T T he main symptoms he main symptoms and syndromes in and syndromes in kidney diseases. kidney diseases. S S ymptomatol ymptomatol gy of gy of acute and chronic acute and chronic glomerulonephritis glomerulonephritis and pyelonephritis and pyelonephritis . .
T he main symptoms and syndromes in kidney diseases . S ymptomatol gy of acute and chronic glomerulonephritis and pyelonephritis. cleansing - excretion of metabolic products, salts, dyes, chemicals - PowerPoint PPT Presentation
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TThe main symptoms he main symptoms and syndromes in and syndromes in kidney diseases. kidney diseases. SSymptomatolymptomatolgy ofgy of acute and chronic acute and chronic glomerulonephritis glomerulonephritis and pyelonephritisand pyelonephritis..
renal functionrenal function
cleansing - excretion of metabolic cleansing - excretion of metabolic products, salts, dyes, chemicalsproducts, salts, dyes, chemicals
Homeostatic - maintaining a constant Homeostatic - maintaining a constant internal environment by regulating the internal environment by regulating the blood, osmotic pressure, KLRblood, osmotic pressure, KLR
erytropoetychnaerytropoetychna vnutrishnosekretornavnutrishnosekretorna regulation of blood pressureregulation of blood pressure
creening methods in creening methods in nephrology (the first nephrology (the first stage of the survey)stage of the survey) blood testblood test urinalysisurinalysis with suspected renal dysfunction - the with suspected renal dysfunction - the
content of creatinine in the bloodcontent of creatinine in the blood
the second phase of the the second phase of the surveysurvey
clarifying the main syndrome installation clarifying the main syndrome installation nosology, determining the degree of nosology, determining the degree of activity of the process, clarification of activity of the process, clarification of kidney function.kidney function.
llaboratory aboratory mmethodsethods
Microscopic methods of quantitative urine,Microscopic methods of quantitative urine, biochemical methods of blood and urinebiochemical methods of blood and urine bacteriological,bacteriological, some (test for amyloid, search LE cells in some (test for amyloid, search LE cells in
color (from straw yellow to amber-yellow)color (from straw yellow to amber-yellow) transparency (clear, after settling may transparency (clear, after settling may
become turbid)become turbid) reaction (pH 5.5-6.5)reaction (pH 5.5-6.5) proportion (morning urine ranges from proportion (morning urine ranges from
1015 to 1025). Proteinuria 4 g / l 1015 to 1025). Proteinuria 4 g / l increases the proportion of 0.001 and 10 increases the proportion of 0.001 and 10 g / l glucose - 0,004.g / l glucose - 0,004.
Bacteriological Bacteriological examination of urineexamination of urine
microbial count (the number of bacteria in 1 ml microbial count (the number of bacteria in 1 ml of urine) (low to 20 thousand, the critical 20-of urine) (low to 20 thousand, the critical 20-100 thousand, truth more than 100 thousand)100 thousand, truth more than 100 thousand)
sensitivity to antibiotics and chemotherapysensitivity to antibiotics and chemotherapy special bacteriological tests (detection of L-special bacteriological tests (detection of L-
forms of bacteria, mycoplasma, fungi)forms of bacteria, mycoplasma, fungi) for the diagnosis of tuberculosis of the kidneys for the diagnosis of tuberculosis of the kidneys
(urine for 12 h in enriched environment or (urine for 12 h in enriched environment or biological sample)biological sample)
Evaluation ability of the Evaluation ability of the kidneys to urine dilution kidneys to urine dilution and concentrationand concentration
proportion morning urine (not below 1018-1022)proportion morning urine (not below 1018-1022) test on Zimnitskiy (urine collected during the day test on Zimnitskiy (urine collected during the day
in 3 hours 8 times. determine in each serving in 3 hours 8 times. determine in each serving size, proportion, ratio of night to day diuresis)size, proportion, ratio of night to day diuresis)
sample of deprivation for 12 hours (from 19.00 to sample of deprivation for 12 hours (from 19.00 to 07.00). If the proportion rises to 1024 and more 07.00). If the proportion rises to 1024 and more concentration of kidney function considered concentration of kidney function considered satisfactorysatisfactory
Score azotovydilnoyi function - serum Score azotovydilnoyi function - serum creatinine and urea in serumcreatinine and urea in serum
involved in renal electrolyte metabolism involved in renal electrolyte metabolism as an indicator of kidney function (Na, K, as an indicator of kidney function (Na, K, Ca, Mg, Cl).Ca, Mg, Cl).
X-ray of the kidneys. Survey urography - to determine the size and Survey urography - to determine the size and
shape of the kidney, the presence of shape of the kidney, the presence of concretions.concretions.
Urotomohrafiy - gives a three-dimensional Urotomohrafiy - gives a three-dimensional image of kidneyimage of kidney
Excretory urography - helps to determine not Excretory urography - helps to determine not only morphological but also functional status only morphological but also functional status of the kidneys and urinary tract.of the kidneys and urinary tract.
reveals asymmetry Wire cup-pelvic, strain the reveals asymmetry Wire cup-pelvic, strain the kidneys.kidneys.
Renal angiographyRenal angiography CTCT
Methods of radionuclide Methods of radionuclide studystudy
isotope renografiy - to determine isotope renografiy - to determine vascularization, activity of proximal vascularization, activity of proximal tubules and evacuation capacity of each tubules and evacuation capacity of each kidney.kidney.
Apply hipuran, it is nontoxic, quickly Apply hipuran, it is nontoxic, quickly moves from the blood to the kidneys and moves from the blood to the kidneys and urinary excretion. Kidneys excrete about urinary excretion. Kidneys excrete about 80% due to its secretion in the proximal 80% due to its secretion in the proximal tubule, and only 20% - by KF.tubule, and only 20% - by KF.
duration of 20-60 seconds.duration of 20-60 seconds.
Phase 2 - secretory Phase 2 - secretory (tubular) 2-3 min after (tubular) 2-3 min after injection Contrast agents to injection Contrast agents to 5 min.5 min.
Phase 3 - excretory - Phase 3 - excretory - falling curve (expressing falling curve (expressing Contrast excretion of Contrast excretion of substances from the substances from the kidney. Duration curve is kidney. Duration curve is steep fall in 5 min., A steep fall in 5 min., A plateau from 5 to 8 minutes.plateau from 5 to 8 minutes.
Scanning kidneyScanning kidney visual kidney using radionuclides visual kidney using radionuclides
(neohidrynu) indicates localization, shape (neohidrynu) indicates localization, shape and size of the kidneys, the degree of and size of the kidneys, the degree of local functional activity of the local functional activity of the parenchyma, focal and diffuse lesions, parenchyma, focal and diffuse lesions, abnormalities. Lets differentiate renal abnormalities. Lets differentiate renal tumors, abdominal and extraperitoneal tumors, abdominal and extraperitoneal space.space.
thermographythermography
registration of spontaneous infrared registration of spontaneous infrared radiation of human skin.radiation of human skin.
inflammatory infectious and allergic inflammatory infectious and allergic disease with predominant and primary disease with predominant and primary involvement in the pathological process involvement in the pathological process of glomerular apparatus of the nephronof glomerular apparatus of the nephron
infectious-allergic disease, mainly infectious-allergic disease, mainly affecting vascular renal glomeruli with affecting vascular renal glomeruli with available also changes in the tubules and available also changes in the tubules and interstitial tissueinterstitial tissue
ClinicalClinical
course optionscourse optionsrapid onset, severity of symptoms.rapid onset, severity of symptoms.mono asymptomatic - gradual onset, mono asymptomatic - gradual onset, uclearness of symptoms. uclearness of symptoms.
SyndromesSyndromes bladder - the presence of protein in the urine bladder - the presence of protein in the urine
(proteinuria to 3.5 g per day) formal blood (proteinuria to 3.5 g per day) formal blood elements (red blood cells), cylinderselements (red blood cells), cylinders
nephrotic - proteinuria greater than 3.5 g per nephrotic - proteinuria greater than 3.5 g per day, hypoproteinemia, dysproteinemia, day, hypoproteinemia, dysproteinemia, hyperlipidemia, edemahyperlipidemia, edema
Facies nephriticaFacies nephritica
pale skin, swelling of the face and pale skin, swelling of the face and eyelids, puffiness under the eyes.eyelids, puffiness under the eyes.
inflammation in the glomerulus, tubular inflammation in the glomerulus, tubular epithelial degeneration and progressive epithelial degeneration and progressive proliferation of connective tissue, which proliferation of connective tissue, which leads to the development of secondary leads to the development of secondary wrinkled kidney.wrinkled kidney.
Principles of treatmentPrinciples of treatment considering clinical variant phase, stage of the disease.considering clinical variant phase, stage of the disease. diet number 7 (restriction of salt to 4-5 g, nephrotic diet number 7 (restriction of salt to 4-5 g, nephrotic
aminoquinoline drugsaminoquinoline drugs antihypertensive therapy in the presence of hypertension: beta-antihypertensive therapy in the presence of hypertension: beta-
tyklid, clopidogreltyklid, clopidogrel antibiotics in infectious complicationsantibiotics in infectious complications
PyelonephritisPyelonephritis
Nonspecific infectious inflammatory Nonspecific infectious inflammatory process, which is localized in mostly at process, which is localized in mostly at cup-pelvic kidney and its tubulo-cup-pelvic kidney and its tubulo-interstitial area.interstitial area.
Running across a sluggish, periodically Running across a sluggish, periodically exacerbated bacterial inflammation of exacerbated bacterial inflammation of renal parenchyma (cup-pelvic and renal renal parenchyma (cup-pelvic and renal tubules with subsequent damage tubules with subsequent damage glomeruli and renal vessels)glomeruli and renal vessels)
microbial factormicrobial factor violation of the passage of urine violation of the passage of urine
(mechanical and functional abnormalities (mechanical and functional abnormalities of the urinary tract)of the urinary tract)
neurogenic bladder disorderneurogenic bladder disorder state of nonspecific immune reactivitystate of nonspecific immune reactivity state of cellular and humoral immunity: state of cellular and humoral immunity:
T-immunity level of Ig A, Ig GT-immunity level of Ig A, Ig G
Left secondary chronic pyelonephritis, Left secondary chronic pyelonephritis, latent, non-remission phase. latent, non-remission phase. Nephrolithiasis, stones of left kidney. Nephrolithiasis, stones of left kidney. CRF 0 stage.CRF 0 stage.
Laboratory studies in Laboratory studies in CPNCPN
low proteinuria (up to 1 g / l)low proteinuria (up to 1 g / l) leukocyturialeukocyturia bacteriuriabacteriuria
Instrumental studies in Instrumental studies in CPNCPN
asymmetry curves with radioisotope asymmetry curves with radioisotope studystudy
according to ultrasound and radiography according to ultrasound and radiography lesions cup-pelviclesions cup-pelvic
Diagnosis of CPNDiagnosis of CPN
A historyA history clinical examination dataclinical examination data typical changes of urinary sedimenttypical changes of urinary sediment availability dizuricheskie phenomenonavailability dizuricheskie phenomenon combination of dysuria and urinary signs combination of dysuria and urinary signs
of feverof fever identify predisposing factors and diseasesidentify predisposing factors and diseases
Treatment of chronic renal Treatment of chronic renal failure (principles of failure (principles of pathogenetic therapy)pathogenetic therapy)
Stages of treatmentStages of treatment treatment of acutetreatment of acute maintenance therapy (Antirecurrent maintenance therapy (Antirecurrent treatment)treatment)
Recovery passage of urine (neurogenic, Recovery passage of urine (neurogenic, Dysfunctional or urological)Dysfunctional or urological)
AntibioticsAntibioticsfluoroquinolonesfluoroquinolones zanotsyn (ofloxacin) - blocks the bacterial enzyme zanotsyn (ofloxacin) - blocks the bacterial enzyme DNA hidratazu, damages the cell membrane of DNA hidratazu, damages the cell membrane of bacteria is well into the fabric of the urinary systembacteria is well into the fabric of the urinary system
uroseptics group Nitroxoline (5-NOC) to uroseptics group Nitroxoline (5-NOC) to 0.1 to 4 times a day or nalidixic acid 0.1 to 4 times a day or nalidixic acid (negram, nevihramon) by 0.5-1.0 4 (negram, nevihramon) by 0.5-1.0 4 timestimes
correction of microcirculation and blood flow correction of microcirculation and blood flow in the kidney (aminophylline, pentoxifylline, in the kidney (aminophylline, pentoxifylline, stugeron, heparin, fraksyparyn)stugeron, heparin, fraksyparyn)
effect on free radicals - antioxidants: unitiol, effect on free radicals - antioxidants: unitiol, halaskorbin, emoksypin, Essenciale, halaskorbin, emoksypin, Essenciale, vitamin E, tiotriazolin.vitamin E, tiotriazolin.
Pharmaceutical Pharmaceutical preparations of plant preparations of plant materialmaterial
Hofitol - artichoke leaves drug (2% solution Hofitol - artichoke leaves drug (2% solution for injection)for injection) diuretic, zhovchehinnyy, detoxification, diuretic, zhovchehinnyy, detoxification, solerozchynnyy impactsolerozchynnyy impact shows: Diabetic nephropathy and shows: Diabetic nephropathy and dismetabolic, chronic renal failuredismetabolic, chronic renal failure
lespenefryl (lespyflan) - a drug with stems lespenefryl (lespyflan) - a drug with stems and leaves lespedezy capitate (3-6 and leaves lespedezy capitate (3-6 spatulas of tea a day for 15 minutes spatulas of tea a day for 15 minutes before eating, drinking a small amount of before eating, drinking a small amount of water)water)accelerates the excretion of nitrogenous accelerates the excretion of nitrogenous substances in the urinesubstances in the urine indications: chronic renal failureindications: chronic renal failure
Canephron - contains lovage, rosemary, Canephron - contains lovage, rosemary, centaury, hips. (due to the able 3-4 times a centaury, hips. (due to the able 3-4 times a day)day) anti-inflammatory, antiseptic, diuretic, anti-inflammatory, antiseptic, diuretic, antihypertensive effectantihypertensive effect indications: chronic pyelonephritis, urate indications: chronic pyelonephritis, urate nephrolithiasis, chronic renal failurenephrolithiasis, chronic renal failure
This is a consequence of many chronic renal This is a consequence of many chronic renal diseases, gradual and steady deterioration of diseases, gradual and steady deterioration of glomerular and tubular kidney function such an glomerular and tubular kidney function such an extent that the kidneys can not maintain the normal extent that the kidneys can not maintain the normal composition of the internal environment. composition of the internal environment.
The main property CRF - exhaustive compensatory The main property CRF - exhaustive compensatory abilities kidney impossibility (as opposed to acute abilities kidney impossibility (as opposed to acute renal failure) regeneration of the parenchyma.renal failure) regeneration of the parenchyma.
Etiology and Etiology and pathogenesis of chronic pathogenesis of chronic renal failurerenal failure
obstructive nephropathy (urolithiasis, obstructive nephropathy (urolithiasis, hydronephrosis, tumors of the urinary hydronephrosis, tumors of the urinary system)system)
Major disturbances of Major disturbances of homeostasis in CRFhomeostasis in CRF
excretion of nitrogenous toxins (urea, excretion of nitrogenous toxins (urea, creatinine, uric acid)creatinine, uric acid)
support water and electrolyte balance support water and electrolyte balance (urine output less than 600 ml per day)(urine output less than 600 ml per day)
latent (creatinine level in serum below latent (creatinine level in serum below 0.18 mmol / l, Cp above 50% of 0.18 mmol / l, Cp above 50% of predicted)predicted)
azotemic (cock kraetyninu from 0.19 to azotemic (cock kraetyninu from 0.19 to 0.71 mmol / l KF 50-10% of predicted)0.71 mmol / l KF 50-10% of predicted)
uremic (content creatinine 0.72 mmol / l uremic (content creatinine 0.72 mmol / l and above, cf 10% and below)and above, cf 10% and below)
Each stage is divided into A and BEach stage is divided into A and B
Classification of chronic Classification of chronic renal failure by Ratnerrenal failure by Ratner
I - increase in plasma creatinine 0,17-I - increase in plasma creatinine 0,17-0,44 mmol / l0,44 mmol / l
II - 0,45-0,88 mmol / lII - 0,45-0,88 mmol / l III - 0,89-1,32 mmol / lIII - 0,89-1,32 mmol / l IV - 1,32 and aboveIV - 1,32 and above
(due to delays prolactin)(due to delays prolactin)
Laboratory diagnosis of Laboratory diagnosis of CRFCRF
serum creatinine and blood ureaserum creatinine and blood urea relative density of urinerelative density of urine glomerular filtration and tubular glomerular filtration and tubular
reabsorptionreabsorption
Treatment of chronic Treatment of chronic renal failure (task)renal failure (task)
maintenance of homeostasismaintenance of homeostasis slowing progressionslowing progression treatment of complications of uremiatreatment of complications of uremia KF at 35 to 10 ml / min treatment with KF at 35 to 10 ml / min treatment with
conservative methodsconservative methods with more severe disorders - software with more severe disorders - software
diet (table 7a, 20-25 grams of protein a diet (table 7a, 20-25 grams of protein a day, 7b, 40 - g protein per day)day, 7b, 40 - g protein per day)
adequate fluid intakeadequate fluid intake control input electrolytes - sodium and control input electrolytes - sodium and
potassium, with hiperpotassemia - 20-30 potassium, with hiperpotassemia - 20-30 ml of 10% calcium gluconate or 200 ml of ml of 10% calcium gluconate or 200 ml of 5% sodium bicarbonate, 5% glucose with 5% sodium bicarbonate, 5% glucose with insulininsulin
reduce delays end products of protein reduce delays end products of protein metabolism (sorbents, siphon enema, metabolism (sorbents, siphon enema, laxatives - sorbitol, xylitol)laxatives - sorbitol, xylitol)
antihypertensive therapy - dopehit, antihypertensive therapy - dopehit, hemiton (Clonidine) - do not reduce renal hemiton (Clonidine) - do not reduce renal blood flow.blood flow.
treatment of anemiatreatment of anemia treatment of uremic osteodystrophytreatment of uremic osteodystrophy
correction of acidosiscorrection of acidosis treatment of infectious complicationstreatment of infectious complications med. physsical culturemed. physsical culture treatment of the underlying disease that treatment of the underlying disease that
led to uremialed to uremia
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