Symptoms and treatment of toxic nephropathy. Treatment options and early symptoms of toxic nephropathy Acute infectious toxic kidney injury

Pathology of the kidneys, damage to the glomerular apparatus and kidney tissue, provoked by the introduction of nephrotoxic substances into the body (ICD-10 code - N14.4) or their accumulation.

Allocate the severity of the course of the disease:

mild - minor symptoms, changes in laboratory parameters of blood and urine;
medium - decrease in diuresis, increase in uremia and symptoms;
severe - a decrease in glomerular filtration, the development of edema, the possibility of complications with renal failure.

A number of diseases and factors can lead to nephropathy, for example, diabetes mellitus, and it can also be of an infectious-toxic origin.

Causes and pathogenesis

Kidney damage can occur due to the pathogenic effect on their tissues of the toxic substances themselves, their decay products, as well as against the background of the development of an autoimmune reaction.

Most often, the disease is caused by such substances:

Heavy metals, their salts;
ethylene glycol;
Oxalic, acetic acid;
Pesticides, herbicides;
Arsenic;
Solvents;
Copper vitriol;
Poisons of animals, insects;
mushroom toxins;
Nitrogen-containing compounds;
Volatile ethers;
Poor quality alcohol.

Often, toxic nephropathy is recorded in people employed in hazardous industries, where work is associated with poisons, chemicals, rubber, polymers. All substances can enter the body both through the respiratory organs and through the blood, through the skin (with bites).

The severity of organ damage will largely depend on the type of substance that has entered the body, on its amount, and on the method of entry. The health of the urinary system also plays a certain role before the onset of pathology - in the presence of chronic kidney diseases, nephropathy can develop even from small doses of toxic substances.

The clinical picture resembles that of acute glomerulonephritis. Initially, general symptoms appear - weakness, weakness, lethargy, the temperature may rise. Further, the person notes swelling of the legs, puffiness of the face. Indicators of the composition of urine change - the amount of protein in it increases, blood (erythrocytes) appears.

Other common signs of pathology:

An increase in blood pressure up to very high numbers.
Decrease in diuresis, frequency of urination (sometimes complete anuria).
Pain in the lower back due to swelling of the kidneys.
Seizures.
Decreased heart rate.
Arrhythmia.
Wheezing in the lungs.

Depending on the type of toxic substance, specific symptoms may also be added to the clinical signs described above. For example, if a person has been poisoned by an excessive amount of sulfonamides, then with toxic nephropathy, he has pain in the joints, hemorrhages on the skin and mucous membranes, and a feverish state.

By severity, the disease is differentiated as follows:

The first is a moderate increase in protein, hemoglobin and red blood cells in the blood, mild symptoms.
The second - diuresis falls, the amount of urea, potassium, creatinine in the blood increases greatly, the symptoms increase.
Third - due to swelling of the kidneys and a sharp decrease in glomerular filtration rates, acute renal failure may develop - a deadly complication.

In the progression of renal failure in toxic nephropathy, several stages are also distinguished:

Initial (up to 3 days). There is actually a poisoning of the body with nephrotoxic agents.
Oligoanuric (1-2 weeks). Due to fluid retention, urine output decreases, which leads to an overload of the heart and the development of edema, shortness of breath, and wheezing in the lungs. At this stage, cerebral edema is also possible. There is death from suffocation with pulmonary edema, from cardiac arrest, DIC. Often associated with secondary vasculitis, anemia, thrombocytopenia.
Stage of polyuria (up to several months and years). This stage occurs with a favorable course of the disease. Diuresis increases, which can also lead to dehydration.
Recovery. All indicators of urine and kidney function return to normal, but complete recovery is not possible in all patients.

The main causes and course of toxic nephropathy

As with poisoning by mushrooms, alcohol surrogates or poisons, and with the decay of the body's own tissues, the main problem for the kidneys is the negative effect of toxins on the internal kidney structures. It is the total disruption of the kidneys that leads to life-threatening and health complications.

Toxic nephropathy in the majority of identified cases develops after a certain group of chemical compounds enters the body, these include:

Lead, mercury;
Nitrogen-containing compounds - ammonia, aniline, nitrobenzene;
Halogen derivatives - carbon tetrachloride;
Glycols - diethylene glycol, antifreeze;
Esters - ethyl acrylate, dioxane.

Alkalis, acids, insecticides in high concentrations that enter the body can lead to the development of the disease. Pathology is detected most often in people whose specialties are directly related to working with the listed chemicals. Less commonly, toxic kidney damage occurs when poisoned by highly poisonous mushrooms, poor-quality products, and high doses of alcohol.

The kidneys are a paired organ, similar in shape to a bean, which performs the following functions:

regulate the balance of fluid in the body;
control and maintain blood pressure at the proper level;
participate in the formation of blood cells;
remove metabolic products from the body.

Each of the kidneys consists of many nephrons - these are special filtration particles. Each of the nephrons consists of a glomerulus of small blood vessels, they are semi-impermeable, therefore, metabolic products pass through them, as through a membrane. Well-filtered metabolic products are excreted in the urine.

If toxic substances penetrate the body, then the entire load falls on the nephrons, which begin to cope poorly with their function. The clinical picture directly depends on which toxic substance has entered the body.

The causes of toxic nephropathy include the following factors:

poisoning with low-quality alcohol-containing drinks;
heavy metal poisoning;
ingestion of various solvents;
intoxication caused by pesticides;
an overdose of drugs, as well as treatment with expired or low-quality medicines.

If the nutrition of the kidneys is insufficient, then ischemia may develop, which is considered a reversible condition. If ischemia is not treated for a long time, then necrosis occurs, which is already an irreversible pathology. This condition is characterized by a complete impairment of kidney function, due to which toxic substances accumulate in the body, and they are not excreted in a natural way at all.

Toxic nephropathy requires urgent treatment, otherwise life-threatening complications can occur.

There are a lot of toxic substances that can harm the kidneys. Some of them enter the body in the process of life, while others arise as a result of injuries or diseases. Toxic nephropathy may occur during drug treatment or during emergency medical care. The main factors in the occurrence of toxic nephropathy include:

eating poisonous mushrooms;
poisoning with chemicals, heavy metals (mercury, copper, cadmium);
exposure to radiation (uranium salts);
ingestion of organic poisons (acetic acid, carbon tetrachloride);
poisoning with alcohol surrogates;
long-term use of drugs that contribute to the poisoning of the body (antibiotics, antimicrobials);
transfusion of blood incompatible by group or Rh factor;
severe injuries or burns, when massive destruction of tissues occurs with the ingress of decay products into the blood;
penetration of microbes leading to infection and a septic condition.

As with poisoning by mushrooms, alcohol surrogates or poisons, and with the decay of the body's own tissues, the main problem for the kidneys is the negative effect of toxins on the internal kidney structures. It is the total disruption of the kidneys that leads to life-threatening and health complications.

Toxic nephropathy can be classified depending on the causes of its occurrence. So, the following types of pathology are distinguished:

Nephropathy specific toxic. It develops under the influence of direct ingestion of poisons and toxins. It can be alcohol, various chemicals and metals (arsenic, mercury, lead, cadmium, synthetic rubber, oxalic or acetic acid, etc.). Also, a specific form of toxic kidney damage can also develop as a result of poisoning with poisonous mushrooms or a bite of poisonous animals / insects.

Nonspecific nephropathy. It develops as a result of penetration into the body of toxic substances that do not have a direct toxic effect on the kidneys, but at the same time stimulate organ failure. Here, the causes of the pathology can be a sharp drop in blood pressure, disruptions in the electrolyte balance, a violation of the general blood flow in the kidneys and the body as a whole, or uncompensated acidosis.
Mediated nephropathy is toxic. In this case, toxic substances and poisons are independently produced in the human body in the presence of such renal pathologies as blockage of kidney nephrons with hemoglobin, proliferation of muscle tissue in the kidneys and squeezing the same renal nephrons, excessive production of amino acids in liver failure. Also, the causes of renal toxic insufficiency can be sepsis (blood poisoning), a long process of squeezing muscle tissue as a result of injury and, as a result, a large amount of protein that enters the bloodstream.

In addition, the causes of toxic damage to both kidneys can be such reasons:

Radiation exposure of a person;
Taking non-steroidal anti-inflammatory drugs, sulfonamides or aminoglycosides for a long time and without proper medical supervision.

Nephropathy begins when a person is exposed to poisons or autoimmune reactions of his body. The course of the disease is due to the way the toxin enters, its type and quantity. At risk are people who have constant contact with toxins. But poisoning is possible at the household level. In children, the development of toxic nephropathy is due to the presence of congenital pathologies or factors that affect the kidneys during pregnancy. Among the toxic substances that can cause this pathology, there are the following:

mercury, lead and other heavy metals;
mushroom poison;
poisons of animals and insects;
nitrogen compounds: ammonia, nitrobenzene;
various solvents;
inorganic fertilizers;
various acids;
alcohol surrogates;

The kidneys are a pair of small, bean-shaped organs. Kidney functions:

regulation of water balance in the body;
participation in the control and maintenance of blood pressure;
participation in the formation of blood cells;
excretion of metabolic products.

Each kidney consists of more than 1,000,000 filtration units - nephrons. Each nephron contains glomeruli of small blood vessels (glomeruli). Being semi-permeable, they allow metabolic products dissolved in the blood to pass through the membrane. Filtered metabolic products are excreted from the body with urine.

When toxic substances enter, a significant load falls on the nephrons, which cease to cope with their tasks. The development of the clinical picture largely depends on the nature of the damaging substance. But common is the disruption of normal functioning.

Damage agents include:

low-quality alcohol;
heavy metals;
organic solvents;
pesticides;
drugs (in case of overdose, use of low-quality or expired drugs, violation of the route of their administration).

With insufficient nutrition of the kidney, ischemia develops (a reversible condition), and prolonged ischemia leads to an irreversible consequence - necrosis. This leads to a complete loss of kidney function, the consequence of which is the accumulation of toxic substances in the body and the impossibility of their excretion in a natural way.

Nephropathy can develop under the influence of such substances:

Chemicals - oxalic acid, acetic acid, copper sulfate, nitrogen-containing toxins, polymers, synthetic rubber, sublimate, antifreeze, dichloroethane, ethacrylate.
alcohol.
Heavy metals - mercury, lead, arsenic, cadmium.
Poisonous mushrooms and animal poisons.
High doses of drugs - sulfonamides, aminoglycosides, non-steroidal anti-inflammatory drugs.
Ionizing radiation.

Etiology

the presence of metabolic disorders (diabetes mellitus, gout, etc.);
poisoning of the human body with heavy metals;
long-term use of certain pharmaceuticals, such as anti-inflammatory, analgesics and anticonvulsants;
bearing a child;
the effect of radiation on the human body;
the presence of extrarenal neoplasms of a benign and malignant nature;
industrial and household intoxication;
anomalies in the development of the kidneys and urinary tract, and so on.

Clinical picture

Manifestations of toxic nephropathy and the severity of the course may be different. Often, symptoms of acute glamerulonephritis or renal failure come first. The general range of symptoms is as follows:

arterial hypertension (increased pressure);
oliguria up to anuria;
puffiness of the face;
pain in the lumbar region;
congestion;
convulsions;
proteinuria;
hematuria.

Also, depending on the type of toxic substance, specific symptoms may be attached.

A formidable complication is renal failure - a symptom complex, which is caused by a violation of kidney function due to various reasons. It is characterized by anuria and retention of nitrogenous products in the blood. Further, if timely assistance is not provided, a uremic coma develops against the background of lethargy, weakness, intense headaches, and pruritus.

Kinds

One of the most common types of ailment is dysmetabolic nephropathy. It is divided into several subspecies:

calcium oxalate neuropathy. Such dysmetabolic nephropathy is more common in children;
oxalate. The first signs of the disease appear at any age (even in newborns). If the pathology is not treated, then there is a high risk of developing urolithiasis;
phosphate. The main cause of progression is a chronic infection of the genitourinary system;
urate. There are both primary and secondary;
metabolic nephropathy involving cystine.

Also in medicine, the following types of nephropathy are distinguished:

diabetic nephropathy;
nephropathy of pregnant women;
toxic nephropathy;
gouty nephropathy;
myeloma nephropathy;
Iga nephropathy.

Diabetic form

Diabetic nephropathy is characterized by simultaneous damage to both kidneys, which leads to disruption of their functioning. The main cause of the disease is diabetes. Diabetic nephropathy progresses slowly against the background of diabetes mellitus. Symptoms appear gradually. Clinicians distinguish 5 stages of diabetic nephropathy:

asymptomatic. There are no symptoms. It is possible to identify the presence of pathology only through analysis;
initial structural changes. Blood circulation in the kidneys is increased, as is glomerular filtration;
prenephrotic. The concentration of microalbumin increases to 300 mg/day, but there is no pronounced proteinuria. Blood circulation and glomerular filtration are normalized. Some patients may have a slight increase in blood pressure;
nephrotic. BP is constantly elevated. Protein appears in the urine. Filtration, as well as blood circulation, is reduced. A person has an increase in ESR and cholesterol. Edema appears;
uremic. The filtration function of the kidneys is significantly reduced, which causes the accumulation of urea and creatinine in the blood. Protein levels are further reduced, which increases swelling. Blood pressure can rise to critical levels. In almost all clinical cases, this stage of diabetic nephropathy gradually turns into kidney failure.

Nephropathy of pregnancy

Nephropathy of pregnancy is one of the most dangerous complications during gestation. The reasons for the progression of this condition are not fully understood. At risk are young girls, as well as those who regularly drink alcohol and smoke cigarettes.

Nephropathy of pregnant women is more often diagnosed in the second half of pregnancy. The patient's blood pressure rises to high numbers, edema and proteinuria appear. If adequate treatment of nephropathy in pregnant women is not carried out in a timely manner, then there is a high probability of miscarriage. Doctors observe women with such a diagnosis in stationary conditions in order to constantly monitor their condition.

It is also worth noting that nephropathy of pregnant women is not a rare pathological condition. Recently, cases of progression of the disease have increased significantly.

toxic form

Toxic nephropathy progresses after poisoning the body with various toxic substances. The first symptom is pain at the site of the projection of the kidneys. Further, the clinical picture of toxic nephropathy is supplemented by the following signs:

puffiness;
oliguria;
anuria;
blood in urine;
protein in urine and nitrogenous bases.

It is important to treat toxic nephropathy as soon as possible, since acute renal failure may develop against its background.

Gouty form

The basis of the progression of gouty nephropathy is the accelerated formation of uric acid with its slow removal from the body. As a result, the substance gradually accumulates in the bloodstream and urates are formed in the kidneys. If gouty nephropathy continues to progress, this will lead to deformation of the kidney tissue. The excretory and filtering abilities will decrease significantly.

myeloma form

The main manifestations of myeloma nephropathy are severe proteinuria and the gradual development of renal failure. It should be noted that with this form, all signs indicating nephropathy are absent. But at the same time, dysproteinemia and hyperproteinemia are observed. Also often in patients with this diagnosis, nephronecrosis is detected.

Iga nephropathy

A feature of Iga nephropathy is macro- or microhematuria in combination with proteinuria. As a rule, the disease begins to progress a few days after an acute illness of the upper respiratory airways.

Also, with Iga nephropathy, hyperthermia, arterial hypertension, nephritic syndrome, pain in the lumbar region, and dysuric phenomena are observed. Iga nephropathy is also characterized by a relapsing course.

More rarely diagnosed:

hereditary nephropathy;
family;
paraneoplastic;
tubulointerstitial;
analgesic;
endemic;
hypertonic;
membranous;
reflux;
contrast induced;
medicinal.

Symptoms and stages of the disease

Toxic damage to the kidneys can be classified according to degrees depending on the severity of the patient's condition. So, there are such stages of pathology:

Mild poisoning. In this case, the patient will have protein, erythrocytes in the urine and increased urine density.
The average degree of pathology. To the already existing symptoms, a decrease in the total daily volume of urine will be added, as well as an increase in potassium, creatine and other metabolites in the patient's body.
With a severe stage of poisoning the patient develops acute renal failure, which can lead the patient to a coma.

The symptomatology of the pathology is due to the amount of toxin that has entered the body, the stage of development of toxicosis and the general condition of the patient's genitourinary system. In the presence of chronic diseases of the kidneys, liver or bladder, a small amount of poison is enough to start a pathological condition. Toxic nephropathy has the following symptoms:

a decrease in the volume of urine excreted, up to its complete absence;
increased blood pressure;
weakness, drowsiness, lethargy;
nausea, often vomiting, possible blood impurities in the vomit;
lumbar pain;
swelling of the face and body;
stool disorder;
convulsions;
shortness of breath, possible wheezing in the lungs.

When intoxicated with certain substances, specific symptoms are added to the general symptoms, for example, in case of poisoning with streptocide or norsulfazole, the patient develops "ache" in the joints and a feverish state. The appearance of such indicative symptoms helps the doctor determine the type of poison in the diagnosis.

The development of kidney failure is divided into 4 stages:

Initial. It is characterized, directly, by the effect of the toxin on the body, lasts up to 3 days.
Oligoanuric. At this stage, the body is unable to completely remove fluid, which causes swelling, shortness of breath and pulmonary rales, and there is also a risk of cerebral edema. The duration of the stage is up to 2 weeks.
Polyuric. The stage indicates a favorable course of the disease. It is characterized by increasing diuresis, which is dangerous dehydration. This stage lasts several months or years.
Recovery. Normalization of kidney function and satisfactory results of urine tests. Complete kidney recovery does not occur in all patients.

There are three degrees of toxic nephropathy:

Light.
Average.
Heavy.

Mild degree is reversible: with proper treatment, it is possible to completely restore the functioning of the kidney. In the middle stage, the concentration of toxic substances in the blood increases, which are normally excreted by the kidneys. With a severe degree of toxic nephropathy, renal failure develops.

Signs of illness

a significant decrease in the amount of urine separated (oligoanuria);
lowering blood pressure;
severe shortness of breath;
pain of varying degrees of intensity in the sides or lower back.

Possible manifestation of symptoms associated with the ingestion of poison or toxin in the human body:

nausea and vomiting with blood;
diarrhea;
pain in the upper abdomen;
pronounced bloating of the intestine;

Toxic nephropathy is an acute pathology with a threat to health and life. The disease can lead to acute renal failure, which leads to death or long-term treatment with hemodialysis.

The following symptoms are characteristic of toxic nephropathy:

nausea and vomiting with blood;
diarrhea;
pain in the upper abdomen;
pronounced bloating of the intestine;
deterioration of consciousness from drowsiness and lethargy to fainting.

Toxic nephropathy is an acute pathology with a threat to health and life. The disease can lead to acute renal failure, which leads to death or long-term treatment with hemodialysis.

The general symptoms of toxic poisoning of the kidneys by various poisons are divided into several phases, and the signs of the pathology will depend specifically on the phase.

Yes, at initial phase Renal failure in the patient will experience a decrease in the volume of urine output. This phase lasts from 1 to 3 days depending on the degree of poisoning.
In the oligoanuric phase the patient may develop fluid retention in the body, which will lead to a general overload of the left heart ventricle. Also, the patient may have a wet lung syndrome, which will be characterized by wheezing and shortness of breath. In this phase, the patient is likely to develop cerebral and pulmonary edema. In the body there is an intensive accumulation of toxins (products of protein metabolism). Possible consequences in the form of inhibition and weakness. Possible cardiac arrest. This phase lasts 7-14 days.
The phase is polyuric. If the treatment is prescribed correctly, and the patient's body provides adequate resistance to the pathology, then the previous phase will turn into polyuric. In this case, the total volume of urine will increase day by day. In extreme cases, the daily volume of urine can reach 35 liters per day. In this case, urine will have a low specific gravity. It is worth being careful here, since this phase can lead the patient to dehydration. The phase lasts 15-30 days.
Then comes a period of recovery, in which the specific gravity of urine and its daily volume are normalized. The recovery phase can last 6-24 months.

In general, at home, toxic poisoning in the early stages may have the following morphological signs:

Drawing pains in the back;
Swelling of the legs and face;
Constant thirst;
Some yellowness of the skin and its dryness;
Possible manifestation of a rash on the palms from the inside;
Nausea, diarrhea, vomiting;
muscle and headache;
A sharp drop in blood pressure in a patient;
Decreased volume of urine;
Lethargy, lethargy, hallucinations.

Symptoms and stages of the disease

The development of the clinical picture of the pathology depends on the concentration of the toxin that has entered the body, on the individual characteristics of a particular person, and on whether the patient's kidney function has been impaired. Toxic nephropathy is manifested mainly by the following signs:

There is pain in the projection area of the kidneys, it is most often dull and aching;
General well-being suffers, intoxication signs appear;
Violation of the functioning of the kidneys leads to the development of edema, protein and blood appear in the urine, its amount decreases.

Pathology is divided into three degrees of severity, depending on how impaired renal function is.

With a mild degree, the symptoms are not pronounced, increased protein, hematuria and leukocyturia are determined in the urine.
With an average degree, oliguria joins all of the listed signs, an increase in urea and creatinine is detected in the blood.
In severe cases, the patient has all the signs of acute renal failure.

Symptoms of toxic nephropathy and the severity of the course of the disease can vary significantly. Quite often, the symptoms of completely different diseases are more pronounced - renal failure and glomerulonephritis. Signs of nephropathy can be considered such health disorders:

stable high blood pressure;
oliguria or anuria;
swelling of the face;
pain in the lumbar region;
urinary retention, more than 4 hours;
severe convulsions;
proteinuria;
hematuria.

Depending on the severity of the disease, accompanying symptoms may also join. Symptoms are observed from the first days of toxic kidney damage and gradually increase.

The most dangerous complication of nephropathy is renal failure. In this case, the functions of the kidneys are completely impaired and the organs practically do not work. With such a pathology, all toxic substances are retained in the blood, due to this, severe intoxication occurs. If the patient is not immediately treated, then a uremic coma may develop, which is characterized by apathy, weakness, migraine and characteristic skin rashes.

With toxic kidney damage, edema initially appears on the face, so it is difficult to miss such a pathology.

In the early stages of the progression of the disease, symptoms may not be observed at all. But as it develops, the following warning signs appear:

feeling of thirst;
weakness;
increased fatigue;
headache;
pain in the place of projection of the kidneys.

In the later stages, the clinical picture is supplemented by the following signs:

visible swelling of tissues;
vascular pressure increases;
protein structures appear in urine;
manifestation of symptoms of pyelonephritis is possible, in case of penetration of infectious agents into the organ.

The disease has such manifestations:

pain in the lumbar region;
swelling of the face and lower extremities;
thirst;
dry skin and mucous membranes, with hemolysis - yellowness;
scarlet-like or morbilliform rash;
abdominal pain, nausea, vomiting, loose stools;
anemia, increased bleeding (petechiae, ecchymosis);
fever (depending on the type of poisoning);
tendency to infections;
muscle pain, headache;
drop in blood pressure;
arrhythmia, blockade as a manifestation of hyperkalemia;
decrease in urine output at the stage of oliguria and an increase in diuresis in the polyuric stage;
convulsions;
lethargy, psychosis, hallucinations, general weakness.

Diagnostics

performing ultrasound of the kidneys.

If confirmation of the diagnosis is required, an X-ray and tomographic examination (MRI or CT) is additionally performed. Often it is enough to see the clinical manifestations and know the cause of the poisoning.

At the first stage of the examination, the doctor will always pay attention to the symptoms that indicate toxic nephropathy. It is optimal to accurately determine the product of poisoning or exactly what factors led to nephrotoxic complications. Mandatory diagnostic methods for toxic nephropathy will be:

general clinical tests of urine and blood;
a special study to identify the causative factor in case of poisoning;
assessment of the functional state of the kidneys according to a biochemical blood test;
performing ultrasound of the kidneys.

If the cause of toxic nephropathy is a disease or treatment, then it is necessary to try to immediately remove toxins from the blood and improve the blood supply to the kidneys. If acute renal failure occurs, then the patient must be hospitalized, and in the conditions of the intensive care unit of the hospital, carry out emergency treatment. In chronic renal failure, therapy largely depends on the severity of changes in the kidneys.

Typically, diagnostic measures are already carried out in the department of nephrology, where a patient is brought with suspected acute kidney injury. In addition to the characteristic clinical picture, the doctor pays attention to the anamnesis of the pathology, finds out the possible nature of the poisoning.

Examination methods for toxic nephropathy are as follows:

General analysis of blood, urine;
Blood test for pH, electrolytes;
Biochemical analysis of blood in terms of indicators of kidney function;
Ultrasound of the kidneys;
If necessary, MRI of the kidneys.

With nephropathy, ESR, the number of leukocytes in the blood most often increase, anemia is observed. In the urine, the amount of protein, nitrogenous compounds increases, hemoglobin and erythrocytes, cylinders appear. The specific gravity of urine is increased, and creatinine, urea, uric acid, and potassium increase in the peripheral blood.

Often, the treatment of toxic nephropathy is carried out in the intensive care unit, especially in acute renal failure. In a less serious situation, treatment is carried out in the standard ward of the department of nephrology (urology). It is necessary to start a set of measures for the treatment of the disease immediately, preferably under the supervision of a toxicologist.

The most important are measures to remove toxins, poisons from the body. This is achieved by doing the following:

Plasmapheresis;
Hemodialysis;
Hemofiltration;
hemosorption;
Washing the gastrointestinal tract.

Forced diuresis is carried out by introducing aminophylline, mannitol, lasix. To wash the stomach, vaseline oil or a large amount of liquid is injected into it. Hemodialysis is recommended in the first 6 hours of the disease, then for another 48 hours peritoneal dialysis is done (blood cleaning through the peritoneum).

Of the drugs for toxic kidney nephropathy, sorbents, diuretics, glucocorticosteroids, as well as abundant alkaline drinking can be recommended. Supplement the treatment with the introduction of glucose with vitamin C, insulin, sodium bicarbonate, calcium chloride, vitamins. If necessary, transfuse albumin and plasma.

To accurately diagnose toxic kidney poisoning, experts carry out a number of activities:

General analysis of blood and urine. At the same time, the characteristic evidence of precisely toxic pathology will be the presence of a low level of hemoglobin, elevated leukocytes and platelets, and the density of urine will also change.
Biochemical analysis of urine and blood. Here, elevated levels of creatine, urea will be detected, the acid-base balance is disturbed.
Also, the doctor will prescribe tracking the daily volume of urine and conducting ultrasound diagnostics.
In this case, the work of the kidney vessels on the angiogram will be monitored.
An MRI or CT may be ordered.

If the patient's body has been poisoned, you should immediately contact a toxicologist. An infectious-toxic kidney has a very revealing clinical picture; its diagnosis does not take much time and does not require a large number of studies and analyzes. First of all, the doctor needs to determine the type of toxin that affects the organ, he can do this according to the patient, and after conducting a series of tests. Among them:

general urine and blood tests;
blood chemistry;
analysis for the detection of toxin;
Ultrasound of the kidneys;
MRI (if necessary);

As a rule, tests are indicative of an accurate diagnosis. With a toxic kidney in the urine, ESR, protein and the amount of urea are increased. An increase in the level of leukocytes in the blood is possible, this indicates an infectious-toxic kidney. Studies help determine the exact stage of the disease and the severity of intoxication. All these data are necessary for prescribing the correct treatment and predicting the further course of the disease.

Diagnostic measures are carried out in a hospital. The poisonous substance is determined. History is being collected. The main research methods are:

clinical blood test;
biochemical blood test;
accounting for diuresis and water balance;
general urine analysis;
Ultrasound of the kidneys;
sometimes MRI.

The standard diagnostic plan includes:

ultrasound of the kidneys;
conducting specific tests for calcification in the urine;
biochemical study of urine;
Analysis of urine . It makes it possible to identify salt crystals.

To detect toxic nephropathy and monitor the condition, the following tests are used:

General clinical studies - a general analysis of blood and urine (anemia, leukocytosis, thrombocytopenia, changes in urine density are characteristic).
Biochemical analyzes - creatinine, urea, acid-base balance, blood ion levels (K, Na, Mg), proteinogram, assessment of the coagulation system.
Determination of daily diuresis.
Kidney ultrasound.
X-ray (survey, with the use of contrast).
Angiography.
Excretory pyelography.
CT, MRI.

Treatment

Any of the nephrotoxic factors can lead to dangerous and life-threatening conditions. If kidney damage occurs, it is extremely important to start providing medical care in a timely manner. The main emergency treatments for toxic nephropathy are hemosorption and hemodialysis, which allow you to quickly and effectively cleanse the blood of poison or toxin. If everything is done correctly and on time, then the chances of recovery are optimal and the prognosis is favorable.

Quite often, toxic nephropathy is treated in intensive care, especially if the disease is complicated by renal failure. If the disease is not very severe, then it is allowed to treat the patient in the urology department.

During this period, the most important task is the rapid removal of toxic substances and metabolic products from the body. For this purpose, the following methods can be used:

plasmapheresis;
washing the stomach and intestines;
hemosorption;
hemodialysis;
hemofiltration.

Forced diuresis is carried out by introducing various medications. In order to qualitatively cleanse the gastrointestinal tract of toxins, vaseline oil or a large volume of liquid is injected into it. It can be pure water, a weak solution of potassium permanganate or salted water. Hemodialysis is effective only in the first 6 hours from the onset of the disease, after which the blood is purified through the peritoneum for another two days.

The patient is shown drugs of various drug groups. The patient must take sorbents, diuretics, hormonal drugs and antihistamines to avoid the development of severe allergic reactions. In addition, glucose with vitamin C, insulin, sodium bicarbonate, calcium chloride and a complex of essential vitamins are shown.

It is worth noting that toxic nephropathy is difficult to treat, since kidney cells are difficult to restore. Nephrons can begin to break down already at the earliest stages of the disease. As a result, kidney function is completely impaired. It is because of this that it is so important to start treatment when the first symptoms of the disease appear.

A patient with toxic nephropathy should consume a lot of alkaline drink. This contributes to a quick recovery.

The main factor in the treatment of toxic nephropathy is the rapid elimination of nephrotoxic poisons from the body. The basic treatment options are the following methods:

If it was mushrooms or a simultaneous intake of a large number of drugs, then it is necessary to wash the stomach.
If poisoning with industrial or chemical poisons occurs, an antidote is prescribed (a drug that removes the poison from the body).
To remove nephrotoxin from the blood, it is necessary to use the method of hemosorption (using activated charcoal).
in especially difficult cases, hemodialysis is necessary.

Any of the nephrotoxic factors can lead to dangerous and life-threatening conditions. If kidney damage occurs, it is extremely important to start providing medical care in a timely manner. The main emergency treatments for toxic nephropathy are hemosorption and hemodialysis, which allow you to quickly and effectively cleanse the blood of poison or toxin. If everything is done correctly and on time, then the chances of recovery are optimal and the prognosis is favorable.

In case of serious poisoning and intoxication, the kidneys can be affected primarily with the development of toxic nephropathy. Only timely treatment will help a person avoid the most severe complication of such phenomena - renal failure.

As a rule, all therapy is aimed at detoxifying the patient's body and restoring kidney function. The criteria by which drug therapy is prescribed depend on the severity of the patient's condition. But in general, the following complex of drugs is prescribed first of all:

specific antidotes.
Diuretics. Provides a reduction in swelling and increases the volume of urine.
Polyionic infusions. The patient is administered solutions to normalize the pH of urine.
A transfusion of blood components may also be prescribed.
To cleanse the blood of toxins, plasmapheresis or hemosorption / hemodialysis is used - hardware pumping and blood purification.

Treatment is carried out in a hospital in the department of nephrology and often in the intensive care unit. Toxicologists are involved.

An important step is the removal of the toxin from the body - the elimination of the cause of the pathological condition.

The following events are being held:

hemodialysis;
plasmapheresis;
flushing the entry gate of the toxin, for example, early gastric lavage;
hemofiltration;
forced diuresis(with the use of osmotic diuretics);
anti-shock measures.

Of the drugs in complex therapy, diuretics, glucocorticoids, sorbents and plentiful alkaline drinking are used. Bed rest is prescribed for the duration of treatment. Protein-rich foods, such as meat, eggs, are excluded from the diet. With symptoms of severe uremia, food should be exclusively carbohydrate.

With preserved excretory function of the kidneys, it is recommended to drink plenty of water (3-4 l / day), preferably sweet. Particular attention is paid to the cleanliness of the skin, since the release of toxic products through it provokes itching and scratching. With unsharply pronounced edema and frequent vomiting, food must be added with salt, since sodium chloride is lost during vomiting.

At a severe stage, the prognosis is unfavorable, since the restoration of kidney function does not occur and the patient dies from uremia. Lethality depends on such factors:

type of poisonous substance;
its quantity;
baseline and kidney health;
the severity of the flow;
timely treatment.

Toxic nephropathy is a very formidable condition, but timely access to a specialist and early detection of pathology increase the chances of a favorable outcome of the disease.

A treatment plan is developed only after the type of pathology that struck the person is accurately established.

Diabetic nephropathy in the first and second stages does not require specific treatment, it is only necessary to maintain the concentration of sugar in the blood within normal limits. Since the pathology progresses against the background of diabetes, it is important to follow a special diet. Also, doctors often resort to the introduction of ACE inhibitors, as well as hemodialysis. If all these measures are not effective, doctors may resort to organ transplantation.

Treatment of nephropathy in pregnant women is carried out only in stationary conditions. The therapy is as follows:

strict bed rest;
preparations with a high protein content;
diuretics;
antiplatelet agents;
potassium preparations;
antihypertensive drugs;
antispasmodics.

Treatment of the toxic form is carried out with the help of forced diuresis, gastric lavage, hemosorption, plasmapheresis, hemodialysis, and so on. After hemostasis is normalized, doctors will begin to carry out anti-shock measures.

Basic principles of treatment of dysmetabolic nephropathies:

normalization of your lifestyle;
diet food;
drug therapy. For the treatment of the disease, vitamin E, vitamin A, vitamin B6, dimephosphon and so on are prescribed.

Treatment for gouty form is primarily aimed at eliminating the main ailment - gout, after which further therapy is carried out:

drinking large amounts of liquid;
the treatment plan must be supplemented with diuretics;
antihypertensive drugs;
antibiotics (in case of attachment of infectious agents).

Therapeutic measures are aimed primarily at eliminating the causative factor. When exposed to toxins, detoxification is carried out using intensive infusion therapy and hardware blood purification.

For the treatment of toxic nephropathy, the following drugs are used:

specific antidotes.
Diuretics. Assign with a decrease in diuresis to prevent edema, including pulmonary edema. More often used Mannitol, Lasix.
polyion solutions. Sodium bicarbonate is administered to normalize blood pH.
Blood components. Plasma and albumin transfusions are performed.

To remove toxic substances, the following methods are used: hemodialysis, peritoneal dialysis, ultrafiltration.

Therapy

Treatment is aimed at removing toxins. If nephropathy is caused by acute poisoning, then gastric lavage is indicated in the first hours. In hospitals, the method of forced diuresis is used, detoxification and anti-shock therapy is used.

First aid

If toxic poisoning is suspected, first aid should be provided to the patient as soon as possible. In this case, it is necessary to stop the intake of toxins into the patient's body. That is, if the poisons come in by air, then you need to provide the patient with fresh air (move him outside, further from the source of infection), if the poisons enter the body through the mouth, then you need to wash the stomach with plain water. A simple water enema is also recommended here. As a sorbent, you can give the patient activated charcoal.
If the patient has loss of consciousness and cardiac arrest, it is necessary to perform artificial respiration and chest compressions. Before carrying out all activities, an ambulance should be called.

Complications and prognosis

Any nephrotoxic effect can cause kidney damage, of which the most severe should be distinguished:

Acute renal failure - manifested by a sharp decrease or complete cessation of urination.
Chronic renal failure - arising as an outcome of an acute condition or as a result of moderately severe poisoning.

Toxic nephropathy is almost always the accidental or unintentional ingestion of toxic or harmful substances into the body. Renal complications in severe illness and drug nephropathy are much less common.

The prognosis of the disease directly depends on the poisonous substance that has entered the body, as well as the severity of the course of toxic nephropathy. The number of deaths in this disease is quite impressive and can reach 70% of all cases. But this does not mean that almost every poisoned person is threatened with death; with a timely diagnosis and adequate treatment, the prognosis is quite good.

The worst prognosis for nephropathy is if chemicals such as cadmium, silicon and hydrogen arsenate have entered the body.

Complications most often appear with a significant ingestion of toxic substances into the body, and through the blood. The most dangerous complication is renal failure, which quite often leads to death.

Toxic nephropathy is a very dangerous disease of the kidneys, which, if not treated in time, leads to a number of complications. It is worth remembering that kidney cells are difficult to restore and the sooner treatment is started, the more favorable the prognosis.

Toxic nephropathy occurs due to poisoning, when exposure to toxins and biological decay products leads to impaired renal function. Harmful substances enter the body from outside or may occur due to illness.

The prognosis for toxic nephropathy depends on the type of poisonous substance and the severity of the course of the disease, mortality ranges from 20-70%. The prognosis is favorable only with the adequacy of therapy and its timeliness. The worst prognosis is when cadmium, silicon, hydrogen arsenate enter the body.

Complications most often develop at a high concentration of toxins and poisons in the body, when they are introduced not through the respiratory tract, but through the blood. Complications include hemolytic uremic syndrome, interstitial nephritis, and acute renal failure. The last mentioned complication often leads to death due to necrosis of the kidneys and complete failure of their function.

The lack of correct treatment for poisoning leads to serious consequences, such as hemolytic uremic syndrome, renal failure and interstitial nephritis. The most dangerous condition is kidney failure. Pathology is characterized by partial or complete failure of the organ. It is fraught with coma and, as a result, necrosis - the death of the kidney. Renal failure is often fatal for the patient.

Prevention

As a rule, specific toxic nephropathy occurs in complex chemical plants and in agriculture. In this case, it is possible to prevent possible risks of pathologies by prohibiting people with kidney problems from working, the risk of developing tumors.
In addition, it is possible to reduce the likelihood of toxic damage by mechanizing the enterprise. In this way, direct human contact with chemicals will be minimized.
Workers in chemical plants should wear protective clothing.
An annual medical examination of people working with chemicals is shown. Particular attention is paid to the kidneys.

It is worth knowing that the earlier the disease is detected, the more effective its treatment will be. Modern medicine quite successfully copes with toxic nephropathy.

The favorable outcome of the disease is due to the type of toxin, the duration of its exposure and the timeliness of diagnosis. Statistically, the disease is cured in 20-70% of cases. Preventive measures help to significantly reduce the risk of toxic nephropathy. Often, pathology occurs against the background of an overdose of drugs, taking drugs only as directed by a doctor and in accordance with the instructions will prevent intoxication.

You should refrain from eating questionable types of mushrooms, low quality food and alcohol. Speaking of prevention in the professional field, the use of personal protective equipment, special uniforms, safety precautions and regular visits to the doctor minimizes the chances of developing the disease.

Chronic kidney damage is observed in the production of polymers, rubber, and in agricultural work. Such production should not be allowed to people with a high risk of developing tumors and underlying kidney disease. An important role in prevention is played by the use of mechanized labor with the maximum limitation of human and chemical contact.

Occupational exposure to toxins requires an annual kidney examination. It is necessary to comply with hygiene standards at work, wear protective clothing. If initial changes are identified, it is recommended to change jobs.

In conclusion, it must be said that the success of treatment directly depends on the time of contacting a medical institution. At the first sign of malaise, it is necessary to undergo an examination. With the use of modern methods of treatment, toxic nephropathy can be cured. Be healthy!

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In severe poisoning and severe intoxication, all internal organs are affected, but in some cases the kidneys suffer the most. Toxic substances that do not dissolve in water settle on the walls of these organs, resulting in the development of toxic nephropathy. With this disease, a person needs urgent treatment, since such a serious complication as kidney failure can occur.

Nephropathy is a toxic kidney injury that can be triggered by various substances of a nephrotoxic nature. There are several degrees of the course of this disease:

Mild - with this course of the disease, the symptoms are mild, although pathological changes can already be noticed in the analysis of blood and urine;
Medium degree - with this course, the symptoms are more pronounced, diuresis is reduced, and uremia increases;
Severe degree - with such a course of the disease, glomerular filtration decreases, edema develops. In severe cases, there is a greater likelihood of developing renal failure.

Various factors can provoke this disease, including diabetes mellitus.. In addition, infectious diseases can also cause nephropathy.

Quite often, toxic nephropathy develops when mushrooms are poisoned, there may be complications in the form of kidney failure.

Causes of the disease

The kidneys are a paired organ, similar in shape to a bean, which performs the following functions:

regulate the balance of fluid in the body;
control and maintain blood pressure at the proper level;
participate in the formation of blood cells;
remove metabolic products from the body.

The causes of toxic nephropathy include the following factors:

poisoning with low-quality alcohol-containing drinks;
heavy metal poisoning;
ingestion of various solvents;
intoxication caused by pesticides;
an overdose of drugs, as well as treatment with expired or low-quality medicines.

If the nutrition of the kidneys is insufficient, then ischemia may develop, which is considered a reversible condition.. If ischemia is not treated for a long time, then necrosis occurs, which is already an irreversible pathology. This condition is characterized by a complete impairment of kidney function, due to which toxic substances accumulate in the body, and they are not excreted in a natural way at all.

Toxic nephropathy requires urgent treatment, otherwise life-threatening complications can occur.

Symptoms of the disease

stable high blood pressure;
oliguria or anuria;
swelling of the face;
pain in the lumbar region;
urinary retention, more than 4 hours;
severe convulsions;
proteinuria;
hematuria.

Depending on the severity of the disease, accompanying symptoms may also join. Symptoms are observed from the first days of toxic kidney damage and gradually increase.

The most dangerous complication of nephropathy is renal failure.. In this case, the functions of the kidneys are completely impaired and the organs practically do not work. With such a pathology, all toxic substances are retained in the blood, due to this, severe intoxication occurs. If the patient is not immediately treated, then a uremic coma may develop, which is characterized by apathy, weakness, migraine and characteristic skin rashes.

With toxic kidney damage, edema initially appears on the face, so it is difficult to miss such a pathology.

Disease diagnosis

Diagnosis of this disease is carried out exclusively within the walls of the hospital, as well as treatment.. To clarify the diagnosis, the following examination methods are used:

Do a detailed analysis of blood and urine.
Take into account diuresis and water balance in the body.
An ultrasound examination of the kidneys is performed.
In severe cases, an MRI may be ordered.

Be sure to prescribe a biochemical blood test, which shows a complete picture of the work of the kidneys. If there is a need, the patient can be referred to clarify the diagnosis to narrow specialists.

It is very important to diagnose a toxic lesion as early as possible and prescribe the correct treatment, in which case the risk of complications is significantly reduced.

Features of treatment

In this period the most important task is the rapid removal of toxic substances and metabolic products from the body. For this purpose, the following methods can be used:

plasmapheresis;
washing the stomach and intestines;
hemosorption;
hemodialysis;
hemofiltration.

It is worth noting that toxic nephropathy is difficult to treat, as kidney cells are difficult to repair. Nephrons can begin to break down already at the earliest stages of the disease. As a result, kidney function is completely impaired. It is because of this that it is so important to start treatment when the first symptoms of the disease appear.

A patient with toxic nephropathy should consume a lot of alkaline drink. This contributes to a quick recovery.

Prognosis and possible complications

The prognosis of the disease directly depends on the toxic substance that has entered the body, as well as the severity of the course of toxic nephropathy. The number of deaths in this disease is quite impressive and can reach 70% of all cases. But this does not mean that almost every poisoned person is threatened with death; with a timely diagnosis and adequate treatment, the prognosis is quite good.

The worst prognosis for nephropathy is if chemicals such as cadmium, silicon and hydrogen arsenate have entered the body.

Possible causes of development

eating poisonous mushrooms;
poisoning with chemicals, heavy metals (mercury, copper, cadmium);
exposure to radiation (uranium salts);
ingestion of organic poisons (acetic acid, carbon tetrachloride);
poisoning with alcohol surrogates;
long-term use of drugs that contribute to the poisoning of the body (antibiotics, antimicrobials);
transfusion of blood incompatible by group or Rh factor;
severe injuries or burns, when massive destruction of tissues occurs with the ingress of decay products into the blood;
penetration of microbes leading to infection and a septic condition.

Consequences of toxic nephropathy

Any nephrotoxic effect can cause kidney damage, of which the most severe should be distinguished:

Acute renal failure - manifested by a sharp decrease or complete cessation of urination.
Chronic renal failure - arising as an outcome of an acute condition or as a result of moderately severe poisoning.

Signs of illness

The following symptoms are characteristic of toxic nephropathy:

a significant decrease in the amount of urine separated (oligoanuria);
lowering blood pressure;
severe shortness of breath;
pain of varying degrees of intensity in the sides or lower back.

Possible manifestation of symptoms associated with the ingestion of poison or toxin in the human body:

nausea and vomiting with blood;
diarrhea;
pain in the upper abdomen;
pronounced bloating of the intestine;
deterioration of consciousness from drowsiness and lethargy to fainting.

Toxic nephropathy is an acute pathology with a threat to health and life. The disease can lead to acute renal failure, which leads to death or long-term treatment with hemodialysis.

Methods for diagnosing toxic nephropathy

general clinical tests of urine and blood;
a special study to identify the causative factor in case of poisoning;
assessment of the functional state of the kidneys according to a biochemical blood test;
performing ultrasound of the kidneys.

If the cause of toxic nephropathy is a disease or treatment, then it is necessary to try to immediately remove toxins from the blood and improve the blood supply to the kidneys. If acute renal failure occurs, then the patient must be hospitalized, and in the conditions of the intensive care unit of the hospital, carry out emergency treatment. In chronic renal failure, therapy largely depends on the severity of changes in the kidneys.

Treatment Methods

The main factor in the treatment of toxic nephropathy is the rapid elimination of nephrotoxic poisons from the body. The basic treatment options are the following methods:

If it was mushrooms or a simultaneous intake of a large number of drugs, then it is necessary to wash the stomach.
If poisoning with industrial or chemical poisons occurs, an antidote is prescribed (a drug that removes the poison from the body).
To remove nephrotoxin from the blood, it is necessary to use the method of hemosorption (using activated charcoal).
in especially difficult cases, hemodialysis is necessary.

Toxic Nephropathy

Under toxic nephropathy understand the damage to the parenchyma of the kidneys, their glomerular apparatus, which occurs against the background of exposure to exogenous and endogenous toxic products and metabolites (ICD-10 code - N14.4).

The classification of pathology includes its following types:

specific nephropathy. Associated with acute external toxicosis that occurs when poisoning with various nephrotoxic substances. Often developing renal dysfunction is preceded by toxicogenic liver damage.
Nonspecific nephropathy. It is caused by hemodynamic disorders of various etiologies, provoked by various severe poisonings.

Causes and pathogenesis

Most often, the disease is caused by such substances:

Heavy metals, their salts;
ethylene glycol;
Oxalic, acetic acid;
Pesticides, herbicides;
Arsenic;
Solvents;
Copper vitriol;
Poisons of animals, insects;
mushroom toxins;
Nitrogen-containing compounds;
Volatile ethers;
Poor quality alcohol.

Often, toxic nephropathy is recorded in people employed in hazardous industries, where work is associated with poisons, chemicals, rubber, polymers. All substances can enter the body both through the respiratory organs and through the blood, through the skin (with bites).

After exposure to the kidneys of toxins and metabolites, swelling of the parenchyma cells is observed, as well as a disruption in the functioning of the renal glomeruli, which causes disruptions in cellular respiration and leads to the precipitation of protein fractions. If the body is affected by hemotoxic poisons, they simultaneously destroy red blood cells, as a result of which hemoglobin clogs the structural units of the kidneys - nephrons. In some cases, kidney damage occurs against the background of their inhibition by free amino acids. Whatever the pathogenesis, ultimately, oxygen starvation of the kidney tissue occurs, its ischemia, which, without treatment, leads to necrosis of the tubules and glomeruli.

Other common signs of pathology:

An increase in blood pressure up to very high numbers.
Decrease in diuresis, frequency of urination (sometimes complete anuria).
Pain in the lower back due to swelling of the kidneys.
Seizures.
Decreased heart rate.
Arrhythmia.
Wheezing in the lungs.

By severity, the disease is differentiated as follows:

The first is a moderate increase in protein, hemoglobin and red blood cells in the blood, mild symptoms.
The second - diuresis falls, the amount of urea, potassium, creatinine in the blood increases greatly, the symptoms increase.
Third - due to swelling of the kidneys and a sharp decrease in glomerular filtration rates, acute renal failure may develop - a deadly complication.

In the progression of renal failure in toxic nephropathy, several stages are also distinguished:

Initial (up to 3 days). There is actually a poisoning of the body with nephrotoxic agents.
Oligoanuric (1-2 weeks). Due to fluid retention, urine output decreases, which leads to an overload of the heart and the development of edema, shortness of breath, and wheezing in the lungs. At this stage, cerebral edema is also possible. There is death from suffocation with pulmonary edema, from cardiac arrest, DIC. Often associated with secondary vasculitis, anemia, thrombocytopenia.
Stage of polyuria (up to several months and years). This stage occurs with a favorable course of the disease. Diuresis increases, which can also lead to dehydration.
Recovery. All indicators of urine and kidney function return to normal, but complete recovery is not possible in all patients.

Diagnostics

Examination methods for toxic nephropathy are as follows:

General analysis of blood, urine;
Blood test for pH, electrolytes;
Biochemical analysis of blood in terms of indicators of kidney function;
Ultrasound of the kidneys;
If necessary, MRI of the kidneys.

With nephropathy, ESR, the number of leukocytes in the blood most often increase, anemia is observed. In the urine, the amount of protein, nitrogenous compounds increases, hemoglobin and erythrocytes, cylinders appear. The specific gravity of urine is increased, and creatinine, urea, uric acid, and potassium increase in the peripheral blood.

The most important are measures to remove toxins, poisons from the body. This is achieved by doing the following:

Plasmapheresis;
Hemodialysis;
Hemofiltration;
hemosorption;
Washing the gastrointestinal tract.

Of the drugs for toxic kidney nephropathy, sorbents, diuretics, glucocorticosteroids, as well as abundant alkaline drinking can be recommended. Supplement the treatment with the introduction of glucose with vitamin C, insulin, sodium bicarbonate, calcium chloride, vitamins. If necessary, transfuse albumin and plasma.

Complications and prognosis

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Complex renal dysfunction caused by chemical or organic substances is called toxic nephropathy. This is a common disease of the renal system, according to statistics, it accounts for 30% of kidney diseases. And every year these numbers tend to grow. This disease develops due to the filling of cells with toxins and poisons, more often it occurs through the gastrointestinal tract, respiratory tract, through the pores.

Nephropathy is divided into two types: specific and nonspecific syndrome. The first includes types of poisoning associated with toxic substances, such as mercury, lead, chemical acids, vitriol, arsenic, etc. Due to intoxication of the body, the work of the kidneys and liver is disrupted. In the second type of poisoning, an excess of damaging substances comes from poisons, and can cause hemodynamic disturbances (insect bites, snake bites, intoxication with fungi, poor quality food, alcohol overdose, etc.).

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Poisonous compounds that cause kidney pathology, a large spectrum. Many of them settle in the body during the life of a person, and some are acquired after illnesses. The disease in question can manifest itself from an overdose of drugs during the course of therapy or when providing one-time assistance. The most common causes of nephropathy are:

the penetration of toxic substances into the body due to the consumption of poisonous mushrooms;
entry into the esophagus or through the skin of toxic chemical compounds;
poisoning caused by heavy metal salts;
radioactive contamination;
infectious intoxication;
an excess of alcohol in the blood;
drug use over a long period;
after a blood transfusion procedure that did not fit the characteristics;
severe skin lesions (wounds, burns), resulting in blood poisoning;
entry of foreign microorganisms into the blood.

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Separately, it is worth considering the manifestation of this disease in children. First of all, complications in the child's body are manifested in a change in the composition of urine. The predisposition of children to nephropathic syndrome is due to hereditary pathologies in the renal structure or with congenital lesions of the genitourinary apparatus, or if similar abnormalities were observed in the mother of the child and aggravated during pregnancy. Stimulates the risk of developing abnormalities in children artificial feeding, frequent infectious colds.

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In order to prevent undesirable consequences in time, it is necessary to know the symptoms of nephropathic intoxication. And these are:

oligoanuria - a syndrome of reducing the amount of fluid secreted by the body during urination;
loss of strength - low pressure in the arteries;
complicated breathing;
strong and weak pain in the kidney area;
urge to vomit, gastric emptying with the presence of blood secretions;
diarrhea;
pain in the solar plexus;
possible fainting, weakness, drowsiness.

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After the nephropathic syndrome, the development of such abnormalities as bacterial tissue damage in the kidneys, hemolytic anemia and thrombocytopenia, and acute renal failure is observed. Renal abnormalities are accompanied by pains of varying degrees in the region of the base of the spine, discomfort in the joints, deviations in urination, as well as a sharp decrease in pressure, in addition, the patient can freeze. When studying the blood composition, anemia and an increase in the number of leukocytes can be observed.

Functional uremia can be fatal for the patient, so if symptoms appear, medical attention is needed. It leads to various nephron dysfunctions or to a complete failure of the organ. Symptoms of such a deviation are: a decrease in the amount of urine excreted, the inability to remove toxins and toxins from the body, a decrease or increase in acidity, dehydration. Against the background of such dysfunction, renal necrosis develops, which causes serious consequences and can cause death.

With the manifestation of this disease, the renal system first of all suffers.

Poisoning often occurs due to damage to the body by toxic products unintentionally, much less often the cause is a drug overdose or diseases that have given serious complications. With the development of toxic nephropathy, the renal system primarily suffers, the most severe consequences are:

Acute renal failure. It is characterized by problematic urination - the amount of excreted fluid decreases sharply, up to the complete cessation of the process of urine excretion.
Chronic renal failure. It can develop from acute renal failure, as a syndrome after an exacerbation. Or it becomes the result of intoxication with mild symptoms.

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During a medical examination, the specialist's attention is focused on the symptoms - how suitable they are for the diagnosis of toxic nephropathy. It is necessary to determine as accurately as possible the irritant that caused the organ damage. To find out the factors, you need to do a general urinalysis, take blood for testing for anemia and leukocytosis. In addition, a study of the cause of the syndrome will be carried out. You will need to examine the state of the nephrons and their functionality - a blood test for biochemical composition. You can do an ultrasound of the kidneys. If necessary, additional clarifications are carried out tomography and x-rays. However, in most cases it is enough to know the poisoning factor and analyze the manifestations of the disease.

When an overdose has affected the lesion or the existing disease has given complications, it is necessary to remove toxic substances from the body, and then stimulate blood flow to the kidneys. When the cause is more complex, care must be provided in a clinical setting, and urgent resuscitation of the patient is possible. If the disease is caused by the flow of renal failure into a chronic form, treatment depends on the specific processes occurring in the organs and the nature of the changes taking place.

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The most important action in the treatment of nephropathic poisoning is the neutralization of toxic factors and their urgent elimination from the body. Medical assistance at such times is needed immediately. Here are the most common first aid measures for poisoning:

Gastric lavage - if toxins have entered the bloodstream due to poisonous food or a large amount of medicines.
Reception of a strong sorbent that removes poisons - with chemical intoxication or poisoning with industrial waste.
Taking activated charcoal or hemosorption will help remove toxins that have entered the bloodstream.
The use of an "artificial kidney" device is used in the most severe cases.

Toxic nephropathy is life-threatening for the patient. In the case when there is a nephrotic lesion, qualified support is indispensable. The most common methods of clinical treatment are the use of an "artificial kidney" and detoxification with activated charcoal. These methods make it possible to urgently remove toxic components from the body. If it was possible to carry out neutralization measures in a timely manner, the percentage of favorable consequences is high. Forecasts are loyal in such cases. Full recovery options exist.

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Severe kidney dysfunction can be caused by a number of factors. In this dependence, it is worth taking preventive measures. Increasing cases of mushroom poisoning. This is due to the collection of wild species that turn out to be poisonous. Therefore, in order to avoid serious consequences, it is necessary to limit the consumption of food of dubious origin. An overdose of drugs occurs with self-treatment and the use of potent drugs. Therefore, before using pills or mixtures, it is safer to get a recommendation from a specialist.

Frequent lesions of the renal apparatus occur in chemical industries. Such types of work are contraindicated for people predisposed to the development of oncology or with the risk of developing renal dysfunction. Technical mechanization of labor will help to protect workers from poisoning in order to limit contact with pesticides as much as possible. In cases where direct contact with poisonous substances is inevitable, it is necessary to undergo regular preventive checks of the nephrotic system. In addition, you need to protect yourself, there is specialized protective clothing. It is worth adhering to the established safety precautions. If pathological changes still occur in the body, it is better to change the scope of activity. When symptoms appear, it is better to immediately go to the hospital, then there is a possibility that the necessary assistance will be provided on time.

With possible poisoning, the kidney area most often falls into the risk group with the further development of toxic nephropathy. To avoid complications, for example, the further development of renal failure, it is necessary to contact a specialist in a timely manner. A quality course of treatment will relieve negative consequences.

Toxic nephropathy is a lesion of the kidney parenchyma, glomerular apparatus.

Toxic nephropathy - a schematic representation of a kidney lesion

Such a manifestation is characteristic of poisoning with internal, or external toxic products, metabolites. In medical terminology, two types of disease are distinguished: specific and nonspecific nephropathy. The first type is associated with poisoning by external toxins, which adversely affects not only the kidneys, but also the functional functioning of the liver. The nonspecific type of the disease is due to disorders in the field of hemodynamics.

They produce a large number of harmful elements that can harm the body, in particular the kidneys. In addition to some of the harmful substances that a person acquires during his life, some of them can occur on their own due to injuries, certain diseases.

Toxic nephropathy with mushroom poisoning

Chemical poisoning is the cause of toxic nephropathy

All these reasons are the main provocateurs in the occurrence of toxic nephropathy. The normal functioning of the kidneys is significantly impaired.

In the future, this leads to complications that become a serious threat to life.

The level of damage depends to a large extent on the type of harmful substance, or its method of entry. A significant role is played by the state of the urinary system. Even with a small amount of ingestion of a toxic substance, the clinical picture is complicated if a person suffers from chronic diseases in this area.

The main symptoms of toxic nephropathy are distinguished:

manifestations, discomfort from shortness of breath;
pain in the side, in the lumbar region;
a sharp decrease in blood pressure;
decrease in urine output.

In cases of contact with toxic or poisonous particles, symptoms may manifest as follows:

bouts of vomiting and nausea, possible blood;
bloating and pain in the abdomen;
stomach upset;
drowsiness, fainting, in general, brain activity worsens.

Infectious-toxic nephropathy - manifestations

It is believed that toxic nephropathy causes great harm to human health. It really is. The disease, when ignored, provokes the development of acute renal failure.

First of all, a qualified specialist refers to the symptoms, then determines the cause of the disease. In this case, the following necessary procedures are prescribed:

ultrasound examination of the kidneys;
blood and urine analysis, as well as a biochemical blood test.

These procedures are necessary in order to determine the condition, performance of the kidneys, to prescribe an effective course of treatment.

Often, a specialist will prescribe a series of procedures, such as an MRI or CT, to confirm the diagnosis.

Toxic nephropathy on ultrasound

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Method of treatment of toxic nephropathy

In order to be cured soon, it is necessary to remove harmful substances. The procedure is carried out as quickly as possible. Experts identify the following effective methods.

Washing will be needed in cases of mushroom poisoning, or drugs.
Use of an antidote. This is a drug that helps to remove poison from the body in case of poisoning with industrial or other chemicals.
Hemosorption is a method based on blood purification using activated charcoal.
Allocate hemodialysis. This procedure is reserved for severe cases.

Diuretics are used for treatment, which reduce pulmonary edema (Lasix, Mannitol), as well as polyon solutions, which normalize the pH level in the blood (sodium bicarbonate is used for these purposes).

Depending on the etiology, the pathogenesis of the disease occurs. Due to poisoning, for example, with ethylene glycol, nephron edema occurs.

If the poisoning process occurred due to poisons of a hemolytic nature, then the nephrons become clogged. In this case, erythrocytes are destroyed.

Together, all of the above factors provoke ischemia of the membranes in the nephrons. Continuous ischemia threatens with irreversible consequences in the form of necrobiotic changes in tangles and tubules.

It should be noted that toxic nephropathy is also manifested in children. In this case, you should pay attention to the composition of urine.

Also, toxic nephropathy manifests itself against the background of predisposition due to hereditary pathologies. If the mother of the baby in the family was sick during or before pregnancy, the child's disease can also worsen.

The provocateurs of the disease in childhood can be artificial feeding, or infectious, frequent colds.

Toxic nephropathy in newborns due to artificial feeding

Preventive measures

Separately, it is worth noting that no one canceled the first aid. It is necessary to stop the flow of toxic substances into the patient's body. If the poisoning was due to fumes, then it is necessary to provide fresh air to the person, immediately remove him from the room. If chemicals enter the stomach, then it is urgent to rinse it. Enemas are also used, activated charcoal is used.

If a person has no heartbeat, or he is unconscious, then it is necessary to do an indirect heart massage, artificial respiration.

Together with these actions, it is necessary to call for medical help.

In preventive measures in industries where there is a high risk of poisoning with harmful substances, people with susceptibility to tumors or kidney damage are not allowed. Most often, such industries include heavy agricultural work, the manufacture of rubber, or polymers.

If you work in a production where there is a high risk of kidney damage, then you need to regularly undergo examinations (at least once a year). Compliance with hygiene standards, special protective clothing will also favorably affect your state of health. If you observe the initial stage of kidney damage, then it is advisable not to hesitate and change jobs.

Kidney with toxic nephropathy in section

Effects

If you suspect this disease, you should immediately contact a qualified specialist. Inaction provokes further damage to the kidneys:

acute renal failure, which is accompanied by a gradual decrease or cessation of the full release of urine;
chronic renal failure that occurs after severe poisoning.

Any penetration into the body of toxic, harmful substances are possible causes of the development of the disease. In order to avoid complications, it is necessary to take the necessary measures in a short time.

Thanks to advances in modern medicine, the disease is treatable. It is worth remembering that with the right and quick contact with a specialist, there is a great chance to recover as soon as possible.

And some secrets...

Have you ever suffered from problems due to kidney pain? Judging by the fact that you are reading this article, the victory was not on your side. And of course, you know firsthand what it is:

Discomfort and back pain
Morning swelling of the face and eyelids does not at all add to your self-confidence ...
Somehow even ashamed, especially if you suffer from frequent urination ...
In addition, constant weakness and ailments have already firmly entered your life ...

Toxic damage to the kidneys is one of the most common diseases of the human body. Pathologies arise due to the ingress of toxic substances into the body from the outside or through their production by the body systems themselves. The disease is called toxic nephropathy (in medical circles - toxic kidney). As a rule, the pathology is manifested by a decrease in the total amount of urine per day, nausea, interruptions in the work of the heart and high blood pressure. If the patient has been diagnosed with such a disease, then the treatment is aimed at removing toxic substances and poisons from the body. For this, both drug therapy and hardware methods of cleaning the patient's blood (plasmapheresis and hemodialysis) can be used.

Important: the severe toxic course of the disease is of particular danger to the patient. In this case, the kidneys may fail completely, and an organ transplant will be needed.

Toxic nephropathy can be classified depending on the causes of its occurrence.

Toxic nephropathy can be classified depending on the causes of its occurrence. So, the following types of pathology are distinguished:

Nephropathy specific toxic. It develops under the influence of direct ingestion of poisons and toxins. It can be alcohol, various chemicals and metals (arsenic, mercury, lead, cadmium, synthetic rubber, oxalic or acetic acid, etc.). Also, a specific form of toxic kidney damage can also develop as a result of poisoning with poisonous mushrooms or a bite of poisonous animals / insects.

Important: with the specific development of nephropathy, toxins enter the human body with food, drink, air or through the pores of the skin. In any of these cases, the poison will sooner or later reach the kidneys with blood.

Nonspecific nephropathy. It develops as a result of penetration into the body of toxic substances that do not have a direct toxic effect on the kidneys, but at the same time stimulate organ failure. Here, the causes of the pathology can be a sharp drop in blood pressure, disruptions in the electrolyte balance, a violation of the general blood flow in the kidneys and the body as a whole, or uncompensated acidosis.
Mediated nephropathy is toxic. In this case, toxic substances and poisons are independently produced in the human body in the presence of such renal pathologies as blockage of kidney nephrons with hemoglobin, proliferation of muscle tissue in the kidneys and squeezing the same renal nephrons, excessive production of amino acids in liver failure. Also, the causes of renal toxic insufficiency can be sepsis (blood poisoning), a long process of squeezing muscle tissue as a result of injury and, as a result, a large amount of protein that enters the bloodstream.

In addition, the causes of toxic damage to both kidneys can be such reasons:

Radiation exposure of a person;
Taking non-steroidal anti-inflammatory drugs, sulfonamides or aminoglycosides for a long time and without proper medical supervision.

Toxic kidney damage can be classified into degrees depending on the severity of the patient's condition.

Toxic damage to the kidneys can be classified according to degrees depending on the severity of the patient's condition. So, there are such stages of pathology:

Mild poisoning. In this case, the patient will have protein, erythrocytes in the urine and increased urine density.
The average degree of pathology. To the already existing symptoms, a decrease in the total daily volume of urine will be added, as well as an increase in potassium, creatine and other metabolites in the patient's body.
In the severe stage of poisoning, the patient develops acute renal failure, which can lead the patient to a coma.

The general symptoms of toxic poisoning of the kidneys by various poisons are divided into several phases, and the signs of pathology will depend specifically on the phase

The general symptoms of toxic poisoning of the kidneys by various poisons are divided into several phases, and the signs of the pathology will depend specifically on the phase.

So, in the initial phase of renal failure, the patient will experience a decrease in the volume of urine output. This phase lasts from 1 to 3 days depending on the degree of poisoning.
During the oligoanuric phase, the patient may develop fluid retention in the body, which will lead to a general overload of the left heart ventricle. Also, the patient may have a wet lung syndrome, which will be characterized by wheezing and shortness of breath. In this phase, the patient is likely to develop cerebral and pulmonary edema. In the body there is an intensive accumulation of toxins (products of protein metabolism). Possible consequences in the form of inhibition and weakness. Possible cardiac arrest. This phase lasts 7-14 days.
The phase is polyuric. If the treatment is prescribed correctly, and the patient's body provides adequate resistance to the pathology, then the previous phase will turn into polyuric. In this case, the total volume of urine will increase day by day. In extreme cases, the daily volume of urine can reach 35 liters per day. In this case, urine will have a low specific gravity. It is worth being careful here, since this phase can lead the patient to dehydration. The phase lasts 15-30 days.
Then comes a period of recovery, in which the specific gravity of urine and its daily volume are normalized. The recovery phase can last 6-24 months.

Important: the range of deaths in toxic kidney poisoning ranges from 20% -70%, and completely depends on the causes of poisoning and the complexity of the course of the pathology. If the kidney damage was not critical, then the patient has every chance of a full recovery.

In general, at home, toxic poisoning in the early stages may have the following morphological signs:

Drawing pains in the back;
Swelling of the legs and face;
Constant thirst;
Some yellowness of the skin and its dryness;
Possible manifestation of a rash on the palms from the inside;
Nausea, diarrhea, vomiting;
muscle and headache;
A sharp drop in blood pressure in a patient;
Decreased volume of urine;
Lethargy, lethargy, hallucinations.

Important: if the patient is suspected of toxic poisoning (bites of animals / insects, inhalation of poisons or tactile contact with them, use of toxins), then if the above symptoms appear, you should immediately contact a medical facility. Timely assistance will save the patient from acute renal failure.

If the patient has loss of consciousness and cardiac arrest, it is necessary to perform artificial respiration and chest compressions.

If toxic poisoning is suspected, first aid should be provided to the patient as soon as possible. In this case, it is necessary to stop the intake of toxins into the patient's body. That is, if the poisons come in by air, then you need to provide the patient with fresh air (move him outside, further from the source of infection), if the poisons enter the body through the mouth, then you need to wash the stomach with plain water. A simple water enema is also recommended here. As a sorbent, you can give the patient activated charcoal.
If the patient has loss of consciousness and cardiac arrest, it is necessary to perform artificial respiration and chest compressions. Before carrying out all activities, an ambulance should be called.

In order to accurately diagnose toxic kidney poisoning, experts carry out a number of activities.

To accurately diagnose toxic kidney poisoning, experts carry out a number of activities:

General analysis of blood and urine. At the same time, the characteristic evidence of precisely toxic pathology will be the presence of a low level of hemoglobin, elevated leukocytes and platelets, and the density of urine will also change.
Biochemical analysis of urine and blood. Here, elevated levels of creatine, urea will be detected, the acid-base balance is disturbed.
Also, the doctor will prescribe tracking the daily volume of urine and conducting ultrasound diagnostics.
In this case, the work of the kidney vessels on the angiogram will be monitored.
An MRI or CT may be ordered.

As a rule, all therapy is aimed at detoxifying the patient's body and restoring kidney function.

specific antidotes.
Diuretics. Provides a reduction in swelling and increases the volume of urine.
Polyionic infusions. The patient is administered solutions to normalize the pH of urine.
A transfusion of blood components may also be prescribed.
To cleanse the blood of toxins, plasmapheresis or hemosorption / hemodialysis is used - hardware pumping and blood purification.

As a rule, specific toxic nephropathy occurs in complex chemical plants and in agriculture.

As a rule, specific toxic nephropathy occurs in complex chemical plants and in agriculture. In this case, it is possible to prevent possible risks of pathologies by prohibiting people with kidney problems from working, the risk of developing tumors.
In addition, it is possible to reduce the likelihood of toxic damage by mechanizing the enterprise. In this way, direct human contact with chemicals will be minimized.
Workers in chemical plants should wear protective clothing.
An annual medical examination of people working with chemicals is shown. Particular attention is paid to the kidneys.

Important: if initial pathological changes in the kidneys (toxic nephropathy) were detected during a physical examination, then the type of activity should be changed to a more favorable one as soon as possible.

It is worth knowing that the earlier the disease is detected, the more effective its treatment will be. Modern medicine quite successfully copes with toxic nephropathy.

Source

Nephropathy is a toxic kidney injury that can be triggered by various substances of a nephrotoxic nature. There are several degrees of the course of this disease:

Mild - with this course of the disease, the symptoms are mild, although pathological changes can already be noticed in the analysis of blood and urine;
Medium degree - with this course, the symptoms are more pronounced, diuresis is reduced, and uremia increases;
Severe degree - with such a course of the disease, glomerular filtration decreases, edema develops. In severe cases, there is a greater likelihood of developing renal failure.

Various factors can provoke this disease, including diabetes mellitus.. In addition, infectious diseases can also cause nephropathy.

Quite often, toxic nephropathy develops when mushrooms are poisoned, there may be complications in the form of kidney failure.

The kidneys are a paired organ, similar in shape to a bean, which performs the following functions:

regulate the balance of fluid in the body;
control and maintain blood pressure at the proper level;
participate in the formation of blood cells;
remove metabolic products from the body.

The causes of toxic nephropathy include the following factors:

poisoning with low-quality alcohol-containing drinks;
heavy metal poisoning;
ingestion of various solvents;
intoxication caused by pesticides;
an overdose of drugs, as well as treatment with expired or low-quality medicines.

Toxic nephropathy requires urgent treatment, otherwise life-threatening complications can occur.

stable high blood pressure;
oliguria or anuria;
swelling of the face;
pain in the lumbar region;
urinary retention, more than 4 hours;
severe convulsions;
proteinuria;
hematuria.

Depending on the severity of the disease, accompanying symptoms may also join. Symptoms are observed from the first days of toxic kidney damage and gradually increase.

With toxic kidney damage, edema initially appears on the face, so it is difficult to miss such a pathology.

Diagnosis of this disease is carried out exclusively within the walls of the hospital, as well as treatment.. To clarify the diagnosis, the following examination methods are used:

Do a detailed analysis of blood and urine.
Take into account diuresis and water balance in the body.
An ultrasound examination of the kidneys is performed.
In severe cases, an MRI may be ordered.

It is very important to diagnose a toxic lesion as early as possible and prescribe the correct treatment, in which case the risk of complications is significantly reduced.

In this period the most important task is the rapid removal of toxic substances and metabolic products from the body. For this purpose, the following methods can be used:

plasmapheresis;
washing the stomach and intestines;
hemosorption;
hemodialysis;
hemofiltration.

A patient with toxic nephropathy should consume a lot of alkaline drink. This contributes to a quick recovery.

The worst prognosis for nephropathy is if chemicals such as cadmium, silicon and hydrogen arsenate have entered the body.

Kidney work

The kidneys play an important detoxifying role. Basically, all toxic substances that enter our body are removed from it in three ways: filtration, excretion and secretion using several transport systems. It is thanks to them that the kidneys are able to remove toxic substances that do not dissolve in water, which can sometimes settle in various organ structures and lead to the development of such a pathological condition as toxic nephropathy.

This pathology develops due to:

toxic effects of the toxic substances themselves, as well as their decay products;
occurrence in the lesion of an autoimmune reaction of the body.

At the same time, despite the different trigger mechanism for the development of a toxic kidney, its clinical manifestations are similar to each other. The degree of kidney damage depends on the concentration of toxic substances, their chemical composition and the way they enter the body. The state of the urinary organs also plays an important role. So, if any pathological process is already taking place in the kidneys, toxic nephropathy can develop even when low doses of toxic substances are received.

Kidney damage

In principle, any ingestion of chemical and biological substances can lead to this dangerous condition, but most often toxic damage to the kidney is caused by:

organic solvents;
heavy metal salts;
pesticides;
various drugs (aminoglycoside antibiotics, sulfonamides, non-steroidal anti-inflammatory drugs, anticoagulants, etc.);
physical impact (radiation sickness, electric shock, injury);
exogenous chemical compounds (substances that enter the bloodstream when bitten by poisonous animals and insects, fungal toxins, etc.).

It can be noted that toxic nephropathy is a complex polyetiological disease, therefore, it is necessary to clearly recognize the possible factors that led to its development by clinical symptoms, and, if necessary, immediately conduct antidote therapy.

Most often, this condition is manifested by changes in the general analysis of urine, such as proteinuria and hematuria. They quickly pass, and the person does not even know that his kidneys have just been subjected to a real attack of toxic substances. But if their dose and concentration is too high, then this can lead to severe, irreversible consequences.

Among all toxic nephropathies, the lion's share is occupied by drug damage, while the effect of chemical agents occurs in conjunction with the immune reactions of the macroorganism. This is due to the fact that the kidney tissue includes a well-developed vascular network, and all allergic components (mast cells, interleukins, immunoglobulins) freely enter the lesion, thereby aggravating the course of the process.

Symptoms of medicinal nephropathy are similar to those of acute glomerulonephritis, when the patient feels general malaise, weakness, irritability. He has swelling of the lower extremities and face. In the urine, hematuria and proteinuria increase. The frequency and quantity of urination also decreases (oligoanuria). Another important and formidable symptom should be considered the appearance of arterial hypertension, which can reach completely prohibitive numbers, causing a person to have seizures and stop heart contractions.

Symptoms of the disease

With the toxic effect of sulfanilamide preparations, prominent representatives of which are streptocid and norsulfazol, fever, severe joint pain, skin and mucous membrane lesions in the form of hemorrhagic rashes join the above-described symptoms. At the level of the renal capillaries, it is possible to detect severe damage to the endothelium of these vessels, with ulceration of their walls and an increase in vascular permeability.

Most often, toxic nephropathy can lead to the development of interstitial nephritis, hemolytic uremic syndrome and acute renal failure. Nephritis is manifested by acute or dull pain in the lower back, passing chills, short-term increase in blood pressure, arthralgia (pain in the joints) and changes in the urine (polyuria, microhematuria, decreased glomerular filtration rate, etc.).

In the general blood test, the most common are an increase in ESR, moderate leukocytosis and anemia. Acute renal failure is already a formidable condition, most often leading to death. It is caused by a sudden decrease or complete loss of kidney function and is manifested by a standard set of clinical symptoms: oligoanuria, nitrogenous waste retention in the body, impaired water and electrolyte balance and acid-base state. The main symptom of this condition is necrosis of the cortical layer of the kidneys, leading to irreversible consequences.

Antidote therapy

All variants of toxic nephropathy are difficult to treat. Its most important component should be considered antidote therapy at the initial stages of the disease. If it is not carried out, doctors can only carry out symptomatic and detoxification therapy. In general, experts try to prescribe strict treatment depending on the toxic agent that led to the development of this process. So, in case of poisoning with sulfonamides, an abundant alkaline drink, diuretics, drugs that block carbonic anhydrase are prescribed.

In acute glomerulonephritis and interstitial nephritis, large doses of glucocorticosteroids, which have a powerful anti-inflammatory effect, are prescribed.

In order to remove decay products and residues of harmful substances from the body, plasmapheresis and hemodialysis are performed. The essence of such manipulations is that a special apparatus is connected to the patient, which takes a certain portion of blood from him, drives it through the filter system and returns it to the body, already purified.

Toxic nephropathy is a pathology of the kidneys and urinary tract, which is rare among occupational diseases.

Etiology

Contact of the renal parenchyma and urinary tract with toxic substances, the accumulation of these substances and the transformation in the renal structures determine the risk of damage to the kidneys and urinary tract. The nature of the damage to the urinary system depends on the chemical composition of the compounds, concentration, routes of entry into the body, the general condition of the body and, especially, the kidneys. Depending on the localization of damage and the nature of the pathological process, chemical compounds can be divided into two groups.

The first includes chemical compounds that mostly cause damage to the kidney parenchyma, which predetermines the so-called toxic nephropathy - functional or structural changes in the kidneys that occur under the influence of exogenous chemicals and their metabolites. The development of toxic nephropathy is promoted by chemicals used in the national economy:

metals and their salts (lead, mercury);

glycols (antifreeze);

esters (duxan, ethyl acrylate);

carbon monoxide, acids and other substances.

Occupational kidney diseases are observed in workers employed in the production of synthetic rubber, polymeric materials, and organochlorine pesticides. The use of the latter in agriculture has led to an increase in kidney damage among the population.

It has been established that kidney damage occurs mainly if the concentrations of dust and vapors of nephrotoxic substances in the air of industrial premises exceed the permissible limits. The entry of poisons into the body is activated in the course of production activities, especially in conditions of elevated ambient temperature. The frequency and intensity of damage increase according to the increase in work experience under the influence of pesticides.

The second group includes chemical compounds that cause chemical irritation of the bladder mucosa and can lead to hemorrhagic cystitis, benign (papillomas) and malignant (cancer) tumors of the bladder. These are mainly aromatic amino compounds (benzidine, dianisidine, airnaphthylamine) used in the production of dyes.

Pathogenesis

Poisons enter the human body mainly through the digestive and respiratory systems, although other routes are possible. Thus, nickel and cobalt penetrate the skin in toxic concentrations and accumulate in the form of crystals in the liver and kidneys.

Of great importance is the direct effect of pesticides on the renal parenchyma, however, kidney function can be impaired as a result of changes in the neuroendocrine regulation of the organ, and as a result of vasomotor disorders.

A disorder of renal hemodynamics, a decrease in renal blood flow against the background of impaired general circulation due to chemical trauma is one of the pathogenetic mechanisms of toxic kidney damage.

There are cases when the toxic effect is exerted not by toxic chemicals that have entered the body, but by their metabolites, for example, oxalic acid in case of poisoning with glycols or products of interaction with other organs and tissues, in particular hemoglobin in case of damage by hemolytic poisons.

There is an obstruction of the renal tubules by the decay products of hemoglobin (poisoning with hydrogen arsenite, acetic essence, blue vitriol), myoglobin, oxalate crystals (poisoning with ethylene glycol, oxalic acid). An immunological mechanism of kidney damage (toxic-allergic) is possible, when acute renal failure develops when a small amount or low-toxic chemical compounds enter the body. Increased individual sensitivity to a chemical matters.

With toxic nephropathy, a change in the activity of a number of enzymes in the blood and urine, the processes of transamination in the mitochondria of the liver and kidneys, the content of amino acids in biological media is detected, which indicates a violation of intracellular processes, an increase in the resistance of cell membranes. There is evidence of the role of hyperaminoaciduria due to toxic damage to the liver in the occurrence of secondary changes in the tubular epithelium of the kidneys.

Clinical picture

Acute poisoning.

When a significant amount of nephrotoxins enters the body, acute renal failure develops over a short time, during which four stages are distinguished:

initial (shock);

oligo- and anuric;

restoration of diuresis, or polyuric;

recovery.

Clinical signs of the initial stage are usually symptoms of the underlying disease, namely general hemodynamic disorders, complicated by microcirculation disorders in parenchymal organs, in particular in the kidneys. The main diagnostic criterion is circulatory collapse, which sometimes goes unnoticed due to the duration of the course. The decrease in blood pressure is accompanied by a decrease in diuresis. Symptoms of the initial stage often go unnoticed due to the severity of the underlying disease and shock. This stage lasts from several hours to 1-3 days.

In the second (oligo- and anuric) stage of acute renal failure, there is a sharp decrease or complete cessation of urination. Often the disease develops imperceptibly. After the normalization of hemodynamic disturbances, the state of health of patients improves slightly, a period of imaginary well-being begins, lasting 3-5 days. However, at this time less and less urine is released, its relative density progressively decreases (up to 1007-1010), at the same time, the content of urea, creatinine, nitrogen and chlorides in the daily amount of urine decreases. With hemolysis or myolysis, heme pigment is found in the urine. In the urine sediment, a large number of erythrocytes and leukocytes, epithelial cells and bacteria are determined.

On the 5th-7th day, the state of health of patients deteriorates sharply. Drowsiness, adynamism appear, appetite disappears, vomiting and thirst occur. Body temperature, depending on the background on which acute renal failure has developed, may be normal or elevated. As a result of a decrease in the body's resistance and purulent-septic complications, the body temperature rises slightly, however, in some patients it may be subfebrile and without the presence of infectious complications.

"Uremic" intoxication, changes in water and electrolyte homeostasis often lead to impaired consciousness. Patients cease to navigate in space and time. Sometimes there are "convulsive crises" resembling epilepsy. With dehydration, asthenia and drowsiness alternate with a feeling of anxiety, acute psychosis, and hallucinations. In very severe conditions, a coma develops.

In the case of prolonged anuria, the patient's skin becomes dry and subsequently desquamated. Very often there are rashes, reminiscent of those with scarlet fever or measles. With intravascular hemolysis, the skin and sclera are icteric. Due to a violation of the coagulation properties of the blood, subcutaneous hemorrhages occur, especially at the injection sites, on the conjunctiva. Tongue dry, furred with white or brown coating. Often develop stomatitis, vomiting of gastric mucus and bile.

In the initial period of the oligo- or anuric stage, constipation is observed, which is replaced by diarrhea with an increase in azotemia. The abdomen is slightly painful on palpation. Harsh breathing is heard in the lungs, in severe cases - congestive rales in the lower sections. In the case of hyperhydration resulting from the irrational administration of fluid, pulmonary edema develops.

Possible effusion into the pleural cavity. Shortness of breath develops due to acidosis, anemia and circulatory disorders. With significant acidosis, dyspnea increases, and in patients who are in serious condition, Kussmaul-type breathing is observed.

Heart damage is manifested by myocarditis (deafness of heart tones, systolic murmur, enlargement, pain in the heart), changes in the ECG. The most severe violations of the activity of the heart occur as a result of changes in the content of potassium in the blood. With hyperkalemia, bradycardia, arrhythmia, shortness of breath, vascular insufficiency develop, changes in the ECG are observed.

Changes in the blood picture are characterized by severe hypochromic anemia, a decrease in the number of red blood cells and a decrease in hemoglobin. Already at the beginning of acute renal failure, pronounced anemia is observed.

During the period of oligo- or anuria, the concentration of urea, creatinine in the blood plasma rapidly increases. The development of hypoproteinemia with a decrease in the albumin-globulin coefficient is characteristic. Hypoalbuminemia is combined with an increase in the content of a- and y-globulins.

There is a violation of the acid-base balance. Enhanced catabolism leads to the accumulation of acidic products in the tissues and the development of metabolic acidosis, which can be replaced by respiratory alkalosis due to increased ventilation of the lungs and the removal of a large amount of bicarbonate ions from the body. This helps to maintain the plasma pH in the normal range, although the alkaline reserve is reduced.

Water metabolism disorders consist of hyper- or dehydration. Distinguish between extracellular and intracellular dehydration.

The clinical picture of intracellular dehydration is represented by symptoms of cerebral edema (vomiting, headache, coma, respiratory rhythm disturbance), intercellular (edema) and intravascular overhydration (hypervolemia, increased blood pressure, left ventricular failure with pulmonary edema).

Extracellular dehydration is clinically manifested by hypovolemia, dry skin, and a decrease in blood pressure. In such patients, the pulse of weak filling is determined, the development of collapse is often observed.

The duration of the oligo- and anuric stage is 2-3 weeks.

The third stage (restoration of diuresis) is characterized by an increase in the amount of urine excreted. With an increase in diuresis, the well-being of patients improves. Drowsiness disappears, consciousness is restored, the intensity of headache, muscle pain, pulmonary edema decreases. The skin becomes dry, appetite improves. With an increase in diuresis, the degree of azotemia decreases, and the concentration ability of the kidneys increases.

The fourth stage (recovery) can last from 3-6 months. up to 1-2 years. The condition of patients after acute renal failure improves slowly. The most persistent symptoms are asthenia, anemia, and a decrease in the concentration ability of the kidneys. Full recovery of the functional state of the kidneys occurs in 1-2 years.

Chronic renal failure.

In isolated cases, the transition of acute renal failure to the chronic stage is possible. Changes in the kidneys under the influence of chemicals that form toxic metabolites are regarded as toxic nephropathy. Pronounced forms of nephropathy develop in acute severe poisoning with chemicals (chlorinated hydrocarbons, organic mercury compounds, organochlorine and phosphorus pesticides, etc.) and are accompanied by acute renal failure of varying severity.

Chronic poisoning with chemical nephrotoxic substances occurs against the background of impaired functions of the central and peripheral nervous system, hematopoietic organs. The first symptoms usually occur after contact with the poison for 3 or more years. Initially, after 3-5 years of work under the influence of a harmful production factor, the functional activity of the kidneys may increase: renal blood circulation and plasma flow increase, glomerular filtration and urea clearance increase. Over the next 6-10 years, some normalization of kidney function is observed.

If the work experience under the influence of toxic substances is more than 10 years, then the activity of compensatory mechanisms decreases with the gradual inhibition of these functions, an increase in the filtration fraction, a decrease in the urea purification coefficient, oliguria, nocturia. The relative density of urine first rises slightly and then decreases. In the urine, a small amount of protein, erythrocytes, hyaline cylinders, and renal epithelial cells are found. There is a decrease in cholinesterase activity.

Thus, three phases of chronic toxic nephropathy can be distinguished:

increased activity of the kidneys;

adaptation;

decrease in the functional ability of the kidneys.

In chronic intoxication with various chemicals, toxic nephropathy is rarely the main syndrome of intoxication; usually, functional disorders of the kidneys are determined against the background of a detailed clinical picture of intoxication. Only in case of intoxication with cadmium and p-naphthol, kidney damage is the leading symptom, the early stages of these intoxications are diagnosed on the basis of indicators of the functional state of the kidneys.

Manifestations of nephrotoxic action of heavy metals are most often characterized by relatively mild clinical symptoms. Significant kidney damage can result from lead intoxication. In severe forms of chronic lead poisoning, changes in the vessels of the kidneys, hemorrhages, epithelial necrosis, and fibrotic changes are observed. Transient proteinuria in this case is due to the irritating effect of lead on the tubular epithelium and reversible functional disorders.

Saturnism is characterized by the presence of a spastic state of the kidney vessels, changes in the epithelial cells of the renal tubules with their intranuclear destruction. As a result of lead exposure, changes in the concentration function of the kidneys occur. And although at present most researchers do not support the hypothesis of a lead etiology of chronic nephritis, nevertheless, in cases where lead intoxication is preceded by kidney disease, poisoning with this substance can cause a significant increase in the severity of a nonspecific inflammatory process in the kidneys.

Occupational diseases of the urinary system include tumors of the bladder. It has been proven that phthylamine, benzidine B, adiacetylbenzidine and some of their derivatives have a carcinogenic effect. These substances enter the human body through the skin, respiratory organs and the digestive canal.

The onset of the disease is accompanied by symptoms of chronic irritation of the bladder mucosa. Quite often, patients do not show any complaints for a long time, except for some inconsistent increase in urination, mainly during the day. In the urine, no deviations from the norm are not determined. Over time, urination is increasingly accompanied by cutting pain, some difficulty and intermittent hematuria.

Later chronic irritation of the bladder mucosa, resulting from the release of aromatic amines, is manifested by urination disorder, against which hemorrhagic cystitis can develop with frequent painful urge to urinate, severe hematuria. With the help of cystoscopy, it is possible to detect subepithelial hemorrhages, localized mostly in the region of the triangle and the neck of the bladder. Sometimes they spread to other parts of the mucous membrane. In severe cases, there is a threat of detachment of the epithelium.

Diagnosis of toxic nephropathy is based on the establishment of the professional etiology of the disease and the substance or complex of substances that caused it.

Treatment

In case of severe poisoning with the development of acute renal failure, for example, as a result of intoxication with mercury salts, hydrogen arsenite, patients must be hospitalized in specialized medical institutions.

In the 1st stage of the disease, the treatment and prevention of acute renal failure consists in the appointment of specific antidotes, the elimination of circulatory disorders, and exchange transfusion during hemolysis.

In stage II, therapeutic measures should be aimed at reducing protein catabolism, maintaining the water-electrolyte and acid-base state, preventing the development of cardiovascular insufficiency and infection. If it is not possible to achieve compensation with the help of conservative measures, extrarenal cleansing methods are used - hemodialysis using an “artificial kidney” apparatus or peritoneal dialysis.

In stage III, careful monitoring of the electrolyte composition of the blood serum is necessary. If necessary, it is corrected.

In urological hospitals, they also treat cystitis, surgical interventions for papillomas or bladder cancer.

In recent years, some progress has been made in the chemotherapy of malignant neoplasms of the urinary tract.

Working capacity examination

Workers who, during a preventive examination, revealed changes in the mucous membrane of the bladder by the type of chronic cystitis, as well as papillomas, need to be transferred to work that is not associated with the possible influence of toxic substances.

With the development of neoplasms, there is a question of surgical intervention and the establishment of disability.

The issue of rational employment must be addressed individually in each case.

Prevention

Prevention of toxic nephropathy consists in the introduction of continuous technological processes, the use of hermetic equipment, improvement of automation and remote control of the process. It requires careful monitoring of the use of personal protective equipment by workers.

Preliminary and periodic medical examinations of workers are of particular importance in the prevention of these diseases.

Toxic nephropathy is a lesion of the kidney parenchyma, glomerular apparatus.

Toxic nephropathy - a schematic representation of a kidney lesion

7 causes of the disease

Toxic nephropathy with mushroom poisoning

Among the factors that provoke the development of toxic nephropathy, there are medications. This is especially true for those drugs that are used to provide emergency medical care and others.
Experts in the field of medicine refer to microbial organisms as sources of poisoning. Due to entering the blood, microorganisms contribute to the septic condition. Also, the process of infection can occur with a conventional transfusion. It provokes the development of the disease incompatibility in the group, or the Rh factor of the blood.
Poisonous mushrooms are especially dangerous, they provoke severe poisoning of the body.
Substances of a chemical nature, salts of heavy metals negatively affect the functional work of the kidneys. This category also includes substances of a radioactive nature.
Among the possible causes of toxic nephropathy is the use of antibiotics, or antimicrobial drugs, over a long period of time. With prolonged use, they can cause damage to health.
Poisoning with low quality alcohol, or organic poisons. The latter include acetic acid, or carbon tetrachloride.
Harmful substances can occur after severe injuries or burns. The tissues begin the process of destruction, as a result of which the decay products enter the human blood.

Chemical poisoning is the cause of toxic nephropathy

All these reasons are the main provocateurs in the occurrence of toxic nephropathy. The normal functioning of the kidneys is significantly impaired.

In the future, this leads to complications that become a serious threat to life.

Symptoms

The main symptoms of toxic nephropathy are distinguished:

manifestations, discomfort from shortness of breath;
pain in the side, in the lumbar region;
a sharp decrease in blood pressure;
decrease in urine output.

In cases of contact with toxic or poisonous particles, symptoms may manifest as follows:

bouts of vomiting and nausea, possible blood;
bloating and pain in the abdomen;
stomach upset;
drowsiness, fainting, in general, brain activity worsens.

Infectious-toxic nephropathy - manifestations

It is believed that toxic nephropathy causes great harm to human health. It really is. The disease, when ignored, provokes the development of acute renal failure.

Diagnostics

First of all, a qualified specialist refers to the symptoms, then determines the cause of the disease. In this case, the following necessary procedures are prescribed:

ultrasound examination of the kidneys;
blood and urine analysis, as well as a biochemical blood test.

These procedures are necessary in order to determine the condition, performance of the kidneys, to prescribe an effective course of treatment.

Often, a specialist will prescribe a series of procedures, such as an MRI or CT, to confirm the diagnosis.

Toxic nephropathy on ultrasound

Method of treatment of toxic nephropathy

In order to be cured soon, it is necessary to remove harmful substances. The procedure is carried out as quickly as possible. Experts identify the following effective methods.

Washing will be needed in cases of mushroom poisoning, or drugs.
Use of an antidote. This is a drug that helps to remove poison from the body in case of poisoning with industrial or other chemicals.
Hemosorption is a method based on blood purification using activated charcoal.
Allocate hemodialysis. This procedure is reserved for severe cases.

Pathogenesis

Depending on the etiology, the pathogenesis of the disease occurs. Due to poisoning, for example, with ethylene glycol, nephron edema occurs.

If the poisoning process occurred due to poisons of a hemolytic nature, then the nephrons become clogged. In this case, erythrocytes are destroyed.

Toxic poisoning in children

It should be noted that toxic nephropathy is also manifested in children. In this case, you should pay attention to the composition of urine.

The provocateurs of the disease in childhood can be artificial feeding, or infectious, frequent colds.

Toxic nephropathy in newborns due to artificial feeding

Preventive measures

If a person has no heartbeat, or he is unconscious, then it is necessary to do an indirect heart massage, artificial respiration.

Together with these actions, it is necessary to call for medical help.

Kidney with toxic nephropathy in section

Effects

If you suspect this disease, you should immediately contact a qualified specialist. Inaction provokes further damage to the kidneys:

acute renal failure, which is accompanied by a gradual decrease or cessation of the full release of urine;
chronic renal failure that occurs after severe poisoning.