Classification of kidney disease, symptoms,diagnostics

Update: October 2018

The kidneys are one of the main filters of the body. Through them
blood plasma is filtered, turning first into primary and then
and in the secondary urine, carrying off excess nitrogenous toxins and
mineral salts. AT норме внутренняя среда почек стерильна.

However, microflora often appears in the kidneys, causing
inflammation. This is facilitated by developmental anomalies (expansion
cup plunger). Among the causes of renal pathologies
autoimmune processes, tumors, abnormalities of the structure.

The unit of structure of the kidney is the nephron, which is represented
vascular glomerulus, surrounded by a capsule, and the system of tubules.
The glomerulus filters blood, and partial
reabsorption of sodium, potassium and chlorine ions.

Clinical classification of kidney disease

Glomerulopatii – primary lesions of the glomeruli.

  • Acquired: inflammatory (glomerulonephritis) and
    dystrophic (diabetic or hepatic glomerulosclerosis,
    amyloidosis).
  • Hereditary: hereditary amyloidosis, Alport syndrome
    (nephritis with blindness and hearing loss – hearing loss), lipoid
    nephrosis.

Tubulopathies – pathologies with predominant involvement
tubules.

  • Acquired obstructive: myeloma and gouty
    bud.
  • Приобретенные некротические: некротический nephrosis.
  • Hereditary develops against the background of various disadvantages
    enzyme systems: phosphate diabetes, Albright syndrome, tubulopathy
    with nephrolithiasis.

Kidney stromal disease – acquired inflammations of the type
pyelonephritis or tubulointerstitial nephritis.

Abnormalities of the kidneys:

  • polycystic
  • underdevelopment of the kidney,
  • kidney prolapse.

Tumors of the kidneys:

  • renal cell carcinoma
  • kidney adenoma
  • transitional cell carcinoma
  • cancer of the pelvis
  • nephroblastoma (in children).
  • metastases in the kidney tumors of the pancreas, cancer
    blood.

Exchange pathology: urolithiasis.

Vascular disasters: renal artery thrombosis, heart attack
the kidneys.

Kidney disease symptoms

Pains

In renal diseases located in the lumbar region or side.
In different pathologies, the intensity of pain will be different.

  • So the most intolerable acute pain gives attack urolithiasis
    diseases when the urinary tract closes with a stone. Wherein боль
    will be not only in the projection of the kidney, but also along the ureter on the
    anterior abdominal wall. There will also be a reflection of pain in
    groin and genitals. Pain increases with movement
    and decrease at rest.
  • Torsion of the renal pedicle with a wandering kidney also gives
    intense pain. With the omission of the kidney (nephroptosis) back pain
    occurs during exercise or during lifting
    weights.
  • ATоспалительные заболевания, сопровождающиеся отеком почечной
    tissues, give long aching dull pain in the lower back, which sometimes
    perceived as heaviness in the side. When tapping on the area
    kidney pain increases.
  • Late stages of primary kidney tumors or metastatic tumors
    lesions give pain of different intensity.

Urinary Disorders (Dysuria)

These are frequent first symptoms of kidney disease, characteristic of
most renal pathologies. It may be more frequent.
urination (with pyelonephritis), their pain (pyelonephritis,
urolithiasis), frequent false desires (pyelonephritis), frequent
night urination (glomerulonephritis, pyelonephritis).

  • Changes in the urinary rhythm are also observed.
    (frequent nightly and rare daytime urination), called
    nocturia (with glomerulonephritis).
  • Polyuria – when urine is more than normal (2-3 liters),
    for example, when coming out of acute renal failure, in
    polyuric stage of chronic renal failure.
  • Oligouria – decrease in urine volume in one portion or per day
    (for interstitial nephritis, glomerulonephritis).
  • Anuria – acute urinary retention (in acute or chronic
    renal failure, blockage of the urinary tract with a stone,
    interstitial nephritis).

Changes in urine indicate problems in the kidneys

ATидимое глазом помутнение мочи характерно для воспалительных
kidney diseases (pyelonephritis, glomerulonephritis) due to
the appearance of urine protein. Similar phenomena will occur when
disintegration of renal tumors or breakthrough abscess or carbuncle
the kidneys. Such symptoms of kidney disease in women can
disguised gynecological problems.

  • Urine in the color of meat slop is characteristic of bleeding in the background.
    urolithiasis, in some forms of glomerulonephritis.
    Similar symptoms in men can cause urological
    патологии, поэтому требуется дифференциальная diagnostics.
  • Dark urine is a consequence of an increase in its concentration. So she
    may become inflamed.
  • Too light urine can be in the fall of the ability of the kidneys
    concentrate it. It occurs in chronic pyelonephritis,
    although normal with a significant drinking load it can
    be.

Temperature rise accompanies infectious processes

Pyelonephritis will give a temperature of up to 38-39, and at
apostematic nephritis (abscess or carbuncle kidney) temperature
can rise and up.

Blood pressure jumps

They are characteristic of glomerulonephritis, when vascular lesions
glomerulus leads to spasm of the arteries. Also with congenital anomalies
почечных сосудов can наблюдаться повышенное артериальное
pressure. The third case, when there is arterial hypertension
– перекрут сосудистой ножки у блуждающей the kidneys.

Nausea and vomiting

Reflex nausea and vomiting accompany pyelonephritis, jumps
AD, chronic renal failure, in which there is
poisoning with nitrous slags.

Edema

This is a frequent manifestation of renal ailments (see why the swelling
legs). They are divided into nephritic and nephrotic.

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  • Nephritic – result of blood pressure rises, on
    against which the liquid part of the blood enters the intercellular
    space. They are located on the face, in the area of ​​the eyelids and edema under
    eyes. More often occur in the afternoon. Soft enough and
    easily removed diuretics (see folk diuretics). They
    typical of intersitcial nephritis (for example, on the background of
    intolerance to nonsteroidal anti-inflammatory) or early
    stages of glomerulonephritis.
  • Nephrotic edema – a consequence of an imbalance of protein
    fractions. They развиваются из-за разности онкотического давления
    after a night of sleep. These edemas are located on the face. Later on
    legs and arms, lower back. AT запущенных случаях can отекать
    loin. Anterior abdominal wall or develop continuous edema
    (anasarca) with accumulation of fluid peritoneal cavity, pericardial
    bag, pleural cavity. These swelling are more dense, longer
    develop and harder to clean. They can be observed at
    glomerulonephritis, chronic renal failure.

Skin changes

They представлены бледностью на фоне анемии (из-за нарушения
the production of erythropoietin by the kidneys) with glomeroulonephritis Cutaneous
itching, dryness and “powderedness” develop against the background of chronic
renal failure due to accumulation of nitrogen in the blood
grounds.

Kidney syndromes

Numerous manifestations of renal diseases are often combined in
several syndromes, that is, complexes that are characteristic of
different pathologies.

Nephritic syndrome

It is characteristic of infectious nephritis (most often
poststriptococcal glomerulonephritis), mesangiopro-proliferative
glomerulonephritis, Berger disease. ATторично этот симптомокомплекс
develops against the background of systemic lupus erythematosus (lupus nephritis),
vasculitis. Также этот синдром can стать следствием радиационного
exposure to vaccines.

  • ATсегда в моче присутствует кровь (макрогематурия – когда кровь
    visible to the eye – in about one third of all cases or micro hematuria,
    which is determined only by urine analysis), see blood in
    urine
  • Edema характерны для восьмидесяти процентов больных. it
    nephritic type of edema. ATо второй половине дня отекают веки, а к
    nights swelling appears on the legs (see what to do if swelling
    legs).
  • Approximately 80% of patients have elevations in blood pressure,
    which in advanced cases may be complicated by rhythm disturbances and
    pulmonary edema.
  • In half of the patients there is a decrease in the volume of daily urine and
    thirst.
  • More rare manifestations of the syndrome include: nausea, vomiting,
    appetite disorders, weakness, headaches, back pain or
    the stomach. Very rarely there is a rise in temperature.

Nephrotic syndrome

It is characteristic of diseases with damage to the renal tubules (see
tubulopathy).

  • Edema характерны для 100% случаев нефротического синдрома. They
    dense and described in the section nephrotic edema.
  • ATыделение белка с мочой превышает 3,5 грамма per day.
  • AT биохимическом анализе крови определяется снижение общего
    protein due to albumin, an increase in lipids (cholesterol higher than 6.5
    mmmol per liter).
  • There may be a decrease in urine production (oliguria) up to 1 liter
    per day.
  • Patients often have dry skin, dull hair, pallor.
  • A number of situations manifested nausea, vomiting, pain in
    the stomach.

Acute renal failure syndrome

it острое нарушение всех почечных функций, в результате чего
violated water, electrolyte and nitrogen metabolism. it состояние
develops on the background of interstitial nephritis, acute necrosis
tubules of a kidney, thrombosis of renal arteries. AT части случаев процесс
reversible.

Consider a clinic for acute interstitial nephritis. This
pathology – a consequence of non-infectious inflammation of the tubules and
interstitial kidney tissue. The main reasons are:

  • taking nonsteroidal anti-inflammatory drugs (for example,
    ibuprofen, aspirin)
  • surrogate alcohol poisoning
  • antibiotics (penicillins, gentamicin, kanamycin,
    cephalosporins), sulfonamides
  • immunosuppressants (azathioprine), allopurinol, warfarin.
  • также эта болезнь can развиться на фоне острого инфицирования
    streptococcus, as a manifestation of systemic diseases (lupus erythematosus, synroma
    sjogren, graft rejection)
  • in case of poisoning with vinegar, heavy metals, aniline also
    developing interstitial nephritis.

Manifestations of the disease occur on the 2-3rd day of admission
medication or infection. ATозникает снижение количества мочи,
and then acute cessation its production and allocation. Wherein
swelling is not characteristic. Patients have headaches, nausea.
Weakness, dull back pain. Less often – temperature rises, skin
itching and blotchy skin rash.

With the reverse development of the state, there is abundant urination.
(polyuria) and restoration of kidney function. When
adverse outcome of the kidneys are sclerosed and their function is not
is restored, turning into chronic renal
failure.

Chronic Renal Failure (CRF)

This is the outcome of a long course of renal pathologies in which
connective tissue gradually takes the place of nephrons. AT
a consequence of this, the kidneys lose their function and in the outcome of severe
CKD patient may die from protein poisoning
exchange. So ends up most of the chronic.
glomerulonephritis, kidney amyloidosis, kidney tumors and nephronecrosis on
background thrombosis or renal tissue ischemia. Big kidney stones,
polycystic, hydronephrosis also leads to the shutdown of the kidney. Sugar
diabetes or atherosclerosis of the renal arteries also lead to a similar
syndrome.

For CRF is characterized by a gradual increase in the number and
manifestations of manifestations. The more glomeruli were killed, and the smaller
glomerular filtration rate, the more pronounced the symptoms.

  • The skin in the initial stages is pale due to anemia in the background.
    low kidney erythropoietin production. With urinary retention
    pigments in the tissues of the skin becomes yellowish, and urine
    becomes lighter. Further joins skin itch, dryness
    skin and “uremic frost” or “powder” from urea crystals. Are frequent
    secondary pustular infections of the skin against scratching and falling
    local immunity.
  • Phosphorus-calcium metabolism is disturbed and on the background of increased
    the synthesis of the hormones of the paritoid glands calcium is washed out of the bones,
    which break more easily. Secondary gout can also develop.
    background deposits in the joints and soft tissues of urinary crystals
    acid.
  • The nervous system is usually inhibited. Patients are prone to
    depressions, part of the outbreak of anger or aggression.
    The peripheral nervous system with its defeat gives
    polyneuropathy (goose pimples, frustration
    sensitive and motor activity of the limbs). Can
    observed muscle twitching or muscle pain.
  • Persistent hypertension appears, difficult to respond to.
    drug treatment. AT ряде случаев пациенты переносят
    cerebral hemorrhages or heart attacks.
  • Patients also have heart rhythm disorders,
    shortness of breath, inflammation of the heart muscle. In the later stages it is characteristic
    defeat of the pericardial sac (pericarditis) with a peculiar
    (“Funeral” pericardial friction noise).
  • Irritation of the upper respiratory tract urea
    patients can be tormented by inflammations of the larynx, trachea, bronchi. There are
    cases of pulmonary edema.
  • Appetite decreases, ammoniac odor from mouth appears. Can
    develop nausea and vomiting, weight loss. Are frequent изъязвления
    mucous membranes of the mouth, esophagus and stomach.

In severe stages of chronic kidney disease, patients who do not receive hemodialysis, or
without a transplanted kidney die.

Kidney disease in children

The symptoms of kidney disease in children are identical to those in adults
but may be more blurred, especially at the age of younger childhood
(up to three years). In addition, children are characterized by certain types of
tumors not found in adults due to high mortality
in childhood (nephroblastoma). In children, inflammatory renal
pathologies occur more easily due to lower tonus
urinary tract and underdevelopment of their walls, as well as relatively
wider cups and renal pelvis.

Manifestations of individual renal diseases

Acute pyelonephritis

Characterized by a rise in temperature on the background of acute
infection (staphylococcal, intestinal
wand). Typical dull aching or pressing back pain,
weakness, lethargy, nausea, and sometimes vomiting. Pains appear at the end
urinating or after it. Characteristic darkening of urine, her
turbidity. There are frequent urge to urinate, episodes
night calls. AT анализе мочи появляется белок, увеличивается
white blood cell count, there may be red blood cells (see causes of protein and mucus
in the urine). AT анализах крови характерно ускорение СОЭ, лейкоцитоз,
shift formulas to the left.

Chronic pyelonephritis

It has a perennial course with episodes of acute exacerbations.
jade and remission when changes can only appear in
urinalysis and excretory urography. Are known
hypertensive and anemic variants of chronic pyelonephritis
(see pyelonephritis: symptoms, treatment).

Kidney tuberculosis

It has no bright specific manifestations. In the early stages
the patient may experience malaise, temperature up to 37, 5. When
development of the disease join dull aching pain in the lower back with
hand lesions, eye visible blood in the urine, disorders
urination. If the kidney starts to fall apart, the pain may be
strong, resembling renal colic. Gross hematuria is characteristic
only for 15-20% of patients, as many patients suffer from
increased pressure on late stages of the disease.

AT анализе мочи появляется белок, лейкоциты, эритроциты. Decisive
in the diagnosis becomes bacteriological examination of urine on
Mycobacterium tuberculosis. Also take into account radiological
signs of lung damage, contact for tuberculosis.
Immunospecific blood reactions (PCR) are informative in about 90%
patients. On ultrasound tuberculosis is not visible.

Diffuse chronic glomerulonephritis

  • This is an autoimmune pathology in which immune complexes
    affect the glomeruli of the kidney.
  • Hypertensive variant is characterized by persistent increase
    lower (diastolic) pressure.
  • When nephrotic variant edematous syndrome is noted in
    combined with a large loss of protein in the urine and a decrease in protein
    blood.
  • The combined form gives nephrotic syndrome and resistant
    arterial hypertension.
  • Berger disease (hematuric form) includes blood in the urine,
    increased pressure and swelling.
  • Urinary or latent form manifests itself only in changes.
    анализов (микрогематурия и следы белка in the urine).
  • With prolonged course of glomerulonephritis to the main manifestations
    A chronic renal failure clinic is added.

Kidney cancer

Long can flow hidden and often is only laboratory
finding (see kidney cancer). When ESR is accelerated in blood tests,
in the urine there are red blood cells, protein. In the later stages appear
dull back pain that becomes acute and severe with
disintegration of the renal tissue. Anemia may appear, signs of
intoxication (weakness, loss of appetite, weight loss) and
low-grade (up to 37.9) temperature. Very large tumors can
squeeze the inferior vena cava causing swelling of the legs or liver.

The main methods of diagnosis of renal diseases

If kidney disease is suspected, it is usually prescribed
The following list of surveys:

  • Клинический анализ blood.
  • Biochemical analysis of blood (total protein, electrophoresis of proteins,
    lipid spectrum or cholesterol, creatinine, urea, prothrombin
    index, electrolytes, C-reactive protein, circulating immune
    complexes)
  • Urinalysis common. If necessary, according to Nechiporenko (more
    accurate urinary sediment in 1 ml of urine), Zimnitsky sample (clarification
    kidney concentration function).
  • In men, a three-cup urine sample. For women – inspection
    gynecologist.
  • Counting glomerular filtration rate by creatinine clearance
    (analysis of daily urine).
  • Excretory urography with contrast agents (determined by
    excretory and concentration function).
  • Ultrasound of the kidneys (neoplasms, stones, expansion
    cup-pelvis system, interstitial edema, necrosis, abnormalities
    development, kidney prolapse).
  • Survey X-ray in two positions (with nephroptosis).
  • Less commonly, kidney scintigraphy or tomography (usually for
    clarification of tumor localization).

Thus, the manifestations of renal pathologies are diverse and not
always specific. Therefore, at first doubts about the health of the kidneys.
it is advisable to consult a general practitioner or urologist and go through
even the simplest examination. Timely diagnosis and
treatment can not only get rid of the disease, but also improve the quality
life in the future and prolong life itself.

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