Gouty Nephropathy - Causes, Symptoms and Treatment .MF .
Gouty nephropathy - kidney disease that occurs in gout.Gout - a disease characterized by the deposition in various organs and tissues of urate crystals (uric acid).Gout suffer mostly men, and half of the cases develop gouty nephropathy.
reasons gouty nephropathy
disease is based on increasing the synthesis of uric acid in the body and / or a reduced ability to eliminate it.This causes an increase in serum uric acid and its derivatives in blood urate accumulation in the kidneys, which leads to uric acid nephrolithiasis (formation of stones in pyelocaliceal renal system).Upon accession, inflammation develops pyelonephritis (infection of the renal pelvis and kidney tissue).Moreover, urate have a direct toxic effect on renal tissue, causing interstitial nephritis.In some cases, possible acute blockage of the renal tubular urate crystals.Such a complication called acute Uric acid nephropathy.All these factors directly or indirectly cause damage to the kidney tissue with the development of renal failure.
Diagnosis and symptoms of gouty nephropathy
are the following clinical forms of gouty nephropathy:
• urate nephrolithiasis;
• chronic tubulointerstitial nephritis;
• Acute Uric acid nephropathy.
Urate nephrolithiasis diagnosed when finding kidney stones.As a rule, two-way process, characterized by the re-formation of stones after removing them.Often there are staghorn stones, completely filling the renal pelvis, which can lead to complications such as bleeding or pyelonephritis.
rentgennegativny urate stones, that is, can not be determined with X-ray.Ultrasound is the method of choice for the diagnosis of this disease.
Another feared complication is the urate nephrolithiasis renal colic.Renal colic - is, as a rule, sharply arisen violation patency of the urinary tract, accompanied by urinary retention.This complication is characterized by severe pain.
The examination is possible to detect blood in the urine as a result of urinary tract stone wall injury, increasing the number of leukocytes and the appearance of bacteria in the urine in the formation of a secondary pyelonephritis.Without treatment, renal colic can lead to hydronephrosis (dilation of the renal pelvis due to the impossible a discharge of urine), severe pyelonephritis, and ultimately damage the kidney tissue with the formation of end-stage renal failure.In the absence of renal colic and inflammation in laboratory analysis when uric acid nephrolithiasis is no change.
For chronic tubulointerstitial nephritis typical urinary syndrome and arterial hypertension.Urinary syndrome is diagnosed when a small amount of protein (2 g / l) and in the urine microhematuria (presence 3-4 erythrocytes in the urine unchanged in urine color).During exacerbation of chronic diseases, after previous infections may be a significant increase in protein isolation and the emergence of gross hematuria (visible eye, blood in the urine).
1,2 - Gross hematuria, 3 - the norm.
For chronic tubulointerstitial nephritis is also characterized by hypertension.Usually blood pressure is controlled dosing.The appearance of a malignant (uncontrolled) hypertension shows significant damage kidney tissue replacement it with scar tissue.
Acute Uric acid nephropathy develops suddenly.Dramatically reduces the amount of urine.The attack is accompanied by intense drawing pains in the lumbar region, gross hematuria, may be complicated by renal colic and hypertensive crisis.This renal excretory function is not affected.With acute renal failure with severe poisoning organism harmful waste products it is developing rapidly urine disappears over time.
diagnosis of gout is based on the detection of elevated levels of uric acid in the blood test.In identifying the diagnosis of gout gouty nephropathy becomes more likely.
Treatment of gouty nephropathy
Acute Uric acid nephropathy refers to life-threatening conditions and its treatment is carried out according to the rules of treatment of acute renal failure.
the presence of stones, preventing the normal discharge of urine, showing their surgical removal.Thereafter
assigned intensive intravenous large volumes of fluid in combination with diuretics.This leads to excretion of uric acid and urates.Also shown is the application of alkaline solution (4% sodium bicarbonate) to urate crystals dissolve.If within 60 hours there is no effect of therapy on an emergency basis is shown dialysis.
the treatment of chronic gouty nephropathy (urate nephrolithiasis and chronic interstitial nephritis), the following problems should be solved.
1. normalization of uric acid level .For this nizkopurinovaya assigned diet in combination with abundant alkaline drink.From diet excludes alcohol, meat and foods containing yeast, clams, mackerel, sardines.The drug of choice in this situation is allopurinol.It reduces the formation of uric acid and urate promotes dissolution.To enhance the excretion of uric acid are used uricosuric drugs such as sulfinpyrazone, benzobromaron.A combination of these groups of drugs.
2. For the treatment of high pressure used antihypertensive drugs, such as angiotensin receptor blockers (losartan), or angiotensin converting enzyme inhibitors (enalapril).Many drugs have nephroprotective these groups (protective) effect, which is especially important for preventing the development and progression of renal insufficiency.
3. Treatment of chronic pyelonephritis by using antimicrobials.Early treatment of inflammation allows significant enough to push back in time the development of renal failure.
prognosis of acute forms of gouty nephropathy in a timely and adequate treatment favorable.In chronic renal failure process is formed after about 10-15 years after onset of the disease.Every fourth patient with gout eventually develop end-stage renal failure.
physician therapist, nephrologist Sirotkin EV