Acute renal failure, causes, symptoms, first emergency medical care in acute renal failure.

Acute renal failure is a condition characterized by a decrease in the ability of the kidneys to form urine (fluid filtration). In this case, the kidneys also lose their function of freeing the body from side and excess metabolic products and toxins, which leads to its poisoning (intoxication). 

Acute renal failure, causes, symptoms, first aid in acute renal failure.

Acute renal failure can occur for a variety of reasons. For convenience, they are divided into three main groups. The first group includes factors acting on the body as a whole, for example, bleeding. With a large loss of blood, the supply of all organs, including the kidneys, drops sharply. Too low blood pressure in the vessels of the kidneys does not allow them to effectively filter the fluid.

, with electric shock, bacterial infection of the blood, severe infections with dehydration, extensive burns and other conditions in which an excessive drop in blood pressure occurs. Sometimes, too active use of diuretics, which cause significant loss of fluid, as well as blood diseases, in which there is a decrease in the level of hemoglobin that carries oxygen, can lead to renal failure.

The second group of reasons combines factors that act directly from the side of the kidneys. So, acute glomerulonephritis – a disease in which the formation of antibodies to the components of the kidney capillaries occurs, can become a potential cause of acute renal failure. In addition, a decrease in kidney function can occur in many diseases from the rheumatic group – systemic lupus erythematosus, scleroderma, Goodpasture syndrome, etc. All of them are united by the fact that the immune system begins to perceive kidney tissue as foreign and release special substances that destroy them.

Damage to the kidney tissue causes severe arterial hypertension with sharp drops and a strong increase in blood pressure – it is also called malignant in such cases. Often the cause of such hypertension lies in the kidneys themselves and occurs, for example, with abnormalities in the structure of the renal vessels or tumor of the adrenal gland. Acute renal failure can also develop from various toxic effects on the body..

Substances such as mercury, copper salts, poisons of some mushrooms, directed to the kidneys and inhibit their work. Acetic acid and some of the substances contained in fertilizers for plants have a similar effect. There are also drugs that, with an overdose, have a similar effect on these organs. These are antimicrobial agents (aminoglycosides, sulfonamides) and cancer treatments (methotrexate, azathioprine, etc.).

Finally, the third group of factors combines the causes that act on the part of structures located below the kidneys, i.e., the urinary tract. They are relatively rarer. The so-called subrenal causes of acute renal failure include all those that cause impaired urine outflow at different levels. This can be a stone wedged into the ureter, tumors in the abdominal cavity or pelvis, squeezing the ureter or urethra, a blood clot formed after a trauma to the urinary tract. For example, after surgery.

The reason for the violation of the outflow of urine and acute renal failure can be the germination of the tumor in the urinary tract. If an obstruction to the outflow of urine occurs at the level of the ureter, only one kidney suffers. Violation of the discharge of fluid leads to an increase in pressure in the overlying sections of the urinary system, there is an extension of the structures of the kidney. If timely release of the renal pelvis is not ensured, the renal tissue dies and the organ permanently loses its ability to filter fluid and form urine.

In cases where the block for urine outflow occurs at a lower level (bladder, urethra), both kidneys suffer simultaneously. For the forecast, this is much more dangerous. In addition to the main reasons, there are also risk factors for acute renal failure. People who have them are more prone to this pathology than others.

So, the risk factors for the development of acute renal failure include the presence of a serious kidney and heart disease in a person, a strong increase in blood pressure, age over 60, and diabetes mellitus. The development of acute renal failure is facilitated by any processes leading to a deficiency of fluid in the body (diarrhea, repeated severe vomiting, etc.).

Acute renal failure should be suspected if a person has recently started taking a new drug from the group of toxic to the kidneys or is drinking a lot of painkillers, or has signs of drug use (signs of an injection on his hands). The development of acute renal failure cannot be ruled out if the patient has recently undergone some kind of surgery, he has urolithiasis or neoplasms of the urinary tract.

Symptoms of acute renal failure.

Acute renal failure is not such a rapidly developing condition as a stroke, myocardial infarction, or a seizure. It usually takes up to several hours for the symptoms to fully unfold. The difficulty lies in the fact that it is sometimes difficult to diagnose acute renal failure at first glance. Its manifestations at different stages are very similar to poisoning, shock or other emergency conditions..

In some cases, the patient does not feel the disease at all, the only symptom of which is the lack of urine output. This often happens in people with cardiac problems, for example, those being treated after a myocardial infarction. The classic symptoms of acute renal failure are increased fatigue, weakness, decrease and decrease in volume, and then the cessation of urine output, the absence of urination. Those small portions of urine that are released when acute renal failure develops are darker than usual..

With the increase in signs of body poisoning by-products of metabolism, symptoms such as aversion to food, nausea, vomiting, and sometimes stomach pains appear. Patients complain of an unpleasant taste in the mouth, since the body, which is losing the kidneys as an excretory organ, begins to excrete harmful substances through other organs: skin, mucous membranes, and lungs. That is why sometimes, being near such a patient, you can feel an unpleasant “urinary” odor from his skin and in the air he exhales..

In acute renal failure, electrolyte metabolic disturbances quickly develop, which sometimes causes muscle twitches or even cramps. In patients, consciousness is gradually impaired. They stop talking, it becomes difficult to get in touch with them – they answer questions with a delay, in monosyllables, sometimes incorrectly. Then, in the absence of proper treatment, consciousness is depressed and the person falls into.

It is much simpler in terms of making a diagnosis of those cases when the condition is caused by kidney problems, i.e., obstacles to the outflow of urine. In such situations, there is a very important diagnostic feature – pain. Under the pressure of accumulating urine, the urinary tract, cups and pelvis of the kidneys are stretched, and swelling of the renal tissue is growing. All this together gives severe back pain. On one or both sides, depending on whether one or both kidneys are affected.

The pain has the property of spreading down along the urinary tract – to the inguinal region, genitals, to the inner surface of the thigh. With pressure on the skin on both sides of the navel or over the pubis, the pain intensifies. Whatever the cause of acute renal failure, its key symptom is a lack of urine output. It is always necessary to ask about its quantity at the patient with suspicion of this pathology and at any other urgent conditions. Most of them, whether they are classified as cardiology, neurology or toxicology, can occur with symptoms of renal failure.

First aid for acute renal failure.

If you suspect this condition, you must first ensure that specialized medical care arrives at the patient as soon as possible. If the patient is transported to a hospital, then the transportation position is selected according to his condition. With severe weakness, convulsions, loss of consciousness, a person is transported lying down. If the general state of health is still not very severely affected, transportation in a sitting position is possible.

Before the patient falls into the hands of doctors, the care provider is generally required to take general care measures. For example, help with vomiting. If a person continues to bleed, efforts must be made to stop him. Apply a tourniquet, squeeze an artery, etc. If severely dehydrated, give the patient drink water. In the same situation, if a person is unconscious and has lost a lot of blood, it is permissible before the arrival of doctors to administer intravenous drip replacement drugs – 0.9% sodium chloride solution or 5% glucose solution in an amount of not more than 400 ml.

If acute renal failure is caused by a blockage in the urinary tract, an attempt can be made to catheterize the bladder if you have the skills to perform this procedure. In the same situation, admissible painkillers are acceptable. True, it should be remembered that they will not help to completely relieve pain, but as a measure for some relief of the patient’s condition, they’ll be quite suitable.

As part of pre-medical care, it is necessary to constantly monitor the patient’s breathing and heartbeat. To reduce the intoxication of the body, you can perform gastric lavage and a cleansing enema with cool water. The intestines have an extensive circulatory network, and during these procedures, part of the toxins are removed from the body with water.

For the same purpose, the patient is given enterosorbents (activated carbon, polyphepan). This will slightly improve the patient’s condition before admission to a specialized hospital, where there are opportunities for hardware-based blood purification and treatment of acute renal failure.

Based on the book “Quick help in emergency situations”.
Kashin S.P..

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