Renal coma - Causes, symptoms and treatment. MF.

Renal or uremic coma is an extremely difficult condition that occurs due to renal failure and manifests itself as a deep loss of consciousness.

Causes of renal coma

The immediate cause of renal coma is acute or chronic renal failure. With this pathology, human kidneys begin to filter poorly the urine and because of this all pathological metabolic products are not removed from the blood, but continue to circulate in it. Urea and creatinine, which are these very pathological products, get into the brain, lead to the disorder of thinking and consciousness, and with prolonged stay there, and at all, cause a loss of consciousness with a partial disorder of blood circulation and respiration.

But renal failure is the immediate cause of coma. The causes of kidney failure itself can be many. The most frequent pathological processes that lead to a disorder of the consciousness of renal genesis are chronic kidney diseases. Conditions such as pyelonephritis and glomerulonephritis, characterized by inflammation of the kidney tissue, can cause renal function impairment and lead to the accumulation of kidney exchange products in the human blood.

In addition, the problem can be concealed somewhat lower when the outflow of urine is broken due to the stone of the bladder or prostate adenoma. In this case, stagnation of urine, first in the bladder, and then in the kidneys, leads to the destruction of membranes in the renal tubules, which ends with the direct entry of urine into the bloodstream. Such situations are quite rare, because before the stagnation of urine in the kidneys begins, the patient will be disturbed by acute pains in the pubic area, with which he will necessarily come to the doctor.

But when the blockage occurs somewhat higher, at the level of urine outflow from the kidney, then this situation is quite real. The most common cause of this stagnation is the stone, although there are cases of clogging at this level of the tumor. Clinically, this is manifested by renal colic, which slowly changes into uraemia.

The cause of renal coma can also be a variety of poisonings that lead to a disorder of kidney function. The group of renal toxins includes benzenes, lead and others.

Symptoms of renal coma

By definition, it becomes clear that the renal coma should be manifested by a lack of consciousness. True, it must be remembered that just before the coma there is a period of time when a person from a state of clear consciousness begins to "boot".During this period of time, the so-called uremia of arises, which is very important to diagnose in order to prevent a person from falling into a coma.

During the uremia of the patient, brain complaints begin to disturb. It manifests itself as a confusion of consciousness, constant dizziness, a state of excitement, or, conversely, depression. An accidental person without medical education would have seen such a patient, said that he was just raving. In principle, so it is. The only thing that can indicate a presence of uremia in this situation is the smell of urine from company .As a rule, in such patients it is felt quite distinctly, so that one does not even have to bow close to the patient to feel this smell.

Directly behind uremia comes renal coma .Against the background of all the above complaints, a person slowly begins to lose consciousness. As a rule, the majority of medical examinations of such patients fall precisely on the state of coma. In this state, it is very important to determine whether a person is alive and find out the cause of such a condition. Help with the cause can the same smell of urine from the company, which with the worsening of the state only increases.

Evidence that a person is in a state of coma rather than dead is the presence of independent breathing, a pulse on the carotid and radial artery, and the presence of reflexes from the cornea of ​​the eye. The latter can be very easily checked if one touches an open eye with an object. In the case of coma, the patient will necessarily react with a narrowing of the pupil.

Diagnosis of uremic coma

The entire list of diagnostic procedures during renal coma is aimed at determining the severity of the patient's condition and finding out the immediate cause of the disease. To determine the severity of the patient, he takes blood for a general blood test and a measurement of the amount of urea and creatinine last. The level of these two substances in a person's blood and can direct doctors to the correct treatment.

Many more studies may be needed to determine the root cause of the disease. The first thing is performed ultrasound of the kidneys and radiography of the pelvic organs. On these two studies, you can find out the presence of stones in the bladder or kidneys. In addition, ultrasound gives the doctor a clear idea of ​​the state of the kidney tissue. In more complex cases, a computerized tomography of the abdominal and pelvic organs can be performed.

Kidney ultrasound with stones

In addition, the level of electrolytes in the blood of a person is determined in order to control the amount of infusion therapy that will be performed by the patient.

Treatment of renal coma

Treatment of uremic coma can be divided into medicamental and instrumental. As for the first, in this situation, intravenous infusions of a large amount of liquid are carried out. For this purpose, solutions of glucose or table salt are used, which in the medical language is referred to as physiological saline. After a certain amount of fluid is introduced into the vein to dilute the product of exchange there, diuretics are used that help to remove these very products from the body. For this purpose, such powerful diuretics as lasix or furosemide are used. In principle, these drugs can be bought independently in the pharmacy, but this does not make any sense, since they are introduced only into the vein and in a hospital.

To infusion therapy, in addition, drugs that interfere with blood clotting are used. This group includes all known heparin, it is administered subcutaneously also under conditions of inpatient treatment.

In the most severe cases, hormones are used. This group includes such drugs as prednisolone and dexamethasone.

As far as hardware treatment is concerned, it can be used both to treat kidney coma and to eliminate its underlying cause. For example, if a coma is caused by a stone or a tumor, then in such a situation, one can not do without an operation. If the outflow of urine is impeded by an enlarged prostate, then in such a situation it is necessary to insert a urethral catheter into the bladder cavity, which will immediately remove the symptoms of acute urinary retention.

In a situation where it is not possible to safely remove all toxins from human blood, it is necessary to use methods such as plasmapheresis or hemodialysis. In this case, the patient is connected to a special device, which, passing through a person's blood, cleans it of various toxins and pathological metabolic products.

Hemodialysis machine

Nutrition and lifestyle in renal coma

At the initial stage of treatment of renal coma, the patient generally feeds exclusively through droppers. Later, he is allowed to eat a small amount of low-fat food with just as little water. After renal coma, it is necessary to exclude from the diet those products that contribute to the formation of ammonia in the human body. Most often these are proteins that are found in foods such as meat and legumes.

Rehabilitation after illness

Rehabilitation after renal coma should be aimed at the prevention and treatment of the underlying cause of the disease. For example, if the episode of loss of consciousness was caused by obstruction of urine outflow by concrements, the patient needs an operation to remove these pathological agents. The same situation is observed in the presence of a tumor of the urinary tract.

If the cause of the kidney coma was poisoning by certain substances, then in the future it is necessary to try to avoid repeated episodes and no longer to contact with such substances.

Treatment of renal coma with folk remedies

All cases when the kidney to whom they tried to treat folk remedies, resulted in a fatal outcome. The fact is that in an unconscious state a person can not administer medication through the mouth, and if this can be done with the help of a nasogastric tube, such treatment will not result in absolutely any result.

However, in regard to renal coma, it is necessary to pay tribute to folk healers, who in most cases simply do not undertake to cure such a problem, hoping for the unfortunate experience of their predecessors.

Complications of renal coma

The most formidable complications of renal coma should be considered the effects of the nervous system, which can manifest after the release of a person from this state. Of course, people with disabilities do not remain, but in most of these patients there are quite serious consequences in the form of a disorder of character, thinking, memory and other functions. To prevent such situations, it is necessary to consult a doctor as soon as the patient begins to experience symptoms characteristic of uremia. It must be remembered that such a problem as uremia and renal coma is not a urologist, but an intensive care physician. All patients with renal coma are treated exclusively in the intensive care unit .

Prevention of renal coma

Prophylaxis of renal coma, first of all, should be aimed at treating the underlying disease, which can lead to a severe disorder of kidney function. For example, if a patient is aware of his chronic pyelonephritis or glomerulonephritis, he should periodically consult with a urologist or nephrologist, and periodically undergo diagnostic ultrasound examination of the kidneys. The same tactic should be in patients with prostate diseases.

As for the other group of causes of uremic coma, poisoning, it is necessary to be vigilant about the products used, as well as the place of work. The lion's share of poisoning falls precisely on occupational hazards. In the event that food poisoning is determined by hazardous substances, it is necessary to rinse the stomach immediately and go to the nearest hospital. The tactic of prevention of uremia in this case is the introduction of an antidote, a substance that is capable of neutralizing poison in the blood.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov AN