How to treat kidney nephrosclerosis. Nephrosclerosis: features of the clinical picture and therapy

A disease such as nephrosclerosis has remained unattended by doctors for a long time. Until the 19th century, there was no complete description of it. It began to be considered an independent disease only three decades later, when information about the etiology appeared. The disease was associated with damage to arterial vessels due to their damage by cholesterol. His prognosis is not always favorable. After a course of therapy, many patients have to deal with complications such as blindness and ventricular dysfunction. To maintain the vitality of the body, in such cases, urgent blood purification is required artificially.

Anatomical information: renal nephrosclerosis

If you suspect an illness, you should seek help from such a center or a local physician. The latter, after studying the clinical picture, can give a referral to a specialist.

Diagnosis of the disease begins with a study of the patient’s complaints, his medical history and physical examination. During the consultation, the nephrologist may also palpate the abdominal cavity. The listed manipulations allow us to suggest a preliminary diagnosis and outline further examination tactics.

At the next stage, the patient is prescribed laboratory tests. For example, blood biochemistry may indicate the following symptoms of kidney dysfunction:

increase in performance;
reduction in quantitative protein content;
a decrease in potassium levels, and an increase in phosphorus and magnesium.

A urine test reveals protein and red blood cells, but its density is significantly reduced. When examining a blood test, it turns out that the level of platelets and hemoglobin falls, and the quantitative content of leukocytes increases.

To more accurately assess the functioning of organs, they resort to instrumental methods of examining patients diagnosed with nephrosclerosis. Ultrasound of the kidneys, for example, allows you to assess their size and the condition of the cortex. Urography is mandatory. Angiography gives a complete picture of the condition of the vessels in the affected organ.

Based on the examination results, the doctor confirms or refutes the preliminary diagnosis and makes recommendations for further treatment.

Use of medications

This disease is treated in specialized nephrology centers. It comes down to eliminating the main provoking factor. Attempts to restore lost kidney function without the first step are usually unsuccessful.

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

Anticoagulants (Heparin) to prevent blood clots.
Medicines to lower blood pressure.
ACE inhibitors (Diroton, Berlipril) to dilate the blood vessels of the kidneys.
Diuretics, which remove excess fluid from the body.
Calcium antagonists that promote dilation of arteries (Falipamil).
Multivitamin complexes.

For other disorders caused by kidney dysfunction, medications are selected individually.

Surgery

At stages 3-4 of the pathological process, drug treatment is usually ineffective. In such cases, the patient is indicated for hemodialysis or a transplant. The essence of the first procedure is to cleanse the blood of toxic substances. For this, a special artificial kidney filter is used. The frequency of hemodialysis is determined by the patient’s condition and the severity of the pathological process. The procedure must be accompanied by drug therapy.

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

Nutritional Features

An excellent addition to the course of treatment is to follow a fairly strict diet. Nutrition for kidney nephrosclerosis is selected by the doctor individually for each patient. Typically, the following principles are followed:

Limit protein intake. However, you cannot completely abandon it. When choosing protein foods, preference should be given to poultry, fish and dairy products. It is important to completely exclude potatoes, cereals and bread from the diet.
The diet must necessarily include seafood, but you should not abuse them due to their high phosphorus content.
Limiting table salt consumption. At any consultation, the nephrologist will say that at stages 1-2, up to 15 g of salt per day is allowed, and at stages 3-4 this amount is halved. You cannot completely abandon this spice, as the likelihood of dehydration increases.
Be sure to include potassium-rich foods in your diet. For example, bananas, dried apricots, raisins.
Nutrition should be as balanced as possible, containing the required amount of calories and vitamins.

Most patients are forced to adhere to this diet for the rest of their lives.

Forecast

Renal nephrosclerosis is a chronic disease. In the initial stages of its development, it is possible to maintain organ functions, but for this it is necessary to follow the doctor’s recommendations and adhere to certain restrictions. For example, for patients with this diagnosis, it is important to minimize the consumption of table salt and constantly monitor calcium and phosphorus levels in the blood. With each exacerbation of the pathology, it is necessary to seek medical help and undergo a course of therapy each time.

A “wrinkled kidney” identified at stages 3-4 requires a slightly different approach. In this case, all restrictions are much stricter. It is no longer possible to restore lost organ tissue. Therefore, in such situations, therapy comes down to ensuring the functionality of the remaining nephrons. Sometimes this is not enough.

Everyone knows that the kidneys are a vital organ that cannot be removed when a disease occurs, such as the gallbladder, stomach or appendix. Everyone is usually a little aware of kidney inflammation or kidney cancer. But what is nephrosclerosis, its symptoms, why is it dangerous, why does it develop and is treatment possible?

Nephrosclerosis is a pathological condition in which kidney tissue is gradually replaced by connective tissue (tissue similar to scar). With the development of nephrosclerosis, the kidneys slowly cease to perform their functions. Also, when they talk about nephrosclerosis, they often use the phrase “wrinkled kidney.” These are synonyms.

Kidney functions:

filtering, separating and concentrating

The kidneys continuously filter the blood plasma and remove harmful substances from it (mainly the breakdown products of proteins and fats - nitrogenous compounds), excess salts, water and glucose.

In case of intoxication (alcohol, drugs, medication), toxins are eliminated primarily through the kidneys. Therefore, if a lot of time has passed after taking drugs or excess alcohol, then rinsing the stomach no longer makes sense. Toxins have already been absorbed into the blood and gradually enter the kidneys.

ion-regulating

Blood plasma is filtered through the kidney tubules twice before being converted into urine. During filtration, the body retains all the necessary ions (microelements), and removes excess and harmful ones.

exchange (metabolic)

In the kidney, substances are not only filtered and “sorted,” but also produced and destroyed. In the kidneys, gluconeogenesis occurs (the production of glucose from proteins and amino acids), the conversion of amino acids (glycine is converted to serine, and so on) and protein hormones are destroyed.

hormonal and hematopoietic

The kidneys produce several hormones or hormone-like substances, the most active of which are:

Erythropoietin is a substance that stimulates the production of red blood cells (RBCs) in the bone marrow. When its production is insufficient, a person develops anemia.
Renin – controls intrarenal and general blood pressure.
Calcitriol – together with vitamin D, is responsible for the absorption and metabolism of calcium in the body.
Prostaglandins are multifunctional molecules that regulate the level of inflammation in the body, blood pressure and vascular tone.

Types of nephrosclerosis

Primary wrinkled kidney (in this case, the renal vessels are first affected)
- hypertension
- atherosclerosis
- kidney infarction
Secondary wrinkled kidney (kidney tissue is initially affected):
- pyelonephritis
- urolithiasis
- glomerulonephritis
- kidney tuberculosis
- diabetes mellitus

Nephrosclerosis in arterial hypertension or hypertensive nephrosclerosis

Arterial hypertension is a vascular disease, often hereditary and characterized by an increase in blood pressure above 140/90 mmHg. and hypertensive crises. A hypertensive crisis is a sharp increase in blood pressure, the numbers can vary from 150/90 mmHg. up to 230/140 and more. Constantly increased pressure gradually “wears out” the blood vessels. The impact occurs on absolutely all vessels, but today we are talking about the kidneys. The renal vessels, experiencing constant “bursting” from the inside, become more rigid. The wall becomes less elastic and does not allow plasma to pass through it for filtration.

Thus, the kidneys do not receive enough material to filter, and there is less urine.

Hypertensive crises are a sharp hemodynamic shock to the walls of blood vessels. This condition has a bad effect on all blood vessels, but especially pronounced manifestations in those organs that have already been provoked previously (there was a stroke, surgery on the kidney or heart, and so on).

With a sharp rise in blood pressure, the vessels in the kidneys are maximally spasmed, and the longer the pressure is not reduced, the worse.

We hope that we have informed you enough about hypertension and how dangerous it is for the kidneys and other organs. Some patients do not take hypertension into account when interviewed. We ask about chronic diseases and hear: “I’m not sick with anything.”

Is the pressure rising?
- Yes, the pressure is jumping
What numbers does it rise to?
- And it happens up to 200. Doctor, but I have a problem with urination, I have little urine. What does pressure have to do with it?

This is a very, very common opinion of patients who take blood pressure pills from time to time. And then we understand that kidney complications are already irreversible.

Atherosclerotic nephrosclerosis

Common atherosclerosis is the disease of the century. Along with diabetes, these conditions are considered a non-infectious epidemic of the 20th century. Atherosclerosis is the deposition of dense cholesterol plaques on the inner walls of blood vessels, which over time thicken, grow and turn from fatty cholesterol into fibrosis. Fibrosis is dense, inelastic tissue, like scar tissue.

Firstly, the cholesterol “plaques” themselves narrow the lumen in the vessel and make it more difficult for the blood to reach any organ.
Secondly, these “plaques” cause constant, low-grade inflammation in the vessel, which activates the coagulation system. As a result, blood clots form on the surface of the cholesterol buildup.

The blood clots grow and at some point break off and float with the blood flow wherever they go.

All these facts indicate that we create many problems for ourselves completely on our own through poor nutrition, eating fast food, leading a sedentary lifestyle and not turning to doctors for preventive measures.

Vessels narrowed by atherosclerosis allow less blood to pass to the kidney, and less urine is filtered. Also, not only the “delivery of working material” to the kidney suffers, but also the nutrition of the kidney itself. The mechanism itself is similar in hypertensive and atherosclerotic nephrosclerosis. In both cases, the vessels are narrowed, dense, and poorly permeable.

Kidney infarction

Advanced hypertension with frequent crises, widespread atherosclerosis with the formation of blood clots, and a congenital tendency to form blood clots (thrombophilia) can lead to a blood clot entering the kidney. In the place where the blood clot hits, blood circulation stops and the tissue becomes necrotic and dies. This area is then replaced by scar tissue and never functions as a kidney again. The larger this area, the worse the prognosis for further developments.

Secondary nephrosclerosis

Nephrosclerosis as a result of chronic pyelonephritis

Pyelonephritis is an inflammatory disease of the kidney and renal pelvis. Caused by bacteria, less commonly viruses and fungi. Pyelonephritis occurs, occurs in a fairly mild form, does not worsen for a long time or does not recur at all after one acute episode. In this case, we are talking about pyelonephritis with an early onset (in childhood, at school age), frequent exacerbations (1-2 times a year or more often, usually in spring and/or autumn) and a rapid course of exacerbations.

During an exacerbation, we observe high temperature (increases in the evening, maybe up to 40-41 C), lower back pain of varying severity, difficulty urinating and inflammation according to blood and urine tests.

Each such inflammation leaves tiny scars on the kidney tissue. And the more often a person gets sick, the more the delicate kidney tissue is replaced by rough scar tissue.

The scar tissue is dense and cannot perform the functions of the kidneys. The kidneys decrease in size (shrink) and gradually lose their functions.

Nephrosclerosis with glomerulonephritis

Glomerulonephritis is an immune-mediated kidney disease. Both kidneys are affected at once, unlike pyelonephritis, where there may be a one-sided process. In this disease, the kidney tissue is attacked by its own immune cells and proteins.

This happens after a sore throat or another streptococcal infection. The body produced antibodies against bacteria, but these same antibodies began to affect the kidneys.

Immune inflammation also leads to wrinkling and “drying out” of the kidneys, just like infectious inflammation.

Sclerosis develops at the site of inflammation. The diagnosis indicates the type of sclerosis: segmental (partial) or total (completely) and the percentage of renal tissue that is affected by sclerosis. For example, total nephrosclerosis is 5%, segmental – 25%.

Nephrosclerosis due to urolithiasis

Urolithiasis (UCD) is the formation of salt and mixed deposits of varying sizes in all parts of the urinary system. Stones in the ureters and below (in the bladder, urethra) threaten pain and blood in the urine (renal colic). This condition is difficult to miss; patients usually go straight to the hospital. But stones in the kidneys themselves can gradually grow and enlarge without any symptoms, so the disease is often detected suddenly.

Stones in the kidney structure gradually compress the surrounding tissue and prevent it from functioning normally. Stagnation occurs, ischemia (oxygen starvation) develops in some parts of the kidney, and sclerosis gradually develops in patches.

Nephrosclerosis in kidney tuberculosis

Kidney tuberculosis is an infectious disease that, like pulmonary tuberculosis, is caused by Mycobacterium tuberculosis. These bacteria in any tissue cause inflammation of a similar structure; the kidney tissue seems to liquefy, becoming cheesy and shapeless. Of course, this tissue can no longer function. With timely treatment, the areas of sclerosis are small and the kidney can compensate for their work. But if the process has affected most of the kidney, then nephrosclerosis in this case becomes the cause of renal failure.

Nephrosclerosis in diabetes mellitus

Diabetes mellitus is a very diverse disease that affects many organs. But first of all, these are the kidneys and eyes.

Excess sugar in the blood gradually disrupts the functioning of blood vessels and nerve fibers. It is vascular damage that disrupts the normal functioning of the kidneys. The kidneys are poorly nourished, and the load on them increases greatly. People with diabetes often experience increased thirst and drink a lot, and then urinate a lot. And the kidneys are forced to filter liters of urine with a high level of sugar, and often also containing acetone (with long-term elevated blood sugar).

The kidneys gradually, usually evenly, decrease in size, become denser and lose their function.

Nephrosclerosis in systemic lupus erythematosus

Systemic lupus erythematosus is an autoimmune disease that affects almost all small vessels in the body.

In addition to vascular damage and malnutrition of the kidney, specific immune complexes are deposited in the kidneys. Circulating immune complexes (CICs) are protective proteins in “coupling” with the cells of the body itself, which become aggressive towards their cells.

CECs damage the inner walls of the renal tubules, inflammation occurs, and then sclerosis of the areas.

Kidney amyloidosis

Amyloidosis is a rare disease in which a specific protein, amyloid, is deposited in different organs.

If amyloid is deposited in the kidneys, the body begins to fight and produce antibodies. And here, too, immune complexes are formed that damage the structure of the kidney. Scar tissue gradually forms at the sites of injury.

Amyloidosis rarely affects only the kidneys (but primarily the kidneys); the heart and lungs are also affected.

Radiation damage to the kidneys

If a patient has been exposed to radiation frequently, the effects may appear months or years later. Under the influence of radiation, the walls of blood vessels become denser, become thicker and gradually lose their permeability. In places where normal blood circulation stops, kidney tissue dies.

Severe preeclampsia

Preeclampsia is a specific pathological condition, characteristic ONLY for pregnant women. In this case, the permeability of all blood vessels, including the kidneys, is impaired. Edema occurs (both external - on the legs and face, and internal - swelling of the kidneys, in severe cases, swelling of the lungs and brain). The kidneys cannot cope with their function, and blood pressure rises sharply. The patient is delivered (usually by emergency caesarean section) and treated. But in the long term, such a difficult pregnancy can affect the condition of the kidneys. Women are more prone to kidney damage. And they are much more likely to develop severe nephrosclerosis.

Also at risk are patients who have had syphilis, rheumatic attacks, or received chemotherapy.

Clinical signs

Symptoms of nephrosclerosis and patient complaints are as follows:

swelling of the face, especially the area around the eyes
swelling of the legs and hands
increasing weakness and fatigue
nausea, loss of appetite, especially aversion to meat and other protein foods
dry, pale skin and itchy skin
nagging pain in the lower back
high blood pressure, which is difficult to treat, is accompanied by persistent headaches
decrease in the amount of urine excreted

No matter how scary it may sound, if all this has manifested itself, then the situation is already quite serious. In the early stages there are no symptoms of renal sclerosis.

Diagnostics

Laboratory tests to detect nephrosclerosis

General urinalysis (UCA): here we will see how much protein is excreted in the urine (normally there is none), if there is inflammation or the release of salts and blood.
Biochemical blood test (BAC): here we are interested in the indicators of the so-called nitrogenous wastes - creatinine and urea. If they increase, then it is necessary to undergo an in-depth examination without delay.
Ionogram: with nephrosclerosis, potassium in the blood increases.
Zimnitsky's test: urine is collected during the day in different jars, and then they calculate how much was excreted during the day and how much at night and what is the density of urine in each portion.
Complete blood count (CBC): Anemia is common with kidney damage.

Instrumental diagnostics (ultrasound, urography)

Excretory urography is a method in which a contrast solution is injected into a vein, and then x-rays are taken at certain intervals and monitored as this solution is excreted through the kidneys. With nephrosclerosis, the distribution of contrast is uneven, it does not pass into small vessels, and is excreted slowly.

Computed tomography is an expensive and high-tech study. With CT, we get a layer-by-layer image of the kidney - as if in a virtual section. And he can see the damage to the kidney, where it is located and how severe it is.

Nephrosclerosis ultrasound signs:

atrophy of the outer (cortical) layer of the kidney
The kidneys are reduced in size, their density (echogenicity) is increased, the boundary between the layers of the kidney (cortical and medulla) is erased. The contours of the kidneys are often uneven and wavy, which indicates gradual “drying out.”
visible salt deposits in the kidney tissue (nephrocalcinosis)

Kidney biopsy

A kidney biopsy is the removal of a piece of kidney tissue for analysis. Technically, this is a puncture in the lumbar region under anesthesia, and the collection of a thin “column” of cells from the kidney. Then the resulting material is sent for examination to a doctor - a histologist, who stains the tissue and examines it microscopically. And then makes a final diagnosis. Treatment tactics will depend on the diagnosis.

Treatment

Nephrosclerosis cannot be cured completely, but our task is to “unload” the kidneys as much as possible, ensure normal blood pressure and increase hemoglobin.

Diet

Treatment of nephrosclerosis depends on the stage at which it is diagnosed. But at any stage, and especially at the later stage, a special diet is needed.

The diet of kidney patients should practically exclude salt. Usually in conversation this diet is called “salt-free.” A sufficient amount of calories is achieved through carbohydrates (to a greater extent) and vegetable fats (to a lesser extent). Proteins are strictly limited, their amount is calculated based on body weight and stage of the disease. When proteins break down, they form the same nitrogenous wastes that are not excreted from the body during renal failure and poison the body. Meals should be fractional, the frequency is at least 5-6 times a day.

Drugs

Antiplatelet agents

This is a group of drugs that thin the blood and help improve renal blood flow. They are used only in the early stages, as in later cases they can cause bleeding.

The following are used: dipiradamole (Curantyl), pentoxifylline (Trental), heparin in courses.

Medicines that lower blood pressure

ACE inhibitors are used (enalapril, perindopril, quadropril, etc.), these drugs have the ability to protect the kidneys, and also reduce blood pressure and prevent changes in the heart. But in case of severe renal failure they cannot be used.

Calcium channel blockers (nifedipine and nifedipine retard, amlodipine) are also used in later stages and effectively reduce blood pressure. Allowed during hemodialysis.

Beta-adrenergic receptor blockers (metoprolol, bisoprolol) - reduce blood pressure and pulse, reduce the stress hormone (adrenaline) in the blood.

Alpha-adrenergic receptor blockers (prazosin, doxazosin) - quickly reduce blood pressure, used in emergency cases, less often for continuous use.

Microelements

Potassium preparations (panagin or asparkam in tablets, potassium chloride intravenously) are prescribed strictly according to indications if a low level of potassium is detected in the blood. This can happen if the patient has undergone massive diuretic therapy.

Vitamin D and calcium (calcium D-3 Nycomed, Calcemin Advance) are prescribed to prevent bone complications (osteoporosis - increased bone fragility).

Treatment of anemia

Two groups of drugs are used here: iron preparations and erythropoietins.

Iron preparations (sorbifer, maltofer, ferretab) are used in courses in the early stages of kidney disease.

Erythropoietin (epoetin, epostim, recormon) is a hormone that stimulates the bone marrow. Normally it is produced in the kidneys. When nephrosclerosis has already formed, erythropoietin is not produced; it must be administered artificially. The injection regimen is prescribed by a nephrologist or hematologist.

Sorbents

Sorbents (Polysorb, Enterosgel) are “absorbent” drugs that are used orally to reduce general intoxication of the body.

Herbal remedies

In the treatment of this group of kidney diseases, herbal medicines are used less, but in the early stages they can help maintain kidney health. Cyston, canephron, hofitol, lepenefril and others are used.

Renal replacement therapy

There is no clear division of the course of nephrosclerosis into stages. Conventionally, there is an early stage, when treatment with medication is possible, and a late stage, when renal replacement therapy is required.

Renal replacement therapy (RRT) is blood purification using an artificial method. There are several such methods. The indication for such serious intervention is not a specific disease, but a critical increase in creatinine and urea in the blood.

Such changes in blood tests indicate that the kidneys do not filter the blood, it is not purified and is poisoning the body. The brain is the first to suffer.

Peritoneal dialysis

This is the purification of blood through the microvessels of the peritoneum. A permanent catheter (a tube with a closing valve) is installed in the patient's anterior abdominal wall. Through this tube, 2 liters of a special solution is poured into the abdominal cavity every 6 hours. When the dialysis solution is in the abdominal cavity, it “pulls out” excess fluid, salts and ions, thereby cleansing the body. Then the used solution is drained and fresh is pumped in. Peritoneal dialysis is performed several times in the clinic, and then, when the patient has learned the technique, he is sent home. Such patients can lead a normal life, travel, coming to the hospital only to have tests monitored and dynamically examined by a nephrologist. Peritoneal dialysis is a fairly mild method, so it is carried out continuously.

Hardware hemodialysis

This is the purification of the blood by a device often known as an “artificial kidney.” The principle of blood purification is similar to peritoneal dialysis; it involves passing the patient’s blood through a column with a special solution, and then pouring it back. People go to dialysis often, several times a week, and spend several hours on the machine. In order to conveniently connect the device and draw blood, a fistula is formed on the patient’s forearm. A fistula is an artificially connected vein and artery on the inner surface of the forearm. In order to create it, a small operation is performed, then you need to wait for healing and only then start dialysis.

Hemofiltration

The principle of blood purification with this method is almost the same as with machine hemodialysis, only the blood is passed through a column with filters and membranes.

Kidney transplant

Kidney transplantation is currently a widely used treatment method for patients with chronic renal failure (CRF). With this method, an operation is performed and a donor kidney is transplanted. At the same time, their kidneys can remain in place, or they can be removed (one or both). Kidneys are removed if they are completely non-functional and/or are the source of a chronic infection.

After surgery, patients take immunosuppressive drugs for the rest of their lives to prevent rejection of someone else’s kidney.

The donor can be a relative or other volunteer, and cadaveric kidneys are also used. To determine the future compatibility of the donor kidney and the patient, special complex genetic tests are performed.

Outcome of the disease

In the absence of treatment, and if it is necessary to include renal replacement therapy, the outcome is unfavorable. Unpurified blood gradually poisons organs and tissues and leads to the death of the patient.

With timely initiation of treatment and the use of RRT, the patient’s life becomes more complicated in that he has to go for dialysis, change solutions, constantly undergo tests and weigh himself frequently (the volume of dialysis fluid is calculated based on the patient’s weight). But at the same time, people with nephrosclerosis live, and live long and fully!

The kidneys are an organ that cannot be excluded from metabolism. The development of renal failure and renal sclerosis can be prevented if all its causes (hypertension, diabetes and all of the above) are prevented and treated in a timely manner. Do not ignore medical examination at your place of work and in the clinic. Quite often, the first signs of a problem are revealed precisely by laboratory tests. And always ask your doctor any questions you have.

Nephrosclerosis of the kidneys (Nephrosclerosis) means the replacement of functional parenchymal renal tissue with connective tissue. This tissue cannot perform the function of kidney parenchyma, so the activity of the organ is radically impaired. The formation of connective tissue in the kidney leads to changes in the blood supply to the kidney. The walls of arteries and arterioles thicken, lose elasticity and cannot fully supply the organ with blood. This leads to disruption of the nutrition of the mini-structures of the renal tissue - glomeruli and tubules - and to their further death. As a result, the kidney decreases in volume (primarily shriveled kidney) and does not perform its function.

The outcome for this serious disease is different, depending on the timely initiation of quality treatment and the correct recovery period.

Recovery occurs if treatment was carried out in the early stages of the disease. In other cases, you can only achieve stabilization of the condition for a certain period (its length depends on many factors) and an improvement in the quality of life. Lack of treatment, untimely or incorrect treatment lead to disease progression and death.

Before dwelling on the features of primary and secondary nephrosclerosis, it is necessary to consider the reasons that lead to the development of this disease.

Causes of nephrosclerosis

Nephrosclerosis is not an independent disease. It develops most often against the background of hypertension, atherosclerosis and other diseases of the blood vessels or the kidneys themselves, which causes disruption of the normal blood supply to the organ. According to the mechanism of development, the following types of nephrosclerosis are distinguished: primary, or hypertensive, and secondary.

The main cause of nephrosclerosis is a violation of the blood supply to the organ, which ultimately leads to its dysfunction.

Primary nephrosclerosis: what is it?

The causes of the development of the first form of kidney disease are narrowing of the renal arteries due to damage to them by atherosclerosis, thrombosis or thromboembolism. As a result, the trophism of the kidney tissue is disrupted, which leads to kidney ischemia (impaired blood supply to the kidney). This complication can lead to an even more serious complication - kidney infarction. The danger of these conditions is that the renal vessels can be completely blocked, and the kidneys will stop removing waste products from the body. Acute renal failure developing in such cases can become life-threatening if the patient is not provided with qualified medical care in a timely manner.

The result of primary nephrosclerosis is a primarily wrinkled kidney, which develops in the last stages of hypertension. Constant hypoxia and insufficiency of renal tissue trophism leads to atrophic and dystrophic changes in the organ, with the gradual replacement of parenchyma by connective tissue.

Classification of primary nephrosclerosis

Primary nephrosclerosis, depending on the reasons that caused it, is divided into the following types.

Atherosclerotic

Developing due to the deposition of atherosclerotic plaques on the walls of blood vessels throughout the body, including on the walls of the renal arteries and arterioles. Plaques close the lumens of blood vessels, significantly reducing their elasticity. The walls of the vessels thicken, which also leads to a decrease in their patency. As a result, renal ischemia develops. The surface of the affected kidney becomes nodular, with ischemic scars. This form of kidney nephrosclerosis is considered less dangerous in the prognosis for the patient, since part of the kidney parenchyma remains unaffected by the process and functions.

Macropreparation for arteriolonephrosclerosis of both kidneys. Signs of pathology are clearly visible: they are compacted, the surface is fine-grained. The section shows focal damage to the parenchyma with an increase in adipose tissue

Hypertensive nephrosclerosis

This form of the disease was named in connection with the primary cause of spasm of the renal vessels - hypertension. As a result of vascular spasm, renal ischemia also develops, the parenchyma is replaced by connective tissue. This type of nephrosclerosis is divided into two subtypes: arteriolosclerotic nephrosclerosis and arterionecrotic. The difference between them is that the first subtype is not malignant, unlike the second.

Involutive

Develops with age in older people. After 50 years of age, the process of calcium deposition occurs on the walls of arteries, which affects the elasticity of blood vessels and their patency. This leads to a decrease in blood supply to the kidneys and to ischemia.

Secondary nephrosclerosis

Nephrosclerosis of the kidneys can develop not only due to sclerotic damage to the renal vessels, but secondary to the background of inflammatory and dystrophic processes in the renal structures - the renal glomeruli, tubules and kidney stroma. Often secondary nephrosclerosis and kidney shrinkage are the result of such diseases:

chronic glomerulonephritis;
chronic pyelonephritis;
kidney stone disease;
kidney tuberculosis;
kidney amyloidosis;
diabetic glomerulosclerosis (against the background of diabetes mellitus);
kidney infarction;
severe forms of nephropathy of pregnancy;
injuries and kidney surgeries.

Symptoms of nephrosclerosis

Every tenth inhabitant of the Earth has kidney damage, namely nephrosclerosis at one stage or another of the disease. But many of them are not even aware of their illness. The insidiousness of nephrosclerosis is that at its initial stage there are practically no symptoms. The disease is discovered by chance during urine and blood tests. If at this moment you do not pay due attention to the developing disease, then over time it progresses up to terminal renal failure. At this stage, serious complaints appear and symptoms are pronounced. But the moment when the disease could be defeated or the patient’s condition could be stabilized at this stage has already been missed.

This is what the face of a patient with nephrosclerosis looks like in the stage of developed renal failure

Clinical symptoms of nephrosclerosis appear when renal function is impaired:

specific swelling on the face and legs;
pain and discomfort in the lumbar region;
high blood pressure, accompanied by severe headaches that are difficult to relieve with analgesics;
change in the appearance of urine (reddish, brown, foamy, with flakes, cloudy sediment);
frequent urge to urinate, especially at night;
decrease in the volume of urine excreted per day (less than 500 ml);
constant feeling of thirst;
intolerance to meat food (a feeling of disgust appears);
general weakness, loss of appetite;
shortness of breath, rapid heartbeat;
skin itching;
weight loss.

If these symptoms or some of them occur in a child or an adult, then you should immediately undergo a nephrological examination.

Diagnostics

The basis of nephrological diagnostics are laboratory tests (urine and blood tests), as well as X-ray diagnostics and ultrasound of the kidneys. These studies must be carried out for each person once a year. In the presence of diseases such as diabetes mellitus, arterial hypertension, vascular atherosclerosis, obesity (risk group for chronic nephrosclerosis), it is necessary to conduct a more in-depth study, for example, a test for microalbuminuria, determine the level of creatinine in the blood, perform a Zimnitsky test (determining the relative density of urine ) and conduct other specific studies.

One of the effective diagnostic methods for kidney diseases is ultrasound.

Treatment

Treatment of kidney nephrosclerosis includes two methods: therapeutic and surgical.

The therapeutic method uses medications aimed at stabilizing blood pressure at a certain level. Drugs are selected individually in each specific case. Antihypertensive drugs are taken daily according to a specific schedule to prevent hypertensive crises. In later stages of nephrosclerosis, antihypertensive drugs should be taken with caution, as they can aggravate the condition. For patients with kidney diseases, an immutable law is to adhere to a renal salt-free diet. If the patient's blood tests contain nitrogenous toxins, then the patient must limit his intake of animal protein.

In the early stages of the disease, active therapy is indicated: prednisolone, cytotoxic drugs. This allows in many cases to stop the progression of the disease and its transition to a more unfavorable stage. As the disease progresses, the renal parenchyma is replaced by connective tissue, so renal failure is formed with the accumulation of toxins in the body and the presence of overload on the renal glomeruli. In this situation, nephroprotective therapy is prescribed, aimed at preserving kidney function.

Today, there are modern medications that inhibit the development of nephrosclerosis and have a beneficial effect on its prognosis. These are angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and other modern drugs. They are prescribed only by a nephrologist after careful medical monitoring of the patient.

If cholesterol levels are high in the blood, statins are prescribed, which normalize fat metabolism and have a beneficial effect on the vascular formations of the kidney. In complex treatment, cardioprotectors are not forgotten. For anemia that accompanies the dialysis stage of nephrosclerosis, artificial erythropoietin preparations are prescribed.

One of the effective modern methods of blood purification is hemodialysis, which can prolong the life of patients in the terminal stage of nephrosclerosis

In the terminal stage of nephrosclerosis, three methods of renal replacement therapy are effective:

hemodialysis, hemodiafiltration;
peritoneal dialysis;
kidney transplantation.

Peritoneal dialysis is the purification of blood using a special solution injected into the peritoneum and removed using a catheter after a certain time. The procedure is performed by the patient himself at home.

A kidney transplant (transplantation) from a living relative or a cadaveric donor is also today a full-fledged method of replacing an organ that has lost its function. After a kidney transplant, the patient must constantly take medications that suppress his own immunity. This is necessary so that the transplanted organ is not rejected by the body.

To prevent such a serious disease as nephrosclerosis, it is necessary to show your strong-willed qualities, giving up bad habits once and for all

Prevention

As you know, a disease is easier to prevent than to treat. This fully applies to such a serious disease as nephrosclerosis. Is it possible to prevent it while the kidneys are still healthy? Yes, if you follow the 10 golden rules recommended by nephrologists:

Do not abuse meat foods and salt. Eat more vegetables and fruits. Avoid canned foods.
Avoid excess weight, always keep it within the age norm.
Drink up to 2-3 liters of clean water daily.
Regularly engage in sports that are accessible to your age and health.
Do not smoke or abuse alcohol.
Do not self-medicate, especially with drugs such as antibiotics, antispasmodics, painkillers, and diuretics. Do not get carried away with nutritional supplements, “fat burners”, advertised but untested means of losing weight;
Do not come into contact with toxic substances, dyes, fungicides, heavy metals.
Do not get carried away with exposure to the sun, do not become overcooled.
Constantly monitor blood pressure, blood sugar and cholesterol.
Undergo annual medical examinations to monitor the condition of your kidneys.

In conclusion

As you can see, nephrosclerosis is a serious problem from which no one is immune. And although today there are effective ways to solve it, we see that the later this problem is identified, the less chance of its successful solution, the greater the risk of complications. It should be remembered that even the most modern treatments will be effective if the patient himself is conscious of his health.

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 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%.
The secondary form of the disease occurs as a result of damage to the kidney parenchyma during long-term autoimmune processes, 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 is replaced when the amount of urine, on the contrary, sharply decreases. Anuria (complete absence of 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 the appearance. 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.

(cardiac asthma) occurs as a result of overload of the heart due to the increased amount of fluid in the body. As a result, blood stagnation occurs in the pulmonary capillaries. The patient experiences shortness of breath, coughing, and during an attack there is sweating, cyanosis (blue discoloration of the skin), increased heart rate and respiratory rate. Cardiac asthma is a serious complication that can be fatal if left untreated.

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 in a few years can lead to a complete loss of kidney function, severe and doom the patient to lifelong renal failure. Such an 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 as early as possible through examination, 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, the following abnormalities can be detected: 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 (x-ray of the kidneys with a contrast agent), angiography, 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 proliferation 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.

In end-stage renal failure, when both kidneys have lost their functions, patients are advised to undergo hemodialysis. The only way out in this situation is kidney transplantation; in recent years, this operation has been successfully carried out in Russia, and for citizens of our country it is free.

Throughout life, every person at least once encounters diseases of the urinary system. For some, they pass almost without a trace, but people with weakened immune systems experience complications in the form of kidney shrinkage, otherwise called nephrosclerosis. If previously it was believed that this pathology occurs mainly in patients over sixty years of age, now doctors say that the disease is increasingly manifesting itself in children, adolescents and the working population. This is why it is so important to know what the early symptoms of pathology look like, as well as which doctor you should contact for help.

Kidney nephrosclerosis: definition of the disease

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

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

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

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

Primary and secondary nephrosclerosis

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

Single-sided and double-sided

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

With the development of nephrosclerosis on one side, a healthy kidney assumes all functions

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

Bilateral renal nephrosclerosis is characterized by a more malignant course

Atherosclerotic renal scarring

When cholesterol metabolism is disrupted, plaques containing large amounts of fat form in the walls of blood vessels. They slow down the normal flow of blood through the arteries and veins, causing the kidneys to experience a serious lack of oxygen. This leads to the gradual death of some cells and the replacement of active nephrons with connective tissue, which cannot perform the function of filtration and reabsorption. Atherosclerosis is a consequence of alcohol abuse, smoking and poor nutrition.

Atherosclerotic nephrosclerosis occurs mainly in older people

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

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

Diabetic kidney shrinkage

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

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

Malignant nephrosclerosis

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

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

Hemodialysis lasts at least 4–8 hours

Main clinical symptoms of disease development

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

A compressive headache is often the first sign of the development of renal pathologies

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

With nephrosclerosis, edema forms on the upper half of the body

The author of the article had the opportunity to participate in the treatment of a patient with a malignant form of nephrosclerosis. A man was admitted to the intensive care unit due to an acute hypertensive crisis and a blood pressure of 200/100 millimeters of mercury. At the same time, he developed serious kidney damage: practically no urine was released from the bladder, as a result of which the patient suffered from severe intoxication. Due to the involvement of the nervous system in the pathological process and damage to the cerebral cortex, the patient fell into a long coma. After infusion therapy sessions and several hemodialysis procedures, it was possible to bring him out of this state.

Methods for diagnosing a shriveled kidney

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

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

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

A general urine test allows you to evaluate the physical properties of urine. Normally, it has a light yellow tint, high transparency, and also does not contain foreign impurities. With nephrosclerosis, pronounced clouding is observed, which is caused by the presence of a large amount of protein, leukocytes and salts. A change in urine color to a darker color indicates the development of an inflammatory process in the body.
The appearance of blood in the urine indicates the development of nephrosclerosis
Ultrasound diagnostics makes it possible to evaluate the structure of the pyelocaliceal system and determine the size of the kidney. With nephrosclerosis, the organ shrinks and becomes denser, and its structure changes. On ultrasound images you can see the replacement of part of the functioning tissue with a connective substance, which causes such deformation.
An ultrasound image shows a decrease in size of the organ
Magnetic resonance imaging is one of the most expensive and effective research methods. If it is impossible to discern the presence of some stones, tumors and foreign bodies on an ultrasound, then MRI copes with this task perfectly. By creating a three-dimensional image on a computer screen, the entire human genitourinary system is visualized, which makes it possible to determine the level of damage.
The image shows the presence of a foreign body in the left kidney, which causes nephrosclerosis

How is nephrosclerosis treated?

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

The most important principles of therapy for nephrosclerosis:

restoration of normal urine flow;
lowering blood pressure to normal values;
reduction of inflammatory swelling of soft tissues;
replenishing the body's needs for proteins, fats and carbohydrates;
stabilization of water-electrolyte balance and acid-base balance.

Table: drug therapy for nephrosclerosis

Name of the drug group	Examples of active ingredients	Main effects of use
Antihypertensive drugs	Catapressan; Guanfacine; Moxonidine; Hygronium; Benzohexonium; Pentamin; Reserpine; Labetalol.	Stabilizes blood pressure, preventing its increase and development of crisis, reduces the load on the cardiovascular system
Anti-inflammatory medications	Nimesulide; Askofen; Ketotifen; Nimesulide; Naproxen; Diclofenac; Ketorol; Ketorolac.	Reduce the severity of inflammation in the kidney tissue
Diuretics	Urea; Urea; Mannitol; Cyclopenthiazide; Triamterene; Amiloride; Eufillin.	Remove excess fluid from the body, preventing stagnation of urine in the pelvis
Detoxification therapy	saline solution (sodium chloride); Disol; Acesol; Ringer's and Lugol's solution; Regidron.	Promotes the removal of toxic substances and reduces the manifestations of intoxication
Vitamin complexes and calcium preparations	Aevit; Calcium-D; Panangit; Asparkam; Duovit; Vitrum; Ostemag.	Replenish the body's need for essential micro and macroelements

Photo gallery: drugs for the treatment of wrinkled kidneys

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

Surgical elimination of pathology

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

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

The operation lasts from two to five hours

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

Traditional medicine as an aid

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

Before you start taking any new infusion or decoction, you need to check for any allergic reactions. To do this, be sure to drink a small amount of liquid. If a rash, itching, burning, choking or cough occurs, immediately discard this remedy.

Place one hundred grams of chokeberry in a saucepan with 500 milliliters of still water. Simmer over low heat for half an hour, stirring constantly. After cooling, drink half a glass before each meal. Chokeberry is a berry that has a hypotensive effect. Therefore, before you start using it, you need to measure your blood pressure. This remedy should be used only in the presence of persistent hypertension: an overdose can provoke collapse and shock.
In a thermos with a volume of at least two liters, add 30 grams of lingonberry leaves, three tablespoons of chopped chamomile and mint. Pour boiling water over it and leave for a day. Over the next day, drink one glass every few hours. This mixture of herbs and plants helps remove excess fluid from the body and helps reduce inflammation. It is recommended to use this method no more than three times a week for a course of four months.
Brew two teaspoons of dried calendula flowers in a glass of boiling water, covering with a saucer. Once the liquid has cooled, drink it in small sips before any meal. Calendula has pronounced antiseptic activity and also reduces the likelihood of developing purulent-septic complications. The course of treatment consists of twenty procedures with an interval of several days.

Photo gallery: traditional medicine for the treatment of wrinkled kidneys

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

Video: treating kidney problems with natural remedies

To restore the necessary balance of proteins, fats, carbohydrates and vitamin-mineral elements, patients with a wrinkled kidney are prescribed a special diet. It reduces the load on the cardiovascular and urinary systems and helps normalize blood pressure. Basic principles of proper nutrition for patients with nephrosclerosis:

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

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

What foods are useful for people with nephrosclerosis:

fresh vegetables and fruits (in the form of salads, purees, slices);
milk, cheese, cottage cheese, plain yoghurts, snowballs, kefir, bifidoc;
lean meat (turkey, chicken, beef) and fish (pink salmon, hake, pollock, perch);
cereals (buckwheat, oatmeal, rice, rolled oats, millet);
durum pasta;
nuts;
legumes and peas (beans, chickpeas, lentils).

Photo gallery: healthy food

Fresh vegetables and fruits are the best source of vitamins
Cottage cheese contains a lot of calcium
Eating meat restores protein needs

Prognosis and possible complications of nephrosclerosis

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

As is known, lifestyle also has a significant impact on the development of many complications of nephrosclerosis. In his practical activities, the author of the article treated one patient who had suffered from pyelonephritis for many years. She refused to follow a diet and take medications, which regularly led to a worsening of her condition. A few days after an exacerbation of chronic pyelonephritis, the woman was hospitalized in the intensive care unit, where she was diagnosed with kidney failure due to nephrosclerosis. The affected organ had to be completely removed surgically, and the patient is now required to attend hemodialysis for life. She was also assigned the second disability group. The development of this situation could have been avoided if the patient had promptly adjusted her habits and regularly taken medications prescribed by the doctor. That is why doctors strongly recommend constantly going for examinations and not developing chronic diseases.

What complications and unpleasant consequences can nephrosclerosis entail:

increased risk of developing malignant and benign neoplasms;
formation of stable arterial hypertension and periodic crises;
the addition of bacterial microflora and the occurrence of an abscess, boil and phlegmon;
disturbance of urine excretion and water-electrolyte balance, which is manifested by convulsions and arrhythmia;
infectious-toxic shock and collaptoid conditions;
cerebral edema;
thrombosis and thromboembolism of large vascular trunks;
urolithiasis;
uremic coma and poisoning by breakdown products.

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

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

Based on his experience, the author of the article can say that the most unpleasant prognostic sign is the presence of convulsive syndrome. At the same time, the baby’s body muscle tone increases, it bends spastically, and the limbs become deformed. This pathology indicates the development of excess potassium in the child’s body. This chemical element is responsible for contractions of the muscles of various organs, including regulating the activity of the heart. Its increased content can provoke arrhythmia, which was often observed in children with nephrosclerosis.

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

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

The baby's body has a much greater regeneration potential than the body of an adult. That is why patients under the age of 18 who have been given a similar diagnosis can almost completely recover with a well-chosen course of medicinal procedures.

What medications are used to treat nephrosclerosis in children:

antihypertensive drugs: Veroshpiron, Labetalol, Verapamil, Diltiazem, Chlorpromazine;
anti-inflammatory and antipyretic: Ibuklin, Ibuprofen, Nurofen, Paracetamol, MIG;
diuretics: Spironolactone, Urakton, Fonurit, Diacarb, Hypothiazide.

Photo gallery: medications for the treatment of wrinkled kidneys in children

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

Manifestation of the disease and its treatment in older people

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

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

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

Anticoagulants prevent the formation of blood clots and blood thickening, which often occurs in older patients. The most well-known drugs are: Heparin, Fraxiparin, Clexane, Enoxaparin sodium, Lepirudin, Refludan, Neodicoumarin, Sincumar.
Antiplatelet agents also normalize blood flow and reduce the likelihood of emboli formation. These include: Aspirin, Thrombo ACC, Dazoxiben, Ridogrel, Prostacyclin, Dipyridamole, Curantil, Anturan, Persantine, Tiklid, Plavix.
Herbal medicine: preparations based on various plants and herbs are less aggressive, but highly effective. They help relieve spasm and inflammation in the soft tissue area, and also stimulate urine flow and reduce swelling. The most famous are: Cyston, Canephron-N, Fitolysin, Afala, Urolesan, Flavia, Trinephron.

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

Clexane is a drug from the group of anticoagulants that thins the blood.
Clopidogrel reduces the likelihood of blood clot formation
Cyston is a herbal preparation that helps normalize urination

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

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