Nephrosclerosis or a secondarily wrinkled kidney - etiology, diagnosis, treatment

  • Nephrosclerosis or a secondarily wrinkled kidney - etiology, diagnosis, treatment

    The proliferation of connective tissue in the kidney parenchyma leading to its deformation, structural rearrangement and densification is called nephrosclerosis. Nephrocirrhosis is the last stage in the development of nephrosclerosis. Depending on the mechanism of the development of the disease can be identified:

    1. Primary nephrosclerosis or primarily wrinkled kidney, which develops as a result of a violation of blood supply to the body.
    2. Secondary or secondarily wrinkled kidney, develops as a result of untimely or inadequate treatment of chronic inflammatory diseases.

    Causes of development of nephrosclerosis

    Primary nephrosclerosis occurs against the background:

    • Atherosclerotic lesion
    • Thrombosis
    • Thromboembolism
    • Hypertonic arteriolosclerosis.

    The development of the primary wrinkled kidney in the late stage of hypertension or atherosclerotic lesions occurs due to the fact that circulatory failure leads to hypoxia of the kidney tissues, development of atrophic and dystrophic changes and sclerotization of tissues.

    Specialists divide primary nephrosclerosis into the following forms:

    • Atherosclerotic
    • Involute
    • Hypertonic

    Unlike primary nephrosclerosis, the secondarily wrinkled kidney, whose developmental causes are based on the inflammatory process in the kidneys themselves, develops slowly.

    Factors affecting sclerotization of the renal parenchyma include the following:

    • Chronic pyelone and glomerulonephritis
    • Kidney stones
    • Syphilis and tuberculosis with renal parenchyma lesions
    • Systemic lupus erythematosus
    • Amyloidosis of the kidneys
    • Development of diabetes
    • Radiation exposure - manifested after the lapse oflong after exposure to radiation
    • Injuries and surgical interventions on the kidneys
    • Nephropathy of pregnant women in severe form.

    In addition to these forms there is a secondary nephrosclerosis, characterized by cystic transformation and dilatation of tubules. This form of the disease with oxalaturia, hyperparathyroidism and gout.

    Mechanism of development of the disease

    Nephrosclerosis develops in two stages:

    1. The first is characterized by a picture that is caused by the clinic of the disease that caused the process of sclerotization of the kidney tissue.
    2. At the second stage, the clinical features of the causative disease are no longer evident. The process gradually spreads to the entire kidney, if the cause of nephrosclerosis is pyelonephritis, the kidneys are usually unevenly affected.

    Pathogenetically, two forms of the disease can be distinguished:

    • Benign nephrosclerosis is characterized by slow development, with it affects the walls of small arterioles and atrophy individual groups of nephrons. In this case, there is a proliferation of interstitial connective tissue.
    • Malignant form is characterized by fibrinoid necrosis of arterioles and capillary glomeruli, which is the cause of edema of stromal kidney tissue, hemorrhages and pronounced dystrophic changes in the tubules.

    Diagnosis and clinical picture of the disease

    In order to diagnose nephrosclerosis it is necessary to undergo the following tests:

    • General blood analysis
    • Urine analysis - protein and blood cells can be detected in urine, urine density is decreased,
    • Ultrasound - allows to estimate the size and structure of organs,
    • Radionuclide -determines the rate and amount of excretion of the labeled substance from the kidneys,
    • X-ray - shows deformation and narrowing of the vessels.

    The clinical picture depends on the degree of damage to the kidney tissues and is manifested by the following symptoms: the appearance of edema, persistently high blood pressure, at later stages of development heart diseases, strokes, retinopathies can be added. The outcome of nephrosclerosis can be chronic renal failure and intoxication with nitrogenous compounds.

    This is important! If you are beginning to worry about swelling, a cause that can not be clarified, or a hypertensive stance that does not stop drug treatment, you need to turn to a nephrologist, an early diagnosis and timely therapy will prevent the development of complications.

    Principles of treatment and prevention of wrinkled kidney

    Complex therapy of nephrosclerosis depends on the clinical manifestations of the disease and the patient's condition. If the disease is not accompanied by the development of renal insufficiency, it is clinically manifested by unstable hypertension, the treatment will consist in applying a salt-free diet with restriction of the use of protein products and the appointment of antihypertensive drugs.

    If there is a pronounced renal insufficiency, the pressure reducing agents are prescribed very cautiously, because by lowering the arterial pressure, it is possible to cause blood flow disturbances and worsen the functioning of the organ.

    Malignant form of nephrosclerosis, which rapidly develops kidney failure, leads to the need for surgical interventions - embolization of kidney vessels, nephrectomy( removal of the organ), kidney transplantation followed by chronic hemodialysis.

    Most often, nephrectomy is performed by the method of open access, it is a sufficiently traumatic operation, which has a long postoperative period. With the development of modern technologies, it became possible to remove the kidney by means of the endoscopic method from laparoscopic access( through punctures in the abdominal cavity) or retroperitoneal( punctures are made from the side of the lower back).These methods are less traumatic and shorter postoperative period.

    Prophylaxis of chronic kidney nephrosclerosis development is the timely treatment of chronic kidney inflammatory diseases and constant monitoring by a doctor in the event of hypertension.

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