the early stages of the development of the syndrome. When the stage of oliguria is observed, injections of Mantinol give practically no result.
A prerequisite for the treatment of a shock kidney is the hospitalization of a person in the intensive care unit of a medical institution. In case of acute intoxication with accumulations of toxic substances in body tissues, the patient is prescribed antidotes. In parallel, doctors are conducting activities aimed at removing arterial hypotension. The work of the heart muscle, whose functions are suppressed due to the concentration of potassium in the blood, is restored by injection of drugs containing caffeine and cordiamine.
If the shock condition of the kidneys is caused by injuries, a blood transfusion is prescribed. Powerful painkillers “Promedol”, “Ketonal”, “Fentanyl” are used. In situations where a critical concentration of potassium in the blood is observed, doctors inject a solution of calcium chloride into the vein.
Forecast
The progress of the pathological condition is fraught with serious consequences for the patient. Fatal outcome in the event of the development of shock kidney syndrome is observed among approximately 70% of patients in the intensive care emergency department. Doctors give especially disappointing forecasts when a nuisance is provoked by traumatic influences, mistakes made during blood transfusion and surgical interventions. A critical concentration of potassium in the blood due to inhibition of kidney function often leads to cardiac ventricular flutter and organ failure.
Finally
If the first symptoms of a pathological syndrome are detected, in particular, poor urine excretion from the body, general weakness, dizziness, it is important for the patient to immediately call an ambulance. The solution makes it possible to start therapy in a timely manner in the intensive care unit, avoiding necrosis of the kidney tissue and serious intoxication of the body. A patient susceptible to the syndrome needs to be clearly aware of all the risks and to resort to the services of doctors in a timely manner.