Everyone knows that the kidneys are a vital organ that cannot be removed when a disease occurs, such as the gallbladder, stomach or appendix. Usually, everyone knows a little about kidney inflammation or kidney cancer. But what is nephrosclerosis, its symptoms, how is it dangerous, why does it develop and is treatment possible?
Nephrosclerosis is a pathological condition in which kidney tissue is gradually replaced by connective tissue (scar-like tissue). With the development of nephrosclerosis, the kidneys slowly cease to perform their functions. Also, when they talk about nephrosclerosis, they often use the phrase "shriveled kidney". These are synonyms.
Kidney function:
- filtering, excretory and concentrating
The kidneys continuously filter the blood plasma and remove harmful substances from it (mainly these are the breakdown products of proteins and fats - nitrogenous compounds), excess salts, water and glucose.
In case of intoxication (alcohol, drugs, medication), toxins are excreted mainly through the kidneys. Therefore, if a lot of time has passed after taking drugs or excess alcohol, then rinsing the stomach no longer makes sense. The toxins have already been absorbed into the bloodstream and gradually enter the kidneys.
- ion-regulating
The blood plasma is filtered twice through the renal tubules before being converted into urine. During filtration, the body retains all the necessary ions (trace elements), and removes excess and harmful ones.
- exchange (metabolic)
In the kidney, substances are not only filtered and "sorted", but are produced and destroyed. In the kidneys, gluconeogenesis (production of glucose from proteins and amino acids) occurs, amino acids are converted (glycine is converted to serine, and so on), and protein hormones are destroyed.
- hormonal and hematopoietic
The kidneys produce several hormones or hormone-like substances, the most active of which are:
- Erythropoietin is a substance that stimulates the production of red blood cells (erythrocytes) in the bone marrow. With its insufficient production, a person develops anemia.
- Renin - controls intrarenal and total blood pressure.
- Calcitriol - together with vitamin D, is responsible for the absorption and exchange of calcium in the body.
- Prostaglandins are multifunctional molecules that regulate inflammation in the body, blood pressure, and vascular tone.
Types of nephrosclerosis
- Primarily shriveled kidney (with renal vessels being affected first)
- hypertonic disease
- atherosclerosis
- kidney infarction
- Secondary contracted kidney (kidney tissue is initially affected):
- pyelonephritis
- urolithiasis disease
- glomerulonephritis
- kidney tuberculosis
- diabetes
Nephrosclerosis with arterial hypertension or hypertensive nephrosclerosis
Arterial hypertension is a vascular disease that is often hereditary in nature and is characterized by an increase in blood pressure higher than 140/90 mm Hg. and hypertensive crises. A hypertensive crisis is a sharp increase in blood pressure, the numbers may vary from 150/90 mm Hg. up to 230/140 and more. Constantly increased pressure gradually "wears out" the vessels. The impact occurs on absolutely all vessels, but today we are talking about the kidneys. Renal vessels, experiencing constant "expansion" from the inside become more rigid. The wall becomes less elastic and it is worse for the plasma to pass through itself for filtration.
Thus, the kidneys do not receive enough material to filter, and urine becomes less.
Hypertensive crises are a sharp hemodynamic blow to the walls of blood vessels. This condition has a bad effect on all vessels, but especially pronounced manifestations in those organs that were already provoked earlier (there was a stroke, surgery on the kidney or heart, and so on).
With a sharp rise in blood pressure, the vessels in the kidneys are maximally spasmodic, and the longer the pressure is not reduced, the worse.
We hope that we have informed you enough about hypertension, how dangerous it is for the kidneys and other organs. Some patients do not take hypertension into account when asked. We ask about chronic diseases and hear: "I am not sick with anything."
- Is the pressure rising?
- Yes, the pressure jumps
- To what numbers does it rise?
- And up to 200 happens. Doctor, but I have a problem with urination, I have little urine. What does the pressure have to do with it?
This is a very, very common opinion of patients who take pressure pills from time to time. And then we understand that kidney complications are already irreversible.
Atherosclerotic nephrosclerosis
Common atherosclerosis is a disease of the century. Along with diabetes mellitus, these conditions are considered a non-infectious epidemic of the 20th century. Atherosclerosis is the deposition of dense cholesterol deposits on the inner walls of blood vessels, which over time thicken, grow and turn from fat-like cholesterol into fibrosis. Fibrosis is a dense, inelastic tissue, similar to scar tissue.
- First, the cholesterol "plaques" themselves narrow the lumen in the vessel and it is more difficult for blood to get to any organ.
- Secondly, these "plaques" cause constant sluggish inflammation in the vessel, which activates the coagulation system. As a result, blood clots form on the surface of the cholesterol build-up.
The blood clots grow and at some point break off and float with the blood flow to wherever they go.
All these facts indicate that we make a lot of problems for ourselves completely on our own through improper nutrition, eating fast food, leading a sedentary lifestyle and not turning to doctors prophylactically.
The vessels narrowed by atherosclerosis pass less blood to the kidney, and less urine is filtered. Also, not only the "delivery of working material" to the kidney suffers, but also the nutrition of the kidney itself. The mechanism itself is similar in hypertensive and atherosclerotic nephrosclerosis. In both cases, the vessels are narrowed, dense, and impermeable.
Kidney infarction
The advanced course of hypertension with frequent crises, widespread atherosclerosis with the formation of blood clots, an innate tendency to form blood clots (thrombophilia) can lead to a blood clot entering the kidney. In the place where the blood clot has fallen, blood circulation stops and the tissue is dead, dying. This area is then replaced by scar tissue and never functions as a kidney again. The larger this section, the worse the forecast for further developments.
Secondary nephrosclerosis
Nephrosclerosis as a result of chronic pyelonephritis
Pyelonephritis is an inflammatory disease of the kidney and renal pelvis. It is caused by bacteria, less commonly viruses and fungi. Pyelonephritis happens, proceeds in a rather mild version, does not aggravate for a long time or does not recur at all after one acute episode. In this case, we are talking about pyelonephritis with an early onset (in childhood, at school age), frequent exacerbations (1-2 times a year or more, usually in spring and / or autumn) and a rapid course of exacerbations.
During an exacerbation, we observe a high temperature (it rises in the evening, it can be up to 40-41 C), lower back pain of varying severity, urinary disorders and inflammation according to blood and urine tests.
Each such inflammation leaves tiny scars on the kidney tissue. And the more often a person gets sick, the more the delicate tissue of the kidney is replaced by rough scar tissue.
The scar tissue is dense and cannot function as a kidney. The kidneys decrease in size (shrink) and gradually lose their function.
Nephrosclerosis with glomerulonephritis
Glomerulonephritis is an immune disorder of the kidneys. Both kidneys are affected at once, in contrast to pyelonephritis, where there can be a one-sided process. In this disease, the kidney tissue is attacked by its own immune cells and proteins.
This happens after a sore throat or other streptococcal infection. The body produced antibodies against bacteria, but these same antibodies began to infect the kidneys.
Immune inflammation in the same way leads to shrinking and "drying" of the kidneys, as well as infectious.
Sclerosis develops at the site of inflammation. The diagnosis indicates the type of sclerosis: segmental (partial) or total (completely) and the percentage of renal tissue that is affected by sclerosis. For example, total nephrosclerosis 5%, segmental - 25%.
Nephrosclerosis on the background of ICD
Urolithiasis (Urolithiasis) is the formation of saline and mixed deposits of various sizes in all parts of the urinary system. Stones in the ureters and below (in the bladder, urethra) threaten pain and blood in the urine (renal colic). This condition is difficult to miss, usually patients immediately go to the hospital. But stones in the kidney themselves can gradually grow and increase without any particular symptoms, so the disease is often detected suddenly.
Stones in the structure of the kidney gradually squeeze the surrounding tissue, preventing it from functioning normally. Stagnation occurs, ischemia (oxygen hunger) develops in some parts of the kidney, and gradually, in areas, sclerosis develops.
Nephrosclerosis in kidney tuberculosis
Kidney tuberculosis is an infectious disease that, like pulmonary tuberculosis, is caused by Mycobacterium tuberculosis. These bacteria in any tissue cause inflammation similar in structure, the kidney tissue seems to liquefy, becomes curdled and shapeless. Of course, this tissue can no longer function. With timely treatment, the areas of sclerosis are small and the kidney can compensate for their work. But if the process has affected most of the kidney, then nephrosclerosis in this case becomes the cause of renal failure.
Nephrosclerosis in diabetes mellitus
Diabetes mellitus is a very diverse disease that affects many organs. But first of all, these are the kidneys and eyes.
An excess of sugar in the blood gradually disrupts the work of blood vessels and nerve fibers. It is the vascular lesion that disrupts the normal functioning of the kidneys. The kidneys do not eat well, and the load on them greatly increases. Diabetics often have increased thirst and drink a lot and then urinate a lot. And the kidneys are forced to filter liters of urine with high sugar levels, and often also containing acetone (with prolonged high blood sugar).
The kidneys gradually, usually evenly, decrease in size, harden and lose their function.
Nephrosclerosis with systemic lupus erythematosus
Systemic lupus erythematosus is an autoimmune disease that affects virtually every small vessel in the body.
In addition to vascular damage and malnutrition of the kidney, specific immune complexes are deposited in the kidneys. Circulating immune complexes (CICs) are defense proteins in conjunction with the cells of the body itself, which become aggressive towards their cells.
CECs damage the inner walls of the renal tubules, inflammation occurs, and then hardening of the sites.
Renal amyloidosis
Amyloidosis is a rare disease in which a specific protein, amyloid, is deposited in different organs.
If amyloid is deposited in the kidneys, then the body begins to fight, to produce antibodies. And here also immune complexes are formed that damage the structure of the kidney. At the sites of damage, scar tissue gradually forms.
In amyloidosis, only the kidneys are rarely affected (but the kidneys in the first place), and the heart and lungs are also affected.
Radiation damage to the kidneys
If the patient is often exposed to radiation, then after months or years, the consequences may appear. Under the influence of radiation, the walls of the vessels of the pockets become denser, become thicker and gradually lose their permeability. In places where normal blood circulation stops, kidney tissue dies off.
Severe preeclampsia
Preeclampsia is a specific pathological condition that is typical for pregnant women ONLY. In this case, the permeability of all vessels, including the kidneys, is impaired. Edema occurs (both external - on the legs and face, and internal - kidney edema, in severe cases, pulmonary and cerebral edema). The kidneys do not cope with their function, blood pressure rises sharply. The patient is delivered (usually an emergency caesarean section) and treated. But in the long term, such a difficult pregnancy can affect the condition of the kidneys. Women are more prone to kidney damage. And they are much more likely to develop severe nephrosclerosis.
Also at risk are patients who have had syphilis, rheumatic attacks, and received chemotherapy.
Clinical signs
Symptoms of nephrosclerosis and patient complaints are as follows:
- swelling of the face, primarily around the eyes
- swelling of the legs and hands
- increasing weakness and fatigue
- nausea, impaired appetite, especially aversion to meat and other protein foods
- dry, pale skin and itchy skin
- pulling back pain
- high blood pressure, which is poorly treated, accompanied by persistent headaches
- decrease in the amount of urine excreted
No matter how scary it may sound, but if all this manifested itself, then the situation is already quite serious. In the early stages, there are no symptoms of kidney sclerosis.
Diagnostics
Laboratory tests to detect nephrosclerosis
- General urine analysis (OAM): here we will see how much protein is excreted in the urine (normally it is not), if there is inflammation or excretion of salts, blood.
- Biochemical blood test (BAC): here we are interested in the indicators of the so-called nitrogenous toxins - creatinine and urea. If they increase, then it is necessary to undergo an in-depth examination without delay.
- Ionogram: with nephrosclerosis, potassium in the blood rises.
- Zimnitsky's test: urine is collected during the day in different jars, and then they count how much was released during the day and how much at night and what is the density of urine in each portion.
- Complete blood count (CBC): Anemia is common with kidney damage.
Instrumental diagnostics (ultrasound, urography)
Excretory urography is a technique in which a contrast solution is injected into a vein, and then X-rays are taken at regular intervals and how this solution is excreted through the kidneys. In nephrosclerosis, the contrast distribution is uneven, it does not pass into small vessels, it is removed slowly.
Computed tomography is an expensive and high-tech study. With CT, we get a layer-by-layer image of the kidney - as if in a virtual section. And he can see the lesion of the kidney, where it is located and how pronounced.
Nephrosclerosis ultrasound signs:
- atrophy of the outer (cortical) layer of the kidney
- The kidneys are reduced in size, their density (echogenicity) is increased, the border between the layers of the kidney (cortical and cerebral) is erased. The contours of the buds are often uneven, wavy, which indicates a gradual "drying out".
- salt deposits are visible in the kidney tissue (nephrocalcinosis)
Kidney biopsy
A kidney biopsy is the removal of a piece of kidney tissue for analysis. Technically, this is a puncture in the lumbar region with anesthesia, and the removal of a thin "column" of cells from the kidney. Then the obtained material is given for examination to a doctor - a histologist, who paints the tissue and examines them microscopically. And then he makes a final diagnosis. The treatment tactics will depend on the diagnosis.
Treatment
Nephrosclerosis is not completely cured, but our task is to "unload" the kidneys as much as possible, ensure normal blood pressure and raise hemoglobin.
Diet
Treatment for nephrosclerosis depends on the stage at which it is diagnosed. But at any stage, and especially at a later stage, a special diet is required.
The diet of renal patients should practically eliminate salt. Usually in conversation this diet is called "salt-free". Adequate calories are obtained from carbohydrates (to a greater extent) and vegetable fats (to a lesser extent). Proteins are strictly limited, their amount is calculated based on body weight and stage of the disease. When decaying, proteins form the very nitrogenous toxins that are not excreted from the body in renal failure and poison the body. Meals should be fractional, the frequency is at least 5-6 times a day.
Drugs
Antiplatelet agents
This is a group of medications that thin the blood and help improve renal blood flow. They are used only in the early stages, as in later cases they can cause bleeding.
Applied: dipyradamole (courantil), pentoxifylline (trental), heparin courses.
Blood pressure lowering drugs
ACE inhibitors are used (enalapril, perindopril, quadropril, etc.), these drugs have the ability to protect the kidneys, and also reduce pressure and prevent changes in the heart. But with severe renal failure, they cannot be used.
Calcium channel blockers (nifedipine and nifedipine retard, amlodipine) are also used in the later stages, effectively reducing blood pressure. Allowed against the background of hemodialysis.
Beta-adrenergic receptor blockers (metoprolol, bisoprolol) - reduce blood pressure and heart rate, reduce the stress hormone (adrenaline) in the blood.
Alpha-adrenergic receptor blockers (prazosin, doxazosin) - quickly reduce blood pressure, are used in emergency cases, less often for constant use.
Trace elements
Potassium preparations (Panagin or Asparkam in tablets, intravenous potassium chloride) are prescribed strictly according to indications if a low level of potassium is detected in the blood. This can happen if the patient is undergoing massive diuretic therapy.
Vitamin D and calcium (calcium D-3 Nycomed, Calcemin Advance) are prescribed for the prevention of bone complications (osteoporosis - increased bone fragility).
Treating anemia
Two groups of drugs are used here: iron preparations and erythropoietins.
Gland preparations (sorbifer, maltofer, ferretab) are used in courses in the early stages of kidney disease.
Erythropoietin (epoetin, epostim, recormon) is a hormone that stimulates the bone marrow. It is normally produced in the kidneys. When nephrosclerosis has already formed, erythropoietin is not produced, it must be injected artificially. The injection scheme is prescribed by a nephrologist or hematologist.
Sorbents
Sorbents (polysorb, enterosgel) are "absorbent" drugs that are used internally to reduce the general intoxication of the body.
Phytopreparations
Phytopreparations are less used in the treatment of this group of kidney disease, but in the early stages can help support kidney health. Ciston, kanephron, hophytol, lepenephril and others are used.
Renal replacement therapy
There is no clear division of the course of nephrosclerosis at the stage. Conventionally, the early stage is distinguished, when treatment with medication is possible, and the late stage, when renal replacement therapy is required.
Renal replacement therapy (RRT) is an artificial blood purification. There are several such methods. The indication for such a serious intervention is not a specific disease, but a critical increase in creatinine and urea in the blood.
Such changes in blood tests indicate that the kidneys do not filter the blood, it does not cleanse and poisons the body. First of all, the brain suffers.
- Peritoneal dialysis
this is the purification of blood through the microvessels of the peritoneum. An indwelling catheter (tube with a closing valve) is placed in the patient's anterior abdominal wall. Through this tube, 2 liters of a special solution are poured into the abdominal cavity every 6 hours. When the dialysis solution is in the abdominal cavity, it “pulls out” excess fluid, salts and ions, thereby cleansing the body. Then the used solution is drained and fresh is pumped in. Peritoneal dialysis is performed several times in the clinic, and then, when the patient has learned the technique, they are allowed to go home. Such patients can lead an ordinary life, travel, coming to the hospital only for the control of analyzes and a dynamic examination by a nephrologist. Peritoneal dialysis is a rather mild method, so it is performed continuously.
- Hardware hemodialysis
it is the purification of blood by an apparatus often known as an artificial kidney. The principle of blood purification is similar to peritoneal dialysis, it consists in passing the patient's blood through a column with a special solution, and then poured back. They go on dialysis often, several times a week and spend several hours on the machine. In order to make it convenient to connect the device and take blood, a fistula is formed on the patient's forearm. A fistula is an artificially connected vein and artery on the inner surface of the forearm. In order to create it, a small operation is performed, then you need to wait for healing and only then start dialysis.
- Hemofiltration
the principle of blood purification with this method is practically the same as with hardware hemodialysis, only the blood is passed through a column with filters and membranes.
Kidney transplant
Kidney transplantation is currently a widely used method of treating patients with chronic renal failure (CRF). With this method, an operation is performed and a donor kidney is implanted. At the same time, their kidneys can remain in place, or they can be removed (one or both). Removal of the kidneys is performed if they are completely non-functioning and / or are a focus of chronic infection.
After the operation, patients take immunosuppressive drugs all their lives in order to exclude the rejection of a foreign kidney.
A relative or other volunteer can become a donor; cadaveric kidneys are also used. To determine the future compatibility of the donor kidney and the patient, special complex genetic tests are performed.
Outcome of the disease
In the absence of treatment, and if it is necessary to connect renal replacement therapy, the outcome is poor. Untreated blood gradually poisons organs and tissues and leads to the death of the patient.
With the timely start of treatment and the use of RRT, the patient's life becomes more complicated in the sense that he has to go to dialysis, change solutions, constantly take tests and often weigh himself (the volume of dialysis fluid is calculated per patient's weight). But at the same time, people with nephrosclerosis live, and live long and fully!
The kidneys are an organ that cannot be excluded from metabolism. It is possible to prevent the development of renal failure and renal sclerosis if all its causes (hypertension, diabetes and all of the above) are prevented and treated in time. Do not ignore the clinical examination at the place of work and in the clinic. Quite often, the first signs of a problem are detected precisely by laboratory tests. And always ask your doctor the questions you are interested in.
Content
Replacement of the renal parenchyma with connective tissue against the background of high blood pressure is called hypertensive nephrosclerosis. In medicine, the disease is also called a shriveled kidney or its sclerosis. Pathology code according to ICD-10 - I 12.
Why does kidney shrinkage occur?
With a prolonged increase in blood pressure (BP), vascular spasms develop. They narrow, lose elasticity. As a result, the pressure rises even more, increasing resistance to blood flow. Organs are deprived of normal blood supply, experience oxygen deprivation.
As a result, areas of ischemia appear in the paired organs, which leads to the replacement of parenchymal connective tissue. Secondary wrinkling of the kidney can also occur due to the following diseases:
- amyloidosis;
- diabetes mellitus;
- renal tuberculosis;
- a history of systemic lupus erythematosus;
- nephrolithiasis;
- glomerulonephritis;
- nephropathy of pregnant women;
- injuries;
- pyelonephritis.
Types of nephrosclerosis
Doctors divide nephrosclerosis into several types, based on its cause and characteristic signs. The main classifications of the disease:
|
Classification attribute |
Types of hypertensive nephrosclerosis |
Description |
|
Development mechanism |
Primary |
It develops as a result of impaired blood supply to the renal tissue, atherosclerosis, hypertension. |
|
Secondary |
It is associated with diseases of the kidneys themselves, nephritis or abnormalities in their development. |
|
|
The nature of the flow |
Benign (arteriolosclerotic) |
It is less severe, easily compensated, develops for 10 or more years. |
|
Malignant |
It develops within a couple of years with severe hypertension. |
Disease stages
Nephrosclerosis of the kidneys, regardless of the form, develops over several years. It is characterized by a phased formation. The main stages of nephrosclerosis:
- First. Vivid symptoms of hypertensive nephrosclerosis have not yet appeared. The disease can be detected by determining the rate of filtration of creatinine or insulin or by low albumin levels.
- Second. This is the pre-nephrotic stage. At this stage, microhematuria develops - a small amount of red blood cells in the urine.
- Third. It is accompanied by high blood pressure and swelling.
- Fourth. It begins a couple of years after the onset of proteinuria. Chronic renal failure develops.
Symptoms
Benign nephrosclerosis is characterized by more striking symptoms from the cardiovascular system, since the left ventricle expands. In a malignant course, signs of renal failure come to the fore.
The function of paired organs drops sharply, and the concentration capacity progressively decreases, hematuria and albuminuria occur. 
Benign form
Symptoms of benign nephrosclerosis are either absent or very mild. The first signs of cardiovascular disorders appear: left ventricular hypertrophy, an increase in pressure of more than 200/100 mm Hg. Art. other characteristic signs of a benign form of nephrosclerosis:
- headache;
- weakness;
- dyspnea;
- heart failure;
- muscle pain;
- decreased performance;
- increased heartbeat;
- an increase or decrease in the volume of daily urine;
- nocturia - increased frequency of urination at night;
- anuria - lack of urine;
- proteinuria - excretion of protein in the urine;
- iron-deficiency anemia;
- swelling;
- high blood pressure;
- visual impairment;
- bleeding tendency;
- attacks of angina pectoris;
- tendency to viral pathologies.
Malignant
With a malignant course, hemorrhages occur in the wall of the urinary tubules, which causes atrophy of the cells of their inner layer. It has the same symptoms as the benign form, but they develop much faster. The main signs of malignant nephrosclerosis:
- optic atrophy or complete blindness;
- weight loss;
- uremia;
- attacks of angina pectoris;
- the appearance of blood in the urine;
- a sharp increase in blood pressure;
- angiospasms;
- stroke;
- exhaustion;
- pale yellow complexion;
- progressive anemia;
- uremic intoxication.
Diagnostic methods
The purpose of laboratory tests is to identify changes in renal function at an early stage. The main tests in this group of diagnostic methods are the following:
|
Study name |
Signs of hypertensive nephrosclerosis |
|
Blood chemistry |
|
|
General blood analysis |
|
|
General urine analysis and Zimnitsky's test |
|
To study the vessels and the structure of the organ, instrumental studies are assigned. The following methods help to confirm nephrosclerosis:
- excretory urography of the kidneys;
- angiography of renal vessels;
- kidney scintigraphy;
- dopplerography;
- radiography;
- cT scan.
Symptoms of hypertensive nephrosclerosis can occur in other diseases. The differential diagnosis is carried out with the following pathologies:
- chronic pyelonephritis;
- cystic kidneys;
- chronic nephritis;
- stagnant kidneys;
- kidney infarction.
Treatment principles
The main goal is to treat the underlying disease, because without this, therapy will not bring the desired result. It is carried out in a hospital setting, especially with a malignant course. Arising complications affect the tactics of treatment: nephrogenic arterial hypertension and chronic kidney failure. Treatment regimens at different stages of the disease:
Video
Nephrosclerosis is a chronic kidney disease characterized by increased proliferation of connective tissue in. As a result of this pathological process, the kidneys become denser, changing their structure and shape.
In patients, the question arises as to what it is, how such a failure occurs in the body. Outwardly, it looks as if the kidney is shriveled. Without adequate medical intervention, the patient is at risk of development.
The reasons for the development of pathology
Shrinkage of the kidney is primary and secondary. This is what determines the reasons for the development of this disease. It should be borne in mind that a shriveled kidney is not an independent isolated diagnosis, it is a complication of concomitant diseases. Nephrosclerosis in this case is a late stage of these concomitant pathologies.
There are 2 forms: primary and secondary wrinkled kidney. Regardless of what caused the nephrosclerosis, the outcome is the same - they are deficient in oxygen and nutrition, so the organs atrophy, decreasing in volume, losing their vitality. In place of the kidney tissue, connective tissue grows, and scars are formed.
The primary shriveled kidney is the result of a violation of the blood supply to the kidneys, it is caused by vascular damage. The reasons for this process must be sought in the following:
- Hypertensive disease, chronic leads to the fact that the vessels of the kidneys lose their elasticity, this causes their spasm and constriction. As a result, the blood supply to the kidney is disrupted. Hypertensive nephrosclerosis has 2 course variants: benign and malignant.
- Kidney infarction - the lumen of the renal artery is blocked by a blood clot or embolus and thus narrowed. This, in turn, leads to a decrease in blood supply and the death of healthy areas of the kidney tissue.
- Atherosclerosis. Atherosclerotic plaques, which occur with atherosclerosis, are deposited on the walls of the renal arteries, preventing normal blood flow in them.
- Age-related changes - after 50 years of age there is a thickening of the walls of the arteries, leading to a narrowing of their lumen. This process is the result of calcium deposition on the inner walls of the arteries.
- Venous congestion of the kidneys - this condition prevents the outflow of venous blood from the kidneys, as a result of which excess protein settles on the walls of the vessels.
Secondary processes of kidney wrinkling develop as a result of damage to the parenchyma - renal tissue. The following violations can lead to this:
- diabetes;
- pyelonephritis;
- nephrolithiasis;
Forms of manifestation of the disease
Regardless of the cause of the development of nephrosclerosis, it has common symptoms and signs. The death of nephrons in this disease occurs gradually, affecting individual areas. Therefore, the process of kidney wrinkling has a long course, depending on what caused the disease, whether treatment was carried out, whether the patient adhered to a diet.
The first thing a person should pay attention to and suspect kidney pathology is the symptoms associated with urinary disorders. They are expressed in the following manifestations:
- excessive formation and excretion of urine (more than 2 liters per day) or;
- frequent urination at night or;
- when as a result of the disease, most (90%) of the nephrons die;
- with the death of 70% of nephrons, they appear, i.e., the total volume of daily urine decreases;
- the presence of blood in the urine.
In addition, with nephrosclerosis, such symptoms are observed:
- increased blood pressure;
- increased swelling;
- visual impairment;
- headaches;
- bleeding tendency;
- interruptions in the work of the heart.
In nephrosclerosis, the pressure is considered to be elevated, the values \u200b\u200bof which exceed 140/90 mm Hg. And also the patient is worried about constant pulling pain in the lumbar region.
Puffiness occurs as a result of sodium and water retention in the body against the background of a decrease in protein levels, since it is excreted with urine. Symptoms associated with cardiac dysfunction are caused by prolonged increases in blood pressure and fluid retention. All this leads to an increased burden on the heart.
Kidney nephrosclerosis in a child is not detected, since this disease is characterized by a long course, when adverse factors affect the body for a long time.
However, if children have congenital defects of the urinary organs, then they are at risk for the likelihood of developing this pathology and need regular examination.
Methods for detecting renal pathology
For effective treatment of kidney nephrosclerosis in a child, it needs timely diagnosis. However, it is complicated due to the appearance of pronounced symptoms only in the later stages. Therefore, the treatment of the patient is delayed. The outcome in such cases is negative. Nephrosclerosis of the kidney is diagnosed using laboratory and instrumental methods. The former include:
- Blood chemistry. Renal impairment is determined by elevated levels of urea, creatinine, and uric acid. In addition, total protein decreases. In the last stages of the disease, the level of magnesium, phosphorus and sodium increases.
- ... The disease is determined by an increased protein content and the appearance of red blood cells in the urine. At the same time, it goes down.
- General blood analysis. With nephrosclerosis, the level of hemoglobin and platelets decreases.
With the help of instrumental methods, not only the kidneys are examined, but also its vessels. One of the most common diagnostic procedures is ultrasound. On ultrasound, doctors reveal such signs of nephrosclerosis as atrophy of the cortical layer of the kidney, calcium deposition in the renal tissue and the lack of separation between the cortex and medulla of the kidney.
To detect nephrosclerosis, X-ray examination methods are performed, such as excretory urography of the kidney and angiography of the vessels of the kidney. In both cases, the introduction of a contrast agent is necessary.
- Capable of improving renal blood flow. These are anticoagulants and antiplatelet agents. It is advisable to prescribe such drugs in the early stages of the disease, since in the future they will only increase bleeding.
- Lowering blood pressure. In the last stages of the disease, drugs of this action must be prescribed with caution, since they can cause a deterioration in blood flow in the kidneys.
- Restoring salt balance are potassium preparations, which are designed to normalize not only the acid-base balance of the blood, but also the heart rate. Their appointment must be preceded by an analysis to determine the level of potassium in the blood.
- Multivitamins - they are designed to improve and speed up metabolic processes.
- Raising hemoglobin levels. For this, iron and erythropoietin preparations are prescribed.
- Sorbents and herbal preparations for removing toxins from the body.
Is drug treatment effective in the initial stages of the disease. But when nephrosclerosis reaches 3-4 stages, then the restoration of kidney function in this way becomes impossible. The outcome of the disease for the patient is ambiguous. In this case, hemodialysis or kidney transplantation is required.
Nephrosclerosis of the kidneys is a pathological condition of an organ in which the standard type of tissue is completely replaced by a connective tissue. The functional component of the new type does not allow the organ to perform its functions, since it is not intended for this. The morphology of the renal tissue in this pathology changes diametrically. The circulatory system also suffers, which leads to shrinkage of the kidney and a complete loss of its functions.
The prognosis for such a disease is ambiguous, since it depends on the stage at which the pathology was diagnosed. Late detection, the lack of proper therapy leads to the death of the patient. To understand what nephrosclerosis is, one must turn to the etiology of the disease.
Kidney sclerosis is a pathology that does not proceed as an independent disease, but is an associated pathology. Among the reasons provoking the development of the disease are distinguished:
- Hypertension.
- Atherosclerotic vascular lesions of the urinary system.
- Other pathological disorders of the blood supply to the kidneys.
Depending on the factors that led to the onset of pathology, several types of nephrosclerosis are distinguished.
The cause of nephrosclerosis is a violation of the blood supply to the kidneys, which leads to their dysfunction
Classification
Atherosclerotic vascular lesions, the presence of blood clots are the main reasons for the formation of the first stage of pathology: primary nephrosclerosis.
Primary nephrosclerosis
In this type of kidney sclerosis, the trophic capabilities of the organ tissues are severely impaired. This becomes the cause of ischemic conditions. And in the absence of proper medical care, they provoke a kidney infarction. The potential risk of this pathology is that if the blood supply is completely inhibited, then the excretory system stops functioning. This entails a condition. Such complications are life-threatening for the patient.
The main consequence of primary nephrosclerosis is primary renal wrinkling. This is characteristic of acute hypertension.
In turn, nephroangiosclerosis is divided into several types:
Atherosclerotic nephrosclerosis
A pathological condition that develops as a consequence of an atherosclerotic disease that affects the arterial vessels and arterioles of the kidney. As a result, the lumen of the vessels is strongly narrowed or completely blocked. Degenerative conditions of the organ result from reduced transmission capacity due to thickening of the artery walls.
The early stage is asymptomatic, while a characteristic complication of kidney sclerosis is ischemia, as a result of which changes occur on the surface of the organ and scars form. The prognosis for this type is positive, because not all kidney tissue is affected by destruction, while continuing to perform its functions normally.
Shriveled kidney
Hypertensive nephrosclerosis
This type of pathology owes its name to the etiological factor that caused the spastic conditions of the vessels. As with the previous form, pathogenesis includes ischemic damage to the organ, as well as the change from normal tissues to connective tissue.
In turn, the hypertensive type of pathology is divided into:
- Arteriolosclerotic nephrosclerosis. This is a malignant disease.
- Arterio-necrotic nephrosclerosis. Benign course.
Involutive form
This form of kidney sclerosis occurs in older patients. This is mainly due to calcium deposits on the walls of blood vessels. With a narrowing of the lumen, the development of the pathological condition follows the standard scheme.
Secondary nephrosclerosis
The development of this form of the disease is due not only to atherosclerosis, but is also a consequence of other pathologies. Various infectious and inflammatory processes in the kidney system lead to this disease.
Main reasons:
- in a chronic course.
- in a chronic course.
- Severe forms.
- Tuberculosis.
- Amyloidosis.
- Nephropathy in pregnant women.
- Consequences of trauma and surgery.
Symptoms
In the early stages, the symptoms of renal sclerosis are practically absent. Diagnosis of pathology occurs after prophylactic tests or during the diagnosis of another disease. In the absence of measures taken, pathology develops and with each subsequent stage of development, the severity of symptoms increases.
In nephrosclerosis, the main clinic refers to functional disorders of the organ, which provides symptoms:
- Swelling of the face and lower extremities.
- Lumbodynia.
- Hypertension associated with headaches. Pain syndrome is practically not overcome by painkillers.
- Changes in the physical properties of urine, as well as the presence of various inclusions in it - flocculent sediment, color changes to reddish, turbidity.
- Nocturnal enuresis.
- A sharp decrease in urine output.
- Dry mouth and thirst.
- Apathy, weakness, lack of appetite. Also, patients with nephrosclerosis have an aversion to meat foods.
- Dermatological disorders.
- Losing weight.
- Tachycardia, shortness of breath.
Symptoms and manifestations of nephrosclerosis
Such symptoms in adults and children require immediate diagnosis.
Diagnostic procedures
If the first symptoms of pathology appear, then biochemical studies of blood, urine, instrumental studies of the organs of the urinary system are carried out.
Since the risk of developing the disease increases in the presence of chronic pathologies, patients with diabetes mellitus, hypertension, atherosclerosis, pathological weight gain are recommended to take tests once a year and carry out full functional diagnostics.
This includes:
- Blood test. General and biochemical. Particular attention is paid to creatinine clearance.
- Analysis of urine. The density of urine is important.
- Ultrasound procedure.
- X-ray procedures, including contrast procedures.
Therapy
Treatment of nephrosclerosis is based on two principles. The first is drug therapy, the second is surgery.
When diagnosed with high blood pressure, drugs are selected that reduce blood pressure at the general level. The approach to the selection of funds is individual. Therapy is prescribed only by the attending physician. The choice of medication is based on the characteristics of the patient's body and the possibility of using combinations of funds.
There are several main groups of drugs:
- ACE inhibitors.
- Angiotensive receptor blockers.
The right diet is essential. Salt is completely excluded. In some cases, carbohydrates are contraindicated.
The first stage of the disease, diagnosed in time, implies a classic approach to treatment:
- Hormone therapy. Prednisolone, methylprednisolone. Dosages are determined by the doctor based on the functionality of the kidney.
- Cytostatic agents.
- Drugs that improve the functional ability of the urinary system.
If atherosclerosis is the main cause, then medications from the statin group are prescribed. This reduces the level of cholesterol in the blood, which has a beneficial effect on the functioning of the cardiovascular system. And also allows you to stop nephrosclerosis.
If the disease is diagnosed at one of the last stages, when the patient is experiencing serious problems, then the following methods are shown:
- Blood dialysis... An effective procedure that purifies the blood from toxins that are not filtered by the kidneys due to illness. Usually up to five procedures are performed. By the third procedure, the patient feels much better.
- Peritoneal dialysis... Also an effective method that can be carried out even at home.
- Nephrectomy or transplant... It includes a whole range of procedures for adapting a new organ in the patient's body. The consequences of surgery include the possibility of rejection by the patient's immune system.
Knowing the threat of nephrosclerosis, the patient needs to strictly follow the instructions of the doctors.
Treatment with folk remedies
Treatment of kidney nephrosclerosis with folk remedies includes a set of measures aimed at lowering blood cholesterol levels, improving the functional abilities of the kidneys. And also, additional to the main anti-inflammatory and antiseptic therapy of renal diseases with phytopreparations.
Ayurveda is very popular - it is an Indian phytotherapeutic technique. The main drug that is often used by patients and prescribed by doctors is Cyston. Treatment with such a remedy is long-term and ensures the normalization of renal pressure, relief of the condition in inflammatory processes and increased diuresis.
- Birch buds.
- Lingonberry extracts.
- Mixtures of flax seeds, strawberry leaves, birch buds, nettle leaves, knotweed, horsetail.
- Infusion of licorice root.
Pediatric pathology
In a child, kidney nephrosclerosis cannot develop without the presence of congenital organ diseases. This is due to the fact that pathology appears as a result of a large number of damaging factors, the accumulation of negative effects of which takes years. This is impossible in a child's body.
Preventive measures
Among the preventive measures are:
- Diet recommendations. Doctors advise against neglecting fruits and vegetables. It is also not recommended to overuse meat.
- Body weight control.
- Compliance with the correct water regime.
- Playing sports and giving up bad habits.
- Self-medication exclusion.
- Periodic diagnostic procedures.
- The absence of poisoning and intoxication with chemicals.
Conclusion
What is kidney nephrosclerosis? This is the outcome of diseases that can be successfully treated in the early stages, thereby excluding the development of such a life-threatening pathology. Most of the patients, unfortunately, do not pay attention to the first symptoms, allowing the disease to develop slowly. Only a timely visit to a doctor and correct diagnosis gives a person a chance to live a full life.
Renal nephrosclerosis is a pathological process characterized by the death of nephrons and the replacement of functional renal tissue (parenchyma) with connective tissue. It can be a consequence of various diseases of the kidneys or renal arteries and veins, as a result of which the normal blood supply to the organ is disrupted.
With the progression of the disease, due to a significant proliferation of connective tissue in the affected kidney, dysfunction, characteristic structural and morphological changes are noted. The kidneys decrease in size, become dense and wrinkled. Predominantly nephrosclerosis develops as a complication of diabetes mellitus, hypertension, atherosclerosis, glomerulonephritis or pyelonephritis and gradually leads to chronic renal failure (CRF).
Types and causes of the disease
Depending on the mechanism underlying the onset of the disease, primary and secondary renal nephrosclerosis are isolated. As a result of certain pathological processes, a lack of supply of nutrients and oxygen leads to atrophy or necrosis of the structural and functional units of the kidney (nephrons) located in the parenchyma of the organ. In place of the dead nephrons, connective tissue grows, as a result of which the kidney loses its ability to fully perform its functions.
Primary nephrosclerosis
Primary nephrosclerosis is caused by impaired blood supply to the renal parenchyma and is a consequence of pathological processes in the body that are not directly related to the kidneys. These include:
- hypertonic disease;
- vascular atherosclerosis;
- age-related changes;
- obstructed venous blood flow.
Hypertensive nephrosclerosis develops due to a violation of the blood supply caused by spasm and narrowing of the vascular lumen. There are two types of this disease:
- arteriolosclerotic (benign) nephrosclerosis, characterized by the proliferation of connective tissue in the inner walls of the renal arteries, which leads to a decrease in their elasticity and causes atrophic changes in the nephrons;
- arteriolonecrotic (malignant) nephrosclerosis, characterized by necrosis of arterioles and glomeruli, hemorrhages in the walls of the urinary tubules and impaired protein metabolism in the epithelium of the convoluted tubules.
In arteriolosclerotic nephrosclerosis, the kidney has a fine-grained surface
With atherosclerosis, specific fatty plaques form on the inner walls of the arteries. They lead to a decrease in the diameter of the vessels, a thickening of their walls and a decrease in elasticity, as a result of which blood flow decreases and ischemia of organs and tissues that receive nutrition through these arteries occurs. Most often, atherosclerotic plaques are localized at the entry points of the renal artery into the organ or in the area of \u200b\u200bits branches inside the kidney.
In atherosclerotic nephrosclerosis, the kidney acquires a large, lumpy, wrinkled shape
Age-related changes in blood vessels begin to develop in people after 40 years. They consist in thickening of the walls, loss of elasticity and narrowing of the lumen of the arteries due to deposits on their inner walls of calcium salts, proliferation of connective tissue, accumulation of smooth muscle cells. These processes lead to thinning of the renal cortical layer and atrophy of the cells of the urinary tubules.
Important: After reaching the age of 70, the number of functioning nephrons in the kidney decreases by almost 40%.
When the venous outflow of blood is obstructed in the kidneys, stagnation occurs, impairing the blood supply to the organ. The formation of connective tissue in this case is due to an increase in the synthesis of tropocollagen, a structural unit of collagen, as a result of hypoxia.
Secondary nephrosclerosis
Secondary nephrosclerosis is the result of the progression of inflammatory or dystrophic kidney disease. Among them:
- glomerulonephritis;
- pyelonephritis;
- nephrolithiasis;
- kidney tuberculosis;
- syphilis;
- rheumatism;
- systemic lupus erythematosus;
- hyperparathyroidism;
- diabetic nephropathy;
- interstitial nephritis;
- amyloidosis of the kidneys;
- kidney injury and surgery;
- irradiation;
- nephropathy of pregnant women.
Most often, the secondary form of the disease develops against the background of chronic glomerulonephritis. In this case, the affected kidneys have a fine-grained surface, as in the case of hypertensive nephrosclerosis.
Advice: Timely treatment and control of diseases, the complication of which can be secondary nephrosclerosis, helps to prevent the development of this severe pathology.
Symptoms and Diagnosis
In the early stages of nephrosclerosis, symptoms are mild. The first changes can only be detected by laboratory tests of urine and blood, which reflect renal function. In the analysis of urine, the following deviations are observed:
- an increase in daily urine output;
- discharge of most of the urine at night;
- the appearance of large amounts of protein;
- detection of erythrocytes;
- decrease in specific gravity.
In the biochemical and general blood test, it is noted:
- an increase in the level of toxic products of protein metabolism;
- decreased total protein;
- deviation from the norm in the concentration of potassium, magnesium, phosphorus, sodium;
- lowering the level of hemoglobin and platelets;
- an increase in the concentration of leukocytes.
Patients with progressive renal nephrosclerosis have:
- high blood pressure, not reduced by drugs usually taken for hypertension;
- weakness, headaches;
- swelling;
- attacks of angina pectoris;
- heart failure and heart rhythm disturbances;
- anemia;
- blue skin of the limbs;
- visual impairment, retinal detachment, inflammation of the optic nerve.
Recommendation: If you find the above symptoms, you should seek help from a medical institution. The sooner an accurate diagnosis is made and treatment is started, the more likely it is to prevent the development of severe consequences.
From instrumental diagnostic methods for suspected renal nephrosclerosis are used:
- ultrasound procedure;
- radionuclide renography;
- excretory urography;
- computed tomography;
- angiography of the renal vessels;
- scintigraphy;
- doppler study of renal vessels.
Ultrasound of the kidneys reveals changes in the size of the organ, the thickness of the renal parenchyma, the degree of atrophy of the cortex
Treatment methods
In renal nephrosclerosis, treatment depends on the severity of the disease and the symptoms observed. The earlier it is started, the more likely it is to reduce the risk of onset or delay the development of chronic renal failure. The main task in the treatment of nephrosclerosis is to eliminate or control the underlying disease that provoked pathological changes in the renal parenchyma. Otherwise, the applied methods of nephrosclerosis therapy will be ineffective.
Drug treatment
Medicines are effective in the early stages of the disease. They are taken in a complex and long-term defined courses with short breaks. Depending on the clinical manifestations, they are prescribed:
- antihypertensive drugs;
- diuretics;
- anabolic agents;
- drugs that improve renal blood flow;
- enterosorbents;
- vitamins.
Important: With the progression of renal failure, antihypertensive drugs should be taken with great care, as they can provoke an increase in azotemia and impairment of renal blood flow.
Operative treatment
Operative methods of treatment are used in the rapid course of the disease, progressive renal failure or malignant hypertensive nephrosclerosis. These include:
- renal artery embolization;
- nephrectomy;
- donor kidney transplantation.
Features of nutrition for nephrosclerosis
Compliance with a special diet for kidney nephrosclerosis can reduce the load on the organ and reduce the amount of toxic products of protein metabolism formed. It is especially important at the early stage of chronic renal failure, which is detected when high levels of urea and creatinine in the blood are detected.
The principle of nutrition is to limit the intake of protein, salt and fluids. In addition, it is not recommended to eat foods rich in potassium (bananas, dates, prunes, etc.). Meals should be fractional, divided into 5-6 meals.
When drawing up a diet, the stage of nephrosclerosis must be taken into account. In the absence of signs of CRF, restriction of protein intake is minimal. Low-fat varieties of meat, fish, dairy products, eggs are recommended. In the case of chronic renal failure, the basis of the diet should be vegetables, fruits, cereals. With normal blood pressure and the absence of edema, the amount of salt entering the body is not reduced. Fluid restriction is necessary in the later stages of nephrosclerosis.
