Kidney nephrosclerosis ("wrinkled kidney"): causes, symptoms, signs, diagnosis and treatment. Causes of nephrosclerosis Glomerulonephritis with outcome in nephrosclerosis

Nephrosclerosis is a disease caused by the replacement of the renal parenchyma with connective tissue, which contributes to the compaction and wrinkling of the organ. As a result of this pathological process, the functions of the kidneys are impaired. In medicine, there is another name for such a pathology - wrinkled kidney.

Nephrosclerosis of the kidneys is of 2 types, depending on the mechanism of development:

• primary, arising from a violation of the blood supply to the tissue of the organ, due to hypertension, atherosclerosis and other vascular diseases;
• secondary, which accompanies some renal diseases, for example, nephritis, congenital malformations.

This pathological condition occurs not only in humans, but also in animals. For example, nephrosclerosis in cats can occur without obvious clinical signs: the temperature is normal, but there is weakness, lethargy, increased thirst, and weight loss. To identify the disease as early as possible, you need to conduct a urine test and ultrasound.

Types of disease

There is a classification of pathologists, which is based on both the cause of its development and its main manifestations.

1. Hypertensive nephrosclerosis(arteriolosclerotic), which has a primary development mechanism, occurs due to regular increased pressure in the vessels and narrowing of their lumen. As a result of insufficient blood circulation in the organ, cellular hypoxia increases and the replacement of the atrophied kidney parenchyma with connective tissue.

The hypertensive type of the disease can occur in two forms, depending on the symptoms - benign and malignant.

Arteriolosclerotic nephrosclerosis of a benign form is often combined with atherosclerosis of the kidney artery. Although this form can be compensated, but over time, dystrophy of most nephrons leads to renal failure. The malignant form is characterized by fibrinoid necrosis of arterioles and glomerular capillaries, hemorrhages, and protein atrophy of the epithelial tissue of the tubules. This form leads to kidney failure faster than the benign form and is more likely to be fatal if hemodialysis is not performed on time.

2. Atherosclerotic nephrosclerosis due to stricture of the artery of the kidney by an atherosclerotic plaque. Usually the pathology is unilateral. The connective tissue replaces the wedge-shaped atrophied areas, as a result of which the organ becomes large-tuberous, but this does not greatly affect its functionality due to the small volume of the lesion. With this stenosis, hypertension of the renal vessels usually develops.

3. Diabetic nephrosclerosis(DN) is characterized by microangiopathies that completely affect the organ. At the 1st stage, this complication is difficult to diagnose due to the lack of obvious symptoms. With late diagnosis, the disease leads to irreversible results.

Diabetic nephrosclerosis has several stages:

• the first stage is diagnosed only by measuring the glomerular filtration rate of various substances (for example, creatinine or insulin) or by detecting microalbuminuria (low levels of albumin).
• The 2nd stage is prenephrotic, which, in addition to the above diagnostic signs, also has microhematuria (a small number of red blood cells in the urine), and blood pressure also slightly increases.
• Stage 3 - nephrotic, which has visual symptoms - edema and sharply increased pressure. In the general study of urine, proteinuria and cylinduria can be detected.
• Stage 4 diabetic nephrosclerosis appears several years after the onset of proteinuria. Chronic renal failure is connected to it. Clinical signs - severe swelling, regular hypertensive crises, muscle weakness, nausea, sometimes vomiting, itching on the skin.

Common signs and symptoms of nephrosclerosis

Symptoms of nephrosclerosis at the initial stage of the disease are not very pronounced. Changes can only be detected using laboratory diagnostics (for example, when analyzing urine, polyuria, nocturia, protein and red blood cells in the urine, reduced density) are determined. Gradually, clinical symptoms appear - swelling in the face, and then - throughout the body.

As a result of emerging decompensated arterial hypertension, the following complications arise:

• strokes;
• overloaded work of the left ventricle of the heart;
• optic nerve atrophy or total blindness, retinal detachment is also possible.

General principles of therapy

Treatment of nephrosclerosis includes antihypertensive and diuretic drugs (for example, hypothiazide 30-50 mg per day) if the disease is benign. A special diet with a limited amount of protein foods and salt is also prescribed. Monitoring is regularly carried out to see how the renal structures cope with their functions.

Treatment of kidney nephrosclerosis is necessarily carried out in a hospital if the pathology is malignant. In this case, it is necessary to use antihypertensive drugs with caution so as not to further aggravate the patient's condition. Usually embolization of the arteries is carried out or the affected part of the organ is removed. After that, the patient needs hemodialysis or a kidney transplant. With a malignant form of the disease, the life expectancy of patients is about a year.

When parenchymal renal tissue is replaced by connective tissue, nephrosclerosis of the kidneys occurs, as a result of which the functioning of the organ is disrupted. This leads to a change in the blood supply to the kidneys, the arteries and arterioles thicken, the vessels become less elastic and are no longer able to saturate the kidney with blood in full. The glomeruli and tubules of the kidney do not receive proper nutrition and eventually die. As a result, the kidney becomes smaller and no longer performs its functions.

The outcome of the disease depends on how timely and efficiently the treatment is carried out and how correctly the patient behaves during the recovery period. A more favorable prognosis will be if treatment is started in the early stages of the disease. In all other cases, we can only talk about stabilizing the state for the longest possible period. Improper treatment or its absence leads to aggravation of the condition and death.

Nephrosclerosis is primary (impaired blood supply to the organ) and secondary (renal parenchyma is affected). The causes of primary nephrosclerosis can be:

1. Hypertension. Vasospasm causes a prolonged increase in blood pressure, while the vessels narrow, pressure arises that interferes with normal blood flow. Nephrosclerosis as a result of hypertension can be benign or malignant. In the first case, connective tissue grows in the arterial walls, and in the second case, as a result of high pressure, capillaries and arterioles die and hemorrhages appear, which cause cell atrophy.
2. Kidney infarction. In this case, the lumen of the renal artery is partially or completely blocked by an embolus or thrombus. The result is the death of living tissue. If the heart attack was minor or single, then the work of the kidney is compensated by other vessels, but with extensive heart attacks, the main part of the nephrons dies, and in this case, nephrosclerosis develops.
3. Atherosclerosis. Cholesterol plaques are deposited on the arteries, which narrow the lumen and thicken the walls of the vessels. Blood moves through narrowed vessels worse and poorly supplies tissues and cells with nutrients. Most often, atherosclerotic plaques in the renal arteries are localized at the entrance to the kidney or in places where a large vessel divides into smaller branches.
4. Age. After the age of 40, the arterial walls thicken, this is due to calcium deposits or the accumulation of connective muscle tissue. By the age of 70, the nephrons in the kidney become almost half the norm.
5. Venous congestion. This disease leads to the fact that the outflow of venous blood worsens, that is, the connective tissue grows. Such changes take a long time - more than 10 years.

The causes of secondary nephrosclerosis can be:

1. Diabetes. With a high level of glucose, various compounds are formed that tend to be deposited on the walls of blood vessels. In addition, the risk of blood clots in the lumen of blood vessels increases.
2. Pregnancy. When hormonal changes occur in the body, the vessels can receive the wrong commands, this can lead to their spasm, as a result of which the nephrons die. Due to the increased permeability of the vessels of the glomerulus, salts are retained, and protein is excreted in large quantities. This causes swelling and increases blood pressure.
3. Chronic pyelonephritis and glomerulonephritis. Microorganisms that provoke pyelonephritis settle in the urinary tubules, leukocytes begin to collect around them. If the disease is cured, then cicatricial changes remain on the tubules, and if left untreated, abscesses form. All this provokes the death of nephrons.
4. With urolithiasis, the outflow of urine is disturbed. It stagnates and creates favorable conditions for the development of a bacterial infection, bacteria are thrown into the urinary tubules and damage them.
5. Nephrosclerosis can provoke kidney tuberculosis, lupus erythematosus, amyloidosis of the kidney, surgery on the organ or its injury, ionizing radiation.

Symptoms of the disease

Since the disruption of the kidney is associated with the death of nephrons, the fewer of them remain, the brighter the symptoms of the disease will be. At the initial stage, the disease may not manifest itself at all, but with the progression of the disease, the symptoms will intensify:

1. The volume of urination increases. If a healthy person excretes 1–1.5 liters of urine per day, then in those suffering from nephrosclerosis, the volume reaches 2 liters per day.
2. The urge to urinate at night is more frequent than during the daytime.
3. If almost all nephrons die, then there is no urge to urinate at all.
4. Urine contains blood impurities.
5. Swelling of the face and body.
6. Body weight increases due to edema.
7. Blood pressure is high and does not decrease.
8. Vision drops, blurring occurs before the eyes.
9. Pain may be noted in the region of the heart and sternum.
10. With minor bruises under the skin, hemorrhages occur, there are nosebleeds and bleeding gums.
11. Migraines and severe headaches.
12. Fragility of bones.
13. Reduced immunity, resulting in frequent viral and infectious diseases.

If you experience at least a few of these symptoms, you should immediately consult a doctor. In the early stages of the disease, treatment will be much easier and more effective.

Diagnostic measures

Diagnosis of kidney nephrosclerosis consists of instrumental and laboratory studies:

1. A biochemical blood test reveals an increase in urea, uric acid and creatinine. Protein, on the contrary, decreases sharply, and in severe cases it can drop to critical levels. Potassium in the blood decreases, and magnesium, phosphorus and sodium increase.
2. Ultrasound registers a decrease in the volume of the kidney, which occurs as a result of the drying of the cortical layer. The boundary area between the cortical and medulla of the organ disappears, which indicates that a complete sclerotic change has occurred. In addition, deposition of calcium salts is observed in the parenchyma.
3. Decreased blood flow in the kidney can be seen on Doppler ultrasound.
4. The deposition of salts and changes in the shape of the organ can be seen on excretory pyelography.
5. With the help of scintigraphy, it is possible to determine the replacement of parenchymal tissue with connective tissue.

Treatment of the disease

In order for the treatment to be as effective as possible, it is necessary to determine the reason for the development of this pathology. In the early stages, the disease is treated with anticoagulants (Warfarin or Heparin), antiplatelet agents (Dipyridamole, Pentoxifylline). These drugs improve blood circulation in the kidney. Medications that lower blood pressure are shown, but in the later stages of the disease they must be used carefully. Enalapril, Nifedipine, Atenolol, Hypothiazid are prescribed. Potassium-containing drugs are prescribed - Panangin, Asparkam, they are necessary to maintain salt balance. It is also important to take vitamins, sorbents, preparations containing iron.

Chronic renal failure stages 3 and 4 are not treated conservatively to restore kidney function, using hemodialysis or organ transplantation. Hemodialysis is a procedure in which the patient's blood is passed through special filters, where it is cleaned of metabolic products and toxins. How often this procedure needs to be done depends on how active the kidney remains and the general condition of the patient.

A radical method is a kidney transplant. In this case, the patient can return to a normal lifestyle. Donor organs are taken from relatives (with their consent) or from a corpse. After transplantation, special preparations are prescribed that will promote engraftment of the kidney. Organ transplants are complex and dangerous operations that can lead to many negative consequences and complications. Therefore, doctors resort to this method only in extreme cases.

Often, doctors recommend treating nephrosclerosis with hirudotherapy, especially if the patient has chronic renal failure or glomerulonephritis. Leeches are applied to the hepatic zones, to the lower back and to the bottom of the peritoneum. The course of treatment is 10–12 sessions, 2–8 leeches are used in one session.

Nutrition for pathology

Diet for kidney nephrosclerosis is a prerequisite. Eat small meals, but often. It is advisable to limit protein foods. Cereals, potatoes, bread should be excluded from the diet. Protein is best obtained from eggs, dairy products, meat. It is recommended to eat fish dishes, as there is a lot of phosphorus in fish. To prevent swelling, it is necessary to limit the consumption of salty foods and salt as such. However, completely abandoning salt is impractical.

The diet should be balanced - contain the necessary vitamins and minerals. You can eat nuts, buckwheat, seaweed, drink mineral waters with a high content of magnesium. With secondary nephrosclerosis, you should drink plenty of water (up to 3 liters per day), but this should not be done in the presence of heart or vascular diseases.

Grandma's recipes to help

Treatment with folk remedies is not forbidden, but it should not be the only means of therapy. It is forbidden to use any folk remedies without consulting a doctor!

Lingonberry leaves are the most effective folk remedy for kidney nephrosclerosis. In order to prepare a medicinal decoction, it is necessary to pour 70 g of leaves into 0.5 liters of boiling water, boil the remedy for 15 minutes, then cool, strain and drink 100 g 4-5 times a day.

Honey has always been considered an indispensable remedy in the treatment of many ailments. In the case of nephrosclerosis, it will also be very helpful. Take 100 g of natural honey and mix with the same amount of lemon juice, put in a water bath to warm up the product. Take the resulting remedy for 1 tbsp. l. 1 time per day before meals. The mixture must be stored in the refrigerator.

With nephrosclerosis, it is very useful to cleanse the body, but cleansing should be carried out not through the kidneys, but through the gastrointestinal tract. Rice and oatmeal porridge can help with this. The ingredients must be taken in equal parts, washed, and then boiled until thick, it is not recommended to add oil and salt to the porridge, it must be eaten without additives. To prepare porridge for a glass of cereal, you need 2.5-3 glasses of water.

Toxins can be removed from the body with the help of beets. You will need 3 tbsp. l. beetroot cake and 1 boiled beetroot, which must be grated and squeezed out of it juice. The juice should stand for a couple of hours, after which it can be drunk at night. As for the beet pulp, it is necessary to roll balls out of it and take one ball half an hour before a meal. You do not need to chew them, roll them in such a size that you can swallow them whole.

You can prepare the following very useful remedy: take 5 tbsp. l. flax seed, a spoonful of strawberry leaves, a couple of spoonfuls of nettle and birch leaves. Pour all this into 0.5 liters of water, boil for 10 minutes over low heat and take half a glass 3-4 times a day.

It is useful to drink birch sap, insist and drink lingonberry fruits, use an alcohol tincture of aspen buds, as well as an infusion of licorice root.

What are the predictions?

Kidney nephrosclerosis is a chronic disease, as a rule, this pathology has a long course and is characterized by periodic remissions and periods of exacerbation. Provided that the patient follows all the recommendations of the doctor, eats properly and takes all the necessary drugs, remissions can be extended, and the number of exacerbations can be reduced. In this case, we can talk about a favorable prognosis.

If the treatment of the disease is started in the later stages or the disease proceeds in a malignant form and progresses rapidly, then the functionality of paired organs will rapidly deteriorate, which will lead to kidney failure. In this case, the prognosis worsens, and sometimes the only way out is hemodialysis or transplantation of a donor organ.

Preventive measures

If you follow simple rules every day, then such a serious disease as kidney nephrosclerosis can be prevented. In order for the kidneys to work properly and be healthy, it is necessary:

1. Eat varied, without showing preference for salty, fatty and meat dishes, it is necessary to introduce vegetables, fruits, fresh herbs into the diet. Refuse products containing preservatives and various flavoring and aromatic additives.
2. Drink less than 2 liters of water per day. At the same time, it is necessary to drink water, coffee, tea, juices, various carbonated drinks do not count.
3. Eliminate bad habits from your life, especially for beer lovers.
4. It is very important to monitor your weight, but at the same time do not follow strict diets, just eat right and replace sugar and confectionery with fresh fruit.
5. Do not take analgesics, antibiotics, and drugs that have a diuretic effect without urgent need.
6. Try to protect your body from colds and viral infections, and if any arise, then treat them correctly and until complete recovery.
7. Regularly monitor the level of fat in the body and monitor blood pressure.

Fresh air, a healthy and active lifestyle, proper nutrition - these are the "three pillars" on which the prevention of many diseases is based, including the prevention of kidney nephrosclerosis.

Content

The replacement of the renal parenchyma with connective tissue against the background of increased pressure is called hypertensive nephrosclerosis. In medicine, the disease is also called a wrinkled kidney or its sclerosis. ICD-10 pathology code - I 12.

Why does kidney shrinkage occur?

With a prolonged increase in blood pressure (BP), vasospasm develops. They shrink and lose elasticity. As a result, the pressure rises even more, and the resistance to blood flow increases. Organs lose their normal blood supply, experience oxygen starvation.

As a result, areas of ischemia appear in paired organs, which leads to the replacement of parenchymal tissue with connective tissue. Secondary wrinkling of the kidney can also occur due to the following diseases:

• amyloidosis;
• diabetes;
• tuberculosis of the renal tissue;
• history of systemic lupus erythematosus;
• nephrolithiasis;
• glomerulonephritis;
• nephropathy of pregnant women;
• injuries;
• pyelonephritis.

Types of nephrosclerosis

Physicians divide nephrosclerosis into several types, starting from its cause and characteristic features. The main classifications of the disease:

Stages of the disease

Nephrosclerosis of the kidneys, regardless of the form, develops over several years. It is characterized by gradual development. The main stages of nephrosclerosis:

1. First. Vivid symptoms of hypertensive nephrosclerosis have not yet manifested. The disease can be identified by determining the filtration rate of creatinine or insulin, or by low levels of albumin.
2. Second. This is the pre-nephrotic stage. At this stage, microhematuria develops - a small number of red blood cells in the urine.
3. Third. Accompanied by high blood pressure and swelling.
4. Fourth. It begins a couple of years after the onset of proteinuria. Chronic renal failure develops.

Symptoms

Benign nephrosclerosis is characterized by more pronounced symptoms from the cardiovascular system, as 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 ability 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, increased pressure over 200/100 mm Hg. Art. other characteristic signs of a benign form of nephrosclerosis:

• headache;
• weakness;
• dyspnea;
• heart failure;
• muscle pain;
• decrease in working capacity;
• increased heartbeat;
• increase or decrease in the volume of daily urine;
• nocturia - increased urination at night;
• anuria - lack of urine;
• proteinuria - excretion of protein in the urine;
• Iron-deficiency anemia;
• swelling;
• high blood pressure;
• visual impairment;
• tendency to bleed;
• angina attacks;
• susceptibility to viral pathologies.

Malignant

In a malignant course, hemorrhages occur in the wall of the urinary tubules, which causes atrophy of the cells of their inner layer. It is characterized by the same symptoms as the benign form, but they develop much faster. The main signs of malignant nephrosclerosis:

• optic nerve atrophy or total blindness;
• weight loss;
• uremia;
• angina attacks;
• 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 studies is to detect changes in renal function at an early stage. The main diagnostic methods in this group are the following tests:

To study the vessels and structure of the organ, instrumental studies are assigned. The following methods help to confirm nephrosclerosis:

• excretory urography of the kidneys;
• angiography of the vessels of the kidneys;
• kidney scintigraphy;
• dopplerography;
• radiography;
• CT scan.

Symptoms of hypertensive nephrosclerosis can also occur with other diseases. Differential diagnosis is carried out with the following pathologies:

• chronic pyelonephritis;
• cystic kidneys;
• chronic nephritis;
• stagnant kidneys;
• kidney infarction.

Principles of treatment

The main goal is the treatment of the underlying disease, because without this, therapy will not bring the desired result. It is carried out in a hospital, especially with a malignant course. The tactics of treatment are influenced by emerging complications: nephrogenic arterial hypertension and chronic kidney failure. Treatment regimens at different stages of the disease:

Video

During a lifetime, every person at least once encounters diseases of the urinary system. For some, they pass almost without a trace, but people with a weakened immune system get complications in the form of wrinkling of the kidney, otherwise referred to as nephrosclerosis. If earlier it was thought that such a pathology occurs mainly in patients over sixty years old, now doctors say that the disease is increasingly manifested in children, adolescents and the working population. That is why it is so important to know what the early symptoms of pathology look like, as well as which doctor you need to contact for help.

Nephrosclerosis of the kidney: definition of the disease

Nephrosclerosis is a pathological process during which there is a violation of the structural and functional integrity of the human excretory system. Part of the kidney tissue, as a result of a lack of oxygen and nutrients, dies and is replaced by connective tissue, which cannot fully purify the blood. The affected organ shrinks and decreases in size.

During the pathological process, part of the renal substance dies and is replaced by connective tissue

Every year, about 30% of all patients with nephrosclerosis become disabled, and 7% die from developing acute or chronic kidney failure. At the same time, a little less than a third of all victims seek qualified help.

The kidneys are organs of the excretory system located in the retroperitoneal space. Their structural unit is the nephron - a collection of tubules in which urine is filtered and nutrients are reabsorbed. The kidneys also have small cups that form pelvises, from which the ureter then exits. Under normal conditions, about 180-200 liters of liquid are filtered through them daily. If the kidney tissue is damaged and some area does not perform its functions, this negatively affects the general condition of the body.

Primary and secondary nephrosclerosis

Currently, it is customary to classify the disease according to the causes of its occurrence. If the disease develops in a person who has not previously been diagnosed with any other kidney disease, such a pathology is considered primary. Common causes of its development are thrombosis, compression of the vessels that feed the renal substance, malignant and benign formations. In secondary nephrosclerosis, the defeat of the pyelocaliceal system occurs against the background of pre-existing chronic inflammatory pathologies (pyelonephritis, glomerulonephritis, pyelitis, amyloidosis, stone formation).

Single sided and double sided

If only one organ is involved in the pathological process, then this is accompanied by much less pronounced clinical symptoms, since the human body copes with the processes of filtration and reabsorption of fluid for a long time by increasing the functions of the second kidney. Depending on the localization, left-sided or right-sided nephrosclerosis is isolated.

With the development of nephrosclerosis, on the one hand, a healthy kidney takes over all the functions

If both organs are involved in the pathological process, this type of disease is called symmetrical or bilateral. At the same time, the kidneys cannot cope with the load, and all symptomatic manifestations appear already in the second fourth week. This type of nephrosclerosis is recognized as the most unfavorable for the patient.

Bilateral renal nephrosclerosis is characterized by a more malignant course

Atherosclerotic shriveling of the kidney

When cholesterol metabolism is disturbed, plaques containing a large amount of fats form in the wall of blood vessels. They slow down the normal flow of blood through the arteries and veins, causing the kidneys to experience a serious lack of oxygen. This leads to the gradual death of some cells and the replacement of existing nephrons with a connective tissue substance that cannot perform the function of filtration and reabsorption. Atherosclerosis is a consequence of alcohol abuse, smoking and malnutrition.

Atherosclerotic nephrosclerosis occurs predominantly in older people.

A persistent increase in blood pressure greater than 140/90 millimeters of mercury is called hypertension. At the same time, against the background of such an ailment, a vascular spasm develops in a person - the necessary amount of arterial blood does not enter the kidneys and they die. Most often, with hypertensive nephrosclerosis, two organs are involved in the pathological process at once, which makes it an extremely unfavorable form. And also to the defeat of the urinary system, the phenomena of heart failure are added: shortness of breath, asthma attacks, arrhythmias and chest pain, swelling of the lower extremities and face.

Hypertensive nephrosclerosis is formed against the background of a constant increase in blood pressure

Diabetic shriveling of the kidney

In patients suffering from chronically elevated blood glucose levels, toxic compounds of this metabolite with proteins and other substances are regularly formed. They damage the smallest arteries, veins and capillaries, making the vessels more fragile and less elastic. As a result, a huge number of small blood clots are formed, which impede the blood supply to the renal substance. Malnutrition of one organ leads to the fact that the second takes on a dual function and also quickly fails. It is known for certain that all patients suffering from diabetes mellitus experience this form of nephrosclerosis between the ages of 45 and 70.

Diabetic nephrosclerosis occurs in patients who suffer from high glucose levels for a long time.

Malignant nephrosclerosis

This variant of the pathology is one of the varieties of hypertensive wrinkling of the kidney. Its peculiarity lies in its extremely rapid and rapid development: such patients often suffer from crises - acute attacks of rising blood pressure up to 220/110 millimeters of mercury. In this case, the centralization of blood circulation and the gastrointestinal tract, the urinary and endocrine systems are practically deprived of oxygen and nutrients, since they are all used to maintain the activity of the heart and brain. Malignant nephrosclerosis develops in the first thirty minutes after the onset of a hypertensive crisis. To restore kidney function, the patient must be hospitalized in the intensive care unit and connected to hemodialysis.

Currently, to get out of emergency situations, an artificial blood purification system is often used. A hemodialysis machine consists of a series of filter membranes that allow all the fluid circulating in the body to pass through. This allows the removal of toxins and saves time for doctors and the patient.

Hemodialysis lasts at least 4-8 hours

The main clinical symptoms of the development of the disease

Almost all forms of nephrosclerosis, except malignant, are slowly progressive diseases. In the first few months (in a separate case - even years), the disease may not have any symptomatic manifestations. Patients feel mild fatigue, headaches, increased fatigue and reduced resistance to physical exertion. This condition is perceived by most patients as a typical reaction of the body to stress and nervous strain.

A compressive headache is often the first sign of kidney disease.

A few months later, these symptoms are accompanied by a steady increase in blood pressure, dizziness, nausea and vomiting without connection with meals. Patients complain of night sleep disturbances, frequent awakenings and nightmares. In parallel with this, symptoms such as urinary retention, swelling of soft tissues, discoloration of urine, the appearance of blood, sand and other pathological impurities in it develop. About 30% of all patients note an increase in the volume of urine excreted, while the other 70% complain of a decrease in this indicator. No less important manifestations are changes in the neuropsychic status: patients become inhibited, lethargic and depressive, do not respond to external stimuli. This is an extremely unfavorable prognostic sign, as it indicates damage to the nervous system and the development of poisoning of the body with the breakdown products of proteins, fats and amino acids.

With nephrosclerosis, edema is formed on the upper half of the body.

The author of the article happened to participate in the treatment of a patient with a malignant form of nephrosclerosis. The man was admitted to the intensive care unit due to an acute hypertensive crisis and a pressure of 200/100 millimeters of mercury. At the same time, he developed serious kidney damage: urine practically did not stand out from the bladder, as a result of which the patient suffered from serious intoxication. Due to the involvement of the nervous system in the pathological process and damage to the cerebral cortex, the patient fell into a long coma. After sessions of infusion therapy and several hemodialysis procedures, it was possible to bring him out of this state.

Methods for diagnosing a wrinkled kidney

The first methods with which the search for the disease begins are the examination and questioning of the victim. The patient needs to tell in as much detail as possible about the illnesses (pyelonephritis, glomerulonephritis, amyloidosis, tumors), as well as to mention the presence of operations in the pelvic area. During the examination, the doctor assesses the condition of the skin and soft tissues. If, with prolonged pressure on fatty tissue, a hole remains on it, this indicates the development of edema. Immediately after the conversation with the doctor, the patient is assigned additional instrumental and laboratory tests. They allow you to assess the state of the urinary system, as well as to identify the cause that could provoke the development of nephrosclerosis.

In his practice, the author of the article often encountered the fact that patients use containers and containers for food, paints and chemicals for testing. Even with the most thorough treatment with antiseptic agents, there is a possibility that some of the protein-fat deposits will not be removed. They can contribute to the appearance of foreign impurities in the urine test, which will not allow a correct conclusion to be made, and the diagnosis will be significantly delayed. That is why doctors strongly recommend purchasing special disposable vacuum-packed containers in a pharmacy or supermarket that are designed to collect urine.

What methods of laboratory and instrumental diagnostics are used for nephrosclerosis:

1. A general urinalysis allows you to evaluate the physical properties of urine. Normally, it has a light yellow hue, high transparency, and also does not contain foreign impurities. With nephrosclerosis, there is a pronounced turbidity, which is due to the presence of a large amount of protein, salt leukocytes. A change in the shade of urine to a darker one indicates the development of an inflammatory process in the body.

   The appearance of blood in the urine indicates the development of nephrosclerosis

2. Ultrasound diagnostics allows you to evaluate the structure of the pelvicalyceal system and determine the size of the kidney. With nephrosclerosis, the organ shrinks and becomes denser, and its structure changes. On ultrasound images, you can see the replacement of part of the functioning tissue with a connective substance, which causes such a deformation.

   An ultrasound image shows a decrease in the size of the organ

3. Magnetic resonance imaging is one of the most expensive and effective research methods. If it is impossible to see the presence of some stones, tumors and foreign bodies on ultrasound, then MRI does an excellent job with this task. Thanks to the creation of a three-dimensional image on the computer screen, the entire human genitourinary system is visualized, which makes it possible to determine the level of damage.

   The picture shows the presence of a foreign body in the left kidney, which causes nephrosclerosis

How is nephrosclerosis treated?

Shrinkage of the kidney is a rather serious disease that requires the immediate initiation of therapy. Without treatment, this pathology can lead to chronic urinary insufficiency in three to five years. All methods are divided into conservative (proper nutrition, the use of medications, folk remedies) and operational (surgical elimination of the problem of nephrosclerosis). Often the combination of these methods allows you to achieve optimal results in just a few weeks.

The most important principles of therapy for nephrosclerosis:

• restoration of normal outflow of urine;
• lowering blood pressure to normal values;
• reduction of inflammatory edema of soft tissues;
• replenishment of the body's need for proteins, fats and carbohydrates;
• stabilization of water and electrolyte balance and acid-base balance.

Table: drug therapy for nephrosclerosis

Photo gallery: drugs for the treatment of shriveled kidney

Furosemide is a diuretic that removes excess fluid from the body.
Nise is an anti-inflammatory drug that reduces swelling of the kidney tissue.
Trisol removes toxins from the body
Complivit restores the body's need for vitamins

Surgical elimination of pathology

With the development of malignant nephrosclerosis and the addition of a bacterial infection, doctors decide to perform an operation. This condition directly threatens not only the health, but also the life of the patient, as it can lead to death. Contraindications for surgical intervention are:

• general serious condition of the patient (coma, septic shock, myocardial infarction);
• allergic reaction to anesthetic drugs;
• terminal stage of HIV infection;
• age over 90 years.

The operation takes two to five hours.

After introducing the patient into an artificial sleep, the doctors proceed to the operation. Soft tissues in the lumbar region are sequentially cut: skin, fatty tissue, muscle fibers. Next, surgeons find and study the condition of the kidney: it looks much smaller than a healthy organ. A clamp is applied to the place of origin of the neurovascular bundle and ureter to avoid the development of massive blood loss. Then doctors remove a section of the damaged kidney or the entire organ. At the end of the operation, a drainage system is installed in the wound to drain the pathological contents, and the patient is transferred to the intensive care unit, where he is under the supervision of doctors for a long time.

Traditional medicine as an aid

Various decoctions and infusions are widely used for the treatment of kidney diseases at the present time. Along with medications, they help relieve the symptoms of nephrosclerosis and alleviate the general condition of the patient. However, one should not completely abandon the means of the pharmaceutical industry: only the medicines prescribed by the doctor will help eliminate the cause that provoked the development of the pathology.

Before you start taking any new infusion or decoction, you need to check for allergic reactions. To do this, be sure to drink a small amount of liquid. With the appearance of a rash, itching, burning, choking and coughing, immediately abandon this remedy.

1. Put one hundred grams of chokeberry in a saucepan with 500 milliliters of non-carbonated water. Cook over low heat for half an hour, stirring constantly. After cooling, drink half a glass before each meal. Chokeberry is a berry that has a hypotensive effect. Therefore, before starting its use, it is necessary to measure blood pressure. It is worth using this remedy only in the presence of persistent hypertension: an overdose can provoke collapse and a state of shock.
2. Pour 30 grams of lingonberry leaf, three tablespoons of chopped chamomile and mint into a thermos with a volume of at least two liters. Fill with boiling water and leave for a day. Throughout the next day, drink one glass every few hours. This mixture of herbs and plants helps remove excess fluid from the body and helps reduce inflammation. It is recommended to use this method no more than three times a week for a course of four months.
3. Boil two teaspoons of dried calendula flowers in a glass of boiling water, covered with a saucer. Once the liquid has cooled, drink it in small sips before any meal. Calendula has a pronounced antiseptic activity, and also reduces the likelihood of purulent-septic complications. The course of treatment consists of twenty procedures with an interval of several days.

Photo gallery: traditional medicine for the treatment of a shriveled kidney

Chokeberry lowers blood pressure
Chamomile relieves soft tissue inflammation
Calendula has an antiseptic effect

Video: treatment of kidney ailments with natural remedies

To restore the necessary balance of proteins, fats, carbohydrates and vitamin and mineral elements, patients with a wrinkled kidney are prescribed a special diet. It allows you to reduce the load on the cardiovascular and urinary system and contributes to the normalization of blood pressure. Basic principles of proper nutrition for patients with nephrosclerosis:

• reduction of salt volumes to 5 grams per day;
• the number of meals - at least 6 times a day (breakfast, lunch, dinner, snack);
• the ratio of proteins, fats and carbohydrates should be 1:1:4.

Doctors recommend adding more berries to the usual diet. The most useful are cherries, cranberries and lingonberries, as they have an antiseptic and mild diuretic effect, and also contain a large amount of vitamin C.

What foods are useful for people with nephrosclerosis:

• fresh vegetables and fruits (in the form of salads, mashed potatoes, cuts);
• milk, cheese, cottage cheese, yoghurts without additives, snowball, kefir, bifidok;
• lean meat (turkey, chicken, beef) and fish (pink salmon, hake, pollock, perch);
• cereals (buckwheat, oatmeal, rice, oatmeal, millet);
• hard pasta;
• nuts;
• legumes and peas (beans, chickpeas, lentils).

Photo gallery: healthy food

Fresh vegetables and fruits are the best source of vitamins
Curd contains a lot of calcium
Eating meat restores the need for protein

Predictions and possible complications of nephrosclerosis

Like any other pathology that damages internal organs, kidney shrinkage has a negative impact not only on the urinary system, but on the entire human body. With a timely start of a course of drug therapy, doctors manage to reduce the risk of developing pathological complications to a minimum. It is known that the success of recovery largely depends on factors such as the age of the patient, his behavior and attitude to treatment, the presence of chronic diseases (alimentary obesity, diabetes mellitus, hypertension, gout).

As you know, lifestyle also has a significant impact on the development of many complications of nephrosclerosis. In his practice, the author of the article treated one patient who had suffered from pyelonephritis for many years. She refused to follow a diet and take medications, which regularly led to a deterioration in her condition. A few days after the exacerbation of chronic pyelonephritis, the woman was hospitalized in the intensive care unit, where she was diagnosed with kidney failure against the background of nephrosclerosis. The affected organ had to be completely surgically removed, and the patient is now required to attend hemodialysis for life. And also she was assigned the second group of disability. The development of this situation could have been avoided if the patient had corrected her habits in a timely manner and regularly took the medications prescribed by the doctor. That is why doctors strongly recommend that you constantly go for examinations and not start chronic diseases.

What complications and unpleasant consequences can lead to nephrosclerosis:

• increased risk of developing malignant and benign neoplasms;
• the formation of stable arterial hypertension and periodic crises;
• the addition of bacterial microflora and the occurrence of an abscess, furuncle and phlegmon;
• violation of urine output and water-electrolyte balance, which is manifested by convulsions and arrhythmia;
• infectious-toxic shock and collaptoid states;
• cerebral edema;
• thrombosis and thromboembolism of large vascular trunks;
• urolithiasis disease;
• uremic coma and poisoning with decay products of substances.

Features of the manifestation, symptoms and treatment of the disease in children

The body of a child is very different from the body of an adult. Due to the insufficient development of adaptation mechanisms to environmental factors, babies are much more sensitive to the formation of inflammatory diseases of the genitourinary system. Even pyelonephritis transferred at an early age can cause nephrosclerosis. Children react much more sharply to pathological processes occurring in the body: they are characterized by an increase in body temperature up to 39 degrees, chills, sweating, loss of consciousness due to sudden pressure surges.

Based on my own experience, the author of the article can say that the most unpleasant prognostic sign is the presence of a convulsive syndrome. At the same time, the tone of the muscles of the body increases in the baby, it is spastically bent, and the limbs are deformed. Such a pathology indicates the development in the child of an excess content of potassium in the body. This chemical element is responsible for the contraction of the muscles of various organs, including regulating the activity of the heart. Its increased content can provoke arrhythmia, which is often observed in children with nephrosclerosis.

During an attack of seizures, the baby takes an unnatural position

All babies with suspected development of such a pathology are subject to mandatory hospitalization. Therapy in the department of nephrology is carried out according to the same principles as in adults, however, dosages and drugs are replaced with more gentle ones, it is permissible to use various decoctions and herbal infusions. After discharge from the hospital, the child must follow a diet, limit the intake of salt, sweets and fast food, as they slow down the metabolic processes in the human body.

The body of a baby has a much greater potential for regeneration than the body of an adult. That is why patients under the age of 18 who have been diagnosed with such a disease can almost completely recover with a well-chosen course of medical procedures.

What drugs are used to treat nephrosclerosis in children:

• antihypertensive agents: Veroshpiron, Labetalol, Verapamil, Diltiazem, Chlorpromazine;
• anti-inflammatory and antipyretic: Ibuklin, Ibuprofen, Nurofen, Paracetamol, MIG;
• diuretics: Spironolactone, Urakton, Phonurite, Diakarb, Hypothiazid.

Photo gallery: medicines for the treatment of a wrinkled kidney in children

Verapamil stabilizes blood pressure
Hypothiazide - a diuretic that removes excess fluid from the body
Ibuprofen is an NSAID that reduces inflammation

The manifestation of the disease and its treatment in the elderly

The occurrence of nephrosclerosis in people over 60 years of age is directly related to the development of chronic diseases such as atherosclerosis, hypertension and diabetes mellitus. At the same time, kidney shrinkage develops gradually, remaining almost invisible against the background of other health problems. People who have been suffering from nephrosclerosis for a long time may not even be aware of it. Patients over 60 often complain of nocturnal awakenings due to constant urge to go to the toilet, prolonged headaches and discoloration of urine, but do not associate this with possible kidney damage. Body temperature rarely rises to 27 degrees, but older people often suffer from drops in blood pressure (more than 60 millimeters of mercury during the day).

Quite often, nephrosclerotic kidney damage is detected in patients during a planned general urine test or during an ultrasound examination.

In the treatment of wrinkling of urine in persons over 60 years of age, there are certain aspects that must be taken into account when prescribing and selecting medications. First of all, it is imperative to find out what drugs the patient is currently taking, and whether it is possible to allow their combination with each other. In addition to the main therapy, the following groups of drugs are prescribed:

1. Anticoagulants prevent the formation of blood clots and thickening of the blood, which is often found in older patients. The most famous drugs are: Heparin, Fraxiparin, Clexane, Enoxaparin sodium, Lepirudin, Refludan, Neodicumarin, Sinkumar.
2. Antiplatelet agents also normalize blood flow and reduce the likelihood of emboli formation. These include: Aspirin, Thrombo ACC, Dazoxyben, Ridogrel, Prostacycline, Dipyridamole, Curantil, Anturan, Persanthin, Ticlid, Plavix.
3. Phytotherapy: preparations based on various plants and herbs are less aggressive, but highly effective. They help relieve spasm and inflammation from the soft tissue area, and also stimulate urine output and reduce swelling. The most famous are: Cyston, Kanefron-N, Fitolizin, Afala, Urolesan, Flavia, Trinephron.

Photo gallery: drugs for the treatment of nephrosclerosis in the elderly

Clexane is an anticoagulant drug that thins the blood.
Clopidogrel reduces the likelihood of a blood clot
Cyston - a herbal preparation that helps to normalize urination

Nephrosclerosis belongs to the group of extremely dangerous pathologies, untimely diagnosis and treatment of which can lead to the development of many unpleasant complications. That is why all doctors strongly recommend not to engage in therapy at home, but to immediately seek medical help. This can avoid the negative consequences of nephrosclerosis. And also special attention should be paid to the prevention of diseases of the urinary tract: pyelonephritis, glomerulonephritis and pyelitis are among the most common causes of the disease. Regular check-ups with the doctor and taking the necessary urine and blood tests will help to avoid these infections.

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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 the result of various diseases of the kidneys or renal arteries and veins, as a result of which the normal blood supply to the organ is disturbed.

With the progression of the disease, due to a significant proliferation of connective tissue in the affected kidney, there is a dysfunction, characteristic structural and morphological changes. The kidneys decrease in size, become dense and wrinkled. Mostly 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 what mechanism underlies the onset of the disease, primary and secondary kidney nephrosclerosis is distinguished. As a result of certain pathological processes, the lack 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 outflow of blood.

Hypertensive nephrosclerosis develops due to impaired blood supply caused by spasm and narrowing of the lumen of the vessels. There are two types of this disease:

• arteriolosclerotic (benign) nephrosclerosis, characterized by the growth of connective tissue in the inner walls of the renal arteries, which leads to a decrease in their elasticity and causes atrophic changes in 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.

With 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, thickening of their walls and a decrease in elasticity, resulting in a decrease in blood flow and ischemia of organs and tissues that receive nutrition through these arteries. Most often, atherosclerotic plaques are localized in the places where the renal artery enters the organ or in the area of ​​its branches inside the kidney.

With atherosclerotic nephrosclerosis, the kidney acquires a large-tuberous 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 of calcium salts on their inner walls, proliferation of connective tissue, accumulation of smooth muscle cells. These processes lead to thinning of the cortical layer of the kidney 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%.

With difficulty in the venous outflow of blood in the kidneys, congestion occurs that worsens 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 kidney diseases of an inflammatory or dystrophic nature. Among them:

• glomerulonephritis;
• pyelonephritis;
• nephrolithiasis;
• kidney tuberculosis;
• syphilis;
• rheumatism;
• systemic lupus erythematosus;
• hyperparathyroidism;
• diabetic nephropathy;
• interstitial nephritis;
• amyloidosis of the kidneys;
• trauma and surgery on the kidneys;
• exposure;
• nephropathy in pregnancy.

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, reflecting kidney function. In the analysis of urine, the following deviations are observed:

• increase in daily diuresis;
• excretion of most of the urine at night;
• the appearance of large amounts of protein;
• detection of erythrocytes;
• reduction in specific gravity.

In a biochemical and general blood test, it is noted:

• increased levels of toxic products of protein metabolism;
• decrease in total protein;
• deviation from the norm of the concentration of potassium, magnesium, phosphorus, sodium;
• lowering the level of hemoglobin and platelets;
• increase in the concentration of leukocytes.

Patients with progressive kidney nephrosclerosis have:

• high blood pressure, not reduced by drugs usually taken for hypertension;
• weakness, headaches;
• puffiness;
• angina attacks;
• heart failure and cardiac arrhythmias;
• anemia;
• blue skin of the extremities;
• blurred vision, retinal detachment, inflammation of the optic nerve.

Recommendation: If you notice the above symptoms, you should seek help from a medical facility. The sooner an accurate diagnosis is established and treatment is started, the more likely it is to prevent the development of serious consequences.

Of the instrumental diagnostic methods for suspected kidney nephrosclerosis, the following are used:

• ultrasound procedure;
• radionuclide renography;
• excretory urography;
• computed tomography;
• angiography of the renal vessels;
• scintigraphy;
• Doppler study of the vessels of the kidney.

Ultrasound of the kidneys reveals a change in the size of the organ, the thickness of the renal parenchyma, the degree of atrophy of the cortex

Treatment Methods

In kidney nephrosclerosis, treatment depends on the severity of the disease and the symptoms observed. The sooner it is started, the more likely it is to reduce the risk of onset or delay the development of CRF. The main task in the treatment of nephrosclerosis is to eliminate or control the underlying disease that provoked pathological changes in the kidney parenchyma. Otherwise, the applied methods of therapy for nephrosclerosis will be ineffective.

Medical treatment

Medicines are effective in the early stages of the disease. They are taken in a complex and long-term certain courses with short breaks. Depending on the clinical manifestations 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 caution, as they can provoke an increase in azotemia and worsen renal blood flow.

Surgical treatment

Operative methods of treatment are used in the rapid course of the disease, progressive renal failure or malignant hypertensive nephrosclerosis. These include:

• embolization of the renal arteries;
• nephrectomy;
• donor kidney transplant.

Features of nutrition in 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 an 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 liquid. In addition, it is not recommended to eat foods rich in potassium (bananas, dates, prunes, etc.). Nutrition should be fractional, divided into 5-6 meals.

When compiling a diet, the stage of nephrosclerosis is necessarily taken into account. In the absence of signs of CKD, restriction of protein intake is minimal. Lean meats, 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 no edema, the amount of salt entering the body is not reduced. Fluid restriction is necessary in the later stages of nephrosclerosis.