What is nephrosclerosis of the right kidney. Renal nephrosclerosis

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, when certain types disease, a situation often arises when functional fabric is replaced by an ordinary connective. 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.

Kidneys – 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 different high content urea, uric acid and so on. It is sent to the 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 support is provided water-salt balance, 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. Age-related changes may also be the cause if they lead to a decrease in the cross-section of the bloodstream and stagnation 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 it most of 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 – elevated blood sugar levels provoke 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, swelling forms, the pressure is maintained at high level, which all together leads to the death of nephrons and their replacement with connective tissue.
At chronic glomerulonephritis circulating immune complexes are not destroyed and ultimately 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 renal glomeruli, which provokes inflammation. At the same time, the vessels narrow, and even recovery is fraught with the formation of scars.
Lupus erythematosus - 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 may be observed, some general weakness and decreased performance. 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 to 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 include last sign– change in urine volume. It is directly related to the number of dead nephrons, which indicates the stage of the disease.

TO 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 is an indirect sign, not permanent. 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.
Increased arterial 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. arise hypertensive crises– 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, extreme thirst. The skin becomes yellowish color, 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 papillary edema optic nerve. 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 an emotional outburst, there is a strong sharp pain in the heart or behind the sternum.
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 of the 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.

General analysis urine 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.

To more accurately assess the condition of the organ, instrumental research methods are used.

Ultrasound of the kidneys - with disease, the size of the cortical layer and its functionality decrease. Specific salt deposits are noted in the parenchyma.
– receiving x-ray kidneys 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.
Radiography is the most informative method on early stages illness. 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 long-term treatment is carried out. 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.
For improvement 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 must be accompanied by a diet that limits consumption 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 well as alcohol infusion aspen buds, which is taken in the amount of 30 drops before meals.
Lingonberry infusion - 1 tablespoon per 200 ml of 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 is ineffective in most cases.

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 has provided close relative. The likelihood of rejection and the development of urological complications is very high. Surgical intervention of this kind 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. In this case, the medication course has to be taken again 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. Special preventive measures there is no way to prevent it, but the most common recommendations are diet, physical activity, absence of overexertion, sufficient rest, may well prevent its occurrence.

The term “renal nephrosclerosis” refers to a pathology that occurs due to the replacement of the renal parenchyma with connective tissues. There are several types of diseases that arise from various reasons. Symptoms increase as the disease progresses. This affects the methods of treating pathology. There are no special preventive measures. Predicting the course depends on many factors, the main one of which is the benignity or malignancy of the disease.

A pathological phenomenon is the process of overgrowing of the kidney parenchyma with connective tissue.

The disease was first diagnosed in the early 20th century. The cause of the development of nephrosclerosis is the replacement of the organ parenchyma with connective tissue, causing the kidney to become denser and wrinkled. Another name for the disease is “shrunken kidney.” This leads to deterioration in the functioning of the organ. Previously, it was believed that the disease was provoked by glomerulonephritis; now experts are inclined to believe that the main causes of the development of kidney nephrosclerosis are diabetes and arterial hypertension. Statistics say that the disease is diagnosed in every 6 people out of 10 thousand.

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Types and forms

Due to its formation, a wrinkled kidney is classified into 2 types:

primary wrinkled kidney (the blood supply to the organ deteriorates due to atherosclerosis, hypertension, or age-related changes that develop in older people);
secondary wrinkled kidney (results from organ trauma, radiation or other kidney pathologies, for example, pyelonephritis or tuberculosis).

Primary renal sclerosis occurs:

hypertensive;
involutive;
diabetic;
atherosclerotic.

Hypertensive nephrosclerosis is characterized by a frequent increase in pressure in the vessels when the lumen narrows. The kidney cells do not receive enough oxygen, and the parenchyma of the organ is replaced by connective tissues. Hypertensive nephroangiosclerosis is a disease that affects the small vessels of the kidney. Nephroangiosclerosis of the arteries develops against the background of arterial hypertension. Atherosclerotic nephrosclerosis occurs against the background of arterial stricture, the cause of which is a sclerotic plaque. The disease usually does not lead to large-scale damage to the kidney, and its functions are preserved.

In diabetic nephrosclerosis, microangiopathy develops, which leads to complete defeat organ. Pathology develops in 4 stages:

1st - not accompanied by pronounced symptoms;
2nd (prenephrotic) - characterized a little high blood pressure and changes in blood formulas, which are reflected in the results of general and biochemical tests;
3rd (nephrotic) - swelling appears and blood pressure increases greatly;
The 4th stage of diabetic nephrosclerosis is accompanied by renal failure and develops over several years.

The course of the disease allows us to distinguish the following types of nephrosclerosis:

benign;
malignant.

Benign nephrosclerosis takes a long time to develop. It takes a long time for the function of the artery to be impaired. First, a thickening of the inner layer occurs, which over time spreads to the entire thickness of the organ wall, causing blockage of the vessel. The development of the pathological process leads to deterioration of blood flow in the kidney, resulting in impaired renal function. Malignant nephrosclerosis is characterized by a more rapid development of processes, so timely diagnosis is important, which will help prevent changes in the kidney. The prognosis for benign sclerosis is much better.

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Causes of sclerotic kidney

Structural abnormalities of the kidneys can be a consequence of complications of diabetes, tuberculosis, and other inflammations of internal organs.

thromboembolism;
atherosclerosis;
hypertension.

The wrinkled organ in which the secondary lesion occurred is a consequence of other kidney pathologies:

tuberculosis;
nephropathy in pregnant women;
pyelonephritis;
amyloidosis;
glomerulonephritis;
injuries;
diabetes mellitus

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Pathological anatomy

Sclerotic pathology develops in 2 phases. At the first stage, it is important to determine the disease, which is the cause of sclerotic processes in the organ. At this point, the relationship is quite easy to find. At the second stage, this is much more difficult to do, sometimes unrealistic. Wrinkling occurs very quickly, covering more and more kidney tissue. In this case, the organ increases slightly, its surface becomes granular, many irregularities form, and tissue scarring begins. Sometimes the organ shrinks evenly, sometimes not.

The disease can develop in benign and malignant forms. With benign sclerosis of the kidney, individual groups of nephrons shrink, the process develops slowly. Connective tissues first replace the intermediate space, and then the atrophied zones. With malignant wrinkling, pathological changes occur faster, which worsens the prognosis. Necrosis of arterioles and capillary glomeruli develops, and many complications arise. Fatal outcome when not timely diagnosis- a common occurrence.

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Symptoms of the disease

Wrinkling of the kidneys is manifested by swelling, pressure surges, and frequent urge to go to the toilet.

In the initial stages, shriveled organs do not make themselves felt at all or the symptoms are mild. The problem can only be diagnosed by blood and urine tests, which show small changes in the functioning of the organ. The main symptoms appear at a late stage. The first symptoms are:

increased urination;
frequent urination;
the presence of protein in the urine;
high blood pressure;
swelling.

In addition, there are:

symptoms of damage to the heart and blood vessels;
Iron-deficiency anemia.

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Risk of kidney nephrosclerosis in a child

Sclerotic kidney damage in a child cannot be diagnosed. The development of pathological changes that lead to wrinkling is facilitated by prolonged exposure to unfavorable factors. If the baby has congenital pathologies kidneys and genitourinary system, the risk of developing nephrosclerosis increases, so it is important to carefully examine such children.

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Diagnostic methods

When a patient visits a doctor, the doctor first takes a history and visually examines the patient. After analyzing the symptoms of the disease, the specialist performs palpation abdominal cavity patient. All these methods make it possible to suggest a certain diagnosis and understand in what perspective to continue research.

Laboratory diagnostic methods:

blood biochemistry (an increase in the level of urea, creatine is observed, a decrease in protein in the later stages, sodium, magnesium, potassium, phosphorus may be increased);
complete blood count (hemoglobin and platelet levels are low);
general urinalysis (the protein in the urine is increased, the density of the substance decreases, red blood cells and casts are visualized, which should not be in the urine).

The diagnosis cannot be made without instrumental methods research:

Ultrasound (on the monitor during an ultrasound it can be seen that the size of the organ is less than normal, atrophy of the cortical substance is observed);
angiography of the vessels of the organ (the places of narrowing and deformation that have occurred in small vessels are visualized, the cortex becomes thinner, the contour of the organ changes);
excretory urography (iodine-containing substances are administered, so it is clear that the organ and its cortex are smaller than normal);
vascular Doppler (blood flow in nephrons and vessels is slower);
scintigraphy (it is clear that the isotope is not distributed evenly);
CT scan;
radionuclide renography;
biopsy and histological analysis of the biopsy sample (a macropreparation is used).

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Treatment options

Sclerotic changes begin to be treated only after diagnosis. If signs have not yet appeared and the disease is at an early stage, the patient may be prescribed treatment with the following medications:

Early deformations of the kidney structure can be stopped with pills, and later ones can only be stopped with surgery.

anticoagulants (for example, Heparin);
potassium preparations to normalize salt balance (for example, Asparkam);
antiplatelet agents that improve blood flow (for example, Trental);
multivitamins;
vitamin D;
iron supplements;
sorbents.

Medications are also used that help reduce blood pressure, but their use at a later stage, when the kidney has shriveled, is extremely undesirable:

calcium antagonists (for example, Verapimil);
diuretics (for example, Furosemide);
adrenergic receptor blockers (for example, Propranolol).

If renal sclerosis is diagnosed in the last stages, drug treatment is ineffective. The patient needs hemodialysis or surgical treatment. The essence of hemodialysis is that the blood of a patient whose kidneys have shriveled is passed through a special filter for an artificial kidney. This cleanses the blood of toxic substances and normalizes salt balance. The frequency of hemodialysis is determined by the patient’s condition and the degree of renal dysfunction. The procedure is accompanied by treatment with pharmaceuticals.

Surgical treatment for patients with kidney shrinkage is carried out through kidney transplantation. This is one of the few types of transplantation when an organ can be removed not only from a corpse, but also from a living person. At the same time, this is an extremely difficult operation. During the recovery period, the patient is recommended to rest completely and take medications that inhibit the defense mechanisms of the immune system. Signs of glomerulonephritis or kidney failure can sometimes be treated with hirudotherapy (leeches). Leeches are placed in the lumbar region in quantities of up to 8 pieces. The duration of the course of treatment is 7-12 times (5 procedures every other day, and the rest - once a week).

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Nutritional Features

A change in the parenchyma of the right or left kidney requires an indispensable change in nutrition. You need to eat small portions many times a day. The presence of protein should be limited. Among protein products, it is better to choose meat, dairy, dairy products, egg white. It is not recommended to eat cereals, potatoes or bread. The diet should include fish, as it is rich in phosphorus.

To prevent such a sign as edema, it is necessary to limit the amount of salt, but not completely abandon it. Nutrition should be rational. It should contain a lot of vitamins. The diet encourages the consumption of seaweed, buckwheat, nuts and mineral waters, which contain a lot of magnesium. If the patient has a secondary disease, it is necessary to drink up to 3 liters of water per day, which cannot be done if there are signs of problems with the heart or blood vessels.

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Traditional treatment

You can help your kidneys recover from nephrosclerosis with infusions and decoctions of natural ingredients.

Treatment with folk remedies cannot be the only type of therapy used. It is prohibited to use folk remedies without preliminary consultation doctor Healers say that the symptoms of the disease can be smoothed out using the following medications:

Birch juice;
infusion of lingonberry fruits;
infusion of alcohol from aspen buds;
a decoction of flaxseed (5 spoons), strawberry leaves (1 spoon), birch (2 spoons) and nettle (2 spoons) leaves;
licorice root in infusion.

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Prognosis for recovery

The diagnosis of nephrosclerosis implies different outcomes. Since this chronic pathology, in which remissions and exacerbations constantly occur, with compensation for the pathology of one kidney, dietary nutrition and following the recommendations of your doctor, you can reduce the number of attacks. In this case, the patient will lead a normal life and will not lose his ability to work. The prognosis for the outcome of malignant shrinkage of the kidney is not so favorable, since the nephrons die and renal failure develops. Usually the patient awaits permanent hemodialysis or transplantation. Failure to do this leads to death.

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Disease prevention

There are no special preventive measures that can prevent the kidney from shrinking. Doctors recommend sticking to proper nutrition, do not bring yourself to overexertion, rest. It's good to get enough sleep. An important point is to maintain an active lifestyle. You should monitor your blood pressure and promptly consult a doctor if you feel unwell.

Most people over forty suffer from a benign form of nephrosclerosis, which means that the blood vessels in the kidneys gradually change, but these changes do not occur as quickly and do not require treatment. For patients with benign nephrosclerosis, all that is required is to monitor their condition and take measures to prevent the progression of the disease. Other patients have a malignant form of nephrosclerosis, in which case damage to the renal vessels occurs so quickly that drug treatment or even surgical intervention is necessary.

Definition

Nephrosclerosis is the process of replacement of the renal parenchyma with connective tissue, which leads to thickening of the walls of arteries and arterioles in the kidneys. Such arteries cannot normally supply blood to the kidney, a disruption in the nutrition of the glomeruli and tubules occurs, and subsequently their death and replacement with connective tissue. The kidney decreases in volume (primarily shriveled kidney) and begins to lose its functions.

Pain in the lumbar region indicates possible problems with kidneys

Types of disease

Depending on the cause, there are two types of kidney nephrosclerosis:

primary, which occurs as a result of impaired blood supply to the kidneys in diseases and conditions such as atherosclerosis, hypertension, renal infarction, venous stasis in the kidneys, etc. Primary nephrosclerosis also often occurs due to senile changes in the body;
secondary, which develops against the background of existing kidney diseases (glomerulo- and pyelonephritis, kidney stones, tuberculosis, syphilis, renal amyloidosis, diabetes mellitus), as well as as a result of their injury, or exposure to ionizing radiation on the body.

Primary nephrosclerosis, in turn, is further divided into the following forms:

atherosclerotic;
involutive;
hypertensive.

Also, depending on the course of the process, there are:

benign nephrosclerosis, in which there is a gradual and long-term deterioration in the functions of the renal arteries. First, the inner layer of the walls of smaller vessels thickens and gradually this thickening spreads to the entire wall, sometimes blocking the central channel of the vessel. Fat is then deposited in the degenerated wall tissue. Large arteries have excess elastic tissue, which can block their channels. Both of these conditions cause disruption of blood flow to vital areas in the kidneys, which in turn leads to poor functioning of the kidney tissue;
malignant nephrosclerosis, in which the above changes develop much faster.

Causes

The cause of nephrosclerosis is a violation of the blood supply to the kidneys, which is the result of a narrowing of the lumen of its vessels. Hypoxia occurs, as a result of which atrophy and degeneration of the renal parenchyma and proliferation of connective tissue develop. Such processes are most often observed in the kidneys with atherosclerosis and hypertension. Also, nephrosclerosis can develop due to the development of inflammatory and dystrophic processes in the kidneys in diseases such as glomerulo- and pyelonephritis, diabetes mellitus, tuberculosis, syphilis, kidney stones, systemic lupus erythematosus, and renal amyloidosis.

Sometimes nephrosclerosis can be associated with age-related changes vascular system kidney

Symptoms

On initial stages nephrosclerosis symptoms are often absent. The first signs of kidney damage can be observed in urine tests, which will be characterized by poly- and nocturia, the presence of protein in the urine, microhematuria, decreased renal clearance, and hyposthenuria. Patients complain of increased blood pressure (diastolic blood pressure exceeds 120 mm Hg).

The main symptoms of kidney nephrosclerosis include:

visual impairment ;
blood in urine;
weight loss;
uremia (accumulation of urea and other nitrogenous compounds in the blood);
attacks of angina.

Diagnostic methods

First you need to properly collect anamnesis and analyze clinical picture. When diagnosing, they use laboratory methods, among which:

biochemical blood test, which reveals increased levels of urea, creatinine and uric acid, a decrease in total protein, and in the final stages an increase in potassium, magnesium, phosphorus and sodium;
general urine test, which reveals increased amount protein, a decrease in the relative density of urine, as well as the presence of red blood cells and casts that are absent normally;
a general blood test, which shows a decrease in hemoglobin and platelet levels.

Among the instrumental research methods that are effective are:

ultrasonography, in which a decrease in the size and function (atrophy) of the renal cortex is detected, as well as the presence of calcifications in the renal parenchyma;
excretory urography of the kidneys, which allows you to identify a decrease in the volume of the kidney and its cortex;
angiography of the renal vessels, which determines the narrowing and deformation of small renal arteries, uneven contour of the kidney, thinning of the renal cortex;
kidney scintigraphy, which reveals uneven distribution of the radioisotope in nephrosclerosis;
renal vascular Doppler, which detects slowing of blood flow in the renal vessels and nephrons;
radionuclide renography, which detects delayed accumulation and excretion of a radiopharmaceutical drug by the kidneys;
computed tomography of the kidneys;
kidney biopsy.

Treatment options

First you need to determine the cause and begin treatment causative disease. Therapy in the early stages involves drugs such as anticoagulants (heparin, warfarin), antiplatelet agents (pentoxifylline, trental, dipyridamole), which help improve renal blood supply. Drugs are also used to lower blood pressure, but in the later stages of nephrosclerosis they should be used with caution. These include ACE inhibitors(captopril, enalapril), calcium antagonists (verapamil, nifedepine), β-adrenergic receptor blockers (atenolol, propranolol), diuretics (furosemide, hypothiazide). Potassium preparations (asparkam, panangin) are also prescribed in order to eliminate salt imbalances. No less important are multivitamin preparations, iron supplements, and sorbents.

During development III-IV stages chronic renal failure, when drug treatment It is impossible to restore kidney function; hemodialysis or kidney transplantation are used. During hemodialysis, the blood of a patient with nephrosclerosis is passed through a special membrane in an artificial kidney apparatus, which cleanses the body of toxins and metabolic end products and normalizes the water-salt balance.

The frequency of hemodialysis procedures depends on the patient’s condition and the degree of functional activity of the kidneys. During hemodialysis, the patient is prescribed antihypertensive drugs, vitamins, potassium supplements and other medications.

Carrying out hemodialysis procedures for nephrosclerosis

A kidney transplant is a radical method that allows the patient to lead his usual lifestyle. A donor organ can be taken from a corpse or from a living donor (for example, from relatives with their consent). After kidney transplant surgery, patients are prescribed special medications that suppress the activity of the immune system to prevent rejection of the donor organ.

Doctor's note: you need to remember that a kidney transplant operation is extremely dangerous, since it can entail many complications such as bleeding, rejection of the transplanted kidney, and urological complications. Therefore, resorting to this method of treatment should only be used as a last resort.

If the patient has glomerulonephritis or chronic renal failure, they also resort to hirudotherapy (treatment with medicinal leeches). In this case, leeches are placed in the lumbar zone, sacral zone, lower abdominal and hepatic zones. Advantage is given to the lumbar area. During one session of hirudotherapy, from 2 to 8 leeches are used, depending on the severity of the patient’s condition. The course of treatment includes from 7 to 12 procedures, with the first 5 procedures carried out at intervals of a day, and the next 2 times a week.

Also used in the treatment of renal nephrosclerosis traditional medicine by preparing infusions from various medicinal herbs, for example:

It is recommended to drink birch sap, which cleanses the kidneys; alcohol infusion from aspen buds, take 30 drops diluted in a tablespoon of water before meals;
lingonberry infusion, for the preparation of which take 1 tablespoon of lingonberry fruits, 200 ml of boiled water, take 1 spoon 4 times a day;
infusion of strawberry leaves (10 g), birch (20 g), nettle (20 g) and flax seed (50 g). Take 100 ml 4 times a day before meals;
licorice infusion, which is prepared from 2 tsp. licorice and one and a half glasses of hot water. The infusion should be drunk in several doses throughout the day.

Features of nutrition in nephrosclerosis

For achievement maximum effects from treatment, you need to eat properly and rationally. When creating your diet, you must adhere to some rules, namely:

limit protein because it is a substrate for the production of urea. Among protein foods, preference should be given to poultry, rabbit, low-fat varieties beef, fish, dairy and sour-milk products, egg whites. You should exclude bread, cereals, and potatoes from your diet;
for patients with nephrosclerosis, the diet must include dairy and fish products, but you should not abuse them, as they contain a lot of phosphorus;
Limit salt as it increases swelling. In the early stages, up to 10-15 g of salt per day is allowed, in the later stages up to 3-7 g. But salt should not be completely abandoned, as this can lead to dehydration of patients; include foods rich in calcium and potassium in your diet; calcium is found in peas, beans, green vegetables, and whole grain flour. Foods such as raisins, dried apricots, bananas, and chocolate are rich in potassium. But in the later stages of nephrosclerosis, foods containing potassium should be limited;
nutrition should provide a sufficient amount of calories and vitamins;
You need to eat 4-5 times a day in small portions.

Doctor's opinion: in the initial stages of nephrosclerosis, when blood pressure is not elevated and there is no swelling yet, water may not be limited. But in the later stages, the volume of liquid should be no more than 800-900 ml per day.

An approximate menu for a patient with nephrosclerosis is as follows:

First breakfast: low-fat boiled fish, bread from sowings, butter, weak tea with lemon.

Lunch: buckwheat with milk, compote.

Lunch: vegetable soup, boiled lean meat (chicken, rabbit, turkey), baked potatoes, fruit juice.

Dinner: rice porrige with dried apricots, dried fruit compote. An hour before bedtime: crackers, jelly.

Forecast

Nephrosclerosis is chronic disease, which lasts for a long time with alternating periods of exacerbations and remissions. Therefore, with good compensation for the underlying disease, following the diet and doctor’s prescriptions, the patient will be able to reduce the number of periods of exacerbations and lead an active life. But a malignant course of nephrosclerosis is also possible, in which kidney function quickly deteriorates, nephrons die and chronic renal failure sets in, which in the future can only be compensated with the help of hemodialysis or kidney transplantation.

Prevention

There is no specific prevention of renal nephrosclerosis. The main methods to prevent the progression of the disease are to follow a diet, avoid physical and mental stress, get enough rest, constantly monitor blood pressure, and maintain an active lifestyle.

Kidneys are vital important bodies, without them our body would not be able to function. Therefore, you need to remember that when you take care of them, the frequency of exacerbations of the underlying disease that caused nephrosclerosis is reduced.

Renal nephrosclerosis is a pathology accompanied by the death of nephrons and replacement of parenchyma with connective tissue. Due to such pathological changes, the kidneys are not able to function successfully, clearing the blood of toxins and waste products.

Also, due to such pathological processes, the renal organ is significantly reduced, wrinkled, and subsequently provokes the occurrence of renal failure.

Nephrosclerosis of the kidney is a disease that, by medical standards, is quite “young”, since it was discovered at the beginning of the last century.

At the same time, it was tracked and scientifically proven close connection between two pathological processes, one of which is hypertension, and the second is renal vascular sclerosis.

Causes and classification of pathology

Depending on what causes the pathology, nephrosclerosis is classified into primary and secondary.

The primary form of nephrosclerosis of the kidney occurs against the background of impaired blood supply to the parenchyma, which is typical for those patients who are characterized by frequent increases in blood pressure, as well as those who have been diagnosed with atherosclerosis.

Nephrosclerosis of the kidneys

Also, the primary type of nephrosclerosis develops if the patency of the renal arteries is impaired; thrombosis and thromboembolism act as the cause of such disorders.

Blockage of the renal veins can be caused by renal infarction, as well as venous stasis. Poor circulation and, accordingly, the occurrence of nephrosclerosis are quite often diagnosed in older people.

Secondary nephrosclerosis occurs after damage to the renal organs by some other pathological processes. Most often, pathologies such as pyelonephritis, glomerulonephritis, amyloidosis, and diabetes mellitus act as provocateurs of nephrosclerosis.

Can provoke secondary nephrosclerosis negative impact ionizing radiation.

If for some reason the kidneys are injured, the patient after a short period of time may discover signs of nephrosclerosis.

Doctors classify primary nephrosclerosis of the kidney into three separate forms: involutive, hypertensive, atherosclerotic.

This disease is classified into two more types depending on the course of the pathological process.

Ultrasound angiography

If the functions of the renal veins are accompanied by persistent deterioration, but only gradual and rather slow, doctors point to a benign form of nephrosclerosis.

With benign nephrosclerosis, the walls of the renal arteries thicken, after which fat begins to accumulate near them, as a result of which the lumen of the renal veins decreases, the blood flow is practically blocked.

In this regard, the blood circulation of the kidneys is disrupted, as a result of which their functioning is seriously impaired. The malignant form of kidney nephrosclerosis develops rapidly, so the patient quickly begins to feel the corresponding symptoms and just as quickly needs emergency treatment.

Symptoms

With nephrosclerosis, symptoms, unfortunately, do not appear immediately, but only in the last stages of the pathological process. In this regard, patients often seek help from a doctor only when the disease has already become irreversible.

Nephrosclerosis can be detected during laboratory tests. Found in urine a large number of protein, signs of hematuria. The density of the urinary fluid is noticeably reduced. Also during the diagnostic process, polyuria and nocturia are detected.

Urine protein test

The process of polyuria is characterized by an excessive increase in the total volume of urine excreted; in most cases, the amount of daily urine exceeds two liters.

Nocturia is characterized by an increase in the number of urinary processes at night; a third of the daily urine excreted occurs during this period.

Patients are faced with the appearance of swelling, which at the very beginning appears only on the face, but later spreads to the entire body. The patient's condition begins to deteriorate, and due to renal ischemia, patients are additionally seriously worried about arterial hypertension.

Due to the fact that arterial hypertension is accompanied by a malignant nature, it is very difficult to respond to any medical therapy. For this reason, patients face some additional complications that pose health risks.

In particular, there may be coronary insufficiency, due to the fact that the left ventricle of the heart takes on increased loads.

Patients often become hostages to such dangerous concomitant pathologies as strokes.

Nephrosclerosis can cause vision problems. The pathology provokes retinal detachment, as well as swelling of the optic nerve papilla, and subsequently its complete atrophy, which leads to blindness.

Of course, another symptom of nephrosclerosis is pain concentrated in the lumbar region, which is characteristic of many kidney pathologies.

Diagnostics

In order to identify pathological processes and make a correct diagnosis, doctors refer the patient to diagnostic examination kidney

When carrying out diagnostic measures, laboratory tests of urine and blood are required.

Blood analysis

Nephrosclerosis is indicated by an increase in protein in the urinary fluid, the detection of red blood cells, and a decrease in urine density. When conducting biochemical analysis blood, on the contrary, a decrease in the amount of protein in the blood is detected.

An increase in the amount of urea and creatinine is also detected in the blood. If laboratory diagnostics carried out when the pathology has reached the last stages, an increase in the growth of magnesium is detected in the blood, as well as potassium, which is not excreted in the urine during urination.

When conducting a general blood test, the patient may notice a decrease in hemoglobin levels, along with an increase in the number of leukocytes, which is the main sign of poisoning of the body.

However, doctors are not limited to the results of laboratory tests only. The patient is also referred for instrumental diagnostics.

Ultrasound examination creates conditions so that the doctor can analyze the size of the renal cortex, examine salt deposits in the parenchyma, and also evaluate the functioning of the renal organs.

The patient may be referred for urography, during which images of the organ are taken, on the basis of which it is possible to identify changes in the size of the kidneys due to nephrosclerosis, as well as detect salt deposits.

Angiography

Angiography is another type of kidney diagnostics that focuses on assessing the renal veins and arteries. During its implementation, fractured arterial branches are revealed, which indicates the development of nephrosclerosis of the kidney.

To assess blood flow, Doppler of the renal vessels is used. X-rays demonstrate the functionality of the renal glomeruli and urinary tubules.

Computed tomography is accompanied by high information content, since thanks to its capabilities it is possible to obtain a holistic picture of the pathological changes in the organ. When it is carried out, it is possible to identify changes in the size of the kidneys, their contour, structure and condition of blood vessels.

To clarify the malignant or benign form of nephrosclerosis, the patient is recommended to undergo a kidney biopsy, which involves taking kidney tissue for analysis.

Medical assistance

For kidney nephrosclerosis, treatment is primarily aimed at eliminating the pathology or cause that triggered the onset of the disease.

If the root cause is not eliminated, it is impossible to hope for a cure for nephrosclerosis in the future. It is very important to develop a treatment plan that will help restore kidney function.

Diuretics

The patient must be prepared for a fairly long-term treatment, since a short course will not eliminate all the problems that have arisen.

Doctors prescribe medications that are aimed at preventing blood clots. Also shown medicines, the intake of which favors vasodilation.

Patients are prescribed diuretics to get rid of swelling. Due to the fact that nephrosclerosis is accompanied by arterial hypertension, doctors prescribe drugs that help lower blood pressure.

However, such drugs are prescribed very carefully. The urologist carefully calculates the exact dosage, since a sharp decrease in blood pressure can, on the contrary, negatively affect the patient’s health.

The issues of regulating the water-salt balance in the body must be considered. To maintain immunity, doctors recommend taking multivitamin complexes.

With nephrosclerosis, a wrinkled kidney is not able to function properly, as a result of which chronic renal failure occurs at the 3-4 stage of the pathology.

This dangerous kidney disease is characterized by the fact that breakdown products cannot be eliminated from the body. in a natural way. For this reason, the patient needs artificial blood filtration.

Such patients are prescribed hemodialysis with a frequency depending on the individual characteristics of the human body.

The only option to avoid hemodialysis is kidney transplantation.

In order to improve efficiency conservative treatment the patient is recommended to adhere to a special diet, as well as to maintain a correct daily routine, which should include sufficient time for rest.

Patients whose kidney function has been compromised should not engage in heavy physical labor.

So, nephrosclerosis is dangerous disease, if the patient ignores his treatment in the first stages of the development of the pathology. Only when strict observance With all the doctors’ prescriptions, it is possible to reduce the number of exacerbations that occur, increase the performance of the kidneys, restore their functioning, and, accordingly, avoid the occurrence of renal failure.

No kidney disease goes away without a trace; any pathological process in the kidney leads to damage and death of its structural and functional units - nephrons. The loss of single nephrons does not affect the function of the organ in any way. With the massive death of renal structures, they are replaced by connective tissue, and the function of the kidney is lost.

The process of replacing functioning nephrons with connective tissue is nephrosclerosis. This is not an independent disease, but a possible outcome of any pathological processes in the kidney. The outcome of nephrosclerosis is complete loss of function, reduction in size and ultimately shrinkage of the kidney. Sometimes doctors even replace the term “nephrosclerosis” with the concept of “wrinkled kidney”; in essence, they are the same thing.

Causes of nephrosclerosis

Atherosclerosis of the renal arteries will sooner or later lead to nephrosclerosis.

There are two forms of this pathology: primary and secondary wrinkled kidney.

Primary nephrosclerosis is caused by vascular damage and impaired blood supply to the renal tissue as a result of hypertension, atherosclerosis of the renal vessels and renal infarctions, and impaired venous outflow. The structure of the kidneys undergoes sclerotic changes with age; by the age of 70, the number of active renal structural units in the kidneys decreases by 30-40%.
Secondary form the disease occurs as a result of damage to the kidney parenchyma during prolonged glomerulonephritis, chronic pyelonephritis, urolithiasis, autoimmune processes, diabetes mellitus, amyloidosis, syphilis, kidney tuberculosis, severe nephropathy in pregnant women and organ trauma can lead to nephrosclerosis.

In recent decades, the main causes of this pathology are considered to be hypertension and diabetes mellitus, although literally 20 years ago glomerulonephritis was in the lead.

Main symptoms of nephrosclerosis

The disease can last for decades, with the deterioration of kidney function occurring gradually, and the symptoms initially do not bother patients much. A doctor is often consulted when edema appears, urination problems and signs of arterial hypertension appear. With such symptoms, changes in the kidneys are often irreversible, and the function of the organ is already significantly reduced.

Urinary dysfunction

This symptom includes polyuria (excessive urination - 2 liters per day or more) and nocturia (increased number and volume of urination at night).

In severe forms of nephrosclerosis, polyuria gives way to oliguria, when the amount of urine, on the contrary, sharply decreases. Anuria ( complete absence urine may indicate end-stage renal failure).

Also, an admixture of blood appears in the urine, and it turns the color of meat slop - this symptom is called gross hematuria.

Arterial hypertension

When the blood supply to the kidneys is disrupted, a protective mechanism is activated aimed at increasing the pressure in the renal vessels, as a result of which substances are released into the blood that increase the pressure throughout the bloodstream. With nephrosclerosis, arterial hypertension reaches very high values, hypertensive crises are possible with an increase in systolic pressure to 250-300 mm Hg. Art., and it is very difficult to reduce the pressure.

Edema

Fluid retention in the body leads to edema. They first appear on the face in the morning and go away after a while. Then they gradually go down, the fingers on the hands swell (patients note that they cannot take off the rings in the morning) and shins (can’t put on shoes, can’t fasten boots). As the disease progresses, swelling spreads throughout the body, and anasarca occurs - generalized swelling of subcutaneous fat, soft tissues, and in the worst case, internal organs.

Pulmonary edema (cardiac asthma) occurs as a result of overload of the heart due to the increased amount of fluid in the body. The result is heart failure and blood stagnation in the pulmonary capillaries. The patient experiences shortness of breath, cough, sweating, cyanosis (blue discoloration) is observed during the attack. skin), increased heart rate and breathing rate. Cardiac asthma is serious complication which, if left untreated, can be fatal.

Stages of nephrosclerosis

There are 2 periods in the development of this pathology:

In the first phase, there are no manifestations of nephrosclerosis, however, the patient has and may progress one or more diseases leading to the replacement of normal renal parenchyma with connective tissue. During this period, changes characteristic of kidney damage already appear in urine and blood tests.
Symptoms characteristic of nephrosclerosis, and, accordingly, renal failure, appear in the second stage of the process, when changes in the structure of the kidneys can be detected using ultrasound and other instrumental research methods.

Also, depending on the course of the pathological process, malignant and benign forms of nephrosclerosis are distinguished.

Fortunately, in the vast majority of patients, the second form of the disease occurs, in which the process progresses slowly; with successful treatment of the underlying disease, the progression of nephrosclerosis can be slowed down.

In a malignant course, nephrosclerosis progresses quickly and within a few years can lead to complete loss of kidney function, severe renal failure and doom the patient to lifelong hemodialysis. Such unfavorable outcome can be observed with malignant arterial hypertension and eclampsia in pregnant women.

Diagnosis of nephrosclerosis

With nephrosclerosis, corresponding changes will be detected in a general urinalysis.

Since the symptoms of a shriveled kidney appear in the later stages, it is very important to identify this pathology with the help of an examination as early as possible, since the effectiveness of treatment in this case will be much higher. Taking the patient's medical history plays an important role.

General urine analysis. Any examination of the kidneys, of course, begins with a urine test; with initial nephrosclerosis, following deviations from the norm: a decrease in the relative density of urine, the appearance of protein, single red blood cells and casts.
Blood tests. In a clinical blood test, a decrease in the level of hemoglobin and platelets is possible. In biochemical – a decrease in the amount of total protein, an increase in the level of urea, creatinine, uric acid and sodium. An increase in glucose and cholesterol levels should alert you.

Such changes in urine and blood tests are very nonspecific and can be observed not only in kidney diseases. However, the combination of such deviations in the results of laboratory tests, in the presence of a history of factors that can lead to kidney damage, forces the doctor to think about further diagnosis.

For examination, many instrumental methods are used, such as ultrasound, excretory urography (x-ray of the kidneys with contrast agent), angiography, computed tomography, radioisotope studies, etc. All of them reveal a decrease in the size of the kidney, the presence of calcium deposits, impaired blood flow in the renal vessels and other changes indicating the proliferation of connective tissue. A biopsy can give an accurate answer about the condition of the renal parenchyma.

Treatment of nephrosclerosis

There is no specific therapy aimed at treating nephrosclerosis. It is necessary to treat the disease, which has led to kidney damage and death of nephrons, followed by their replacement with connective tissue. That is why not only a nephrologist, but also a specialized specialist treats patients with nephrosclerosis.

In addition to therapy aimed at treating the underlying disease, patients must follow a diet. It is recommended to limit the amount of protein and table salt; the diet should contain enough vitamins and mineral salts. In the absence of arterial hypertension and edema, fluid and protein restriction is not required.

At terminal stage renal failure, when both kidneys have lost their functions, hemodialysis is indicated for patients. The only way out in this situation is a kidney transplant; in recent years, this operation has been successfully carried out in Russia, and for citizens of our country it is free.

Which doctor should I contact?

A nephrologist treats kidney diseases and their complications, in particular nephrosclerosis and renal failure. If necessary, consultations with other specialists are prescribed: a cardiologist (if high blood pressure), endocrinologist (for diabetes), vascular surgeon (for atherosclerosis of the renal artery), urologist (for urolithiasis), infectious disease specialist (for suspected kidney tuberculosis). You can get a referral for a kidney examination by contacting your general practitioner with relevant complaints.

The term “renal nephrosclerosis” refers to a pathology that occurs due to the replacement of the renal parenchyma with connective tissues. There are several types of disease that occur for various reasons. Symptoms increase as the disease progresses. This affects the methods of treating pathology. There are no special preventive measures. Predicting the course depends on many factors, the main one of which is the benignity or malignancy of the disease.

A pathological phenomenon is the process of overgrowing of the kidney parenchyma with connective tissue.

General information

The disease was first diagnosed in the early 20th century. The cause of the development of nephrosclerosis is the replacement of the organ parenchyma with connective tissue, causing the kidney to become denser and wrinkled. Another name for the disease is “shrunken kidney.” This leads to deterioration in the functioning of the organ. Previously, it was believed that the disease was provoked, but now experts are inclined to believe that the main causes of the development of kidney nephrosclerosis are diabetes mellitus and arterial hypertension. Statistics say that the disease is diagnosed in every 6 people out of 10 thousand.

Types and forms

Due to its formation, a wrinkled kidney is classified into 2 types:

primary wrinkled kidney (the blood supply to the organ deteriorates due to atherosclerosis, hypertension, or age-related changes that develop in older people);
secondary wrinkled kidney (results from organ trauma, radiation or other kidney pathologies, for example, pyelonephritis or tuberculosis).

Primary renal sclerosis occurs:

hypertensive;
involutive;
diabetic;
atherosclerotic.

With diabetic nephrosclerosis, microangiopathies develop, which lead to complete damage to the organ. Pathology develops in 4 stages:

1st - not accompanied by pronounced symptoms;
2nd (prenephrotic) - characterized by slightly increased blood pressure and changes in blood formulas, which are reflected in the results of general and biochemical tests;
3rd (nephrotic) - swelling appears and blood pressure increases greatly;
The 4th stage of diabetic nephrosclerosis is accompanied by renal failure and develops over several years.

The course of the disease allows us to distinguish the following types of nephrosclerosis:

benign;
malignant.

Causes of sclerotic kidney

Structural abnormalities of the kidneys can be a consequence of complications of diabetes, tuberculosis, and other inflammations of internal organs.

thromboembolism;
atherosclerosis;
hypertension.

The wrinkled organ in which the secondary lesion occurred is a consequence of other kidney pathologies:

tuberculosis;
pyelonephritis;
amyloidosis;
glomerulonephritis;
injuries;
diabetes mellitus

Pathological anatomy

Symptoms of the disease

Wrinkling of the kidneys is manifested by swelling, pressure surges, and frequent urge to go to the toilet.

increased urination;
frequent urination;
the presence of protein in the urine;
high blood pressure;
swelling.

In addition, there are:

symptoms of damage to the heart and blood vessels;
Iron-deficiency anemia.

Risk of kidney nephrosclerosis in a child

Sclerotic kidney damage in a child cannot be diagnosed. The development of pathological changes that lead to wrinkling is facilitated by prolonged exposure to unfavorable factors. If a baby has congenital pathologies of the kidneys and genitourinary system, the risk of developing nephrosclerosis increases, so it is important to carefully examine such children.

Diagnostic methods

When a patient visits a doctor, the doctor first takes a history and visually examines the patient. After analyzing the symptoms of the disease, the specialist palpates the patient’s abdominal cavity. All these methods make it possible to suggest a certain diagnosis and understand in what perspective to continue research.

Laboratory diagnostic methods:

The diagnosis cannot be made without instrumental research methods:

Ultrasound (on the monitor during an ultrasound it can be seen that the size of the organ is less than normal, atrophy of the cortical substance is observed);
angiography of the vessels of the organ (the places of narrowing and deformation that have occurred in small vessels are visualized, the cortex becomes thinner, the contour of the organ changes);
excretory urography (iodine-containing substances are administered, so it is clear that the organ and its cortex are smaller than normal);
vascular Doppler (blood flow in nephrons and vessels is slower);
scintigraphy (it is clear that the isotope is not distributed evenly);
CT scan;
radionuclide renography;
biopsy and histological analysis of the biopsy sample (a macropreparation is used).

Treatment options

potassium preparations to normalize salt balance (for example, Asparkam);

antiplatelet agents that improve blood flow (for example, Trental);

multivitamins;

vitamin D;

iron supplements;

sorbents.

Medications are also used that help reduce blood pressure, but their use at a later stage, when the kidney has shriveled, is extremely undesirable:

calcium antagonists (for example, Verapimil);
diuretics (for example, Furosemide);
adrenergic receptor blockers (for example, Propranolol).

In late stages of the disease, a kidney transplant is indicated

During the recovery period, the patient is recommended to take complete rest and use medications that inhibit the defense mechanisms of the immune system. Signs of glomerulonephritis or kidney failure can sometimes be treated with hirudotherapy (leeches). Leeches are placed in the lumbar region in quantities of up to 8 pieces. The duration of the course of treatment is 7-12 times (5 procedures every other day, and the rest - once a week).

Most people over forty suffer from a benign form of nephrosclerosis, which means that the blood vessels in the kidneys gradually change, but these changes do not occur as quickly and do not require treatment. For patients with benign nephrosclerosis, all that is required is to monitor their condition and take measures to prevent the progression of the disease. Other patients have a malignant form of nephrosclerosis, in which case damage to the kidney vessels occurs so quickly that drug treatment or even surgery is necessary.

Definition

Pain in the lower back indicates possible kidney problems

Types of disease

Depending on the cause, there are two types of kidney nephrosclerosis:

primary, which occurs as a result of impaired blood supply to the kidneys in diseases and conditions such as hypertension, renal infarction, venous congestion in the kidneys, etc. Primary nephrosclerosis also often occurs due to senile changes in the body;
secondary, which develops against the background of existing kidney diseases (glomerulo- and pyelonephritis, kidney stones, tuberculosis, syphilis, renal amyloidosis, diabetes mellitus), as well as as a result of their injury, or exposure to ionizing radiation on the body.

Primary nephrosclerosis, in turn, is further divided into the following forms:

atherosclerotic;
involutive;
hypertensive.

Also, depending on the course of the process, there are:

benign nephrosclerosis, in which there is a gradual and long-term deterioration in the functions of the renal arteries. First, the inner layer of the walls of smaller vessels thickens and gradually this thickening spreads to the entire wall, sometimes blocking the central channel of the vessel. Fat is then deposited in the degenerated wall tissue. Large arteries have excess elastic tissue, which can block their channels. Both of these conditions cause disruption of blood flow to vital areas in the kidneys, which in turn leads to poor functioning of the kidney tissue;
malignant nephrosclerosis, in which the above changes develop much faster.

Causes

Sometimes nephrosclerosis can be associated with age-related changes in the renal vascular system.

Symptoms

In the initial stages of nephrosclerosis, there are often no symptoms. The first signs of kidney damage can be observed in urine tests, which will be characterized by poly- and nocturia, the presence of protein in the urine, microhematuria, decreased renal clearance, and hyposthenuria. Patients complain of increased blood pressure (diastolic blood pressure exceeds 120 mm Hg).

The main symptoms of kidney nephrosclerosis include:

visual impairment ;
weight loss;
uremia (accumulation of urea and other nitrogenous compounds in the blood);
attacks of angina.

Diagnostic methods

First you need to correctly collect anamnesis and analyze the clinical picture. Laboratory methods are also used for diagnosis, including:

, in which increased levels of urea, creatinine and uric acid are detected, a decrease in total protein, and in the final stages an increase in potassium, magnesium, phosphorus and sodium;
a general urinalysis, which reveals an increased amount of protein, a decrease in the relative density of urine, as well as the presence of red blood cells and casts that are absent normally;
a general blood test, which shows a decrease in hemoglobin and platelet levels.

Among the instrumental research methods that are effective are:

ultrasound examination, which reveals a decrease in the size and function (atrophy) of the renal cortex, as well as the presence of calcifications in the renal parenchyma;
excretory urography of the kidneys, which allows you to identify a decrease in the volume of the kidney and its cortex;
angiography of the renal vessels, which determines the narrowing and deformation of small renal arteries, uneven contour of the kidney, thinning of the renal cortex;
kidney scintigraphy, which reveals uneven distribution of the radioisotope in nephrosclerosis;
renal vascular Doppler, which detects slowing of blood flow in the renal vessels and nephrons;
radionuclide renography, which detects delayed accumulation and excretion of a radiopharmaceutical drug by the kidneys;
computed tomography of the kidneys;
kidney biopsy.

Treatment options

First you need to determine the cause and begin treatment of the causative disease. Therapy in the early stages involves drugs such as anticoagulants (heparin, warfarin), antiplatelet agents (pentoxifylline, trental, dipyridamole), which help improve renal blood supply. Drugs are also used to lower blood pressure, but in the later stages of nephrosclerosis they should be used with caution. These include ACE inhibitors (captopril, enalapril), calcium antagonists (verapamil, nifedepine), β-adrenergic receptor blockers (atenolol, propranolol), diuretics (furosemide, hypothiazide). Potassium preparations (asparkam, panangin) are also prescribed in order to eliminate salt imbalances. No less important are multivitamin preparations, iron supplements, and sorbents.

With the development of stage III-IV chronic renal failure, when it is impossible to restore kidney function with drug treatment, hemodialysis or kidney transplantation are used. During hemodialysis, the blood of a patient with nephrosclerosis is passed through a special membrane in an artificial kidney apparatus, which cleanses the body of toxins and metabolic end products and normalizes the water-salt balance.

Carrying out hemodialysis procedures for nephrosclerosis

Doctor's note: you need to remember that a kidney transplant operation is extremely dangerous, since it can entail many complications such as bleeding, rejection of the transplanted kidney, and urological complications. Therefore, resorting to this method of treatment should only be used as a last resort.

In the treatment of kidney nephrosclerosis, traditional medicine is also used, preparing infusions from various medicinal herbs, for example:

It is recommended to drink birch sap, which cleanses the kidneys; alcohol infusion from aspen buds, take 30 drops diluted in a tablespoon of water before meals;
lingonberry infusion, for the preparation of which take 1 tablespoon of lingonberry fruits, 200 ml of boiled water, take 1 spoon 4 times a day;
infusion of strawberry leaves (10 g), birch (20 g), nettle (20 g) and flax seed (50 g). Take 100 ml 4 times a day before meals;
licorice infusion, which is prepared from 2 tsp. licorice and one and a half glasses of hot water. The infusion should be drunk in several doses throughout the day.

Features of nutrition in nephrosclerosis

To achieve maximum effects from treatment, you need to eat properly and rationally. When creating your diet, you must adhere to some rules, namely:

limit protein because it is a substrate for the production of urea. Among protein foods, preference should be given to poultry, rabbit, lean beef, fish, dairy and fermented milk products, and egg whites. You should exclude bread, cereals, and potatoes from your diet;
for patients with nephrosclerosis, the diet must include dairy and fish products, but you should not abuse them, as they contain a lot of phosphorus;
Limit salt as it increases swelling. In the early stages, up to 10-15 g of salt per day is allowed, in the later stages up to 3-7 g. But salt should not be completely abandoned, as this can lead to dehydration of patients; include foods rich in calcium and potassium in your diet; calcium is found in peas, beans, green vegetables, and whole grain flour. Foods such as raisins, dried apricots, bananas, and chocolate are rich in potassium. But in the later stages of nephrosclerosis, foods containing potassium should be limited;
nutrition should provide a sufficient amount of calories and vitamins;
You need to eat 4-5 times a day in small portions.

Doctor's opinion: in the initial stages of nephrosclerosis, when blood pressure is not elevated and there is no swelling yet, water may not be limited. But in the later stages, the volume of liquid should be no more than 800-900 ml per day.

An approximate menu for a patient with nephrosclerosis is as follows:

First breakfast: low-fat boiled fish, fresh bread, butter, weak tea with lemon.

Second breakfast: buckwheat porridge with milk, compote.

Lunch: vegetable soup, boiled lean meat (chicken, rabbit, turkey), baked potatoes, fruit juice.

Dinner: rice porridge with dried apricots, dried fruit compote. An hour before bedtime: crackers, jelly.

Forecast

Nephrosclerosis is a chronic disease that lasts a long time with alternating periods of exacerbations and remissions. Therefore, with good compensation for the underlying disease, following the diet and doctor’s prescriptions, the patient will be able to reduce the number of periods of exacerbations and lead an active life. But a malignant course of nephrosclerosis is also possible, in which kidney function quickly deteriorates, nephrons die and chronic renal failure sets in, which in the future can only be compensated with the help of hemodialysis or kidney transplantation.

Prevention

Kidneys are vital organs; without them, our body would not be able to function. Therefore, you need to remember that when you take care of them, the frequency of exacerbations of the underlying disease that caused nephrosclerosis is reduced.

Nephrosclerosis is a kidney disease chronic course, characterized by increased proliferation of connective tissue in. As a result of this pathological process, the kidneys become denser, changing their structure and shape.

Patients have questions about what it is and how such a malfunction occurs in the body. Outwardly, it looks as if the kidney is wrinkled. Without adequate medical intervention the patient is at risk of developing.

Reasons for the development of pathology

Kidney shrinkage can be primary or secondary. This is what determines the causes of the development of this disease. It must be borne in mind that a wrinkled kidney is not an independent isolated diagnosis; it is a complication concomitant diseases. Nephrosclerosis in this case represents a late stage of these concomitant pathologies.

There are 2 forms: primary and secondary wrinkled bud. Regardless of what causes nephrosclerosis, the outcome is the same - they experience a deficiency in oxygen and nutrition, so the organs atrophy, decreasing in volume, losing their viability. In place of the kidney tissue, connective tissue grows and scars form.

A primarily wrinkled kidney is the result of impaired blood supply to the kidneys; it is caused by vascular damage. The reasons for this process must be sought in the following:

Chronic hypertension causes the kidney vessels to lose their elasticity, causing them to spasm and narrow. As a result, the blood supply to the kidney is disrupted. Hypertensive nephrosclerosis has 2 variants of its course: benign and malignant.
Renal infarction—the lumen of the renal artery becomes blocked by a blood clot or embolus and, accordingly, narrows. This, in turn, leads to a decrease in blood flow and the death of healthy areas of kidney tissue.
Atherosclerosis. Atherosclerotic plaques, which occur during atherosclerosis, are deposited on the walls of the renal arteries, preventing normal blood flow in them.
Age-related changes – after 50 years, the walls of the arteries thicken, leading to a narrowing of their lumen. This process is the result of calcium deposits on the inner walls of the arteries.
Venous congestion of the kidneys – this condition prevents the outflow of venous blood from the kidneys, as a result of which excess protein deposits on the walls of the vessels.

Secondary processes of kidney shrinkage develop as a result of damage to the parenchyma - renal tissue. The following violations can lead to this:

diabetes;
pyelonephritis;
nephrolithiasis;

Forms of manifestation of the disease

Regardless of the cause of the development of nephrosclerosis, it has general symptoms and signs. The death of nephrons in the disease under consideration occurs gradually, affecting individual areas. Therefore, the process of kidney shrinkage has a long course, depending on what caused the disease, whether treatment was carried out, and whether the patient adhered to a diet.

The first thing a person should pay attention to and suspect kidney pathology are the symptoms associated with urinary disorders. They are expressed in the following manifestations:

excessive formation and excretion of urine (more than 2 liters per day) or;
frequent urination at night or;
when as a result of the disease most (90%) of nephrons die;
with the death of 70% of nephrons, they appear, i.e., the total volume of daily urine decreases;
the presence of blood in the urine.

In addition, with nephrosclerosis the following symptoms are observed::

increased blood pressure;
increased swelling;
visual impairment;
headache;
tendency to bleed;
interruptions in heart function.

In nephrosclerosis, blood pressure is considered elevated if it exceeds 140/90 mmHg. The patient is also worried about constant nagging pain in the lumbar region.

Swelling occurs as a result of sodium and water retention in the body against the background of a decrease in protein levels, as it is excreted along with urine. Symptoms associated with cardiac dysfunction are caused by a prolonged increase in blood pressure and fluid retention in the body. All this leads to increased stress on the heart.

Kidney nephrosclerosis is not detected in a child, since this disease is characterized by a long course, when for a long time the body is affected by unfavorable factors.

However, if children have congenital defects of the urinary organs, then they are at risk for developing this pathology and need regular examination.

Methods for detecting renal pathology

For effective treatment Kidney nephrosclerosis in a child requires timely diagnosis. However, it is complicated due to the appearance of pronounced symptoms only in the later stages. Therefore, the patient’s treatment occurs late. The outcome in such cases is negative. Kidney nephrosclerosis is diagnosed using laboratory and instrumental methods. The first include:

Blood chemistry. Renal dysfunction is determined by increased level urea, creatinine and uric acid. In addition, it decreases total protein. In the last stages of the disease, the levels of magnesium, phosphorus and sodium increase.
. The disease is determined by increased content protein and the appearance of red blood cells in the urine. At the same time it decreases.
General blood analysis. With nephrosclerosis, the level of hemoglobin and platelets decreases.

Using instrumental methods, not only the kidneys, but also its vessels are examined. One of the common diagnostic procedures is ultrasound examination. On ultrasound, doctors identify such signs of nephrosclerosis as atrophy of the renal cortex, calcium deposition in the renal tissue and lack of separation between the renal cortex and medulla.

To detect nephrosclerosis, X-ray examination methods are performed, such as excretory urography of the kidney and angiography of the kidney vessels. In both cases, the administration of a contrast agent is necessary.

Capable of improving renal blood flow. These are anticoagulants and antiplatelet agents. It is advisable to prescribe such drugs in the early stages of the disease, since in the future they will only increase bleeding.
Lowering blood pressure. In the last stages of the disease, drugs of this type must be prescribed with caution, as they can cause deterioration of blood flow in the kidneys.
Restoring salt balance are potassium preparations that are designed to normalize not only the acid-base balance of the blood, but also heartbeat. Their appointment must be preceded by an analysis to determine the level of potassium in the blood.
Multivitamins are designed to improve and speed up metabolic processes.
Increasing hemoglobin levels. For this purpose, iron and erythropoietin preparations are prescribed.
Sorbents and herbal preparations to remove toxins from the body.

Treatment medicines Is it effective in the initial stages of the disease? But when nephrosclerosis reaches stage 3–4, restoring kidney function in this way becomes impossible. The outcome of the disease for the patient is ambiguous. In this case, hemodialysis or a kidney transplant is required.