Nephrosclerosis of the kidney ("wrinkled kidney"): causes, symptoms, signs, diagnosis and treatment

Such a disease, like nephrosclerosis, for a long time remained without doctors' attention. Until the 19th century, there was no complete description of it. He began to reckon as an independent illness only three decades later, when information about etiology appeared. The disease was associated with damage to the arterial vessels on the background of their defeat by cholesterol. His forecast is not always favorable. Many patients after the course of therapy have to face such complications as blindness, ventricular dysfunction. To maintain the viability of the body, in such cases, urgent purification of blood by an artificial method is required.

Anatomical reference: kidney nephrosclerosis

What it is? This disease, in which the active elements of the organ (parenchyma) are replaced by a connective tissue. The latter plays the role of a kind of neutral filler, but does not adopt the basic functions. To understand the essence of the pathological process, it is necessary to turn to an anatomical reference.

The kidneys are a paired organ, shaped like beans. Its main part is the parenchyma, where urine is formed. Also important are calyxes and pelvis, which represent a whole system for the accumulation and subsequent excretion of urine. The filtration is carried out by nephrons of the parenchyma. All the kidneys are united by a branched network of tiny vessels that extend from the main artery.

Kidneys perform many functions, among which are:

• Synthesis of renin - a substance that affects the condition of the walls of blood vessels;
• Elimination of harmful substances from the body;
• Maintaining a certain level of acid;
• The production of erythropoietin, which directly affects the process of hematopoiesis.

This multifunctionality of the kidneys does not allow us 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 the process of successive replacement of the renal parenchyma with connective tissue, which causes a decrease (wrinkling) of the size of the organ and a decrease in its functionality. In the absence of treatment, a complete cessation of working capacity may occur.

Previously it was believed that the main cause of the disease is glomerulonephritis. Today, physicians have revised this point of view by identifying diabetes mellitus and arterial hypertension as its main provocateurs.

By the mechanism of development, primary and secondary nephrosclerosis of the kidneys are distinguished. Each of the forms of the disease has its own prerequisites for emergence, as well as characteristic features. On this issue it is worthwhile to dwell in more detail.

Primary nephrosclerosis

The primary form of the disease develops against the background of disruption in the operation of blood vessels, narrowing the working cross 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 is of several types: atherosclerotic, hypertonic, involutive. In the first case, the main cause of the narrowing of the vessels is deposition on their walls of fatty plaques. As a result, the lumen decreases, which entails kidney ischemia. The surface of the organ becomes knotty, and scars of irregular shape are easily discernible on it. This type of ailment is considered the safest.

Hypertensive nephrosclerosis is a manifestation of a severe spasm of blood 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 kidney nephrosclerosis can be benign and malignant.

Involute type of disease is associated with age-related changes. For example, after 50 years, most people on the walls of the arteries begin to accumulate calcium, which helps reduce the lumen. On the other hand, it is with age that atrophy of urinary canaliculus elements 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 different states and disorders:

1. Diabetes. Increasing blood sugar levels provokes changes in the walls of blood vessels. They become denser and swell, but permeability increases. As a result, the protein enters the bloodstream, which increases coagulability to compensate for the disorder. Simultaneously, the current slows down, which entails the defeat of not only the kidneys, but also other organs.
2. Chronic glomerulonephritis. With this pathology, immune complexes do not collapse, but fall directly into the kidneys. They damage the membranes of the vessels in the glomeruli. To compensate for the ongoing processes, synthesis of substances that increase thrombogenesis begins.
3. Pyelonephritis. This disease is accompanied by the penetration of the bacterial flora into the renal glomeruli and tubules, where thrombi form. Around them consistently accumulate leukocytes. After recovery on the damaged areas, scars or abscesses form.
4. Urolithiasis disease. When the urine is stagnant, bacteria begin to multiply actively in it. In the case of a reverse urine cast, the pathogenic flora can damage the internal walls of the urinary tubules.
5. Lupus erythematosus. This systemic disease is characterized by the synthesis of immune complexes, which can begin an attack on their own organs.
6. Nephropathy of pregnant women. During the gestation of the baby, the hormonal system of the woman undergoes changes, this leads to various failures. One of these disorders is spasmodic capillaries. As a consequence, blood pressure rises, and the blood supply of the kidneys is disrupted. A woman develops swelling, and nephrons begin to actively die.

Given the information provided, several conclusions can be drawn. Primary kidney nephrosclerosis most often develops against the background of circulatory disorders in the organ. The secondary form of the pathological process is usually preceded by inflammatory-destructive disorders.

Separately, it should be noted a group of factors provocateurs, from the impact of which the likelihood of the disease significantly increases. First of all, it is the abuse of alcoholic beverages and food additives, smoking, uncontrolled use of medicines. A sedentary lifestyle and infectious diseases also increase the risk of developing nephrosclerosis. Therefore, the main measure of its prevention is the elimination of these factors.

Stages of the disease development

Elements of kidney tissue die gradually, so the disease itself develops in stages. In the first phase there is a picture caused by a specific disease that provoked the sclerotic process. This is the early stage of kidney nephrosclerosis. What it threatens for the patient, it is difficult to predict if to ignore the doctor's prescribed therapy.

The next stage is the death of nephrons, their replacement with a connective tissue. The pathological process contributes to the onset of renal failure, which also develops in stages.

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 a strong thirst, a feeling of dryness in the mouth. At the next stage, high blood pressure remains, which even does not lend itself to medicamentous effects. Patients are concerned about severe headaches, nausea. If a patient is prescribed a strict diet in nephrosclerosis of the kidneys in a timely manner, 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, strong weakness. Such a person appears to be addicted to viral diseases. Against the background of constant thirst, the volume of urine released is greatly reduced. The skin becomes a characteristic yellowish shade. In the fourth stage, urine is practically not excreted. Intoxication develops rapidly, the process of blood clotting is disrupted. At this stage, the listed changes are irreversible.

Clinical picture

Nephrosclerosis, also known as the "wrinkled kidney," is difficult to identify at the initial stages, since there are no characteristic symptoms. The patient does not feel discomfort at the same time. Only when referring to a doctor with other complaints and after a diagnostic examination, it becomes possible to identify abnormal processes.

When the disease acquires a stable character, its following symptoms appear:

• Swelling of the face and extremities;
• The number of urges to urinate increases, but the volume of urine released decreases;
• Pain in the lower back;
• Strong thirst;
• High blood pressure;
• Fatigue, fatigue;
• Itching of the skin.

The listed symptoms of nephrosclerosis of the kidneys should be the reason for going through a deeper medical examination. Only after receiving its results can you start therapy.

Complex diagnosis of kidney disease

Nonspecific features of the disease significantly complicate the diagnosis. Usually such questions are dealt with in specialized nephrological centers. Here, too, various organ transplant surgery procedures are performed .

If you suspect a disease, you should seek help from such a center or a local therapist. The latter, after studying the clinical picture, can give direction to a narrow specialist.

The diagnosis of the disease begins with a study of the patient's complaints, his history and physical examination. On consultation, the nephrologist can also palpate the abdominal cavity. The above manipulations allow us to presume a preliminary diagnosis and outline further survey 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 of the quantitative content of protein;
• Decrease in potassium, and increase in phosphorus and magnesium.

In the analysis of urine, the protein and erythrocytes are detected, but its density is significantly reduced. When examining the 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 the authorities, resort to instrumental methods of examining patients diagnosed with nephrosclerosis. Kidney ultrasound, for example, allows one to assess their size and the state of the cortex. Mandatoryly appointed urography. 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, makes recommendations for further treatment.

Use of medicines

Therapy of this disease is carried out in specialized nephrological centers. It is reduced to eliminating the main factor-provocateur. Attempts to restore the lost kidney function without a first step are usually futile.

Treatment is always complex and long-term. Depending on the clinical picture and general condition of the patient, the following medicines may be required:

1. Anticoagulants ("Heparin") for the prevention of blood clots.
2. Drugs for lowering blood pressure.
3. ACE inhibitors ("Diroton", "Berlipril") for the expansion of the blood vessels of the kidneys.
4. Diuretics that remove excess fluid from the body.
5. Promoting the expansion of arteries, calcium antagonists ("Falipamil").
6. Polyvitaminic complexes.

With other disorders due to kidney dysfunction, drugs are selected individually.

Operative intervention

At the 3-4th stage of the pathological process, medication is usually ineffective. In such cases, the patient is shown hemodialysis or a donor kidney transplant. The essence of the first procedure is reduced to the purification of blood from toxic substances. For this, a special artificial kidney filter is used. The periodicity of hemodialysis is determined by the patient's condition, the degree of severity of the pathological process. The procedure must be accompanied by drug therapy.

Surgical treatment involves the transplantation of the donor kidney. This is one of the few types of operations, when the organ can be removed both from a living person, and from a corpse. During the recovery period, the patient is given serious medication and complete rest.

Features of food

An excellent addition to the course of treatment is the observance of a fairly strict diet. Nutrition for nephrosclerosis of the kidneys is selected by a doctor for each patient individually. Usually, the following principles are observed:

1. Restriction of protein intake. In this case, you can not completely reject it. When choosing protein foods, preference should be given to meat, poultry, fish and dairy products. Potatoes, cereals and bread are important to completely eliminate from the diet.
2. The diet should necessarily include seafood, but they should not be abused because of the high content of phosphorus.
3. Restriction of consumption of table salt. At any consultation, the nephrologist will say that in the 1-2 stages, up to 15 grams of salt per day is allowed, and on the 3-4th this amount is cut by half. Completely refuse this spice can not, because the likelihood of dehydration increases.
4. Be sure to include in the diet of potassium-rich foods. For example, bananas, dried apricots, raisins.
5. Food should be as balanced as possible, contain the necessary amount of calories and vitamins.

Such a diet, most patients are forced to adhere to the end of life.

Forecast

Nephrosclerosis of the kidneys 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 certain limitations. For example, for patients with this diagnosis it is important to minimize the intake of table salt, constantly monitor the calcium and phosphorus in the blood. At each exacerbation of a pathology it is necessary to apply for medical help and each time to pass a course of therapy.

The "wrinkled kidney" revealed at the 3rd and 4th stages requires a slightly different approach. In this case, all restrictions are much stricter. It is no longer possible to restore the lost tissues of organs. Therefore, in such situations, therapy is reduced to providing the functionality of the remaining nephrons. Sometimes this is not enough.