Such a disease as nephrosclerosis, for a long time remained without the attention of doctors. Until the 19th century, a complete description of it was absent. He began to be considered an independent ailment only three decades later, when information about the etiology appeared. The disease was associated with damage to arterial vessels against the background of damage to their cholesterol. His prognosis is not always favorable. After a course of therapy, many patients have to deal with complications such as blindness, dysfunction of the ventricles of the heart. In order to maintain the viability of the body, in such cases, urgent clarification of the blood by artificial means is required.
Anatomical reference: renal sclerosis
What it is? This is a disease in which there is a replacement of the active elements of an organ (parenchyma) with connective tissue. The latter plays the role of a kind of neutral filler, but does not take on the main functions. To understand the essence of the pathological process, it is necessary to refer to the anatomical reference.
The kidneys are a paired organ shaped like beans. Its main part is the parenchyma, where urine is formed. Also important are cups and pelvis, which represent a whole system for the accumulation and subsequent excretion of urine. Filtration is carried out by parenchyma nephrons. All renal bodies are united by an extensive network of tiny vessels extending from the main artery.
The kidneys perform many functions, including:
- synthesis of renin - a substance that affects the state of the walls of blood vessels;
- excretion of harmful substances from the body;
- maintaining a certain level of acid;
- the production of erythropoietin, on which the process of hematopoiesis directly depends.
Such multifunctionality of the kidneys does not allow to doubt their importance in the work of the whole organism. Therefore, any pathological processes in this area can adversely affect the state of human health.
Nephrosclerosis of the kidneys - what is it?
This is a process of successive replacement of the renal parenchyma with connective tissue, which leads to a decrease (wrinkling) of the size of the organ and a decrease in its functionality. If untreated, a complete cessation of performance may occur.
It was previously believed that the main cause of the disease is glomerulonephritis. Today, doctors revised this point of view, identifying diabetes and arterial hypertension as its main provocateurs.
According to the development mechanism, primary and secondary renal sclerosis are distinguished . Each of the forms of the disease has its own prerequisites for the occurrence, as well as characteristic features. It is advisable to dwell on this issue in more detail.
Primary nephrosclerosis
The primary form of the disease develops against a background of disruption in the functioning of blood vessels, narrowing of the working section of the artery. The consequence of ischemia are numerous heart attacks and scars. Another cause of the pathological process can be considered age-related changes if they lead to stagnation of venous blood.
Primary nephrosclerosis can be of several types: atherosclerotic, hypertonic, involutive. In the first case, the main cause of vasoconstriction is the deposition of fatty plaques on their walls. As a result, the clearance decreases, which entails ischemia of the kidney. At the same time, the surface of the organ becomes nodular; irregular scars are easily distinguishable on it. This kind of ailment is considered the safest.
Hypertensive nephrosclerosis is a manifestation of severe spasm of the vessels, which is caused by the disease of the same name. The consequence of the pathological process is narrowing of the arteries and severe ischemia. Hypertensive renal sclerosis can be benign and malignant.
An involutive type of disease is associated with age-related changes. For example, after 50 years, most people begin to accumulate calcium on the walls of arteries, which helps to reduce the clearance. On the other hand, it is with age that atrophy of the elements of the urinary tubules is observed. Therefore, the functionality of the body falls.
Secondary nephrosclerosis
Secondary nephrosclerosis develops against the background of inflammatory and / or dystrophic processes occurring in the kidneys. The causes of the pathological process can be various conditions and disorders:
- Diabetes. An increase in blood sugar provokes changes in the walls of blood vessels. They condense and swell, but permeability increases. As a result, the protein enters the bloodstream, which increases coagulation to compensate for the disorder. At the same time, the current slows down, which entails damage not only to the kidneys, but also to other organs.
- Chronic glomerulonephritis. With this pathology, the immune complexes are not destroyed, but directly into the kidneys. They damage the shells of blood vessels in the glomeruli. To compensate for the ongoing processes, the synthesis of substances that increase thrombus formation begins.
- Pyelonephritis. This disease is accompanied by the penetration of bacterial flora into the renal glomeruli and tubules, where blood clots form. Around them, white blood cells sequentially accumulate. After recovery, scars or ulcers form in the damaged areas.
- Urolithiasis disease. With stagnation of urine, bacteria begin to multiply actively in it. In case of reverse urine reflux, pathogenic flora can damage the inner walls of the urinary tubules.
- Lupus erythematosus. This systemic disease is characterized by the synthesis of immune complexes that can launch an attack on their own organs.
- Nephropathy of pregnant women. During the bearing of the baby, the hormonal system of the woman undergoes changes, this leads to various malfunctions. One of these disorders is spasm of the capillaries. As a result, blood pressure rises, and blood supply to the kidneys is disturbed. A woman develops edema, and nephrons begin to die actively.
Given the information presented, several conclusions can be drawn. Primary nephrosclerosis of the kidneys most often develops against a background of circulatory disorders in the organ. The secondary form of the pathological process is usually preceded by inflammatory and destructive disorders.
Separately, it should be noted a group of provocative factors, from the impact of which the likelihood of developing a disease significantly increases. First of all, this is the abuse of alcoholic beverages and food additives, smoking, uncontrolled use of drugs. A sedentary lifestyle and infectious diseases also increase the risk of nephrosclerosis. Therefore, the main measure of its prevention is the elimination of these factors.
Stages of the development of the disease
Elements of the kidney tissue die gradually, therefore, the disease itself develops in stages. In the first phase, a picture is observed due to a specific disease that provoked the sclerotic process. This is an early stage of kidney nephrosclerosis. It is difficult to predict what it threatens for the patient, if the therapy prescribed by the doctor is ignored.
The next stage is the death of nephrons, their replacement with connective tissue. The pathological process contributes to the occurrence of renal failure, which also develops in stages.
At first, there is a decrease in working capacity and a deterioration in overall well-being after physical exertion. Sometimes polyuria develops. The patient may be tormented by severe thirst, a feeling of dry mouth. At the next stage, high blood pressure remains, which is not even amenable to drug exposure. Patients are disturbed by severe headaches, nausea. If the patient is promptly prescribed a strict diet for kidney nephrosclerosis, as well as drug therapy, all unpleasant symptoms will quickly disappear.
The third stage of the pathological process is characterized by a lack of appetite, severe weakness. Such a person has a tendency to viral diseases. Against the background of constant thirst, the volume of urine excreted is greatly reduced. The skin acquires a characteristic yellowish tint. At the fourth stage, urine is practically not allocated. Rapidly developing intoxication, the process of blood coagulation is disrupted. At this stage, the listed changes are irreversible.
Clinical picture
Nephrosclerosis, also known as a shriveled kidney, is difficult to detect at the initial stages, since there are no characteristic symptoms. The patient does not feel discomfort. Only when contacting a doctor with other complaints and after a diagnostic examination is it possible to identify abnormal processes.
When the disease becomes stable, the following symptoms appear:
- swelling of the face and limbs;
- the urge to urinate increases, but the amount of urine excreted is reduced;
- pain in the lumbar region;
- intense thirst;
- high blood pressure;
- fatigue, weakness;
- itching of the skin.
The listed symptoms of kidney nephrosclerosis should be the reason for undergoing a deeper medical examination. Only after receiving its results can you start therapy.
Comprehensive diagnosis of kidney disease
The non-specificity of the signs of the disease significantly complicates the diagnosis. Typically, such issues are dealt with in specialized nephrology centers. Organ transplantation of varying degrees of complexity is also performed here .
If you suspect an ailment, you should seek help from just such a center or a local therapist. The latter after studying the clinical picture may give direction to a narrow specialist.
Diagnosis of the disease begins with a study of the patient's complaints, his medical history and physical examination. At the consultation, the nephrologist can also palpate the abdominal cavity. The above manipulations suggest a preliminary diagnosis and outline further examination tactics.
At the next stage, the patient is assigned laboratory tests. For example, blood biochemistry may indicate the following symptoms of impaired renal function:
- increase in urea, creatinine ;
- reduction in the quantitative content of protein;
- a decrease in potassium, and an increase in phosphorus and magnesium.
In the analysis of urine, protein and red blood cells are detected, but its density is significantly reduced. When examining a blood test, it turns out that the level of platelets and hemoglobin decreases, and the quantitative content of leukocytes increases.
For a more accurate assessment of the work of organs, they resort to instrumental methods for examining patients with a diagnosis of nephrosclerosis. An ultrasound of the kidneys, for example, allows you to evaluate their size and condition of the cortical substance. Urography is mandatory. Angiography gives a complete picture of the state of the vessels in the affected organ.
Based on the results of the examination, the doctor confirms or refutes the preliminary diagnosis, gives recommendations for further treatment.
Drug use
The treatment of this disease is carried out in specialized nephrological centers. It comes down to eliminating the main factor provocateur. Attempts to restore lost kidney function without the first step are usually unsuccessful.
Treatment is always comprehensive and designed for a long time. Depending on the clinical picture and general condition of the patient, the following medications may be required:
- Anticoagulants ("Heparin") for the prevention of blood clots.
- Medicines to lower blood pressure.
- ACE inhibitors (Diroton, Berlipril) for the expansion of the vessels of the kidneys.
- Diuretics that remove excess fluid from the body.
- Contributing to the expansion of arteries, calcium antagonists ("Falipamil").
- Multivitamin complexes.
For other disorders caused by renal dysfunction, medications are selected individually.
Surgical intervention
At the 3-4th stage of the pathological process, drug treatment is usually ineffective. In such cases, the patient is shown hemodialysis or transplantation of a donor kidney. The essence of the first procedure is to cleanse the blood of toxic substances. For this, a special artificial kidney filter is used. The frequency of hemodialysis is determined by the condition of the patient, the severity of the pathological process. The procedure must be accompanied by drug therapy.
Surgical treatment involves transplantation of a donor kidney. This is one of the few types of operations when an organ can be removed from a living person or from a corpse. During the recovery period, the patient is prescribed serious medical support and complete rest.
Power Features
An excellent addition to the course of treatment is to follow a fairly strict diet. Nutrition for renal nephrosclerosis is selected by the doctor for each patient individually. Typically, the following principles are followed:
- Limit protein intake. At the same time, you cannot completely abandon it. When choosing protein foods, preference should be given to poultry, fish and dairy products. It is important to completely exclude potatoes, cereals and bread from the diet.
- The diet must necessarily include seafood, but they should not be abused due to the high phosphorus content.
- Limiting the consumption of salt. At any consultation, the nephrologist will say that in stages 1-2, up to 15 g of salt per day is allowed, and in the 3-4th, this amount is halved. It is impossible to completely abandon this spice, since the probability of dehydration of the body increases.
- Be sure to include potassium-rich foods in your diet. For example, bananas, dried apricots, raisins.
- Nutrition should be as balanced as possible, contain the required number of calories and vitamins.
Most patients are forced to adhere to this diet for the rest of their lives.
Forecast
Nephrosclerosis is a chronic disease. At the initial stages of its development, it is possible to maintain the functions of organs, but for this it is necessary to follow the recommendations of the doctor and adhere to some restrictions. For example, for patients with such a diagnosis, it is important to minimize the consumption of table salt, constantly monitor the levels of calcium and phosphorus in the blood. With every exacerbation of the pathology, it is necessary to seek medical help and each time undergo a course of therapy.
Revealed at the 3-4th stage, the “wrinkled kidney” requires a slightly different approach. In this case, all the restrictions are much stricter. It is no longer possible to restore lost organ tissue. Therefore, in such situations, therapy is reduced to ensuring the functionality of the remaining nephrons. Sometimes this is not enough.