8. Hypertension Syndrome

CAUSES:

1. the actual renal arterial hypertension (most kidney diseases),

2. Vasorenal arterial hypertension is the result of narrowing of the renal arteries. It is considered in the framework of symptomatic arterial hypertension.

SYMPTOMS: see cardiology section

9. Renal eclampsia syndrome

REASONS: acute, chronic glomerulonephritis, last months of pregnancy, 1 day after birth. In

fact, this is a variant of acute cerebrovascular accident due to increased arterial, intracranial

pressure, and cerebral edema.

SYMPTOMS:

1. Harbingers: headache, dizziness, nausea, apathy, insomnia, blurred vision, high blood pressure - 240 / 130,300 / 160 mm. Hg. Art.

2. An attack occurs suddenly

• loss of consciousness

• cramps in the limbs

• rolling eyes

• biting the tongue: pink foam from the mouth

• cyanosis of the face

• shortness of breath

• involuntary urination, defecation

• coma

• post-attack sleep

3. The duration of the attack is 1-30 minutes

4. After the attack, transient:

• blindness (anaurosis)

• dumbness or speech disorder

• memory loss (amnesia)

5. Complications: - stroke

- pulmonary edema

- stillbirth in 13 -19% of women in labor after eclampsia - death in 5 - 9% of pregnant women

10. Acute renal failure (arf)

CAUSES:

1. Prerenal - a sharp decrease in blood pressure (shock, cardiac tamponade, vascular dilatation in sepsis, anaphylaxis, blood loss, dehydration).

2. Renal - ischemic or toxic nephronecrosis, glomerulonephritis, tubular disorders.

3. Postrenal - blockage or compression of the urinary tract, congenital anomalies.

4. Arenal - absence or removal of the kidneys.

Most often, acute renal failure is observed in patients due to hemocirculatory disorders (75%) and poisoning with nephrotoxic poisons (15%). Impaired renal blood flow and a drop in glomerular filtration are the most important mechanisms of acute renal failure.

SYMPTOMS:

Stage 1 - hours duration - up to 2 days. Signs of the underlying disease leading to acute renal failure are expressed.

2. stage. Oligo-anuric, up to 2 weeks - anuria, oliguria

- back pain - azotemia - anemia

- symptoms of uremia: lethargy, drowsiness, up to coma, muscle twitching, noisy breathing, the smell of urine, signs of gastritis, pericarditis, pleurisy, etc.

- skin is pale, dry bloating

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• hyperkalemia, leading to muscle paralysis, up to cardiac arrest

• death or transition to stage 3.

3 stage. Polyuric, about 20 days

• urine - more than 1800 ml / day

• loss of electrolytes, including hypokalemia

• protein dystrophy

• vitamin deficiency

• signs of uremia disappear

• hypoproteinemia

4 stage. Recovery - 3-4 months - up to a year

- slow protein replenishment restoration of damaged kidney structures at the micro level

11. Chronic renal failure

REASONS: kidney disease with outcome in nephrosclerosis, arterial hypertension, diabetic

nephrosclerosis.

SYMPTOMS:

1st stage. Initial, latent, latent

• there may be no complaints

• signs of underlying disease

• possible hypoisostenuria (urine density -1012-1017)

• glomerular filtration (CF = 20% -50%), water reabsorption is changed little

• creatinine up to 0.2-0.25 mmol / l

2 stage. Azotemic

• weakness, asthenia, disability

• headache

• cough

• arterial hypertension

• dyspeptic disorders: loss of appetite, discomfort in the epigastric region, unpleasant taste and dry mouth, nausea, vomiting, hiccups, heartburn, diarrhea, stomatitis, smell of urine

• polyuria, nocturia

• skin is pale, dry, sometimes itchy

• periodically muscle twitching

• CF up to 5-20%

• creatinine up to 0.7 mmol / l

• hypoisostenuria (density 1009-1012), nocturia, polyuria

• Signs of a uremic lesion of the gastrointestinal tract (gastritis, enterocolitis) nausea, vomiting with blood, diarrhea with blood, abdominal pain, sometimes mimicking an acute abdomen, the phenomenon of stomatitis

• signs of damage to the respiratory system: (bronchitis, cough, asthma attacks, pleural friction noise, exudate, hoarseness)

• Signs of encephalopathy (drowsiness during the day, insomnia at night, lethargy, including coma, headaches, blurred vision, retinopathy)

• joint pain, up to secondary gout,

• dermatitis: dryness, itching of the skin, traces of scratching, the skin is covered with uremic

―dust‖

• hemorrhagic diathesis (bleeding from the nose, gums, gastrointestinal bleeding)

• anemia

• hypostenuria

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• creatinine greater than 0.7 mmol / l

• CF less than 5%

• hyperkalemia greater than 5.0 μmol / l

• hypocalcemia less than 2.12 μmol / l

• decrease in diuresis, up to anuria

• arterial hypertension

• heart failure

metabolic acidosis

Chronic kidney disease (CKD) - damage to the kidneys or a decrease in their function for 3 months or more. This collective term, which can also be used as a separate diagnosis, was proposed by the US National Kidney Fund in 2002 and has become widespread. The introduction of this terminology is accompanied by a new classification into 5 stages, which differ in tactics of patient management and the risk of developing terminal renal failure and cardiovascular complications.

Table

5.1

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5.1. TEST TASKS

(Choose one or more correct answers)

1. The most reliable sign of chronic renal failure is

1) arterial hypertension

2) hyperkalemia

3) increased blood creatinine

4) oliguria

5) anemia

2. What is the change in urine suspected of chronic renal failure

1) high specific gravity

2) massive proteinuria.

3) isohypostenuria

4) anuria

5) pallakiuria

3. Frequent urination, more than 6 times a day is called

1. oliguria

2. nocturia

3. pollakiuria

4. dysuria

5. anuria

4. The allocation of more than 2 liters of urine per day is called

1) oliguria

2) polyuria

3) dysuria

4) pallakiuria

5) ishuria

4. What sample can detect a decrease in glomerular filtration rate

1) Nechiporenko

2) Zimnitsky

3) Reberga-Tareeva

4) Addis-Kakovsky

5) Amburge

4. Painful urination is

1. pollakiuria

2. stranguria

3. ishuria

4. anuria

5. polyuria

7. In the formation of edematous syndrome with nephrotic syndrome, mechanisms prevail

1) violation of vascular permeability

2) system activation: aldosterone-ADH

3) decrease in plasma oncotic pressure

4) a sharp decrease in renal filtration (retention edema)

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5) a sharp increase in hydrostatic pressure in the venous channel of blood circulation

8. From the symptoms below, select those that are most common for nephritic syndrome:

1) arterial hypertension

2) edematous syndrome

3) hematuria

4) hyaline and granular cylinders

5) hyperlipidemia

8. The main sign of nephrotic syndrome is

1. leukocyturia

2. proteinuria

3. hematuria

4. cylindruria

5. bacteriuria

10. The concept of urinary syndrome includes 1) proteinuria, edema, cylindruria

2) proteinuria, leukocyturia, hematuria

3) proteinuria, glucosuria, ketonuria

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5.2 Situational tasks for the section "Nephrology"

Task 1

Patient M., 60 years old, was admitted to the hospital with complaints of intolerable pain in the left lumbar region with radiation to the inguinal region along the inner surface of the thigh. The patient cannot find a place for pain. Pain is accompanied by nausea, vomiting, bloating, and frequent painful urination.

Similar attacks in the patient were repeated more than once, and the patient noticed that their occurrence was associated with prolonged ―shaking" riding in vehicles.

On examination: the abdomen is soft, painless. Sharply positive symptom of Pasternatsky on the right.

Urinalysis: relative density - 1,020, yellow, cloudy, alkaline reaction, protein - absent, transitional epithelium in large quantities, leukocytes - 3-7 in the field of view, red blood cells - 15-20 in the field of view, cylinders absent, oxalates in large quantities .

1. What clinical syndrome can be distinguished in a patient?

2. What are the urinary symptoms in this case?

3. What disease should the patient think about?

4. What additional studies should be carried out by the patient?

Task 2

Patient M., 37 years old, was admitted to the clinic with complaints of common persistent edema.

For 8 years, he suffers from chronic glomerulonephritis with rare exacerbations, usually manifested by edema. The last exacerbation began 2 weeks ago: he woke up in the morning and barely opened his eyes due to edema, then the edema quickly spread throughout the body.

On examination: the face is pale, pasty, the eyelids are swollen, the eye slits are narrowed. Edema of the upper and lower extremities, lower back. Edema is soft, mobile. Heart sounds are weakened, the rhythm is correct. Pulse 88 beats per minute, blood pressure - 130 and 80 mm Hg The abdomen is soft, painless. The kidneys are not palpable. Pasternatsky’s symptom is negative on both sides. 400 ml of urine were excreted per day.

Urinalysis: amount 70 ml, relative density 1.028, transparency incomplete, protein 6 g / l, white blood cells 1-3 in the field of view, red blood cells 0-1 in the field of view, hyaline cylinders 6-8 in the field of view , granular - 2-4 in the field of view, waxy - 4-6 in the field of view, mucus and bacteria in small quantities.

1. What is the leading syndrome in this patient?

2. What research is needed to confirm this syndrome, and what symptoms can be identified in this case?

Task 3

Patient S., 27 years old, 2 weeks ago suffered a sore throat. Sore throats, fever up to 40 ° C were noted. I did not go to the doctors, I was treated myself, on the third day I went to work. Currently, edema under the eyes, more pronounced in the morning, headache, dull pain in the lumbar region, severe weakness, oliguria (excretes up to 500 ml of urine per day) is disturbing.

On examination: pallor and puffiness of the face, swelling of the lower extremities. During auscultation of the heart, I tone at the apex weakened the accent of II tone above the aorta, the

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heart rate was correct. Pulse - 50 beats per minute, intense. HELL - 170 and 100 mm Hg 450 ml of urine were released per day.

Urinalysis: amount of 65 ml, relative density - 1,025, color - type of "meat slops", protein - 2.5 g

• l, tubule epithelium cells - 1-2 in the field of view, red blood cells - 5-70 in the field of view, white blood cells - 1-3 in the field of view, hyaline cylinders - 3-5 in the field of view, granular - 2-4 in the field of view, a lot of mucus, bacteria - a small amount.

1. What are the urinary symptoms of this patient?

2. What clinical syndromes can be distinguished in this case?

3. What large clinical syndrome can be formulated on the basis of the data obtained?

Answers to the tasks to the section "Nephrology"

Task 1

1. Renal colic syndrome

2. Leukocyturia, microhematuria, oxalaturia.

3. Urolithiasis

4. Ultrasound examination of the abdominal organs, survey radiography of the kidneys, intravenous urography.

Task 2

1. Nephrotic syndrome.

2. Determine the daily proteinuria, the level of total protein (hypoproteinemia) and albumin (hypoalbuminemia) in the blood serum, as well as to detect hyperlipidemia, the content of cholesterol and triglycerides in the blood.

Task 3

1. Microhematuria, proteinuria, cylindruria.

2. Edema, hypertension, oliguria, urinary syndrome.

3. Acute nephritic syndrome.

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