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

A disease such as nephrosclerosis has long been ignored by doctors. Until the 19th century, there was no complete description of it. It began to be considered an independent disease only three decades later, when information about the etiology appeared. The disease was associated with damage to arterial vessels against the background of damage to their cholesterol. His prognosis is not always favorable. Many patients after a course of therapy have to deal with complications such as blindness, dysfunction of the ventricles of the heart. In order to maintain the viability of the body, in such cases, urgent blood purification is required by artificial means.

Anatomical note: kidney nephrosclerosis

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

Diagnosis of the disease begins with a study of the patient's complaints, his anamnesis and physical examination. During the consultation, the nephrologist can also palpate the abdominal cavity. These manipulations allow us to assume a preliminary diagnosis and outline further examination tactics.

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

increase in indicators;
reduction in the quantitative content of protein;
a decrease in potassium, and an increase in phosphorus and magnesium.

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

For a more accurate assessment of the work of the organs, they resort to instrumental methods for examining patients with a diagnosis of "nephrosclerosis". Ultrasound of the kidneys, for example, allows you to assess their size and the state of the cortical substance. Urography is mandatory. Angiography gives a complete picture of the state of the vessels in the affected organ.

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

Use of drugs

Therapy of this disease is carried out in specialized nephrological centers. It boils down to eliminating the main provocateur factor. Attempts to restore lost kidney function without a first step are usually unsuccessful.

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

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

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

Surgery

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

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

Nutrition Features

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

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

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

Forecast

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

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

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

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

Kidney functions:

filtering, excretory and concentrating

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

With intoxication (alcohol, drugs, medication), toxins are excreted mainly through the kidneys. Therefore, if a lot of time has passed after taking drugs or excess alcohol, then it no longer makes sense to wash the stomach. Toxins have already been absorbed into the blood and gradually enter the kidneys.

ion-regulating

Blood plasma is filtered through the renal tubules twice before becoming urine. During filtration, the body retains all the necessary ions (trace elements), and removes excess and harmful ones.

exchange (metabolic)

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

hormonal and hematopoietic

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

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

Types of nephrosclerosis

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

Nephrosclerosis in arterial hypertension or hypertensive nephrosclerosis

Arterial hypertension is a vascular disease, often hereditary and characterized by an increase in blood pressure above 140/90 mm Hg. and hypertensive crises. A hypertensive crisis is a sharp increase in pressure, the numbers can be different from 150/90 mm Hg. up to 230/140 or more. Constantly elevated pressure gradually "wears out" the vessels. The impact occurs on absolutely all vessels, but today we are talking about the kidneys. Renal vessels, experiencing constant "bursting" from the inside, become more rigid. The wall becomes less elastic and passes plasma through itself for filtration worse.

Thus, the kidneys do not receive enough material to filter, urine becomes less.

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

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

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

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

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

Atherosclerotic nephrosclerosis

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

Firstly, the cholesterol "plaques" themselves narrow the lumen in the vessel and make it more difficult for blood to reach any organ.
Secondly, these "plaques" cause a constant sluggish inflammation in the vessel, this activates the coagulation system. As a result, blood clots form on the surface of the cholesterol growth.

Blood clots grow and at some point break off and float with the blood flow to where it will turn out.

All these facts indicate that we make a lot of problems for ourselves completely on our own by malnutrition, eating fast food, leading a sedentary lifestyle and not turning to doctors preventively.

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

Kidney infarction

The neglected course of hypertension with frequent crises, widespread atherosclerosis with the formation of blood clots, an innate tendency to form blood clots (thrombophilia) can lead to a blood clot entering the kidney. In the place where the thrombus hit, blood circulation stops and the tissue dies and dies. This area is then replaced by scar tissue and never again functions as a kidney. The larger this area, the worse the forecast for further developments.

Secondary nephrosclerosis

Nephrosclerosis in the outcome of chronic pyelonephritis

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

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

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

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

Nephrosclerosis with glomerulonephritis

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

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

Immune inflammation in the same way leads to wrinkling and "drying out" of the kidneys, as well as infectious.

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

Nephrosclerosis against the background of ICD

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

Stones in the structure of the kidney gradually squeeze the surrounding tissue, preventing it from functioning normally. There is stagnation, ischemia (oxygen starvation) develops in some parts of the kidney, and gradually, sclerosis develops in patches.

Nephrosclerosis in kidney tuberculosis

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

Nephrosclerosis in diabetes mellitus

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

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

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

Nephrosclerosis in systemic lupus erythematosus

Systemic lupus erythematosus is an autoimmune disease that affects almost every small vessel in the body.

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

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

Renal amyloidosis

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

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

In amyloidosis, only the kidneys are rarely affected (but the kidneys are primarily affected), and the heart and lungs also suffer.

Radiation damage to the kidneys

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

Severe preeclampsia

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

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

Clinical signs

Symptoms of nephrosclerosis and patient complaints are as follows:

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

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

Diagnostics

Laboratory tests to detect nephrosclerosis

General urine analysis (OAM): here we will see how much protein is excreted in the urine (normally it is not), if there is inflammation or the release of salts, blood.
Biochemical analysis of blood (BAC): here we are interested in the indicators of the so-called nitrogenous slags - creatinine and urea. If they rise, then it is necessary to undergo an in-depth examination without delay.
Ionogram: with nephrosclerosis, potassium in the blood rises.
Zimnitsky's test: urine is collected during the day in different jars, and then they calculate how much was released during the day, and how much at night, and what is the density of urine in each portion.
Complete blood count (CBC): with kidney damage, anemia is often present.

Instrumental diagnostics (ultrasound, urography)

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

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

Nephrosclerosis ultrasound signs:

atrophy of the outer (cortical) layer of the kidney
The kidneys are reduced in size, their density (echogenicity) is increased, the boundary between the layers of the kidney (cortical and cerebral) is erased. The contours of the kidneys are often uneven, wavy, indicating gradual "shrinking".
salt deposits are visible in the kidney tissue (nephrocalcinosis)

Kidney biopsy

A kidney biopsy is the removal of a piece of kidney tissue for analysis. Technically, this is a puncture in the lumbar region with anesthesia, and the collection of a thin "column" of cells from the kidney. Then the obtained material is given for examination to a doctor - a histologist, who stains the tissues and examines them microscopically. And then makes the final diagnosis. Treatment will depend on the diagnosis.

Treatment

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

Diet

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

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

Preparations

Antiplatelet agents

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

Are applied: dipyradamole (chimes), pentoxifylline (trental), heparin courses.

Drugs that lower blood pressure

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

Calcium channel blockers (nifedipine and nifedipine retard, amlodipine) are also used in the later stages, effectively reducing blood pressure. Permitted on the background of hemodialysis.

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

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

trace elements

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

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

Anemia treatment

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

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

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

Sorbents

Sorbents (polysorb, enterosgel) are "absorbent" drugs that are used orally to reduce the overall intoxication of the body.

Phytopreparations

In the treatment of this group of kidney disease, herbal remedies are used less, but in the early stages they can help maintain kidney health. Cystone, kanefron, hofitol, lepenefril and others are used.

Renal Replacement Therapy

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

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

Such changes in blood tests indicate that the kidneys do not filter the blood, it is not purified and poisons the body. First of all, the brain suffers.

Peritoneal dialysis

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

Hardware hemodialysis

it is the purification of the blood by an apparatus often known as an "artificial kidney". The principle of blood purification is similar to peritoneal dialysis, it consists in passing the patient's blood through a column with a special solution, and then pouring it back. They go on dialysis often, several times a week and spend several hours on the machine. In order to make it convenient to connect the device and take blood, a fistula is formed on the patient's forearm. A fistula is an artificially connected vein and artery on the inner surface of the forearm. In order to create it, a small operation is performed, then it is necessary to wait for healing and only then begin dialysis.

Hemofiltration

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

kidney transplant

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

After surgery, patients take immunosuppressive drugs for the rest of their lives to prevent rejection of a foreign kidney.

A relative or other volunteer can become a donor; cadaveric kidneys are also used. To determine the future compatibility of the donor kidney and the patient, special complex genetic analyzes are carried out.

Outcome of the disease

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

With the timely start of treatment and the use of RRT, the patient's life becomes more complicated in the sense that he has to go to dialysis, change solutions, constantly take tests and often weigh himself (the volume of dialysis fluid is calculated per patient's weight). But at the same time, people with nephrosclerosis live, and live long and fully!

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

Under nephrosclerosis of the kidneys (Nephrosclerosis) is meant the replacement of functional parenchymal renal tissue with connective tissue. This tissue cannot perform the function of the kidney parenchyma, so the activity of the organ is drastically disrupted. The formation of connective tissue in the kidney leads to changes in the circulatory system of the kidney. The walls of the arteries and arterioles thicken, lose their elasticity and cannot fully supply the organ with blood. This leads to malnutrition of mini-structures of the renal tissue - glomeruli and tubules - and to their further death. As a result, the kidney decreases in volume (primary shriveled kidney) and does not perform its function.

The outcome for this serious disease is different, depending on the quality treatment started on time and the correct recovery period.

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

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

Causes of nephrosclerosis

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

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

Primary nephrosclerosis: what is it

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

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

Classification of primary nephrosclerosis

Primary nephrosclerosis, depending on the causes that caused it, is divided into such types.

atherosclerotic

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

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

Hypertensive nephrosclerosis

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

involutive

Develops with age in the elderly. On the walls of the arteries after 50 years, there is a process of calcium deposition, which affects the elasticity of the vessels and their patency. This leads to a decrease in the blood supply to the kidneys and to ischemia.

Secondary nephrosclerosis

Kidney nephrosclerosis can develop not only due to sclerotic lesions of the renal vessels, but secondarily against the background of inflammatory and degenerative processes in the renal structures - renal glomeruli, tubules and stroma of the kidney. Often secondary nephrosclerosis and wrinkling of the kidneys are the result of such diseases:

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

Symptoms of nephrosclerosis

Every tenth inhabitant of the Earth has kidney damage, namely nephrosclerosis at one stage or another of the disease. But many of them are not even aware of their illness. The insidiousness of nephrosclerosis is that at the initial stage, symptoms are practically not expressed. The disease is discovered by chance during the delivery of urine and blood tests. If at this moment you do not pay due attention to the developing disease, then over time it progresses up to terminal renal failure. At this stage, serious complaints appear and symptoms are pronounced. But the moment when the disease could be defeated or the patient's condition stabilized at this stage has already been missed.

This is how the face of a patient with nephrosclerosis in the stage of advanced renal failure looks like

Clinical symptoms of nephrosclerosis appear when kidney function is impaired:

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

If such symptoms or some of them occur in a child or in an adult, then it is worth immediately undergoing a nephrological examination.

Diagnostics

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

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

Treatment

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

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

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

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

With high levels of cholesterol in the blood, statins are prescribed, which normalize fat metabolism and favorably affect the vascular formations of the kidney. In complex treatment, do not forget about cardioprotectors. With anemia that accompanies the dialysis stage of nephrosclerosis, artificial erythropoietin preparations are prescribed.

One of the effective modern methods of blood purification is hemodialysis, which allows prolonging the life of patients in the terminal stage of nephrosclerosis.

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

hemodialysis, hemodiafiltration;
peritoneal dialysis;
kidney transplant.

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

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

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

Prevention

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

Do not abuse meat food and salt. Eat more vegetables and fruits. Avoid canned foods.
Do not allow excess weight, constantly keep it within the age norm.
Drink up to 2-3 liters of pure water daily.
Regularly engage in sports that are accessible by age and health.
Do not smoke or abuse alcohol.
Do not self-medicate, especially with drugs such as antibiotics, antispasmodics, painkillers, diuretics. Do not get carried away with nutritional supplements, "fat burners", advertised, but unverified means for losing weight;
Do not come into contact with toxic substances, dyes, fungicides, heavy metals.
Do not get involved in sun exposure, do not overcool.
Constantly monitor blood pressure, blood sugar and cholesterol.
Annually undergo medical examinations that allow you to monitor the condition of the kidneys.

Finally

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

Not a single kidney disease passes without a trace, any pathological process in the kidney leads to damage and death of its structural and functional units - nephrons. The loss of single nephrons does not affect the function of the organ. With the mass death of renal structures, they are replaced by connective tissue, while the function of the kidney is lost.

The process of replacing functioning nephrons with connective tissue is nephrosclerosis. This is not an independent disease, but a possible outcome of any pathological processes in the kidney. The outcome of nephrosclerosis is a complete loss of function, a decrease in size and, ultimately, wrinkling of the kidney. Sometimes doctors even replace the term "nephrosclerosis" with the concept of "shrunken kidney", in fact it is the same thing.

Causes of nephrosclerosis

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

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

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

In recent decades, hypertension and diabetes mellitus have been considered the main cause of this pathology, although literally 20 years ago glomerulonephritis was in the lead.

The main symptoms of nephrosclerosis

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

Urination disorder

This symptom includes polyuria (excessive urination - 2 liters per day or more) and nocturia (an increase in the amount and volume of urination at night).

In a severe form of nephrosclerosis, polyuria is replaced when the amount of urine, on the contrary, decreases sharply. Anuria (complete absence of urine may indicate end-stage renal failure).

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

Arterial hypertension

In case of violation of the blood supply to the kidneys, a protective mechanism is activated, aimed at increasing the pressure in the renal vessels, as a result of which substances are released into the blood that increase the pressure in the entire bloodstream. With nephrosclerosis, arterial hypertension reaches very high values, hypertensive crises are possible with an increase in systolic pressure up to 250-300 mm Hg. Art., while reducing the pressure is very difficult.

Edema

Fluid retention in the body leads to the appearance. They first appear on the face in the morning and disappear after a while. Then they gradually go down, fingers on the hands swell (patients pay attention that they cannot take off the rings in the morning) and lower legs (do not put on shoes, do not fasten boots). With the progression of the disease, edema spreads throughout the body, anasarca occurs - a generalized edema of the subcutaneous fat, soft tissues, and in the worst case, internal organs.

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

Stages of nephrosclerosis

There are 2 periods in the development of this pathology:

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

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

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

In a malignant course, nephrosclerosis progresses rapidly and in a few years can lead to a complete loss of kidney function, severe and doom the patient to life. Such an unfavorable outcome can be observed in malignant arterial hypertension and eclampsia in pregnant women.

Diagnosis of nephrosclerosis

With nephrosclerosis, corresponding changes will be detected in the general urine test.

Since the symptoms of a wrinkled kidney appear in the later stages, it is very important to identify this pathology as early as possible with the help of an examination, since the effectiveness of treatment in this case will be much higher. An important role is played by the collection of anamnesis of the patient.

General urine analysis. Any examination of the kidneys, of course, begins with a urinalysis, with initial nephrosclerosis, the following abnormalities can be detected: a decrease in the relative density of urine, the appearance of protein, single red blood cells and cylinders.
Blood tests. In a clinical blood test, a decrease in the level of hemoglobin and platelets is possible. In the biochemical - a decrease in the amount of total protein, an increase in the level of urea, creatinine, uric acid and sodium. It should alert the increase in glucose and cholesterol levels.

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

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

Treatment of nephrosclerosis

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

In addition to therapy aimed at treating the underlying disease, patients need to follow a diet. It is recommended to limit the amount of protein, sodium chloride, in the diet there should be enough vitamins and mineral salts. In the absence of arterial hypertension and edema, fluid and protein restriction is not required.

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

During a lifetime, every person at least once encounters diseases of the urinary system. For some, they pass almost without a trace, but people with a weakened immune system get complications in the form of wrinkling of the kidney, otherwise referred to as nephrosclerosis. If earlier it was thought that such a pathology occurs mainly in patients over sixty years old, now doctors say that the disease is increasingly manifested in children, adolescents and the working population. That is why it is so important to know what the early symptoms of pathology look like, as well as which doctor you need to contact for help.

Nephrosclerosis of the kidney: definition of the disease

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

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

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

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

Primary and secondary nephrosclerosis

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

Single sided and double sided

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

With the development of nephrosclerosis, on the one hand, a healthy kidney takes over all the functions

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

Bilateral renal nephrosclerosis is characterized by a more malignant course

Atherosclerotic shriveling of the kidney

When cholesterol metabolism is disturbed, plaques containing a large amount of fats form in the wall of blood vessels. They slow down the normal flow of blood through the arteries and veins, causing the kidneys to experience a serious lack of oxygen. This leads to the gradual death of some cells and the replacement of existing nephrons with a connective tissue substance that cannot perform the function of filtration and reabsorption. Atherosclerosis is a consequence of alcohol abuse, smoking and malnutrition.

Atherosclerotic nephrosclerosis occurs predominantly in older people.

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

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

Diabetic shriveling of the kidney

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

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

Malignant nephrosclerosis

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

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

Hemodialysis lasts at least 4-8 hours

The main clinical symptoms of the development of the disease

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

A compressive headache is often the first sign of kidney disease.

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

With nephrosclerosis, edema is formed on the upper half of the body.

The author of the article happened to participate in the treatment of a patient with a malignant form of nephrosclerosis. The man was admitted to the intensive care unit due to an acute hypertensive crisis and a pressure of 200/100 millimeters of mercury. At the same time, he developed serious kidney damage: urine practically did not stand out from the bladder, as a result of which the patient suffered from serious intoxication. Due to the involvement of the nervous system in the pathological process and damage to the cerebral cortex, the patient fell into a long coma. After sessions of infusion therapy and several hemodialysis procedures, it was possible to bring him out of this state.

Methods for diagnosing a wrinkled kidney

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

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

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

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

How is nephrosclerosis treated?

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

The most important principles of therapy for nephrosclerosis:

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

Table: drug therapy for nephrosclerosis

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

Photo gallery: drugs for the treatment of shriveled kidney

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

Surgical elimination of pathology

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

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

The operation takes two to five hours.

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

Traditional medicine as an aid

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

Before you start taking any new infusion or decoction, you need to check for allergic reactions. To do this, be sure to drink a small amount of liquid. With the appearance of a rash, itching, burning, choking and coughing, immediately abandon this remedy.

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

Photo gallery: traditional medicine for the treatment of a shriveled kidney

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

Video: treatment of kidney ailments with natural remedies

To restore the necessary balance of proteins, fats, carbohydrates and vitamin and mineral elements, patients with a wrinkled kidney are prescribed a special diet. It allows you to reduce the load on the cardiovascular and urinary system and contributes to the normalization of blood pressure. Basic principles of proper nutrition for patients with nephrosclerosis:

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

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

What foods are useful for people with nephrosclerosis:

fresh vegetables and fruits (in the form of salads, mashed potatoes, cuts);
milk, cheese, cottage cheese, yoghurts without additives, snowball, kefir, bifidok;
lean meat (turkey, chicken, beef) and fish (pink salmon, hake, pollock, perch);
cereals (buckwheat, oatmeal, rice, oatmeal, millet);
hard pasta;
nuts;
legumes and peas (beans, chickpeas, lentils).

Photo gallery: healthy food

Fresh vegetables and fruits are the best source of vitamins
Curd contains a lot of calcium
Eating meat restores the need for protein

Predictions and possible complications of nephrosclerosis

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

As you know, lifestyle also has a significant impact on the development of many complications of nephrosclerosis. In his practice, the author of the article treated one patient who had suffered from pyelonephritis for many years. She refused to follow a diet and take medications, which regularly led to a deterioration in her condition. A few days after the exacerbation of chronic pyelonephritis, the woman was hospitalized in the intensive care unit, where she was diagnosed with kidney failure against the background of nephrosclerosis. The affected organ had to be completely surgically removed, and the patient is now required to attend hemodialysis for life. And also she was assigned the second group of disability. The development of this situation could have been avoided if the patient had corrected her habits in a timely manner and regularly took the medications prescribed by the doctor. That is why doctors strongly recommend that you constantly go for examinations and not start chronic diseases.

What complications and unpleasant consequences can lead to nephrosclerosis:

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

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

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

Based on my own experience, the author of the article can say that the most unpleasant prognostic sign is the presence of a convulsive syndrome. At the same time, the tone of the muscles of the body increases in the baby, it is spastically bent, and the limbs are deformed. Such a pathology indicates the development in the child of an excess content of potassium in the body. This chemical element is responsible for the contraction of the muscles of various organs, including regulating the activity of the heart. Its increased content can provoke arrhythmia, which is often observed in children with nephrosclerosis.

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

All babies with suspected development of such a pathology are subject to mandatory hospitalization. Therapy in the Department of Nephrology is carried out according to the same principles as in adults, however, dosages and drugs are replaced with more gentle ones, it is permissible to use various decoctions and herbal infusions. After discharge from the hospital, the child must follow a diet, limit the intake of salt, sweets and fast food, as they slow down the metabolic processes in the human body.

The body of a baby has a much greater potential for regeneration than the body of an adult. That is why patients under the age of 18 who have been diagnosed with such a disease can almost completely recover with a well-chosen course of medical procedures.

What drugs are used to treat nephrosclerosis in children:

antihypertensive agents: Veroshpiron, Labetalol, Verapamil, Diltiazem, Chlorpromazine;
anti-inflammatory and antipyretic: Ibuklin, Ibuprofen, Nurofen, Paracetamol, MIG;
diuretics: Spironolactone, Urakton, Phonurite, Diakarb, Hypothiazid.

Photo gallery: medicines for the treatment of a wrinkled kidney in children

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

The manifestation of the disease and its treatment in the elderly

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

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

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

Anticoagulants prevent the formation of blood clots and thickening of the blood, which is often found in older patients. The most famous drugs are: Heparin, Fraxiparin, Clexane, Enoxaparin sodium, Lepirudin, Refludan, Neodicumarin, Sinkumar.
Antiplatelet agents also normalize blood flow and reduce the likelihood of emboli formation. These include: Aspirin, Thrombo ACC, Dazoxyben, Ridogrel, Prostacycline, Dipyridamole, Curantil, Anturan, Persanthin, Ticlid, Plavix.
Phytotherapy: Preparations based on various plants and herbs are less aggressive, but highly effective. They help relieve spasm and inflammation from the soft tissue area, as well as stimulate urine output and reduce swelling. The most famous are: Cyston, Kanefron-N, Fitolizin, Afala, Urolesan, Flavia, Trinephron.

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

Clexane is an anticoagulant drug that thins the blood.
Clopidogrel reduces the likelihood of a blood clot
Cyston - a herbal preparation that helps to normalize urination

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

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