Monday, February 6, 2012

Renal amyloidosis

Kidney amyloidosis is a chronic disease characterized by accumulation of abnormal proteins - amyloid kidney.


Etiology
Renal amyloidosis occurs secondary to the disease such as tuberculosis, chronic suppuration, tumors and rheumatoid arthritis.

The clinical picture
Amyloidosis primary surgery glomeruli, a major clinical findings were proteinuria (protein in urine findings). In the beginning was to moderate and intermittent proteinuria, but becomes more pronounced over time, developed nephrotic syndrome and renal failure. Amyloid is deposited first in the mesangium, and in the tubules leading to renal tubular acidosis.

Diagnosis
It is based on renal biopsy and histopathological examination of the sample obtained, or evidence of amyloid in submucosal lining of the rectum.

Treatment
Treatment of the underlying disease can lead to partial regression of renal changes.Treating the nephrotic syndrome. Dimethylsulfoxide is used in amyloidosis caused by rheumatoid arthritis - leading to the recovery of renal function. The terminal uremia apply to dialysis and kidney transplantation.

Nephrotic syndrome

Nephrotic syndrome (Syndrome nephroticum) is a clinical condition characterized by heavy proteinuria (protein in urine), hypoproteinemia (decreased levels of protein in the blood) with hypoalbuminemia, hyperlipidemia (elevated fats in the blood) and edema (the islands).



The cause of
Nephrotic syndrome can develop in a variety of immune, toxic, metabolic or vascular disorders, in which the damage occurs primarily as increased permeability of glomerular capillary wall. According to the causal disease nephrotic syndrome is usually divided into primary nephrotic syndrome, occurring in primary glomerular disease, and secondary nephrotic syndrome, which develops over a number of other diseases (systemic diseases-systemic lupus erythematosus, polyarteritis, rheumatoid arthritis, dermatomyositis, sarcoidosis, hereditary and Metabolic Diseases - alportov syndrome, diabetes, amyloidosis, cancer, infection, allergens, toxins, and immunization, hemijsak compounds and drugs, circulatory disorders, etc.).


The clinical picture
The clinical picture intertwined are the symptoms and signs of underlying disease and nephrotic syndrome. The most characteristic sign are pale, doughy edema about the ankles, face and fingers, sometimes very severe, so as to give a picture anasarke (generalized edema) with effusions in body cavities. The appearance of other signs of kidney disease (hypertension - high blood pressure, hematuria - blood in urine, azotemia - nitrogen components in the blood) and their expression depends on the nature glomerulskog damage.


Nephrotic syndrome can follow a number of complications. These patients are very prone to infections, then often suffer from atherosclerosis and coronary heart disease due to long-term hyperlipidemia. As there are complications and thrombosis, acute renal insuficijencja, endocrine and metabolic disorders and inadequate diet with abundant proteinuria can lead to malnutrition. The skin is dry, thin, brittle nails, with white cross races, the hair is dry, colorless, often present and anemia.

Diagnosis
It is based on clinical picture, laboratory tests (urine and blood test)


Treatment
Treatment depends on the causal disease. Patients can propose appropriate hygiene - dietary regimen, along with symptomatic therapy, and treatment of complications. It is advisable to rest, a normal protein intake and restricted salt intake. The combination of diuretics are used to increase urine output and reduce edema.

Endemic Nephropathy

Endemic nephropathy is a family tubulointersitial chronic nephropathy, which occurs in hot spots, endemic, along the river Kolubara, Drina, Sava and Morava. It occurs in areas of South East Europe, and focus have been confirmed in Serbia, Bosnia and Herzegovina, Croatia, Romania and Bulgaria. The disease is clinically manifested in an adult rural population, typically between 30 and 50 years of age, with a slight predominance of females.
The cause of
Etiology of endemic nephropathy is unknown. The possible causes of stress are some elements that are found in traces (lead, cadmium, silicon), live agents (bacteria and viruses), fungal and plant toxins, genetic factors and immune mechanisms.

The clinical picture
Acute phase of illness does not exist. The disease is inconsiderable, relatively asymptomatic and very well tolerated, sometimes even decades. Weakness occurs only at the stage of renal failure, when the anemia is severe and when there is retention of nitrogenous products in blood. Patients complain of vague gastric discomfort. High blood pressure is encountered in about 30 - 40% of patients in advanced stages and in older patients. There is edema of renal origin.

The disease progresses to kidney failure and end-stage renal disease.

Diagnosis
It is based on medical history, epidemiological data, clinical presentation, objective examination, laboratory tests, ultrasound, intravenous urography, renal biopsy.

Treatment
For patients with nephropathy endemdske, whose etiology and pathogenesis are not yet known, consists mainly in higijenskodijetetski regime. Marked renal insufficiency requires hipoproteinski diet, correction of anemia, antihypertensives with existing hypertension in end-stage and active treatment (dialysis and transplantation).

Prevention
Comes down to taking general hygiene measures in terms of lifestyle, diet and drinking water supply from areas not affected.

Kidney failure

Irreversibly damage the majority of nephrons causes a chronic inability to remove waste products via the kidney. The causes are numerous pathological conditions, and damage to the kidneys and urinary tract.


INTRODUCTION

The kidneys are organs of excretion in the urinary system, located in the upper abdominal cavity. The shape is similar to kidney beans beans. The kidneys receive blood from the renal artery, which comes from the aorta. The body at rest, the kidneys receive about 1.2 liters of blood per minute. Kidney function is to maintain the volume of organic liquid, and this objective is achieved by removing, through the urine.

ACUTE RENAL FAILURE

It is a condition characterized by reduced excretion of urine with a consequent change in the volume and composition of organic liquids. There are prerenal, renal and post-renal causes.


Prerenal acute renal failure resulting from a reduced amount of blood that occurs in the kidney. Common causes of this are: bleeding, vomiting, dehydration, burns, shock or cardiac failure.

The most common causes of renal failure, acute renal failure are all diseases, mostly: tubular necrosis, acute glomerulonephritis, renal infarction and cortical necrosis.Sometimes it can also cause severe kidney infection.

Post-renal acute renal failure caused by a variety of reasons that cause urinary tract obstruction with anuria. The most common reasons are: kidney stones, tumor compression, prostate enlargement and stenosis.

In the beginning of the disease the patient has no symptoms that would indicate acute renal failure. At this stage occurs only to a reduced excretion of urine. After that the patient appears malaise, fatigue, and aversion to food. Symptoms are worse if you do not intervene in time. The patient loses concentration and becomes very nervous. In more advanced stages, people fall into a state of stupor, which is occasionally punctuated by episodes of delirium or convulsions. Breathing is very profound, intermittent periods of complete cessation of breathing, the tongue is dry, the muscles tremble involuntarily.Almost regularly, after a few days of the occurrence of anuria, there is bleeding or infection. If it starts at the time of treatment, survival is 5-10 days from the occurrence of renal failure.

CONSEQUENCES

One consequence of the disturbed water balance. Entered the water is eliminated through sweat, intestine and kidney. When there is an inability of elimination of water via the kidneys, then a hiperhidracije. Due to water intoxication leads to digestive, respiratory and heart problems and nervous symptoms.
When an imbalance of electrolytes leads to lasting consequences. Electrical conductivity of the electrolyte solution is higher than the conductivity of the water. Electrolytes play an important function in the body because elektroneutralnost maintain internal solution, water movement etc..
During anuria often comes to a lack of or increase in the concentration of potassium, calcium, sodium and phosphorus in the body which can cause serious heart problems.
The kidney is the organ that regulates the acid-base balance. Metabolic acidosis is a common complication of renal insufficiency. Metabolic acidosis causes cerebral and digestive disorders. Because renal failure leads to the retention of nitrogen compounds.Another important and often poljedica renal insufficiency is anemia. Finally there is another consequence, which is a disorder of coagulation.

THERAPY

In acute renal failure is the most important primary treatment of pathological situations.In acute tubular necrosis, it is important to maintain normal levels of organic liquids, the concentration of substances contained in them. The patient must be stationary, isolated, in bed, to prevent the possible infection. Giving fluids must be offset losses of organic liquids.

Meals must meet energy needs, but also must limit the intake of protein. Particular attention should be paid to the potassium. When the patient overcome the stage of oliguria, food and fluid intake should gradually return to normal. Protein intake should be restricted until the normalized concentrations of urea and creatinine levels. In most patients, measures of child and providing a controlled fluid and electrolytes are not enough. For this reason most often resort to dialysis, which prevents the occurrence of complications.

CHRONIC RENAL FAILURE

Chronic renal failure is the final stage of kidney disease. Irreversibly damage the majority of nephrons causes a chronic inability to remove waste products via the kidney. The causes are numerous pathological conditions, and damage to the kidneys and urinary tract. To chronic renal insuficiijencije often lead: glomerulonephritis, mercury poisoning, kidney infections, congenital anomalies of the kidney, and so on. Among the first signs of renal failure are polydipsia and polyuria. Due to the inability of the remaining nephrons to concentrate the urine leads to an imbalance of electrolytes.

Start of chronic renal failure is unnoticeable. On the third of a functional kidney tissue is processed in the normal amount of a substance. In this way the patient feels no symptoms. Only laboratory tests can show a reduction in glomerular filtration rate and a defective ability to concentrate. The quantity of urine is growing, and the patient has to urinate more often. As a progressive disease progresses, there is a phase in uremic kojo comes to a series of changes hematokemijskih. It emphasizes the increase in urea, creatinine and uric acid, and often leads to anemia. The protein, calcium and sodium are often decreased, while potassium and phosphorus increased. Picture of electrolytes is disturbed. Because anemia patient feels a strong general weakness, and easily fatigued.The patient was pale and feeling sick, poor appetite, and persistent hiccups. Often the patient depressed, anxious or iritabilan. Most of these symptoms disappear when the patient begins treatment with dialysis.
Often in advanced stages of uremia leads to pericarditis. It is an inflammatory reaction of both papers pericardium. It manifests as pain behind the breastbone and a general feeling of weakness.

THERAPY

The main goal of therapy is to preserve the functional integrity of the remaining nephrons. As long as the laboratory findings and the patient's condition does not indicate the risk of uremia, there is no reason for the significant limitation of protein intake. The patient can be taken from 0.50 to 0.75 g of high quality protein (meat, eggs). During dialysis can lead to loss of protein, and these losses must be replaced. The diet should be introduced more vitamins and folic acid. The patient should not be limited or salt intake.Drastically reducing salt intake can cause deterioration of the electrolyte imbalance.

The amount of sodium in the diet is determined by the metered quantity of sodium ejected by the patient for 24 hours. A useful indicator of the daily control of body weight.If the patient's weight increases, meaning that the body retains water, and that there is an excess of sodium in the body.  If there is visible already compromised bone tissue, the patient is given, and vitamin D. For maintenance of renal function is the most important quantity of water that enters the patient in the course of 24 hours.

Hemodialysis is a treatment that must be done regularly and consistently, and it can keep patients alive for several years, or until a possibility of kidney transplantation. In most cases (70-80%) in a patient comes to the acceptance of transplanted kidneys. Then the patient can quickly return to normal life activities.

Chronic glomerulonephritis

Glomerulonephritis is inflammation of the kidney where the glomeruli are affected, and the possible development of renal failure. The most common causes of glomerulonephritis include: bacteria, viruses and fungi.


STATEMENT

Glomerulonephritis is inflammation of the kidney where the glomeruli are affected, and the possible development of renal failure. The most common pathogens responsible for the development of glomerulonephritis include: bacteria, viruses and fungi.
Acute glomerulonephritis usually occurs after infection of throat or skin beta-hemolytic streptococcus. But the infection can be due to other bacteria or viruses. However, in many cases where it is not preceded by acute glomerulonephritis, the cause is unknown.

Chronic glomerulonephritis can sometimes occur after an acute glomerulonephritis. In most patients the initial symptoms are: swelling of the ankles, reddish color of urine, polyuria, headache and dizziness.

DIAGNOSIS

The simplest analysis that may lead to suspicion of glomerulonephritis is the analysis of urine. If the proteins present in the urine, it is a sign of glomerular damage. Proteinuria can be a sign of lumbar lordosis, renal or lowered orthostatic proteinuria, and proteinuria are the other important findings, which may be obtained from the urine sediment.Analysis of sediment can show a number of erythrocytes. Determination of plasma in one minute, filtered through the glomeruli (in normal conditions is 120 ml / min) is another important test. Testing known even for a layman to determine urea. Increase in urea is often a sign of kidney failure.

A kidney biopsy is done when clinical symptoms and laboratory findings indicate the suspicion of chronic glomerulonephritis. Biopsy to differentiate types of changes in nephropathy. It determines the development of different diseases and creates the possibility of distinguishing primary from secondary glomerulonephritis, which has important therapeutic implications.
Basic Histological are focal glomerulosclerosis, membranous glomerulonephritis, a membrane-ploriferativni glomerulonephritis and focal proliferative glomerulonephritis.

THERAPY

It is important to reduce the patient's physical activity and do not expose it to unnecessary effort, but not absolutely necessary to rest, because it favors catabolism.The patient should be able to protect against influenza infection or cold. The patient should get exactly as much liquid and loses and has to be accurately measured.
When taking food to watch out for the energy needs, but should reduce the intake of salt and protein. The therapy using corticosteroids with symptomatic therapy. If there is a stronger deterioration, the patient has to go on dialysis.