Chronic glomerulonephritis with outcome in nephrosclerosis. Kidney nephrosclerosis: causes, forms, treatment

Main symptoms:

Nephrosclerosis is a kidney pathology, which is characterized by the gradual death of nephrons - the cells responsible for the functioning of the organ, and is replaced by growing tissue that is not responsible for the functioning of the kidney. The disease is characterized by the fact that the kidneys become denser, shrink, and accordingly lose their normal volumes and efficiency, as a result of which renal failure begins to progress.

The disease does not appear on its own, but occurs against the background of other chronic or infectious processes in the human body, which are characterized by severe progression. This disease is diagnosed in 600 people out of a million, 20% of whom live on hemodialysis, and 22% of the total number of patients die annually.

This disorder has many different forms and several types of causes, but for any of them, for diagnosis it is necessary to take a urine test and undergo an ultrasound examination. The main method of treatment is to maintain the functioning of the kidney with hemodialysis or transplant a healthy organ.

Etiology

As mentioned earlier, the causes of nephrosclerosis are varied. Thus, the primary factors for the onset of the disease include:

• disturbance of blood supply;
• the formation of blood clots that block the flow of blood to the entire kidney or to certain areas of it, which can cause;
• – in which the lumen of the arteries narrows through the formation and deposition of fats on them;
• patient's age;
• decreased elasticity of renal vessels.

Secondary causes of nephrosclerosis are:

• hormonal changes associated with pregnancy lead to a constant increase in blood pressure and the removal of protein from the body through urine, which is the cause of the death of nephrons;
• the chronic type increases the likelihood of blood clots;
• . An inflammatory disease that progresses due to the entry of viruses or bacteria into the bloodstream or the return of urine from the bladder;
• education ;
• pressure on the ureter;
• – the body destroys its own cells;
• the appearance of amyloid protein in the kidneys;
• numerous injuries to this organ;
• consequences of surgery;
• the effect of radiation on the body.

Varieties

Depending on the causes of occurrence, nephrosclerosis can be:

• primary nephrosclerosis– caused by disturbances within the body;
• secondary nephrosclerosis– appeared from the influence of any factors;
• hypertensive nephrosclerosis– appears against a background of high blood pressure and insufficient blood flow through narrow arteries. This type is divided into several forms - benign, it is possible to stop the progression of the disease, often manifests itself without symptoms, kidney failure develops more slowly, and malignant - death of the kidneys occurs much faster. Also called arteriolosclerotic nephrosclerosis;
• atherosclerotic nephrosclerosis– unlike other types, it spreads unilaterally;
• diabetic nephrosclerosis affects the entire organ and occurs in several stages. The first is characterized by a course without manifestation of symptoms, with the second it increases slightly arterial pressure, on the third, in addition to high pressure, severe swelling appears, and the fourth is characterized by swelling, which makes itself felt several years after detection of protein in the urine.

Symptoms

Since this kidney disorder is characterized by the death of nephrons, the more of them that die, the more pronounced the symptoms will be. At an early stage, nephrosclerosis does not show any signs, but the more the development of the disease worsens, the more severe the following symptoms will appear:

• increase in the volume of urine emitted per day. For healthy person this figure is a liter or one and a half liters of urine, and in patients with nephrosclerosis, the volume increases to two liters of fluid excreted per day;
• frequent urge to urinate at night than during the day;
• a decrease in the volume of urine excreted is observed when 70 percent or more of nephrons die;
• a complete absence of the urge to urinate occurs with 90% of the death of nephrons;
• urine is excreted mixed with blood;
• decreased iron levels in the blood – originates from 65% cell death;
• detection of urine in the blood - occurs when almost all nephrons die;
• the appearance of swelling that spreads from the face and further down throughout the body;
• the increase in the patient’s body weight is caused by increasing edema;
• persistent high blood pressure;
• impaired visual acuity, a feeling of blurred vision;
• pain in the chest and heart;
• bleeding of the nose and gums, subcutaneous hemorrhages form even with the slightest bruise;
• severe and prolonged headaches that develop into;
• a person's predisposition to frequent fractures. The kidneys stop converting vitamin D, as a result of which calcium is not absorbed in the intestines. A person can break a bone even if he falls from his own height;
• decreased immunity, which makes a person susceptible to frequent infectious and viral illnesses.

If you seek help in the early stages of symptoms, treatment will be much easier than if you do not seek help from specialists in a timely manner.

Diagnostics

The main task of diagnosis is to identify nephrosclerosis in the early stages of symptoms. Diagnostic measures presented in the form of the following complex:

• collection complete information about the course of the disease - from the first time symptoms are identified, complaints about the patient’s discomfort, to the identification of possible causes of the disease;
• study of blood tests in laboratory conditions - which will reveal a high level of urea, uric acid, phosphorus, potassium, magnesium and creatinine, decreased protein concentration. Sodium is elevated, but it is possible for a person to independently reduce it by limiting the addition of salt to food. Level and – reduced;
• a urine analysis study - which will show an increased protein content, the appearance of red blood cells, and a decrease in urine density;
• radiography with the introduction of a contrast agent;
• scintigraphy;
• biopsy - during which a small piece of an organ is taken for subsequent microscopic examination.

After receiving complete information about the course of the disease and test results, the doctor determines the severity of the pathology (directly depends on the signs of the disease) and prescribes the most effective treatment.

Treatment

In the initial stages of nephrosclerosis, as well as moderate symptoms, treatment of the disease consists of:

• improving blood flow in the kidneys. This method of therapy is indicated only in the initial stages, as it later causes severe bleeding;
• lowering blood pressure;
• eliminating imbalanced salts;
• enriching the body with vitamins through appropriate injections;
• an increase in hemoglobin and red blood cells in the blood;
• eliminating the retention of proteins and toxins in the body.

In case of a more complex course of the disease, when the functioning of the kidney cannot be restored, other treatment methods are provided, consisting of:

• hemodialysis – when a person’s blood is purified through a special device, the so-called artificial kidney. This process occurs as follows: blood enters the device from one vein, undergoes purification there and enters the body through a tube on the other arm. This treatment method is combined with taking medications;
• implantation of a healthy organ from a donor, closest relative or corpse.

After normal kidney function is restored, the patient must adhere to a special diet, which includes avoiding the consumption of foods high in protein and limiting the use of table salt for culinary purposes. Nutrition should be balanced and enriched with vitamins. There should be several meals, preferably five, but in small portions. In addition, it is necessary to adhere to the drinking regime - if there is no edema, drink at least two liters of water per day, and if there is edema, reduce it and drink less than a liter of liquid per day.

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This pathological condition caused by the death of nephrons, their replacement connective tissue with increasing renal failure. Manifested by polyuria, nocturia, hypertension, swelling, discomfort in the lower back, later stages- oliguria, hematuria, intoxication. Diagnosed using laboratory tests, Ultrasound, CT, MSCT of the kidneys, nephroscintigraphy, angiography of the renal vessels, urography, biopsy. For treatment, etiopathogenetic therapy of the underlying disease, anticoagulants, antiplatelet agents, antianemic, detoxification, vitamin and mineral agents, replacement therapy, and kidney allotransplantation are used.

General information

Nephrosclerosis is a secondary clinical and anatomical condition, manifested by compaction, wrinkling of the kidneys and a decrease in their functional capacity due to the replacement of parenchyma with fibers and interstitial substance of connective tissue. The shriveled kidney was first described in 1914 by the German clinician F. Volhard and pathologist K.T. Farom.

Typically, nephrosclerosis complicates the course of urological and other somatic pathologies. In the twentieth century, its leading cause was considered to be glomerulonephritis, currently - arterial hypertension and diabetes mellitus (more than 60% of all diagnosed cases). Prevalence of nephrosclerosis in European countries is 0.06%. At the same time, 10-20% of patients require regular hemodialysis, and mortality from chronic renal failure reaches 22%.

Causes of nephrosclerosis

Kidney shrinkage is a polyetiological process that complicates various vascular disorders And urological diseases. Depending on the type of nephrosclerosis, specialists in the field of urology and nephrology distinguish two groups of causes causing primary or secondary replacement renal parenchyma fibrous structural elements of connective tissue. A primarily wrinkled kidney is formed against the background of damage to the renal vessels caused by diseases such as:

• Arterial hypertension. In patients with essential hypertension and symptomatic hypertensive conditions, the renal vessels persistently spasm and narrow, and the nutrition of the parenchyma is disrupted. Connective tissue compaction of the vascular wall or death of arterioles and glomerular capillaries ends, respectively, with the formation of slowly progressive arteriosclerotic nephrosclerosis or malignant arteriolenecrotic glomerulosclerosis of Farah.
• Atherosclerosis of the renal arteries. Deposit on the inner lining atherosclerotic plaques makes the vascular wall less elastic, narrows the lumen of the vessels feeding the renal parenchyma. A decrease in tissue perfusion provokes the destruction of nephrons and tissue hypoxia, which promotes excessive formation of connective tissue. As a result, as a result of atherosclerosis, the cortical substance becomes thinner, the cells of the urinary tubules atrophy, which reduces the functional capacity of the kidney.
• Chronic venous congestion. Against the background of stagnation caused by nephroptosis, narrowing or chronic thrombosis of the renal veins, parenchymal vessels dilate paretically, the flow of oxygenated arterial blood decreases, and ischemia increases in the tissues. The situation is aggravated by compaction of the vascular walls, which further disrupts tissue metabolism. Under hypoxic conditions, partial cell death occurs, and nephrosclerosis occurs within 10-15 years.

In some patients, angiogenic renal destruction occurs acutely with partial or complete thromboembolism of the renal artery. A sharp disruption of blood circulation causes a kidney infarction - massive death of nephrons as a result of acute ischemia. Subsequently, the necrotic area is gradually replaced by connective tissue, and nephrosclerosis develops.

A secondarily wrinkled kidney is spoken of in cases where the patient initially suffers urological disease, in which the renal parenchyma is destroyed under the influence of infectious agents, autoimmune complexes, mechanical factors (stretching, trauma by stones), etc. The main causes of secondary (nephrogenic) nephrosclerosis are:

• Kidney diseases. Hardening of the parenchyma can result in pyelonephritis, renal tuberculosis, glomerulonephritis, urolithiasis, polycystic disease. A separate group of causes of nephrosclerosis consists of secondary nephropathies, which complicate the course of other pathological processes - diabetes mellitus, systemic lupus erythematosus, malignant neoplasia, preeclampsia.
• Diseases of the lower urinary tract. Nephrosclerosis can develop against the background of hydronephrosis, caused by obstructive stagnation of urine during sclerosis of the bladder neck, the formation of uretero-vaginal fistulas, and compression by pelvic tumors. Atrophic processes are observed in 30-60% of patients suffering from vesicoureteral reflux.

Pathogenesis

Despite the variety of causes that cause nephrosclerosis, the mechanism of development of the disease as a whole is common. Initially, under the influence of various damaging factors (hypoxia, inflammatory and dystrophic processes caused by pathogenic factors of microorganisms, autoimmune complexes, direct traumatic effects, etc.), destruction of the glomerular and tubular epithelium occurs with the exclusion of some nephrons from the general blood supply.

Since kidney cells are not capable of regeneration, after phagocytosis of destroyed cellular elements, nephrosclerosis begins - the damaged area is replaced by connective fibers, and the kidneys themselves become denser. In the remaining glomeruli, blood circulation and filtration increase, resulting in an increase in the volume of urine excreted and a decrease in its relative density. Against the background of blood flow disturbances, the synthesis of renin, which regulates glomerular filtration, increases, which contributes to the occurrence or worsening of arterial hypertension.

Due to the high compensatory capabilities of the renal tissue, clinical signs of renal failure appear only with severe nephrosclerosis with the loss of 70% of the nephrons of both kidneys or 85% of one. If 5% of cells or less are retained, functional failure of the organ occurs, requiring replacement therapy.

Symptoms of nephrosclerosis

The clinical picture of the disease at an early stage is characterized by an increase in the amount of daily urine (more than 2 l), increased frequency of urination at night (more than 3 times per night), constant nagging pain in the lumbar region, increased blood pressure. As nephrosclerosis progresses, swelling appears: first on the face, then it spreads evenly throughout the body. Swelling is most pronounced in the morning.

At a later stage, the symptoms worsen: the volume of daily urine decreases to 0.5–0.8 l, blood may appear in the urine, the patient is bothered by dry mouth, constant thirst. Arise and grow general symptoms intoxication: headache, nausea and vomiting, weakness, muscle pain.

Complications

Serious disturbances in the processes of filtration and reabsorption, which occur with the destruction of more than 70-75% of the initial number of nephrons, lead to the formation of chronic renal failure. Because the shriveled kidney stops producing erythropoietin, which is necessary for the maturation of red blood cells in the bone marrow, iron deficiency anemia often develops. Patients with nephrosclerosis have an increased risk of nephrogenic arterial hypertension due to excess renin production. When vitamin D metabolism is disrupted, osteoporosis occurs with increased bone fragility and a tendency to form pathological fractures.

Diagnostics

Patients with suspected nephrosclerosis are prescribed a comprehensive examination to determine the features of the morphological structure of the kidneys, identify signs of parenchymal atrophy, and assess the functional viability of the organ. The most informative laboratory and instrumental methods for diagnosing a wrinkled kidney are:

• General urine analysis. For nephrosclerosis, a significant decrease in the relative density of urine (up to 1.005-1.015 g/l) is indicative. With increasing signs of chronic renal failure, erythrocyturia (up to 2-3 red blood cells in the field of view), cylindruria, proteinuria (up to 0.033 g/l) are possible.
• General blood analysis. In patients with a shriveled kidney, the content of hemoglobin and red blood cells decreases, moderate thrombocytopenia, and an increase in the duration of bleeding and blood clotting time are noted. Slight leukocytosis often occurs.
• Blood biochemistry. Assessment of functional capacity using biochemical parameters reveals renal failure. With nephrosclerosis, the content of uric acid, creatinine, urea, magnesium, phosphorus, and sodium may be increased. The level of protein and potassium decreases.
• Sonography. Characteristic echographic signs of nephrosclerosis are a decrease in the size of the affected organ, thinning of the parenchyma, atrophy of the cortex, and its unclear differentiation with the medulla. Often, kidney ultrasound reveals nephrocalcinosis.
• X-ray methods. With survey and excretory urography, the size of the kidneys and the cortical layer are reduced, and calcifications are detected in the parenchyma. Impaired filling of the pyelocaliceal system with a contrast agent may indicate the development of chronic renal failure.
• Angiography. On renal angiograms, the arteries are usually narrowed and deformed. In some patients, the fine arterial pattern may be absent (the “burnt wood” symptom). The cortex is thinned. Irregularity of the outer contour of the kidneys is typical.
• Dynamic nephroscintigraphy. When the kidney shrinks, it accumulates and excretes nephrotropic radionuclide more slowly. The study is complemented by static nephroscintigraphy, which reveals parenchymal defects by the uneven distribution of the radiopharmaceutical.
• Renal tomography. Three-dimensional models and layer-by-layer images obtained during CT and MSCT reveal thinning of the cortical layer and a decrease in the size of the organ. Signs of nephrosclerosis are narrowing and deformation of small arterial vessels.
• Needle biopsy of the kidneys. At histological analysis Kidney biopsy shows a significant decrease in the number of nephrons and a large number of connective tissue fibers. During the study, the condition of arterioles and capillaries is assessed.

Differential diagnosis of nephrosclerosis is carried out with sugar and diabetes insipidus, acute renal failure, rapidly progressive glomerulonephritis, hepatorenal syndrome, hypochloremic azotemia. If necessary, the patient, in addition to a nephrologist and urologist, is consulted by a therapist, cardiologist, phthisiatrician, rheumatologist, endocrinologist, oncologist, and oncohematologist.

Treatment of nephrosclerosis

Conservative therapy for the initial stages of kidney shrinkage is aimed at correcting the underlying disease that provoked the sclerotic process and increasing renal failure. Taking into account the pathology that caused nephrosclerosis, the patient is prescribed antibiotics, antihypertensive drugs, statins, glucocorticosteroids, antiglycemic, diuretic, non-steroidal anti-inflammatory and other etiopathogenetic drugs. To relieve disorders caused by functional renal failure, the following can be used:

• Anticoagulants and antiplatelet agents. By influencing the rheological properties of blood, they improve blood flow in the renal arterioles and capillaries and, by restoring tissue perfusion, they slow down nephrosclerosis. Prescribed with caution when chronic renal failure increases.
• Vitamin and mineral complexes. To correct changes in the biochemical composition of the blood caused by impaired filtration, potassium, calcium, vitamin D, multivitamin formulations, and bisphosphonates are used. Taking them improves metabolism and prevents osteoporosis.
• Antianemic drugs. If anemia is detected, erythropoietin preparations are prescribed, which stimulate the formation of red blood cells, and iron, necessary for the synthesis of hemoglobin. Reducing hemic hypoxia makes it possible to slow down sclerotic processes in the kidney tissues.
• Detoxification therapy. To speed up the elimination of toxic metabolites that accumulate in the body during nephrosclerosis, enterosorbents are used, which bind metabolic products in the intestine. To reduce urea levels may be prescribed herbal remedies based on artichoke.

If kidney shrinkage is combined with chronic renal failure III-IV stages, renal replacement therapy is indicated - peritoneal dialysis, hemodialysis, hemodiafiltration, hemofiltration. A radical treatment method recommended for nephrosclerosis with a decrease in the number of viable nephrons to 5% or less is kidney transplantation after abdominal or laparoscopic nephrectomy.

Prognosis and prevention

With timely detection of the disease, the prognosis is relatively favorable; the appointment of adequate therapy allows one to achieve a long-term state of compensation for nephrosclerosis. Over time, the functioning of the nephrons deteriorates, and chronic renal failure develops: such patients require an organ transplant or regular hemodialysis.

To prevent nephrosclerosis, it is necessary to follow the recommendations of a specialist in the treatment of nephrological diseases (especially of an inflammatory nature), monitor the level of blood pressure, blood glucose, avoid hypothermia, and do not abuse salt and meat foods. Plays an important role in preventing the development of a wrinkled kidney. regular visit family doctor for early detection and correction of somatic pathology.

When parenchymal renal tissue is replaced by connective tissue, renal nephrosclerosis 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 begins in the early stages of the disease. In all other cases, we can only talk about stabilizing the condition for as long a period as possible. Incorrect treatment or its absence leads to a worsening of the condition and death.

Nephrosclerosis can be primary (the blood supply to the organ is disrupted) and secondary (the 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, creating pressure that interferes with the normal flow of blood. 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. At the same time, the clearance renal artery partially or completely blocked by an embolus or thrombus. As a result, living tissue dies. If the infarction was minor or single, then the work of the kidney is compensated by other vessels, but with extensive infarctions, 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 provides poor blood supply nutrients tissues and cells. 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 40 years, the arterial walls become thicker, this is due to calcium deposits or the accumulation of connective tissue. muscle tissue. By the age of 70, the number of nephrons in the kidney becomes almost half the normal amount.
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. At high level glucose, various compounds are formed, which tend to be deposited on the walls of blood vessels. In addition, the risk of blood clots forming in the lumen of blood vessels increases.
2. Pregnancy. When hormonal changes occur in the body, the vessels may receive incorrect commands, this can lead to their spasm, as a result of which the nephrons die. Due to the increased permeability of the glomerular vessels, 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, and leukocytes begin to collect around them. If the disease is cured, then scar changes remain on the tubules; in the absence of treatment, ulcers form. All this provokes the death of nephrons.
4. With urolithiasis, the outflow of urine is disrupted. It stagnates and creates favorable conditions for development bacterial infection, bacteria are thrown into the urinary tubules and damage them.
5. Nephrosclerosis can be provoked by kidney tuberculosis, lupus erythematosus, kidney amyloidosis, surgery or trauma to the organ, and ionizing radiation.

Symptoms of the disease

Since kidney dysfunction is associated with the death of nephrons, the fewer of them left, the brighter the symptoms of the disease will be. On initial stage The disease may not manifest itself at all, but as the disease progresses, the symptoms will intensify:

1. The volume of urination increases. If a healthy person produces 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 is more frequent at night than during the daytime.
3. If almost all nephrons die, then there is no urge to urinate at all.
4. Urine contains blood.
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 decreases and blurred vision appears.
9. Pain may be felt in the area of ​​the heart and sternum.
10. With minor bruises, hemorrhages occur under the skin, there are nosebleeds and bleeding gums.
11. Migraines and severe headaches.
12. Brittle bones.
13. Decreased immunity, resulting in frequent viral and infectious diseases.

Swelling on the face of a patient with developed renal failure

If any of these symptoms occur, 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 records a decrease in the volume of the kidney, which occurs as a result of drying out of the cortex. The border area between the cortical and medulla layers of the organ disappears, indicating 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. Deposition of salts and changes in the shape of the organ are visible on excretory pyelography.
5. Using scintigraphy, it is possible to determine the replacement of parenchymal connective tissue.

Treatment of the disease

In order for treatment to be as effective as possible, it is necessary to determine the reason for the development 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. Medicines that lower blood pressure are indicated, but in later stages of the disease they must be used with caution. Enalapril, Nifedipine, Atenolol, Hypothiazide are prescribed. Potassium-containing drugs are prescribed - Panangin, Asparkam, they are necessary to maintain salt balance. It is also important to take vitamins, sorbents, and preparations containing iron.

Chronic renal failure stages 3 and 4 are not treated conservatively; to restore kidney function, hemodialysis or organ transplantation is used. 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 patient's general condition.

The 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 the transplant, special medications are prescribed that will promote kidney engraftment. Organ transplants are complex and dangerous operations which can entail a lot negative consequences and complications. Therefore, doctors resort to this method only in extreme cases.

Doctors often recommend treating nephrosclerosis with hirudotherapy, especially if the patient has chronic renal failure or glomerulonephritis. Leeches are applied to the liver areas, 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 - required condition. You should eat food in small portions, but often. It is advisable to limit protein foods. Porridge, potatoes, and bread should be excluded from the diet. It is better to get protein from eggs, dairy products, and meat. It is recommended to eat fish dishes, as fish contains a lot of phosphorus. To prevent swelling, it is necessary to limit the consumption of salty foods and salt itself. However, it is not advisable to completely give up salt.

The diet must be balanced - contain the necessary vitamins and microelements. You can eat nuts, buckwheat, seaweed, drink mineral water with a high content of magnesium. With secondary nephrosclerosis, you need to drink a lot of water (up to 3 liters per day), but if you have heart or vascular diseases, you should not do this.

Grandma's recipes to help

Treatment with folk remedies is not prohibited, but it should not be the only means of therapy. It is prohibited 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, you need to pour 70 g of leaves into 0.5 liters of boiling water, boil the product 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 useful. Take 100 g of natural honey and mix with the same amount of lemon juice, put on water bath so that the product heats up. Take the resulting product 1 tbsp. l. 1 time a day before meals. The mixture should 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 oat 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 should be eaten without additives. To prepare porridge, you will need 2.5–3 cups of water per glass of cereal.

Toxins can be removed from the body with the help of beets. You will need 3 tbsp. l. beet pulp and 1 boiled beet, which must be grated and juice squeezed out of it. The juice should sit for a couple of hours, after which it can be drunk at night. As for beet pulp, you need to roll it into balls and take one ball half an hour before meals. There is no 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 spoons each 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, infuse and drink lingonberry fruits, use an alcohol tincture of aspen buds, as well as an infusion of licorice root.

What are the forecasts?

Nephrosclerosis of the kidney 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 doctor’s recommendations, eats properly and takes everything necessary medications, remissions can be prolonged and the number of exacerbations reduced. In this case, we can talk about a favorable prognosis.

If treatment of the disease is started on late stages or the disease occurs in malignant form and progresses rapidly, the functionality of the paired organs will rapidly deteriorate, leading to renal failure. In this case, the prognosis worsens, and sometimes the only option is hemodialysis or a donor organ transplant.

Preventive measures

If you follow simple rules every day, then such a serious disease as kidney nephrosclerosis can be prevented. For your kidneys to work properly and be healthy, you need to:

1. Eat a varied diet, without showing a preference for salty, fatty and meat dishes; you must definitely introduce vegetables, fruits, and fresh herbs into your diet. Avoid products containing preservatives and various flavoring and aromatic additives.
2. Drink less than 2 liters of water per day. At the same time, you need to drink water, coffee, tea, juices, and 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 not to follow strict diets, just eat right and replace sugar and confectionery with fresh fruit.
5. Do not take analgesics, antibiotics, or drugs that have a diuretic effect unless absolutely necessary.
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 your body fat levels and monitor your blood pressure.

Fresh air, 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.

Kidney nephrosclerosis is a disease characterized by the replacement of parenchymal connective tissue, which causes a decrease in its size (wrinkling), a decrease in functional activity and, as a result, a complete cessation of performance.

Mainly due to reduced blood supply caused by various diseases, which leads to vascular atrophy and, consequently, the replacement of parenchymal tissue with connective tissue.

If there is inflammation that is not treated with antibiotics, then toxic substances begin to accumulate in the kidney that poison the body, so the kidney should be removed.

If no inflammatory process is observed, then surgical removal not required. In any of these two cases, one kidney stops functioning, and the other compensatory takes over its function.

But it will not be possible to cleanse the blood of waste and toxins alone, so patients are prescribed hemodialysis or the use of an artificial kidney machine.

These procedures cannot replace self-cleansing of the body, but will significantly prolong a person’s life and improve their quality of life.

Two mechanisms of disease development

According to the mechanism of development, the following types of disease are distinguished:

1. Primary wrinkled kidney, which appears when the kidney's own arteries are damaged. Diseases in which this form appears are high blood pressure with the presence of hypertensive crises, heart disease vascular system.
2. A secondary wrinkled kidney occurs when the kidney parenchyma itself is damaged as a result of various diseases that affect both the excretory system and other organs and systems of the human body.

Reasons for the development of pathology

The prerequisites for the development of a wrinkled kidney are various diseases associated with both vascular diseases and disorders metabolic processes or diseases of the excretory system.

Primary nephrosclerosis is characterized by the following causes:

1. High blood pressure is a chronic disease manifested by high blood pressure above 140/90 mmHg and periodic hypertensive crises (temporary high blood pressure caused by

   emotional or physical stress).

2. Atherosclerosis - atherosclerotic damage to blood vessels circulatory system, characterized by the presence on the inner surface of atherosclerotic plaques - seals consisting of calcium and lipids (cholesterol, a substance of lipid nature, which is one of the main cells in the body). Atherosclerosis is expressed in hardening and decreased elasticity of the walls of blood vessels, mainly arteries, arterioles, and narrowing of the lumen due to plaques.
3. Kidney infarction is a sudden cessation of blood flow, which leads to necrosis, that is, death of tissue that is temporarily left without blood supply. In this case, the vessels are first affected, which subsequently become scar and connective tissue.

The following diseases are characteristic of a secondary wrinkled kidney:

1. Pyelonephritis - inflammatory process in the kidneys, caused by bacteria
2. Tuberculosis - infection, which is caused by microbacteria tubercle bacilli. This disease affects almost all organs and tissues of the body, including the excretory system.
3. Nephrolithiasis is a disease characterized by the presence of stones in the kidney tubules.
4. Diabetes mellitus is a chronic disease caused by insufficient amounts of the pancreatic hormone insulin. The disease causes disturbances in all types of metabolism. Increased sugar in the blood, with diabetes mellitus, destroys the blood vessels of the kidney, which leads to nephrosclerosis. Without proper treatment, the disease progresses greatly, which can lead to loss of function of both kidneys.

Phases of disease development

There are 4 phases of the disease:

1. The first is detected only through laboratory tests.
2. The second, prenephrotic, is also detected through research, but clinical signs also appear: the appearance of blood in the urine and a slight increase in pressure.
3. The third, nephrotic - protein appears in the urine. Blood pressure is more elevated. The face begins to swell and swelling becomes visible.
4. The fourth, diabetic - severe swelling on the face and torso, the appearance of hypertensive crises, itchy skin, vomit. Appears several years after the onset of the disease. Often, by this stage of the disease, renal failure already appears.

Features of the clinical picture

The main symptoms of kidney nephrosclerosis include various types of urination disorders:

• polyuria - increased urination exceeding 2 liters per day, the volume can reach up to 10 liters;
• nocturia - increased urination at night, the volume can reach up to 40% of the daily amount;
• hematuria - the appearance of blood (red blood cells) in the urine.

Arterial hypertension is also often observed - high blood pressure, above 140/90.

Even if such pressure is considered normal for you, such indicators will have a negative impact on the condition of the blood vessels in the future.

Increased tension in the walls of the arteries and increased work of the heart muscle are not the longevity of the cardiovascular system.

Pain in the lumbar region, it feels like pulling, squeezing, and does not go away. Swelling that appears in the face and neck and then spreads downwards.

Laboratory tests show changes from the norm:

• the appearance of protein in secondary urine;
• reduced density of secondary urine, below 1.005-1.012.

Diagnosis of the disease

Diagnosis of nephrosclerosis includes several stages and stages.

Initially, this is a general examination by a doctor, urologist. It includes:

• history of the present disease - provides information about the time of onset of symptoms and complaints, progression, visits to the doctor and possible treatment and prevention;
• collection of complaints - exactly what symptoms appear in a given patient and in what intensity;
• life history - collecting information about diseases, especially those related to the excretory system, the presence bad habits, physical activity, living conditions;
• family history - whether there are any diseases and what diseases occur in the family.
• palpation and percussion - detection of pain, increase or decrease in the size of the kidneys, prolapse;
• External examination reveals swelling and redness.

Body fluids such as blood and urine are also analyzed.

Appointed laboratory techniques kidney diagnostics:

• X-ray examination;
• angiography;

Therapy: conservative and surgery

To treat kidney nephrosclerosis, drug and surgical treatment are used.

Prescribed medications

Since nephrosclerosis most often appears with high blood pressure, treatment is aimed specifically at reducing it.

The drugs are prescribed by a doctor and taken daily to prevent hypertensive crises.

You should follow a certain diet that limits your salt intake. If there is swelling, then you should take diuretics.

If laboratory tests show that the blood contains nitrogen toxins, then it is worth limiting protein intake so as not to create additional stress on the kidneys.

The use of vitamins and sorbents will also have a positive effect on the condition of the patient.

Surgery

Occasionally, in particularly severe cases, nephrectomy is used, which has several options:

• abdominal surgery - an incision is made on the abdomen;
• laparoscopy - through abdominal wall several tubes are inserted and the kidney is removed using special equipment;
• removal through a puncture in the lower back.

Preventive actions

The goal of prophylaxis is to prevent progression of the disease and improve blood flow to the shriveled kidney.

An important point is to reduce the load on the kidneys. During an epidemic of colds, you should take antiviral drugs and vitamins to improve immunity.

If cold symptoms have already appeared, you should drink a large dose of vitamin C in the first days to prevent the virus from spreading further throughout the body.

Also, nutrition and diet can reduce the load on the kidneys. You should reduce your intake of table salt and protein.

Diseases of the gastrointestinal tract can also be treated, especially chronic constipation. When stool retention occurs poisoning of the body with toxic substances, which has a negative effect on the kidneys.

Physical activity increases blood circulation both throughout the body and in the kidneys, which improves the nutrition of sclerotic tissues.

To remove toxic substances from the body, in addition to the kidneys, the excretory system includes the skin and gastrointestinal tract. Excretion through the skin occurs through sweating, so visiting the bathhouse and sauna will have a good effect on the condition of the body.

Possible consequences

Complications develop due to decompensated arterial hypertension. It could be:

• stroke;
• hypertrophy and overload of the left half of the heart;
• atrophic changes in the optic nerve leading to blindness, retinal detachment.

Renal nephrosclerosis - general information about the disease

Kidney nephrosclerosis is a pathological condition in which the organ parenchyma is replaced by connective tissue. The disease can develop as a result of various pathologies of the kidneys and renal vessels.

Causes

The occurrence of primary nephrosclerosis is promoted by:

• hypertension;
• atherosclerosis;
• vascular thromboembolism.

Causes of development of secondary nephrosclerosis:

• glomerulonephritis;
• pyelonephritis;
• amyloidosis;
• urolithiasis disease;
• tuberculosis;
• diabetes;
• kidney infarction;
• nephropathy of pregnancy.

Due to all of the above, we can conclude that primary nephrosclerosis occurs as a result of circulatory disorders in the organ, and secondary nephrosclerosis occurs due to a long-term inflammatory-destructive process.

Stages of development

The pathological process leading to the occurrence of nephrosclerosis goes through two successive phases: nosological and syndromic. During the nosological phase, all changes in the kidney are characteristic only of the specific disease that caused nephrosclerosis, and during the second, all these characteristic changes are smoothed out and manifestations of renal failure come to the fore.

With nephrosclerosis, the kidneys become dense, the surface is uneven, and a complete restructuring of the renal tissue occurs. To determine the cause of the development of such a process, attention is paid to the nature of the wrinkling of the kidney.

For example: hypertensive nephrosclerosis has a fine-grained structure, and in diabetes, amyloidosis, pyelonephritis it is lumpy. Thanks to these features, during an autopsy, the cause of kidney damage can be accurately diagnosed.

Signs

The main symptoms of the development of nephrosclerosis are determined already in the later stages of the diseases that caused its development. TO early signs pathologies include:

• polyuria (increased urine production);
• nocturia (the patient goes to the toilet more often than expected);
• proteinuria (excretion of proteins in urine exceeding normal indicators(30–50 mg/day);
• micro- or macrohematuria (admixture of blood in the kidney);
• hyposthenuria (decreased urine density);
• periodic or constant increased diastolic pressure;
• swelling of the body.

In addition to all that has been said, we can add that at the height of nephrosclerosis, symptoms of damage to the cardiovascular system appear:

• left ventricular overload and coronary insufficiency;
• swelling and atrophy of the optic nerve;
• retinal disinsertion;
• acute disorders cerebral circulation and strokes.

Here you can add the symptoms of iron deficiency anemia due to impaired synthesis of erythropoietin (a hormone that affects the development and appearance of red blood cells in the human bone marrow).

In patients suffering from nephrosclerosis, the likelihood of a bone fracture increases approximately 2–3 times, since the kidneys lose the ability to convert vitamin D, and a decrease in calcium and phosphorus is observed in the blood.

In the second stage of development of nephrosclerosis, symptoms of weak immune reactivity of the body occur, which appears regularly. colds and the occurrence of bacterial infection.

Diagnostics

Diagnosis of nephrosclerosis consists of a comprehensive application of clinical data, laboratory and instrumental methods. A biochemical blood test indicates the following symptoms of renal dysfunction:

• There is a significant increase in the level of urea (4-8 mmol/l), creatinine (60-100 µmol/l) and uric acid (250-500 µmol/l).
• The amount of total protein decreases, and in the later stages this process can reach catastrophic figures.
• Potassium decreases, and phosphorus, magnesium and sodium increase.

In a general urine analysis, red blood cells and protein appear, while its density decreases significantly. When examining a blood test, it turns out that the level of platelets and hemoglobin decreases, and leukocytes, on the contrary, increase.

Ultrasound diagnostics indicate a decrease in the size of the kidney due to drying out of the cortex relative to the medulla. It often occurs that the boundary between these layers disappears, this indicates a complete sclerotic change. In addition to the symptoms, the deposition of calcium salts in the parenchyma is added. Doppler ultrasound shows slow blood flow in the kidney.

Excretory pyelography also reveals changes in the shape of the kidney and the deposition of calcifications (nephrocalcinosis). Examining the kidney using scintigraphy, an uneven distribution of the radioisotope is detected, which indicates the degeneration of the parenchyma into connective tissue.

Treatment methods

Treatment of nephrosclerosis is considered a difficult task, since it is impossible to stop irreversible changes. The course of therapy is aimed at the use of symptomatic remedies and correction of metabolic disorders caused by the underlying disease.

Conservative therapy:

• Diet therapy, table No. 7 (maximum 5 grams of salt per day, minimum animal protein).
• Drugs that improve blood flow in the kidneys (Pentoxifylline, Trental, Heparin, Warfarin).
• Treatment high blood pressure by using ACE inhibitors(Captopril, Enalopril), calcium channel blockers (Nifedepine), beta blockers (Metaprolol, Propronalol).
• Correction of salt metabolism (Asparkam, Panangin).
• Preventing the development of osteoporosis (vitamin D and calcium).
• Elimination of anemia (Ferumlek, Sorbifer Durules).
• Herbal preparations that improve kidney condition (urolesan, canephron).

Surgical treatment is carried out in the late stages of nephrosclerosis and involves removal of the sclerotic organ. Along with the operation, hemodialysis treatment is periodically performed, aimed at removing breakdown products of proteins and other substances.

What is kidney nephrosclerosis and what is the outcome of the disease?

Kidney pathologies occupy a leading place among diseases modern man. And one of them is kidney nephrosclerosis. The disease involves the primary proliferation of replacement renal tissue and subsequent shrinkage of the organ due to a critical decrease in its functions. That is, due to poor functioning of the vascular system of the kidneys, healthy kidney tissue is replaced with connective tissue. Because of this, the blood supply to the kidneys is reduced and their functions gradually decline.

Important: when timely diagnosis The disease and effective treatment of kidney sclerosis can be completely defeated. If the disease is diagnosed late or the treatment was not carried out entirely correctly, then, at best, one can only achieve stable remission. In the worst cases (lack of treatment for the pathology), death.

Causes of the disease

It is worth knowing that nephrosclerosis itself is not an independent disease. This pathology is a consequence of problems with blood vessels in humans. Therefore, nephrosclerosis most often affects those patients who suffer from atherosclerosis, hypertension, thromboembolism, thrombosis and other diseases of the cardiovascular system. Wherein renal pathology can be divided initially into two groups:

• Primary nephrosclerosis;
• Secondary disease.

In the first case, the pathology develops due to problems with the blood supply to the kidneys. Those, in turn, begin against the background of pathology of the vascular system. Primary nephrosclerosis can even lead to kidney infarction, which is unfavorable for the patient. In the worst case, the patient will experience a toxic coma and death. In turn, primary nephrosclerosis is classified depending on the root cause of its development. The following types of primary pathology are distinguished:

• Atherosclerotic nephrosclerosis. It develops under the influence of atherosclerotic plaques deposited on the walls of blood vessels and renal arteries in the patient’s body. This leads to a decrease in vascular elasticity and, as a consequence, to renal ischemia. This type of disease is considered the most favorable for the patient, since part of the renal parenchyma is largely not affected by pathology and the kidney continues to function.
• Hypertensive nephrosclerosis. This type of kidney pathology develops due to spasm of the renal vessels, which occurs against the background of hypertension in the patient. Moreover, this type of renal sclerosis is divided into two more subtypes - arteriolosclerotic nephrosclerosis and arterionecrotic renal sclerosis. The main difference between them is their good quality. The first subtype (arteriolonephrosclerosis) does not pose a strong danger to the patient, while arteriononecrotic pathology is malignant.
• Involutive nephrosclerosis. It develops mainly in patients from the 50+ group under the influence of calcium deposited on the walls of blood vessels. As a result, the permeability of blood vessels and their elasticity decreases.

Secondary nephrosclerosis develops as a complication after the following pathological conditions:

• Pyelonephritis;
• Glomerulonephritis;
• Stones in the kidneys;
• Kidney amyloidosis;
• Kidney tuberculosis;
• Diabetic glomerulosclerosis;
• Nephropathy during pregnancy;
• Complex kidney injuries;
• Kidney surgery;
• Kidney infarction.

Clinical picture of the disease

Those who want to understand what nephrosclerosis is should know that nephrosclerosis is a rather insidious pathology that does not manifest itself in the initial stages. That is, a person may not even suspect that he has a kidney pathology. In most cases, it is possible to accidentally diagnose the disease at the initial stage during a general urine test for a standard medical examination. If the pathology is advanced, the patient will have the following symptoms:

• Swelling of the face and limbs;
• Pain in the lumbar region;
• Elevated blood pressure that cannot be corrected with antihypertensive drugs;
• Headache that does not go away even with taking antispasmodics and analgesics;
• Change in urine color to darker or red;
• Frequent need to urinate, especially at night;
• Reducing the daily volume of urine to 0.5 l;
• Aversion to meat dishes;
• Fatigue and weakness;
• Itchy skin;
• A sharp decrease in body weight.

Important: all of these nephrosclerosis symptoms, whether taken together or even individually, require urgent hospitalization of the patient.

Diagnosis of the disease

All patients at risk (with the diseases listed above, such as hypertension, etc.) should regularly examine their kidneys so as not to miss the possible onset of the disease. The following methods are used to diagnose pathology:

• General urine analysis and urine analysis according to Zimnitsky;
• Ultrasound of the kidneys and urinary system;
• X-ray examination with a contrast agent to determine kidney function;
• CT and MRI to assess the functioning of an organ in the presence of pathology in the patient’s body.

Therapy

Treatment of nephrosclerosis can be carried out either conservatively or surgically, depending on the condition of the patient’s kidneys at the time of diagnosis. So, if a conservative treatment method is applied to the patient, then its tactics will be as follows:

• Normalization of blood pressure. To do this, the patient is prescribed antihypertensive drugs that significantly regulate blood pressure levels.
• Stopping the progression of the disease. For this, the patient is prescribed drugs such as Prednisolone and other cytostatic drugs.
• Providing nutrition to kidney cells. To stop the connective tissue from growing, nephroprotective drugs are prescribed. They help stimulate the growth of healthy kidney tissue.
• Reducing cholesterol levels. Here they prescribe drugs from the group of statins, which normalize fat metabolism in the body and have a positive effect on the blood vessels of the kidneys.
• Salt-free diet. Along with drug therapy, the patient is prescribed a salt-free diet and nutrition with the exclusion of protein foods or reducing protein in the diet to a minimum.

Additional procedures and surgery

If the patient has critical renal failure, the patient is indicated for nephrectomy (kidney removal) or kidney transplantation. Before surgery, patients may be prescribed hemodialysis (filtering blood through an artificial kidney machine). This procedure gives a relatively good effect if it is carried out three times a week for 4 hours each session.

Peritoneal dialysis may also be prescribed instead of hemodialysis. The procedure is performed by introducing into abdominal cavity special solution for blood purification. After a certain time, this solution is removed using a catheter. In this way, the blood of a patient with end-stage nephrosclerosis is further purified.

Surgery involves either removal of the kidney (which is unlikely, since most often both kidneys are affected) or organ transplantation. A donor kidney is taken either from a healthy blood relative with his consent, or from a cadaveric donor.

Diet therapy

After effective treatment of nephrosclerosis, the patient should be very attentive to himself. Any deviations from a normal diet and healthy lifestyle can lead to relapse. The basis for preventing recurrent disease is diet and a healthy lifestyle. Their principles are:

• Do not abuse salt and preservatives;
• Eat strong and rich meat broths less often;
• Maintain your weight at a normal level, avoiding critical gain;
• Observe drinking regime day, drinking at least 2-3 liters of liquid per day;
• Quit smoking and alcohol;
• Take any medications only as prescribed by a doctor;
• Do not get carried away with special and fashionable diets;
• Avoid contact with dyes and other toxic substances;
• Do not overheat in the sun and do not freeze in the water.

In addition, it is advisable to constantly monitor your blood pressure and periodically donate blood for cholesterol and sugar. Remember: preventing a disease is always easier than treating it for a long time and not always successfully.

Renal nephrosclerosis is a secondary chronic disease usually associated with high blood pressure. Nephrosclerosis leads to the death of kidney tissue and organ dysfunction.

It is no secret that the functionality of an organ is determined by the structure and functions of its tissues. However, with certain types of disease, a situation often arises when functional tissue is replaced by ordinary connective tissue. The latter acts as a neutral filler, but, alas, does not take on the functions of the replaced fabric. It is clear that in this case the activity of the organ is irrevocably impaired.

Such diseases include kidney nephrosclerosis.

Nephrosclerosis of the kidney - what is it?

This definition means the replacement of parenchyma with connective tissue. To understand the essence of this disease, you need to look at the structure of the organ.

The kidneys are a paired parenchymal organ in the form of beans, located behind the parietal layer of the peritoneum. The organ is protected by a connective tissue fibrous membrane and includes parenchyma and systems for storing and excreting urine. The parenchyma, in turn, consists of an outer cortex and an inner medulla.

The cortex of the parenchyma consists of nephrons - functional units of the organ that perform the task of producing urine. The tubules of these structures form a kind of loop, as if connecting the cortex and medulla. In the medulla there are excretory tubules through which accumulated urine enters the renal calyces - an element of the excretion system.

The task of the parenchyma is the formation of urine. The process is carried out in 2 stages:

• formation of primary fluid - as a result of filtration, several liters of primary urine are formed. Its volume is much greater than the amount of urine that is usually excreted by the body: 150–180 liters per day, while the volume of urine does not exceed 2 liters. Primary urine is reabsorbed;
• when reabsorbed, excess water, as well as salt and trace elements, necessary for the body, return back to the blood. Secondary urine is characterized by a high content of urea, uric acid, etc. She goes to renal pelvis and then excreted through the ureter into the bladder.

In this way, not only the blood is purified from frankly toxic substances, but also the water-salt balance is maintained, as well as the required concentration of osmotic substances in the blood.

With nephrosclerosis, nephrons die, and their place in the parenchyma is taken by connective tissue, which is not able to perform this function. At the same time, the organ decreases in size, becomes denser and loses functionality, which leads to kidney failure. In this case, it is no longer possible to restore kidney function.

According to the International Classification of Diseases ICD-10, the disease code is I12.9.

Healthy kidney and kidney with nephrosclerosis

Classification and reasons

Nephrosclerosis is not an independent disease. The impetus for its appearance is hypertension, atherosclerosis and any other vascular or kidney diseases that lead to disruption of the blood supply to the organ. The classification of types of disease is associated with various causes that provoke nephrosclerosis.

There are primary and secondary nephrosclerosis.

The primary one is caused precisely by disturbances in the functioning of blood vessels - a narrowing of the working cross-section of the artery, which leads to ischemia of the organ, the development of heart attacks, the appearance of scars, and so on. The reason may also be age-related changes, if they lead to a decrease in the cross-section of the bloodstream and stagnation of venous blood.

There are several types of primary nephrosclerosis:

• Atherosclerotic - the cause of vasoconstriction in this case is the deposition of atherosclerotic plaques of a fatty nature. Plaques noticeably reduce the elasticity of the vessel, thicken the walls, which ultimately leads to a decrease in the lumen, and, in turn, to renal ischemia. Most often, plaques are deposited at the entrance of the renal artery or at branching sites.

The surface of the kidney becomes coarsely nodular, and irregularly shaped scars are visible on it. However, it is atherosclerotic nephrosclerosis that can be considered the most harmless, since most of the parenchyma remains functional. However, the disease may be accompanied by hypertension.

• Hypertensive nephrosclerosis got its name due to the cause - vascular spasms caused by hypertension. The result is the same: narrowing of the arteries and ischemia. In this case, the parenchyma is gradually replaced by connective tissue: the surface of the organ appears fine-grained. There are 2 subtypes of the disease:
  • arteriosclerotic - or benign. Connective tissue grows in the inner walls of the arteries, causing a decrease in the lumen and loss of elasticity of the vessel;
  • arteriolonecrotic – malignant. This is necrosis of arterioles and glomeruli, accompanied by hemorrhage in the urinary tubules, impaired protein metabolism, and so on.
• Involutive – associated with age-related changes. For example, after 45–50 years, calcium begins to be deposited on the walls of the arteries, which causes thickening of the walls and, accordingly, a decrease in the lumen. In addition, with age, thinning of the cortical layer and atrophy of urinary tubule cells is possible, which leads to a decrease in the functionality of the organ.

There are others possible options. The cause, for example, may be chronic venous congestion. It is fraught with stagnation of venous blood, which provokes the synthesis of collagen, the main protein of connective tissue, in the walls of blood vessels.

Secondary nephrosclerosis is caused by dystrophic or inflammatory processes occurring directly in the kidney.

The causes can be a variety of diseases:

• Diabetic – increased level Sugar in the blood provokes deposits on the walls of blood vessels, primarily small ones. In this case, the wall swells and thickens, but its permeability increases. As a result, protein enters the blood. To compensate for this damage, substances that increase clotting are released into the blood. In this case, the blood flow in the capillary vessels slows down, which leads to damage not only to the kidneys, but also to other organs.
• Nephropathic – during pregnancy, hormonal changes often lead to disruptions in various systems. One of them is capillary spasm, which causes an increase in blood pressure and impaired blood supply to the kidneys. Against this background, edema forms, the pressure is maintained at a high level, which all together leads to the death of nephrons and their replacement with connective tissue.
• In chronic glomerulonephritis, circulating immune complexes are not destroyed and eventually reach the kidneys. CICs damage the lining of blood vessels in the glomeruli. To compensate, substances are synthesized that increase thrombus formation, which leads to vasoconstriction.
• With pyelonephritis, bacteria enter the kidney glomeruli and tubules and form bacterial clots in them. Leukocytes accumulate around the latter. During recovery, scars remain in such areas; if the disease lasts, ulcers form. Both formations lead to the death of nephrons.
• Urolithiasis - when urine stagnates, bacteria multiply in it, and when fluid flows back, the latter enter the urinary canaliculi and damage the internal walls.
• Tuberculosis - the tuberculosis bacillus can settle on the walls of the kidney glomeruli, which provokes inflammation. At the same time, the vessels narrow, and even recovery is fraught with the formation of scars.
• Lupus erythematosus is a systemic disease in which synthesized immune complexes “attack” their own organs. Once in the kidneys, CICs destroy the tissue of the renal glomeruli.
• The situation is similar with amyloidosis, a disorder of protein metabolism. The CEC, designed to fight the abnormal protein amyloid, damages the kidney tissue.
• Trauma or even kidney surgery can cause a piece of kidney tissue to lodge in an artery and block it. In this case, blood circulation is greatly impaired, which leads to the rapid death of nephrons.

Possible causes of kidney nephrosclerosis

Stages and degrees

The cells of the kidney tissue die gradually, which is why the disease develops in stages. Symptoms of the disease appear months and years after the onset of the disease.

There are 2 stages of development:

• The first period is the formation of a factor that leads to impaired blood supply to the kidneys. Symptoms are characteristic of the disease provoked by this factor.
• The second period is the actual death of nephrons and their replacement with connective tissue. The process causes renal failure, which is also divided into 4 types depending on the severity of the disease:
  • at the first stage, fatigue after exercise, some general weakness and decreased performance may be observed. Polyuria and an increase in the volume of urine excreted at night may occur. The patient often suffers from thirst and dry mouth. Protein can be detected in the urine - not always; the content of sodium, calcium and phosphorus in the blood changes;
  • at the second stage, the level of urea in the blood increases and its volume decreases. Blood pressure remains high and does not respond well antihypertensive treatment. Headaches, nausea, vomiting are observed due to lack of appetite and weakness. At successful treatment the symptoms of the underlying disease usually disappear;
  • for the third stage the characters are severe weakness, lack of appetite, tendency to viral diseases. The volume of urine decreases due to constant strong thirst. The skin acquires a characteristic yellowish tint caused by bile pigment - normally it should be excreted in the urine;
  • at the fourth stage, urine is completely absent or is excreted in critically small quantities. Poisoning develops - uremia, a blood clotting disorder is observed. Blood pressure is very high, pulmonary edema develops. All changes at this stage are irreversible.

In addition, according to the speed of development of the disease, 2 forms of nephrosclerosis are distinguished.

• Benign – characterized by gradual development. In this case, the walls first thicken in small vessels, then in large ones. Fat is deposited in the altered tissue, and excess elastic tissue appears in large vessels, which contributes to clogging of the bloodstream. All together leads to disruption of blood supply and gradual death of nephrons.

The likelihood of developing the disease increases with age, since age-related changes already aggravate the condition of blood vessels.

• The malignant form is characterized by the rapid development of the same process. As a rule, without timely hemodialysis, the prognosis is extremely unfavorable. The disease is more common in people of the Negroid race. In general, malignant nephrosclerosis is poorly distributed and rarely occurs in people with persistently elevated blood pressure.

Signs and symptoms

The symptoms of the first stage are not expressive, and, moreover, since they are associated with the main ailment, they can be inconsistent.

The first signs include symptoms characteristic of almost any disease associated with increased blood pressure or cardiac ischemia:

• general weakness and lethargy;
• nonspecific headaches;
• increase in blood pressure – unstable and inconsistent;
• poor appetite and weight loss;
• change in the daily amount of urine.

The symptoms of the disease are determined by the form of nephrosclerosis - primary and secondary. The most informative is the last sign - a change in urine volume. It is directly related to the number of dead nephrons, which indicates the stage of the disease.

Primary signs include the following symptoms.

• Polyuria - fluid from primary urine does not return to the blood, but is absorbed by the urinary tubules. As a result, the volume of daily urine is higher than the volume of liquid drunk - by more than 2 liters.
• – usually the volume of urine excreted at night is less than during the day. However, when the disease occurs at night, the blood vessels relax, and the volume of urine at night exceeds that during the day. This sign usually appears first.
• Cylindriuria – indirect sign, fickle. In a general urine test, casts are detected - casts of blood proteins.
• Proteinuria is observed in both primary and secondary nephrosclerosis. Protein from the blood, due to a violation in the walls of blood vessels, enters the primary urine, but does not return back to the blood and is excreted in urine. Protein is found in TAM.
• Iron deficiency anemia - due to problems with the synthesis of erythropoietin, red blood cells are not produced in the required quantities. This is the main cause of weakness and dizziness.
• High blood pressure – common feature, the severity depends on the stage. With poor blood supply, the kidneys begin to produce renin, which maintains blood pressure at a high level, significantly worsening the patient’s condition. In this case, headaches, numbness of the extremities, vomiting, and nausea appear. Hypertensive crises occur - up to 250/130 and 300/140. The effects of conventional blood pressure-lowering drugs are very weak.
• Tendency to bleeding - due to decreased production of urokinase, blood clotting decreases. Bleeding from the nose and gums becomes possible, and hematomas appear on the skin from the slightest mechanical impact.
• Headaches – occur due to increased blood pressure. At the same time, all the vessels narrow and an imbalance occurs between the blood entering the brain and its outflow - stagnation. He determines headache. Most often it is concentrated in the occipital region, but with a steady increase in blood pressure it turns into pressure and is not localized.
• The tendency to viral diseases is associated not so much with the condition of the blood vessels, but with the medications taken during treatment. Drugs in this group reduce immunity.

Secondary symptoms develop with significant damage to the renal tissue and obvious organ dysfunction:

• Oliguria – observed when blood filtration is impaired. The volume of daily urine decreases significantly - to 500–800 ml. This is a sign of the death of 70–75% of nephrons.
• Anuria – lack of urine. Accompanied by lethargy, nausea, vomiting and other signs of poisoning. Anuria occurs when about 90% of nephrons die. In the absence of urgent treatment, the patient dies.
• – red blood cells penetrate into primary urine, but are not absorbed in the urinary tubules and are excreted along with secondary urine. The latter acquires a characteristic red color; analysis shows the presence of red blood cells in it.
• Edema – the same renin contributes to the retention of water and sodium ions. The fluid enters the surrounding tissues rather than being eliminated. Swelling, as a rule, appears first on the face and legs, and then “hidden edema” forms. The patient's weight increases to 0.5–1 kg per day. Protein is found in urine.
• Azotemia - products of protein metabolism - urea - are not excreted. Manifests itself as drowsiness, nausea, palpitations, severe thirst. The skin becomes yellowish in color, and a characteristic ammonia odor is heard from the mouth. Azotemia appears when 65–70% of nephrons are damaged.
• Uremia – products of protein metabolism and other toxic substances are not excreted from the body. Self-poisoning develops. To the symptoms listed above are added atrophy of muscle tissue, impaired sensitivity, urea crystals are deposited on the skin - “uremic frost”. Uremia indicates the death of 90% of cells.
• Visual impairment - there are two characteristic damages: retinal detachment and swelling of the optic nerve papilla. In the first case, the accumulation of fluid under the retina leads to detachment, which is accompanied by sparks, a veil before the eyes, and the appearance of dark spots. In the second case, fluid stagnates near the optic nerve in the orbital cavity. Swelling leads to compression of the nerve fibers and damage. It is accompanied by the appearance of a veil, headaches and rapidly progressing blindness.
• – vasospasm ultimately leads to disruption of the blood supply to the heart. At physical activity or emotional outburst there is a strong sharp pain in the area of ​​the heart or behind the breastbone.
• Cardiac asthma - in later stages, cardiac ischemia and edema lead to left ventricular failure. As a result, blood begins to stagnate in the pulmonary vessels, which causes swelling lung tissue. The first asthma attacks appear during physical activity, then night attacks begin. The cough is usually almost dry or with a small amount of mucus. At the same time it appears cold sweat, the skin turns blue and the heart rate increases significantly. When listening to the lungs, moist rales are recorded.

Diagnostics

The nonspecificity of symptoms in primary nephrosclerosis and even in secondary nephrosclerosis at the first stage makes diagnosis difficult. However, laboratory tests help clarify the picture quite quickly.

A biochemical blood test for kidney problems will reveal the following factors:

• increased urea and creatinine;
• decreased protein levels;
• increased potassium content - at stages 3–4 of the disease, since potassium is not excreted in the urine;
• increased sodium content - this sign may not be present if the patient is on a diet;
• An increase in the level of magnesium in the blood is also characteristic of the last stages.

A general urine test is no less eloquent:

• there is an increase in the amount of protein;
• appearance of red blood cells;
• the relative density of urine decreases.

A general blood test reports a decrease in the level of hemoglobin, red blood cells and platelets. At the same time, the proportion of leukocytes increases, which indicates poisoning.

Laboratory testing makes it possible to localize the lesion, as it clearly indicates disturbances in the functioning of the kidneys.

For a more accurate assessment of the condition of the organ, they resort to instrumental methods research.

• Ultrasound of the kidneys - with disease, the size of the cortical layer and its functionality decrease. Specific salt deposits are noted in the parenchyma.
• – obtaining an x-ray of the kidney and urinary tract. With nephrosclerosis, the size and contours of the organ change. Urography also allows you to evaluate salt deposition.
• Angiography – gives the most complete picture of the condition of the vessels in the kidneys. With nephrosclerosis, there is a narrowing and fracture of the branches of the artery - the effect of “burnt wood”.
• Vascular Doppler - carried out to assess blood flow in the kidneys: in case of illness, blood circulation is slow.
• X-ray is the most informative method in the early stages of the disease. Allows you to assess the condition of the glomeruli and urinary tubules.
• (CT) is a comprehensive study that provides information about the structure, structure, size of the kidney and the condition of the blood vessels.
• Biopsy - removal of tissue for analysis. A biopsy is the only type of analysis that allows you to accurately determine what form of the disease is being discussed - benign or malignant.

Treatment

Treatment is primarily focused on treating the underlying disease. Attempts to restore kidney function without eliminating the main active factor are doomed to failure.

To restore the organ, complex treatment is carried out, designed to long term. Typically, therapy is prescribed in courses with short intervals between treatments.

Depending on the stage and degree of organ damage, medications are prescribed.

• Anticoagulants - heparin, and antiplatelet agents - trental. The drugs prevent the formation of blood clots.
• Medicines from the group that lower blood pressure late stages diseases are used with great caution, since a sharp drop in blood pressure is detrimental for the patient.
• ACE inhibitors - berlipril, diroton, block the synthesis of angiotensin, due to which the vessels in the kidneys dilate.
• Calcium antagonists - falipamil, dilate arteries, including those in the kidneys.
• Diuretics - indapamide, remove excess fluid and sodium ions.
• Locators of b-adrenergic receptors - propranolol, reduce the production of renin, thereby reducing blood pressure.
• Alpha adrenergic blockers - prazosin, increase the rate of blood passage through the glomerular arteries.
• To regulate the water-salt balance, special potassium preparations - panangin - can be prescribed.
• To improve the general condition, multivitamin preparations are administered.

For other disorders associated with kidney dysfunction, special medications are also prescribed. Thus, for osteoporosis, which is often observed with involuting nephrosclerosis, treatment includes calcium supplements. To treat anemia, iron or erythropoietin supplements are prescribed.

Treatment is necessarily accompanied by a diet that limits the consumption of table salt and animal proteins.

In the first stages, it is possible to treat the patient with folk remedies:

• For example, birch sap helps eliminate toxins, as does an alcoholic infusion of aspen buds, which is taken in 30 drops before meals.
• Lingonberry infusion – 1 tablespoon per 200 ml boiled water, helps reduce blood pressure.
• Licorice infusion – 2 teaspoons per 200 ml hot water, also help remove toxins.
• An infusion of strawberry, birch, nettle and flax leaves - 10 g, 20 g, 20 g and 50 g, respectively, helps get rid of swelling.

Folk remedies can only act as supports. Very useful to use herbal infusions between courses of drug therapy.

At stages 3–4 of nephrosclerosis drug therapy in most cases ineffective.

It is almost impossible to restore kidney function with such extensive damage – 70–75% of nephrons:

• Hemodialysis - the patient's blood is passed through an artificial kidney machine. Thus, it is cleansed of toxic substances, protein metabolism products, and so on. The frequency of the procedure depends on the severity of the disease. In essence, this is not treatment, but support.
• A kidney transplant is a method that allows you to return to your normal lifestyle. However, such an operation is quite risky, even in cases where the donor organ was provided by a close relative. The likelihood of rejection and the development of urological complications is very high. TO surgical intervention this kind of thing is resorted to only as a last resort.

Forecast

Nephrosclerosis is a chronic disease. At stages 1–2, it is quite possible to maintain kidney function, but it is necessary to comply with all the necessary restrictions: a minimum of table salt, mainly vegetable protein, control over the level of calcium, potassium and phosphorus in the blood and replenishment of these elements if they are not enough in the daily diet. Wherein medication course have to be repeated when the disease worsens.

The periods of remission are longer, the more successful the treatment of the underlying disease is.

At stages 3–4, the course of therapy is carried out more often, restrictions on diet and activity are more stringent. It is impossible to restore dead kidney tissue, so treatment here comes down to supporting the functionality of the remaining nephrons, which may not be sufficient.

The course of benign nephrosclerosis is determined by the condition of the heart. In the absence of cardiac pathologies, the outcome of the disease is always favorable. But against the background of heart failure, treatment is difficult.

The prognosis for malignant nephrosclerosis is unfavorable. Usually, if it is not possible to transplant a kidney, the patient can live no more than a year.

Nephrosclerosis is a secondary disease directly related to the condition of blood vessels and blood pressure. There are no special preventive measures to prevent it, but the most common recommendations are diet, physical activity, absence of overexertion, sufficient rest, may well prevent its occurrence.