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Renal failure and anury
June 14, 2013
The acute renal failure is a state at which there is a sudden termination or very sharp lowering of function of both kidneys or the only kidney. Owing to development of such state the azotemia which quickly accrues is shown, and also heavy water and electrolytic disturbances are noted.
At the same time the anury is a serious condition of an organism at which intake of urine in a bladder completely stops, or for its days no more than 50 ml arrive. The person suffering from an anury has no both urination, and desires to him.
What is going on?
In a pathogeny of a disease of the leader disturbance of blood circulation in kidneys and lowerings of the level of the oxygen delivered in them is. As a result, there is a disturbance of all important functions of kidneys — filtrational, secretory, secretory. Thereof in an organism the maintenance of products of a nitrogen metabolism sharply increases, the metabolism is seriously broken.
Approximately in 60% of cases symptoms of an acute renal failure are observed after surgeries or injuries. About 40% of cases are shown at treatment of patients in a hospital. In rare instances (approximately) this syndrome develops in 1-2% at women during pregnancy.
Distinguish acute and chronic stages of a renal failure. The clinic of an acute renal failure can develop for several hours. If diagnosis is carried out timely, and all measures were taken to prevent such state, then functions of kidneys are recovered completely. The presentation of methods of treatment is held only by the specialist.
Several types of an acute renal failure are defined. The Prerenalny renal failure develops owing to an acute disorder of a blood-groove in kidneys. A renal renal failure — result of defeat of a renal parenchyma. A prerenal renal failure — an effect of sharp disturbance of outflow of urine.
Development of an acute renal failure happens during receiving traumatic shock at which fabrics are damaged. Also this state develops under the influence of reflex shock, reduction of amount of the circulating blood owing to burns, a big loss of blood. In this case the state is defined as a shock kidney. It occurs at serious accidents, heavy operative measures, wounds, a myocardial infarction, at incompatible blood transfusion.
The state called by a toxic kidney is shown owing to poisoning with poisons, organism intoxication by medicamentous means, alcohol abuses, toxicomanias, radiations.
Acute infectious kidney — an effect of serious infectious diseases — hemorrhagic fever, a hay fever. Also it can occur in the course of the heavy course of infectious diseases at which dehydration quickly develops.
The acute renal failure develops also owing to impassability of urinary tract. It occurs if at the patient the tumor grows, there are stones, thrombosis, an embolism of renal arteries is observed, there is an ureter injury. Besides, the anury sometimes becomes complication of acute pyelonephritis and an acute glomerulonephritis.
At pregnancy the acute renal failure is most often noted in the first and third trimesters. In the first trimester such state can develop after the abortion which is especially carried out in unsterile conditions.
The renal failure develops also owing to puerperal bleedings, and also a preeclampsia in recent weeks of pregnancy.
Also a number of cases when it is not possible to define accurately the reasons for which at the patient the acute renal failure develops is allocated. Sometimes such situation is observed when development of a disease is influenced by several different factors at once.
Initially at the patient symptoms of a renal failure, and symptoms of that illness which leads to development of an anury are shown not directly. It will be able to be signs of shock, poisoning, directly illness symptoms. Further symptoms at children and adults are shown by reduction of amount of the emitted urine. Initially its quantity decreases to 400 ml every day (this state is called an oligouriya), later at the patient no more than 50 ml of urine a day are allocated (the anury is defined). The patient complains of nausea, at him vomiting is also observed, appetite disappears.
The person becomes sluggish, sleepy, he notes block of consciousness, and sometimes there are spasms and hallucinations.
Also the condition of skin changes. She becomes very dry, turns pale, hypostases and hemorrhages can develop. The person breathes often and deeply, he notes tachycardia, the heart rhythm is broken and arterial pressure increases. The liquid chair and abdominal distention can be also noted.
The anury recovers if treatment of an anury was begun timely and carried out correctly. For this purpose the doctor has to define the anury reasons accurately. If therapy is conducted correctly, then anury symptoms gradually disappear and the period when diuresis is recovered begins. During improvement of a condition of the patient the anury is characterized by a daily urine in 3-5 liters. However in order that health was completely recovered, it is necessary from 6 to 18 months.
Thus, the course of a disease is subdivided into four stages. At an initial stage the condition of the person directly depends on that reason which provoked a renal failure. At the second, oligoanurichesky stage the amount of urine sharply decreases, or it can be absent completely. This a stage is the most dangerous and if it proceeds too long, then the coma and even a lethal outcome is possible. At the third, diuretic stage at the patient the amount of urine which is emitted gradually grows. Further there comes the fourth stage — recovery.
To the patient with suspicion a number of inspections is appointed to a renal failure or with signs of an anury. First of all, it is consultation of the urologist, biochemical and clinical blood tests, ultrasonic research, intravenous urography. It is easy to diagnose an anury as on poll of the patient it is possible to understand that it had no long time of an urination and desires to it. To differentiate this state from an acute ischuria, bladder catheterization with the purpose to confirm lack of urine in it is carried out.
All patients at whom symptoms of an acute renal failure are observed have to be brought urgently in a hospital where diagnosis and the subsequent treatment is carried out in the intensive care unit or in department of nephrology. The leading value in this case has as much as possible earlier an initiation of treatment of the main illness to remove all causes which led to injury of kidneys. Considering the fact that the disease pathogeny most often is defined by influence on a shock organism, it is necessary to hold antishock events quickly. In the choice of methods of treatment classification of types of an illness has the defining value. So, at the renal failure caused by a loss of blood compensation by introduction of blood substitutes is carried out it. If initially there was poisoning, the gastric lavage for removal of toxic substances is surely carried out. At a renal failure of heavy degree it is necessary to carry out a hemodialysis or a peritoneal dialysis.
Especially serious condition is caused by an end-stage of a chronic renal failure. In this case functions of kidneys are completely lost, and in an organism toxins collect. As a result, such state leads to serious complications. Therefore the renal failure chronic at children and adults has to be exposed to the correct treatment.
Treatment of a renal failure is carried out gradually, taking into account certain stages. Initially the doctor defines the reasons which led to the fact that the patient had symptoms of a renal failure. Further it is necessary to take measures to reach rather normal volume of urine which is emitted at the person.
Depending on a stage of a renal failure conservative treatment is carried out. Its purpose — to reduce that amount of nitrogen, water and electrolytes which come to an organism that this quantity corresponded to that which is brought out of an organism. Besides, an important point of recovery of an organism is the diet at a renal failure, a constant control of its state, and also control of biochemical indicators. Especially careful relation to treatment has to be if the renal failure at children is observed.
The following important stage of treatment of an anury is carrying out dialysis therapy. In certain cases dialysis therapy is applied for the purpose of prevention of complications already at early stages of an illness.
The absolute indication to carrying out sick a dialysis is a symptomatic uraemia, accumulation of liquid in the patient's organism which does not give in to removal using conservative methods.
Special value is given to food of patients. The matter is that both hunger, and thirst can sharply worsen a condition of the person. In this case the low-proteinaceous diet is shown, that is in a diet fats, carbohydrates have to dominate. If the person cannot eat independently, glucose and nutritious mixes is intravenously surely entered.
The course of an acute renal failure often is complicated by infectious diseases. At such current the disease can come to the end with a lethal outcome.
As complications from cardiovascular system the circulatory unefficiency, arrhythmias, hypertensia, a pericardis is. Often at an acute renal failure manifestation of neurologic disturbances is noted. Those patients who are not on a dialysis can note strong drowsiness, disturbances of consciousness, trembling and other disturbances from a nervous system. More often such disturbances develop at elderly people.
From a gastrointestinal tract complications develop also often. It can be nausea, anorexia, impassability of intestines.
Not to allow development of so dangerous condition of an organism, first of all, it is necessary to give timely qualified help to those patients who have a high risk of development of an acute renal failure. These are people with severe injuries, burns; those who just underwent a heavy operation, patients with sepsis, an eclampsia, etc. Very carefully it is necessary to use those medicamentous means which are nephrotoxic.
Not to allow development of a chronic renal failure which develops as an effect of a number of diseases of kidneys it is necessary not to allow exacerbations of pyelonephritis, a glomerulonephritis. Important at chronic forms of these diseases surely to keep to the rigid diet appointed by the doctor. Patients with chronic diseases of kidneys have to be followed up regularly by a doctor.