Chronic kidney diseases often lead to renal coma, a serious pathology that is considered to be the last stage of advanced kidney disease in medicine, which caused the failure of this organ and led to intoxication of the whole organism. Without timely treatment, this pathology is fatal. Coma develops very quickly, over two days. Without first aid in 99% of cases, a person dies.
Description and description of the problem
Renal coma is the last stage of chronic kidney disease associated with impaired activity and leading to renal failure, poisoning of the body.
As the pathology of the organ progresses, its tissues become thinner, overgrow with connective tissue, which leads to disruption of its functioning. Gradually, a person’s condition worsens, a huge amount of urine is excreted from the body, but nitrogenous substances are not excreted with it in sufficient quantities. As a result of this, a large amount of nitrogen begins to accumulate in human blood, azotemia, acidosis develops. All this leads to severe intoxication. The liver also breaks down, it is not able to process toxins, so it also gets poisoned over time, and liver failure develops.
The symptomatology of the pathology is rapidly progressing, kidney failure, coma is developing, and in the absence of emergency medical care death occurs. It is important to conduct timely treatment in order to save a person's life.
Renal Coma: Pathophysiology
The first important sign of developing coma is azotemia. In a person in this condition, an increase in the body of nitrogen, urea and creatinine will be observed. The second important sign is a violation of the water-salt balance, since the kidneys lose their ability to concentrate urine, which is manifested by polyuria. The patient develops oliguria and anuria.
Then the kidneys cease to retain sodium, which leads to salt depletion, that is, hyponatremia.
The third important sign is a violation of the composition of blood and tissue fluid, acidosis appears. The last sign is the development of hyperkalemia.
Reasons for the development of pathology
A coma usually develops in chronic renal failure. With a prolonged course of kidney diseases, toxins accumulate in the body, which appear as a result of metabolism. But kidney pathologies are not always the cause of coma. It can appear as a result of intoxication with medications, especially antibiotics. Renal coma also appears due to shock, prolonged diarrhea and vomiting, blood transfusion if it is incompatible with the patient’s blood, as well as due to poisoning with methanol or industrial poisons.
With inflammation of the kidneys, which can be caused by a number of reasons, the blood circulation in the organ is disturbed. The necessary amount of blood and nutrients ceases to flow into it. As a result of this, oliguria appears, then anuria, then the concentration of urea, creatine and uric acid in the body increases, which leads to the appearance of symptoms of renal coma.
Thus, the main causes of the development of pathology include:
- Lack of therapy for chronic kidney disease.
- Violation of the outflow of urine as a result of the formation of stones in the bladder, prostate adenoma.
- The development of urolithiasis, renal colic, which goes on to a coma.
- Poisoning with drugs, poisons.
- Benign or malignant neoplasms in the ureter or renal pelvis.
Symptoms and signs of the disease
A person does not immediately lose consciousness with a renal coma. Symptoms indicating a critical condition can manifest as asthenic syndrome, weakness, pain in the head, and lethargy. The following symptoms are also observed:
- Dyspepsia. A person's appetite decreases, body weight, anorexia develops. Dry mouth, bitter taste, constant thirst. The activity of the digestive tract is disrupted.
- The characteristic appearance. Dry skin, pallor, and swelling of the face are observed. Constant itching develops. Which brings torment, when combing the skin on it, wounds form that do not heal for a long period of time. Sometimes crystals of uric acid appear in the form of powder on the skin.
- Hemorrhage. Women develop uterine bleeding, while men can bleed from the nose. Breathing is disturbed, shortness of breath develops, blood pressure drops.
- Intoxication of the body causes a disorder of the central nervous system. In humans, reactions to external stimuli are disturbed, hallucinations appear, delirium, he falls into a stupor, and then into a coma. Muscle cramps may also occur.
If the above symptoms of renal coma are detected, emergency care should be provided immediately. In 99% of cases, falling into a coma, a person does not leave it.
Often, this disease develops in pets. For example, a cat's kidney coma will show signs of intense thirst and frequent urination, acquiring a brownish tinge of the tongue. In this case, the animal must immediately be shown to the veterinarian.
First aid
When the first signs of pathology appear, urgent hospitalization of the patient is required. To prevent the development of irreversible effects, it is necessary to provide first aid for a kidney coma:
- Detoxification treatment. In this case, it is necessary to introduce the patient intravenously glucose, insulin, as well as Neocompensan, Hemodez. This helps to normalize urination, blood pressure, and elimination of urea from the body.
- Lead a solution of sodium chloride in order to normalize the process of urination. But the solution is administered only in the absence of hypertension.
- “Strofinin” is used to normalize blood circulation, and homeostasis disorder is corrected.
- It is necessary to wash the stomach and intestines to remove toxins.
- To save life, the patient needs to undergo hemodialysis, that is, cleanse the blood using a special device.
If treatment has not been started, the person loses consciousness. Often, he is in such a condition enters a medical institution. The smell of ammonia from the oral cavity makes it possible to make a preliminary diagnosis.
Diagnostic measures
To determine the severity of the pathology, a blood test is performed on the level of creatinine and urea. Their concentration indicates a further course of action. It is also important to analyze the results of previous diagnostic studies, if they were previously conducted.
The doctor prescribes an ultrasound of the kidneys, radiography of the pelvic organs. According to research, a conclusion is made about the state of the parenchyma, stones in the bladder and kidneys are detected. In severe cases, a CT scan is performed.
Typically, the diagnosis of renal coma is not difficult, especially when a person has a long history of the disease. When the history is difficult due to the patient being in a coma, the diagnosis is made on the basis of symptoms and laboratory blood tests.
Therapy
Patients are treated in the intensive care unit. As drug therapy, drugs are used whose action is aimed at eliminating the causes of the development of pathology. Usually, the doctor prescribes intravenous administration of diuretics, glucose, and saline. "Heparin" is used to reduce blood coagulation. In case of kidney failure, hormonal medications are used.
Also used as a treatment apparatus therapy:
- Hemodialysis.
- Plasmapheresis
Rehabilitation
During the rehabilitation period, the prevention and therapy of the cause that caused the development of coma is carried out. If there is a violation of the outflow of urine and the presence of stones that caused loss of consciousness, the surgeon performs an surgical intervention to remove them. In the presence of a tumor, surgery is also performed. If a person has been poisoned with poisons or medicines, they wash his stomach and intestines, give him sorbents, and exclude contact with hazardous substances in the future.
When the patient is in a coma or immediately after leaving it, food is produced using a dropper. After some time, it is allowed to consume a small amount of water and food, which should not contain fat. From the patient’s diet, it is necessary to exclude all products that contribute to the appearance of ammonia in the body, proteins of animal and vegetable origin can not be consumed.
Complications and consequences
With this pathology, the central nervous system is particularly affected. In people who have undergone this condition, the character often changes, memory and thinking are disturbed. Therefore, it is important when the first signs of pathology manifest themselves to contact a medical institution.
Forecast and Prevention
The prognosis of the disease is usually poor. With untimely treatment or its complete absence, death occurs in 99% of cases. With adequate timely treatment, the patient manages to save life.
For the purpose of prevention, it is recommended to conduct timely therapy of kidney diseases. If unpleasant symptoms appear, you need to visit a urologist. It is also important to lead a healthy lifestyle and review the diet. Doctors recommend periodically examining the kidneys with an ultrasound scan to monitor their condition. This also applies to people who are diagnosed with prostate adenoma.
You can not use medications without prescribing a medic, as this can provoke poisoning and the development of coma. People who, by virtue of their profession, come in contact with chemicals, must adhere to safety rules. With food poisoning, you need to immediately rinse your stomach and intestines, and then call a doctor at home.