Dismetabolic (exchange ) Nephropathy - Causes, Symptoms and Treatment .MF .
dismetabolic or exchange nephropathy - a kidney disease that occurs as a result of metabolic disorders.Dismetabolic nephropathy occupies a significant place in the structure of morbidity in pediatric practice, metabolic disorders are detected in the urine of every third child.
Reasons exchange nephropathy
Depending on the cause of isolated primary and secondary dismetabolic nephropathy.The primary form is caused by hereditary metabolic disorders characterized by early-onset, progressive course, the rapid formation of stones in the kidney and development of renal failure.Secondary dysmetabolic nephropathy associated either with a large intake of certain substances, or in violation of their release.Normally
salts in urine are in the dissolved state.Under the influence of certain factors occurs salt crystallization and precipitation of a precipitate.These factors are divided into environmental factors and internal factors related to the violation of the work of various body systems.By the predisposing
The internal factors include congenital abnormalities of the kidneys and ureters, especially those related to violation of the passage of urine, urinary tract infections, hormonal changes, such as hyperparathyroidism, prolonged bed rest and immobilization, genetically determined metabolic disorders.
Thus, under the influence of the above factors there is crystallization of salts, crystal deposition in kidney tissue with the development of inflammation, and, if the local cluster salts formed stones.
Symptoms dismetabolic nephropathy
Most secondary dismetabolic nephropathy associated with the violation of calcium metabolism (70-90%), urate, 5%, and cystinuria occurs in 3% of cases.
1. calcium oxalate nephropathy is the most common disease of childhood.The reason for its development is a violation of the metabolism of calcium and oxalate.Normally oxalate ingested with food, or generated during metabolism.Oxalates have a high capacity for crystallization, so even a small increase in their concentration in the urine leads to precipitation.
reasons for increasing the concentration of oxalates are:
• Increased dietary intake with the abuse of such products as cocoa, chocolate, beets, celery, spinach, rhubarb, parsley, broth, especially vegetables.
• Enhanced absorption due to inflammatory bowel diseases such as Crohn's disease, ulcerative colitis, and others.
• Increased synthesis in the body under conditions of excess ascorbic acid, pyridoxine shortage, or when genetically determined defect of oxalate metabolism.
oxalate crystals in the renal tubules of the falls, causing their inflammation.When long-term inflammation of the current functional kidney tissue is replaced with scar tissue.
disease is often detected at the age of 7-8 years.Specific symptoms are absent.There may be mild abdominal pain without clear localization, passing on their own, a burning sensation when urinating.In the analysis of urine attracts attention oksolatno-calcium crystalluria, hematuria varying degrees of severity, may be a slight proteinuria and / or leucocyturia in the absence of bacteria.
Children with hyperoxaluria grow and develop normally.During puberty, the disease is usually acute.This is probably connected with hormonal imbalance.With the progression of nephropathy, the formation of urolithiasis, tubulointerstitial nephritis, and the accession of a bacterial infection, pyelonephritis.
2. The main reason secondary phosphaturia - infection of the urinary system.Microorganisms digested uric acid, urine alkalizing it promotes crystallization phosphorus salts.Diagnosis is performed based on the presence of calcium phosphate crystals in urine.
3. Uric acid revealed the final product of purine metabolism.Therefore urikozuricheskih nephropathy occurs when excessive consumption of foods rich in purines (alcoholic beverages, broths, meat products, mushrooms, asparagus, cauliflower), as well as the increased formation of uric acid in the body.The crystallization of urate promotes urine acidic environment as well as reducing its quantity.Primary urate nephropathy caused by a genetic defect in the metabolism of uric acid.Manifestations of urate nephropathy complicated diseases such as multiple myeloma, erythremia, hemolytic anemia.The cause of secondary urate nephropathy is also a long-term use of diuretics, cytostatics, as well as chronic urinary tract infections, such as pyelonephritis.
characterized by a long asymptomatic for urate nephropathy.Changes in urine occur crystalluria, small proteinuria, hematuria.In severe crystalluria urine becomes brick color.With formed urate stones and mixed over time.
4. Cystine is the most insoluble of the amino acids.Crystal formation is caused by the accumulation of cystine in kidney cells, or disorders of cystine reabsorption in the tubules.Both are due to hereditary causes of renal structure.With the defeat of the tubules of the kidneys as a result of pyelonephritis or tubulointerstitial nephritis develops secondary cystinuria.For cystinuria characterized by the development of renal fibrosis, the formation of stones.When you join an infection developing pyelonephritis.
survey of suspected dismetabolic nephropathy
To confirm the diagnosis of finding enough of certain crystals in the urine.Keep in mind the fact that the appearance of urinary urate or oxalate may indicate non-compliance with diet and then disappear without a trace.The appearance of crystals of cystine in the urine is always regarded as a pathology.In addition, necessary to conduct urine biochemical analysis to identify salts as well as assessment of renal function based on the concentration in the urine of some standard substances.Renal ultrasound to determine the structures of seal kidney, kidney stones, as well as signs of inflammation.
Treatment dismetabolic nephropathy
Treatment dismetabolic nephropathy is a multi-component process.Patients shown use sufficient liquid as urine in a large amount reduces the salt concentration and thus reduces the risk of crystallization.Particularly relevant it is the fluid intake before bedtime to prevent stagnation.It is recommended to use simple or mineral water.
The aim of the diet is the complete or partial cessation of intake of the precursor salts with food.
When hyperoxaluria recommended cabbage-potato diet with restriction of products containing oxalates.
|View nephropathy||Prohibited products|
|hyperoxaluria||Meat dishes, spinach, cranberries, beets, carrots, cocoa, chocolate|
|urate nephropathy||liver, kidney, meat broths,peas, beans, nuts, cocoa, alcoholic beverages|
|phosphate nephropathy||cheese, liver, eggs, chicken, beans, chocolate|
|cystine nephropathy||Cottage cheese, fish, eggs, meat|
alsoshows the use of products, alkalizing urine: dried apricots, prunes, pears, alkaline mineral water.Because medical treatment is necessary to use vitamins and antioxidants (tocopherol, pyridoxine, vitamin A).
Diet for urate nephropathy involves giving up foods containing purines.The priorities are considered dairy products and vegetable origin.The amount of fluid consumed must be increased up to two liters.Used tools alkalizing urine: decoctions of herbs (fennel, horsetail, oats, birch leaves), as well as slightly alkaline mineral water.In order to reduce the concentration of uric acid used allopurinol.As a means of renal cell membranes reinforcing ksidifon applied and vitamin B6.
phosphorus-containing products are eliminated in the phosphate crystalluria .Particular attention is paid to the acidification of the urine (mineral water, ascorbic acid).To reduce the phosphorus absorption in the intestine is used Almagelum.An important condition is the treatment of chronic urinary tract infection foci.
Diet for cystinuria seeks to limit foods containing methionine (the precursor cysteine), drinking plenty of fluids, as well as the use of funds, alkalizing urine.Courses used membranstabiliziruyuschie drugs and nefroprotektory.Methods of treatment with the development of renal failure is a kidney transplant.Unfortunately, after 10-15 years of developing nephropathy in kidney transplant.
In primary nephropathy prognosis is unfavorable due to the rapid development of renal failure.Secondary nephropathy is characterized by a more favorable course.Dieting, water-drinking regimen, drug therapy, as well as timely treatment of urinary tract infections often allows for normalization of the main indicators in the urine.
physician therapist, nephrologist Sirotkin EV