Polycystic kidney - Causes, Symptoms and Treatment .MF .
polycystic kidney disease (autosomal dominant polycystic kidney disease adult) - a kidney disorder characterized by the formation and the gradual increase in the fluid-filled cysts in the tissues of both kidneys, which may end stage renal disease.The prevalence of 1: 500-1: 1000
The figure shows a healthy kidney and left stunned by polycystic right.
Possible causes of polycystic kidney disease.
genetically caused disease that is transmitted by inheritance, with dominant inheritance (ie, if the disease is at one of the parents, it is likely that it will manifest itself in all children couples).
reason gene mutations.There are variants of the gene mutations of polycystic kidney disease: a mutation in the short arm of chromosome 16;mutation in the chromosome 4. Localization gene disorders affect the natural history of polycystic adults: the 1st type observed rapid development of renal failure, while at the 2nd and suitable for the development of polycystic renal disease occurs after 70 years.
When such a mutation cyst formation begins in utero and continues throughout life.As occurs and adult polycystic kidney cyst mechanism currently not definitively determined.
symptoms of polycystic kidney
a long time, the disease does not manifest itself, and cysts can be a random finding on ultrasound, with no complaints people up to a certain time will not show.Typically, the first symptoms of polycystic kidney disease appear to 40-50 years, in rare cases, to 60-70.The main symptoms are non-specific, can be accompanied by many other diseases, but the clinical picture as a whole together with the results of laboratory and instrumental methods of research allows the physician to quickly diagnose.
1. Pain.Localized pain in the lumbar region on both sides, and in the abdomen.The nature of the pain aching, pulling.Causes the pain a significant increase in the kidney as a consequence of stretching the kidney capsule and compression of adjacent organs.
2. hematuria (blood in urine).Symptom optional, can be transient.
When you see blood in the urine should immediately consult a doctor (urologist, nephrologist) as causes of bleeding may be different, and the treatment should be chosen depending on the provoking factor.
3. Increase of general weakness, loss of appetite, fatigue.
4. Excessive urination, often more than 2-3 liters per day, the urine is usually light, "dilute»
6. Increased blood pressure.kidney disease generally characterized by concomitant arterial hypertension and the pressure in this disease is also often increased, the patient can not feel, is revealed in a random measurement of blood pressure.
7. Weight loss, decreased appetite.
8. Nausea, chair violation (diarrhea, constipation).
are also possible complications of polycystic kidney disease, in which you need to seek immediate medical attention:
- Inflammation of cyst or pyelonephritis - ieinfection.Since a cyst is a closed space, it is likely festering infected cysts, so the increase in pain in the lumbar region and the body temperature rises need to during the day to see a specialist (urologist, nephrologist) for the selection of therapy - anti-bacterial, and in advanced cases - nephrectomy (removalkidney).
- heart rhythm disturbances - or slowing the appearance of premature beats.This is due to a violation of the electrolyte composition of the blood, in particular, a violation of potassium excretion.To avoid this, you should be tested regularly and, together with the doctor to adjust the treatment.
- cyst rupture.It causes pain and bleeding.You also need to see a doctor, a nephrologist or urologist, who will appoint an appropriate treatment and bed rest.
Diagnosis of suspected polycystic.
So people turned to the doctor with the above complaints, or in connection with a genetic predisposition to the disease.What kind of research will be necessary to go through?
- CBC.As a result it will be possible to determine whether a patient has anemia (often accompanying polycystic kidney disease), and whether there is inflammation in the body.
- Biochemical analysis of blood (especially pay attention to the level of urea, creatinine, total protein, potassium, sodium, iron)
- Urinalysis (if there is inflammatory changes, presence of blood)
urine - renal ultrasound (standarddiagnosis of polycystic kidney disease, to determine the presence of disease, kidney size)
-UZI liver and pelvis (in some patients accompanied by polycystic kidney cysts of the liver and ovaries)
- ECG (for the evaluation of the heart, the presence or absence of arrhythmias)
Prior to the onset of disease in childhood and adolescence, there is no specific recommendations, 1 every 1-2 years to do ultrasound of the kidneys, testing, and try to avoid colds.
case of complaints and analyzes changes in the patient is recommended to start to be observed at the nephrologist in Nephrology Center.To maximize long-term preservation of renal function the patient must go to a regular appointment with the nephrologist and pass a series of tests for the timely correction of possible violations.
primarily attributed to the patient lifestyle factors most conducive to his kidneys and the body as a whole.Firstly, a certain diet: the signs of increased levels of potassium in the biochemical analysis of blood are limited to potassium-containing foods (nuts, bananas, potatoes, spinach, potato chips, dried fruit);limit the use of salt;limit consumption of meat.Secondly, do not limit the drink with the proviso that no swelling, even drinking should be abundant - 3.2 liter / day.Third, strict control of blood pressure levels - the target level of less than 130/80 mm HgFourth, avoid contact sports, intense jogging, weight lifting.And fifth, to prevent chronic foci of infection in your body (carious teeth, inflamed tonsils, sinusitis) and hypothermia.
Actually, the treatment itself is aimed at prevention and treatment of complications:
Antihypertensive therapy (beta-blockers, calcium channel blockers, ACE inhibitors, rarely - diuretics) - in various combinations, depending on comorbidities, intended cardiologist and nephrologist.Means, normalizes blood pressure are very important because at elevated pressure vessels of the kidney hypertrophy and gradually creating sclerosis, which leads to disruption of the blood supply and nutrition, and so is not entirely healthy kidneys.All this leads to a rather rapid loss of kidney function, which is why control of blood pressure is so important.
Antibiotic therapy in the presence of an infection (cephalosporins, fluoroquinolones) -dozirovka adjusted according to renal function.When trying to cure inflammation of the folk ways the infection can spread or cyst may fester, in severe cases leads to the removal of a kidney.Therefore prescribe antibiotics immediately if signs of inflammation in the kidney tissue, after receiving treatment urine culture may somehow be corrected, continuing rate of not less than 10-14 days, can go up to 1 month, and then it is already possible to resort to the reception fitosborov: kidney tea, cranberrysheet, etc., but as a supplement to the basic treatment, but not in lieu thereof.
Treating malnutrition - if necessary, appoint or Ketosteril Supro, amino acids, drugs that can at least partially compensate for the protein deficiency, with the restriction on the use of animal protein (meat) remains in force.
Treatment of anemia - depending on the level of hemoglobin and serum iron levels are appointed by the iron preparations and preparations of erythropoietin, a prerequisite is the continuous monitoring of hemoglobin levels, because of its excessive increase is also harmful.
Treatment of phosphorus-calcium disorders: Depending on the level of calcium, phosphorus and parathyroid hormone in serum calcium prescribe drugs or alpha-kaltsidola.
outcome of the disease is end-stage renal failure - that is, a condition where the kidneys are no longer able to filter blood from harmful substances, and to save the life of the patient should be started renal replacement therapy.Task nephrologist to determine when you need to start hemodialysis.This is determined by the level of glomerular filtration rate, the calculation based on a formula based on laboratory data.Hemodialysis - constant outpatient procedure is usually performed 3 times a week for 4-5 hours, blood is cleansed by water and surplus exchange products.As a rule, pre-formed on the arm fistula for easy and painless procedure.Visit hemodialysis procedures should be constant.In end-stage renal failure pass two or three procedures can be completed for the patient's death.Hemodialysis is a certain stage becomes a regular (3 times a week) and integral.
patients during hemodialysis.
With regular visits to hemodialysis procedures, compliance with all the recommendations of the attending physician, careful monitoring of blood pressure, life expectancy in these patients compared with the general life expectancy in the population.
also possible treatment option in the future is a kidney transplant with a constant intake of immunosuppressive therapy.
Prevention have no disease.Currently, scientists developed drugs that inhibit cyst growth initially, but research is only at the stage of the experiment, the mice on the drug proved to be a success.
Article written by a physician nephrologist Sirotkina EV