Nirka with hospitality nirkovy lack. Gostra nirkova lack of

For a critical interruption, they are developing a state standard and a chronic shortcoming.

Gostra nirkova lack

Gostra nirkova lack of development in rapt, as a legacy of a gross (ale most often circulating) tissue nirok, and is characterized tricky fads some of the sech (oliguria) until the main day (anuria).

Causes of a hostile nirkova disadvantage

Symptoms of a hostile deficiency

• a small number of slashes (oliguria);
• general visibility (anuria).

The patient’s camp is to pogirshutsya, tse supervodzhutsya tediousness, puking, passing, seemingly appetite, Vinnikayut nabrya kintzivok, to get into the furnace. Ailments can be boozy, or navpaki insistence.

V key interruption hostile deficiencies in the development of several stages:

Stage I- pochatkova (symptomatology, overwhelmed by a direct inflow of the cause, which has wicked the gostru nirkov lack), at the moment of inflow of the main cause to the first symptoms from the side, there is a lack of triviality (from decilcoh years to December). Intoxication may appear (blistering, boring,);

II stage- oligoanuric (the main sign is oliguria abo na povna anuria, also characteristically important foreign camp of a sick person, winery and burrowing accumulation in the blood of a secular and some other products in the exchange of adolescents, self-conscious arterial hypertension, Takhіkardієyu, embryos tila, anemієyu, moreover, one of characteristic signsє progressively growing azotemia - the addition of nitrogenous (white) products in the blood to the exchange and importance of intoxication to the body);

III stage- vidnovna:

• the phase of early dyuresis - a clinical course as well as in stage II;
• the phase of polyuria (improvement of the resolution of the battle) and the renewal of the concentration of buildings - normalization of normal functions, the renewal of the function of mental heart-vascular systems, Grass canal, support-roche apparatus, central nervous system; the stage of the three is close to the two;

IV stage- oduzhannya - anatomical and functional renewal of normal performance to out-of-the-box parameters. You can drag on for a lot of months, sometimes it is required up to one rock.

Chronic nirkov deficiency

Chronic nirkov deficiency - tse derogation function of nirok to the general knowledge, wickedness of stepwise bending of nirk fabric as a result of chronic incapacitation of nirok, stepwise substitution of nirk fabric with full tissue and wrinkling of nyrka.

Chronic nirkova lack of wine in 200-500 per million people. In the Danish hour, a number of ailments on chronic nirkov's lack of malnutrition increase scorchingly by 10-12%.

Reasons for the diagnosis of chronic nircum deficiency

The reasons for the diagnosis of chronic nircum deficiency can be rіznі ailing, Yaki to produce up to the level of nirkovy glomeruli. tse:

• sickness nirok chronic glomerulonephritis, chronic pyelonephritis;
• ailment obminu rechovin diabet, Gout, amiloidosis;
• congenital illnesses of nirk polycystosis, incompletely concomitant nirok, congenital ringing of nirk arteries;
• rheumatic fever, scleroderma, hemorrhagic vasculature;
• ailment of sudin arterial hypertension, ailment, scho to cause blood flow to break down;
• sickness, it is possible to produce ailments, hydronephrosis, puffiness to the point of ruin from nirok sechokam'yan, and to produce until the gradual compression of the secular nobles.

Chronic glomerulonephritis, chronic pyelonephritis, diabetes mellitus and congenital anomalies of nirok development are the most frequent causes of chronic nircovascular deficiency.

Symptoms of Chronic Nircovis Disability

Seeing chotiri stages of chronic nirkovo deficiency.

1. Latent stage. At the stage of the stage, the patient may not show scarg, for there is a stomachache in case of physical imbalance, weakness, lasts until evening, dryness in the mouth. With biochemical pre-existing blood, there is little damage to the electrolyte warehouse of blood, only a few blocks in the slaughter.
2. The stage is compensated. At the stage of scarga, there are also ailments, but the stinks often come out. Supervise up to 2.5 liters for extra money. Vyavlyayutsya vyavlyayutsya in the biological indicators of blood and century.
3. Intermittent stage. The robot will change more and more. Determination of the level of promotion in the blood of products of nitrogenous exchange (exchange of bile) The patient has a vicious weakness, swelling stomatism, spraga, dryness in the mouth, the appetite decreases rapidly, it means an inappropriate relish in the mouth, there is a tediousness and blues. Shkira nabuva zhovtuvatiy vidtinok, dry, dry. M'yazi vytrakayut tonus, sposterіgayutsya other smokyuvannya m'yazyv, tremor of fingers and brushes. In some cases there are pains in the folds and slopes. In a sick person, it is much more important than the protection of the respiratory distress, angina, pharyngitis.

   At the same stage there can be turns during the period of training and death in the patient's station. Conservative (without surgical engagement) Therapy gives you the ability to regulate homeostasis, and the sick person’s zagalny camp is not too easy to allow, but a little more physical navantazhennya, Psychic stress, errors in children, intercourse of pitty, infection, operation can lead to the loss of the function of nirok and loss of symptoms.

4. Thermal (kintseva) stage. For the whole stage, the characteristic of emotional lability (apathy is changing to anxiety), disturbed sleep, drowsiness during the day, demented and inadequate behavior. Special odutle, syro-zhovtoy koloru, itchy skin, On the shkіri є, comb, hair, darkness, lamina. An increase in dystrophy, characterized by hypothermia ( lowered temperature tila). There is no appetite. The voice is hoarse. The company smells amicable. Vinikaє aphthous stomatitis. Mowing of coatings, life of swellings, often repeated bloating, haircuts. Neridko - carry, stinky style, dark color. Filtration of building nirok falls to the minimum.

   Ailments can be perceived to oneself a lot by stretching out decal rocky, but at the same stage in the blood, the amount of sechivine, creatinine, secular acid, damage to the electric storage of blood is gradually increased. All of the cyclical uremic intoxication abo uremia (uremia slaughter in the blood). The number of visions will be reduced to the next day. Respect for the best organizers. Vinnikak dystrophy of the heart meat, pericarditis, lack of blood circulation, a lot of legends. Destruction from the side nervous system are manifested by symptoms of encephalopathy (loss of sleep, memory, mood, symptoms of depression). Viral hormones will collapse, changes occur in the gutting system, and immunity will collapse. All the changes may have a nezorotny character. Nitrogen products are exchanged for sweat, and from the sick, it smells like hay.

Prevention of nircum deficiency

Prophylaxis of hostile deficiencies should be made to the extent that there are reasons to fail.

Prevention of chronic nircum deficiency is carried out until such chronic ailments are eliminated: pyelonephritis, glomerulonephritis, ukam'yana hvoroba.

forecast

With the appropriate i correct filling Adequate methods for coping with a greater number of ailments with a hostile nirkovy lack of coaching and turning to a normal life.

Gostra nirkova lack of a werewolf: nirki on the view of the larger organs of the building will increase the function. At the same time, there is a lack of gosstr nirkov - the most important thing is the acceleration of helpless ailments, death does not come quickly.

However, in some of the ailments, there is a lack of glomerular filtration and concentration of health, and in the case of nirkov there is a lack of acceptance. chronic overrun, An important role is played in the course of the whole disease when you have a pyelonephritis.

In neglected patients, death in case of a state of nircovy deficiency is most often infused with uremic Komi, hemodynamic failure and sepsis.

Chronic nirkov lack of need to control and fix early stages If you have ailments, you can make sure to completely waste the nirk functions and clamp down on the nirk transplant.

Can you zrobiti vi?

Most of the time, the patient's mind is to take note of the changes, as they see him like from the side of the self-esteem, so from the side of the slash, and turn to the doctor for help. Ailments, for those who have a confirmed diagnosis of pylonephritis, glomerulonephritis, congenital anomalies of nirka, systemic engulfment, Regularly confessing to a nephrologist.

I, obviously, it is necessary to strictly follow the sign of the lykar.

How can you create a license?

Likar to mark the reason for nirk's lack and the stage of becoming ill. All the necessary visits from the doctor's office and to look for the ailment will be taken into account.

Likuvannya of hostile nirkova lack is directed to the pershu cherga for the deserted cause, yak viklik daniy stan. If you can get sick, come in to fight shock, irritation, hemolysis, intoxication and in. People who are sick with a hostile nirkovo lack of translation into reanimation of information, so they need additional help.

Likuvannya of chronic nirk deficiencies is not common in the likuvannya of nirok, as it called to nirk deficiency.

RCHRH (Republican Center for Development of Health Protection of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2014

nephrology

General information

Short description

expert joy
RSE on REM "Republican Center
protect your health "

Ministry of Health Protection
and social development

Gostra nirkova deficiency (arrester)- a syndrome that develops in the form of a rapid (year-old) decrease in the efficiency of glomerular filtration, which leads to the accumulation of nitrogenous (including serovine, creatine) and non-nitrogenous products in metabolism of metabolism (from nirkami.

In 2004r ADQI (Innovation for improving the quality of skincare), the concept of “hospitality for good quality ), Injury, Failure, Loss, End stage renal disease - Table 2.

Danish term and new classifications in accordance with the method of greater early verification of state-of-the-art medical education, early initiation of innovative therapy (RRT) for non-efficacy conservative methodsі zapobіgannya development of important forms of nirkovo deficiency with unwelcoming inheritance.

I. Introductory part:

Name of the protocol: Gostra nirkova lack of

Protocol code:

Code (codi) according to ICD-10:

Gostra nirkova lack (N17)

N17.0 Gostra nirkova lack of tubular necrosis

Tubular necrosis: NOS. gostry

N17.1 Gostra nirkova lack of gostim cortical necrosis

Cortical necrosis: NOS. gostry. nirkovy

N17.2 Gostra nirkova deficiency with medular necrosis

Medular (papillary) necrosis: NOS. gostry. nirkovy

N17.8 Insha gostra nirkov lack of

N17.9 Gostra nirkov deficiency, unspecified

Fast, as vikoristovyu in the protocol:

ANCA Antineutrophilic antibodies

ANA Antinuclear antibodies

AT Arterial vise

ADQI initiative

AKIN Acute Kidney Injury Network

LVAD Left Ventricular Assist Device

KDIGO Kidney Disease Improving Global Outcomes

MDRD Modification Diet of Renal Disease

RVAD Right Ventricular Assist Device

NOS Without additional details please specify

BRA-II Blokatori angiotensin-II receptor

HRS Hepatorenal Syndrome

HUS hemolytic-uremic syndrome

ZhKK Shlunkovo-intestinal bleeding

RRT Zamisna nirkova therapy

IGD Intermittent (Periodic) Hemodialis

SHVL piece ventilation lungs

I-APF Ingibitori angiotensin converting enzyme

KP-OPP Contrast - Induced OPP

KShchS Acid-Luzhniy mill

Refinery Nonsteroid antiapalny drugs

Surge arrester Gostra nirkova lack

OPP Gostre nirkovy poshkojennya

OTN Hostry tubular necrosis

Otinia Gostriy tubulointerstitial nephritis

BCC Obsyag circulating blood

ВІТ Announcement of Intensive Therapy

RRPT Continued to replace nirkova therapy

PGF Prolonged vino-venous hemofiltration

PVVHD Protraction of the venous-venous hemodialis

PVVGDF Protracted vino-venous hemodynamics

SCF Glomerular fluidity

RIFLE Rizik, waste, lack, waste, TKhPN

ETHC Terminal chronic nirkov deficiency

Chronic Nirkov deficiency

XXN Chronic ailment nirok

CVP Central venous vice

EKMO Extracorporeal membrane oxygenation

Date of release to the protocol: 2014.

Coristas to the protocol: nephrologist, doctor for diagnosing hemodialysis, doctor anesthesiologist-reanimatologist, doctor home practice, Therapist, toxicologist, urologist.

Classification

Classification

Reasons and classification of OPP

For the main mechanism of development OPP is divided into 3 groups:

prerenal;

renal;

Post-renal.

Malunok 1. Classification of the main causes of AKI

prerenal cause

Malunok 2. Cause a pre-renal hostile nirkovo pooshkojennya

morphological classification based on character morphological changes and localization process:

Hostrium tubular necrosis;

Hostria cortical necrosis;

Hostry tubulointerstitial nephritis.

Fallow the size of the dyuresu see 2 forms:

Oliguricheskom (durez less than 500 ml / dobu);

Neoliguric (dures ponad 500 ml / dobu).

Dodatkovo development:

Non-catabolic form (less than 20 mg / dl, 3.33 mmol / l);

Hypercatabolic form (the growth rate of blood is more than 20 mg / dl, 3.33 mmol / l).

Oscillations in large patients with adolescents on OPN / OPP during the day of information about the outgoing standard of the function of nirok, basal rate of creatine, in 1).

Rozrakhunkovy basal creatine (ADQI for fasting) - Table 1

Scr * -creation of blood, KF ** - glomerular filtration

Table 4... PPP stages (KDIGO, 2012)

diagnostics

II. METHODS, APPROACHES AND PROCEDURES OF DIAGNOSTICS AND LIKUVANNIA

Switching the main diagnostic entries

The main (obov'yazkovy) diagnostics of the condition, which is carried out at the outpatient stage:

Send whiskey to the stationary:

Zagalny blood analysis;

Zagalny analysis of the slaughter;

Biochemical analysis of blood (creatine, sechovina, calcium, sodium, calcium);

Viznachennya bіlka in the section (kіlkіsna sample);

Ultrasound nirok.

Dodatkovi diagnostics, scho carried out at the outpatient stage:

Biochemical analysis of blood (bilkovy fractions, M-gradin, calcium and ionization, phosphorus, lipid spectrum);

Rheumatoid factor;

UZDG sudin nirok;

Ultrasonic inspection of organs in the worms empty.

The minimal change of the situation, which must be carried out when directed to the planned hospitalization:

I will look at the need for an extraordinary hospitalization, and enough information about the vision of a battle (oliguria, anuria) and / or a creatine adduction, which is guided by the diagnostic criteria of 12.3 points.

The main (obov'yazkovy) diagnostics of the situation, which is carried out at a stationary station:

Biochemical analysis of blood (blood creatine, blood serum, calories, sodium, extra blood cells and blood cells, ALT, AST, deep blood cells);

KShchS blood;

Coagulogram (PV-INR, APTCH, fibrinogen);

Zagalny analysis of the slaughter (with the manifestation of duresis!);

Ultrasound nirok;

Notes:

All urgent care of patients, planned X-ray contrast monitoring, as well as operations in hand, are responsible for assessing the risk of development of the OPP;

All urgently needed, guilty of supervising the analysis of sechovy, creatine and level of electrolytes;

With the well-developed development of OPP, the patient is guilty of being checked by the nephrologist for the first 12 years, it is indicated that it is indicated before the RRT, the prognosis, and the patient is guilty of referring to a high-profile hospital with the obvious visualization of the hemopoietic correction.

Additional diagnostics of the situation, which are carried out at the stationary hospital:

Analysis of the section for Zimnitskiy;

Rehberg's test (dobov);

Dobova albuminuria / proteinuria abo put albumin / creatinine, protein / creatinine;

Electrophoresis bіlkіv section + M-gradієnt section;

Ekskretsiya kaliyu, sodium, calcium from a cross-section;

Dobova eccentric acid;

Analysis of the Billock Bens-Jones slaughter;

Bacteriological advances in the value of the sentient's sensitivity to antibiotics;

Biochemistry analysis of blood (calcium and ionization, phosphorus, lactate dehydrogenase, creatine phosphokinase, lipid spectrum);

Rheumatoid factor;

Immunological analyzes: ANA, ENA, a-DNA, ANCA, antiphospholipid antibodies, antiphospholipids antigen, complement fractions C3, C4, CH50;

parathyroid hormone;

Vilny hemoglobin in the blood and in the section;

shizotsiti;

Blood procalcitonin;

Ultrasonic scanning of the sectional microscope;

Dopplerography of sudin nirok;

X-ray of the organs of the breast;

Inspection of the face-to-face bottom;

TRUZI of the prostate;

Ultrasound of pleural empty spaces;

Ultrasound of organs in the small pelvis;

CT scan of the thoracic segment, cranial segment, pelvic organs (at adolescence on systemic impairment with polyorganic changes, at adolescence on paraneoplastic nephropathy for malnutrition, metastatic changes; with sepsis - with a first-lasting jerkiness)

Section osmolality, section osmolality;

Puncture biopsies of nirka (vikoristovuyutsya with AKI in folding diagnostics), indicated in renal AKI of unclear etiology, AKI in more than 4 period of anuria, AKI, non-invasive syndrome of nephrotic syndrome

The biopsy of shkiri, mucous membranes, mucous rectum, is clear - for diagnostics of amyloidosis, as well as verification of systemic discomfort;

Electroeencephalography - with the manifestation of neurological symptoms;

IFA for markers of viral hepatitis B, C;

PLR for HBV-DNA and HCV-RNA - for the prevention of virus-associated nephropathy;

Coagulogram 2 (RFMK, ethanol test, antithrombin III, platelet function);

CT / MRI of the brain;

MRI of the thoracic segment, cranial segment, pelvic organs (with adolescence on systemic impairment with polyorganic changes, with adolescence on paraneoplastic nephropathy for malnutrition, metastatic changes; with sepsis - due to an initial sensation;

Seeding blood three times for sterility from both hands;

Seeding blood for blood culture;

Take from wounds, catheters, tracheostomy, sore;

Fibroezophagogastroduodenoscopy - inability to reveal erosive-vyrazkovoj urazhennya, with a glance at the viscous rhizik of slunk-intestinal bleeding with vicious anticoagulants during the period of RRT; viklyuchiti novoryennya at p_dose on the paraneoplastic process;

Colonoscopy - inability to reveal erosive and vascular lesions, with a glance at the high rhizic of intestinal bleeding with vicious anticoagulants during the period of RRT; viklyuchiti novoryennya at p_dose on the paraneoplastic process.

Diagnostics come in, which will be carried out at the stage of shvidkoy inconvenient help:

Zbir skarg and anamnesis given to contact with toxic speech;

Dani about hydrobalance, diuresis;

Physical examination;

Vimіryuvannya arterial vise, correction of AT, according to the standard protocol "Arterial hypertension".

Nadannya nevіdkladnoy additional help when building up legends according to the standard protocol.

diagnostic criteria***:

Skargi zagalny:

Change of the volume of the battle or the appearance of the battle;

Peripheral embankments;

zadishka;

Dryness in the mouth;

weakness;

Nudota blues;

Appetite visibility.

skargi specific- in deposition from the ethology of OPP.

anamnesis:

I will start to get sick to the point of hypovolemia (bleeding, diarrhea, heart failure, surgery, trauma, blood transfusion). With a recently transferred gastroenteritis, crooked diarrhea, memory about HUS, especially in children;

Beasts of respect for the manifestation of systemic ailments, ailments of sudin (mossy stenosis of nirkovy arteries), fever fever, post-infectious glomerulonephritis;

Detection of arterial hypertension, diabetic or malignant new-mongrels (imovirness of hypertension);

Hurry up, the weakening of the jet at the choloviks are signs of post-renal obstruction, vicious ailments before the death of the cholovka. Nirkova kolka with nephrolithiasis can be suppressed to changes in dyuresis;

Reinstall, if you have taken a patient, if you do not have a problem with intolerance to these drugs. In particular, the merit of the priyom: IAPF, BRA-II, non-steroidal anti-fumes, aminoglycosides, the introduction of X-ray contrast speeches. Z'yasuvati contact with toxic, ruptured speeches;

Symptoms of malnutrition (bile, swelling of mucus, increase in creatinase, myoglobinuria in the last), the manifestation of metabolic ailments can be caused by rhabdomyoliasis;

About the incidence of nirok and arterial hypertension and the decline in creatine and sechovine in the past.

The main points required for diagnostics, in case of non-fixed mills with OPP:

Evidence of the broken function of nirok: OPP or HHN?

Damage to nirk blood flow - arterial or venous.

Chi є damage caused by obstructions?

History of history of nirok, exact diagnosis?

physical condition

The main steps in the physical examination of the offensive:

Assessment of the degree of hydration to the body is highly important for the purpose of the tactics of the sick person (spraga, dryness of the skin, slimy, or the appearance of swelling; loss, for example, the increase of vagi; the level of CVT; backlash).

Kolir shkiri, visipannya. Thermometry.

Assessment of the central nervous system

Assessment will become a leg (crust, wheezing, bleeding, etc.).

Assessment of the heart-vascular system (hemodynamics, AT, pulse. Pulsation on the great vessels). Very bottom.

Evidence of hepatosplenomegaly, changes in liver changes.

Palpation can be caused by malnutrition with polycystosis, malignant malignancies with puffins, obstruction of the urethra.

Assessment of dyuresu (oliguria, anuria, polyuria, nikturia).

Cob period: in the debut of the disease of clinical manifestation of OPP nonspecific. Overcome the symptoms of the main disease.

Oliguria development period:

Oliguria, anuria;

Peripheral and empty embankments;

Shvidko overgrowing giponatrієmіya with tediousness, sudom with headache and disorientation є moving to the brain;

Klinichny show azotemia - anorexia, uremic pericarditis, the smell of amiaku from the mouth;

hyperkalієmiya;

Gostra nadnirkova lack;

Metabolic acidosis, an important alkalosis,

Non-cardiogenic tangle of legends,

Respiratory distress syndrome of grown-ups,

Pomirna anemia,

Profuse slunk-intestinal bleeding (in 10-30% of ailments, wiclicans of ischemic mucous membranes, erosive gastritis, enterocolitis on platelet dysfunction and disseminated intravascular coagulation syndrome),

Activation of intellectually pathogenic flora (bacterial or fungal, on the smallest uremic immunodeficiency develops more and less in 50% of patients with renal AKI. sečovyh nobles, Characteristic stomatitis, parotitis, infection of operative wounds);

Generalized infections with septicemia, infectious endocarditis, peritonitis, candidiasis.

Renewal period:

Normalization of nitrogen-visual function of nirok;

Polyuria (5-8 years for doba);

Dehydration manifestations;

hyponatremia;

Hypokaliyamiya (risik arrhythmia);

Hypokaltsієmiya (tetany rhizome and bronchospasm).

Laboratory Doslidzhennya:

UAC: Pidvischennya SHOE, anemia.

OAM: Protein from small 0.5 g / day to important - 3.0 g / dobu, macro / microhematuria, cylindruria, reduction of the overall efficiency of the section

Biochemical analysis of blood: Hypercreatininemia, decreased GFR, electrolyte damage (hypercreatinemia, hyponatriyemia, hypocalcinemia).

KShchS blood: acidosis, a decrease in the level of bicarbonates.

Differential and diagnostic laboratory signs.

Instrumental doslіgennya:

... EHC: disruption to the rhythm of the heart.

... X-ray of the breast organs: the purchase of ridini in pleural empty spaces, a lot of legends.

... angiography: for the viklyuchennya of sudinal causes of AKI (stenosis of the nirkovo artery, aneurysms of the cranial aorta, viscid thrombosis of the lower empty vein).

... Ultrasonic scanning of nirok, worms empty: osyagu nirok, the appearance of concretions in nirkah or sehovividnyh shlyakhs, diagnostics of pukhlins.

... Radioisotopne scanning nirok: assessment of normal perfusion, diagnosis of obstructive pathology.

... Computer and magnetic resonance tomography.

... biopsia of nirka for indications: vicious in case of AKI in folding diagnostics, it is indicated in case of renal AKI of unclear etiology, AKI in more than 4 years in the period of anuria, AKI, in association with mild nephrotic syndrome, gastric nephrotic syndrome.

Shown for consulting fahivts:

Consultation of a rheumatologist - if new symptoms appear or a sign of systemic illness;

Consultation of a hematologist - for ailments of blood;

Consultation of a toxicologist - at times;

Consultation of a resuscitation specialist - for the operation of the surgery, OPP, in case of shock, inadequate treatment;

Consultation of an otolaryngologist - for detecting the disease of infection with the onset of sanitation;

Consultation of a surgeon - in case of adolescence for a surgical pathology;

Consultation of a urologist - for diagnostics and treatment of postrenal AKI;

Consultation of a traumatologist - in case of injuries;

Dentist consultation - for detection of chronic infections with the onset of sanitation;

Consultation of an obstetrician-gynecologist - for women; in case of adolescence for gynecological pathology,; with the mark of the emergence of infections, and the onset of sanitation;

Oculist consultations - for assessing changes in the daytime;

Consultation of a cardiologist - in case of severe arterial hypertension, damage from the side of the EKG;

Consultation of a neurologist - in case of manifestation of neurological symptoms;

Consultation of an infectious disease specialist - in case of the presence of viral hepatitis, zoonotic and іn. Інфекцій

Consultation of a psychotherapist - an obligation to consult a patient at a patient, an oskilka "sickness" of a patient to a piece of equipment and a fear of "abandonment" because of a new one, you can negatively bring the patient to a mental state.

Consultation with a clinical pharmacologist - for the correction of dosage and combination of drugs, with urachuvannya of the drug for creatine, if lykarsky zasobiv vuzky therapeutic index.

Differential diagnosis

Differential diagnosis

In case of damage, with 2-3 stages of AKI, it is necessary to turn on the XXN, and then concretize the form. Morphology and etiology of AKI.

Differential diagnosis of AKI and XXN .

Differential diagnosis of AKI, AKI on XXN and XXN.

To confirm the diagnosis of OPP in the first place, the post-renal form is included. For the detection of obstruction (upper sectional paths, infravesical) at the first stage of obstruction of ultrasonic scanning and dynamic nephroscintigraphy. At the hospital, for verification of obstruction, chromocystoscopy, digital internal urography, CT and MRI, antegrade pyelography. For the diagnosis of the occlusion of the nirkova artery, ultrasound examination, nirkova x-ray contrast angiography are shown.

Differential diagnosis of prerenal and renal AKI .

1 * (Na + sech / Na + plasmi) / (creatine sech / creatine plasma) x 100

2 * (Na + sech / creatine sech) / (creatine plasma) x 100

It is also necessary to investigate the causes of pardon oliguria, anuria

Likuvannya beyond the cordon

Pass a lykuvannya in Korea, Izrail, Nimechchin, USA

Otrimati the consultation on medturism

lykuvannya

Cіlі lіkuvannya:

Visnovok from Gostry Stan (usunennya shoku, stabilization of hemodynamics, heart rhythm etc.);

Renovation of duresis;

Lіkvіdatsіya azotemia, deselectrolіtemіі;

Correction of the acid-puddle mill;

Kupiruvannya nabryakiv, by the court;

normalization arterial vise;

Zapobіgannya formvannyu ХХН, transformation of OPP into ХХН.

Likuvannya tactics:

Lіkuvannya is used conservatively (ethiological, pathogenetic, symptomatic), surgical (urological, suspicious) and active - instead of nirkova therapy - dіalіzny methods (RRT).

Principles of LPO treatment

Stagnation of digital techniques in the early stages of AKI(Orієntovna scheme)

non-drug treatment

mode postіlny pershu dobu, poіm ward, zagalny.

dyeta: obmezhennya kitchen salt(Leading rank, sodium) and і rіdini (obshavana possessed rіdiny rorakhoyuyut with urahuvannya dіuresis for the next day + 300 ml) with a sufficient calorie and together with vitamins. With the appearance of the increase, especially in the period of growth, the change of cooking salt in the food is intertwined up to 0.2-0.3 g per add, instead of the bottle in the add-on ratio, up to 0.5-0.6 g / kg of oil in the main rakhunok bіlkіv tvarinnogo pokazhennya.

Drug treatment

Drug treatment, which is repaired on an outpatient basis

(May be 100% money saving:

V pre-hospital stage without specifying the reasons, they called to the ARI unwisely to identify that drug.

(Less than 100% immobility rate)

Furosemid 40 mg 1 tablet of vrance, under the control of duresis 2-3 times a day;

Adsorbix 1 capsule x 3 times a day - under the control of creatine level.

Drug treatment, which is repaired on a stationary basis

The change of the main lykarsky zasobіv(May be 100% money-saving):

Calcium antagonist - calcium gluconate or chloride 10% 20 ml i.v. re-introduction in the same dose, with an overall effect - hemodialis);

20% glucose 500 ml + 50 IU insulin of a small human short-lived intravenous cap 15-30 OD for skin 3 years 1-3 dB, until normalization of calories in the blood;

Sodium hydrocarbonate 4-5% w / w cap. Dozi rozrahunok according to the formula: X = BE * vaga (kg) / 2;

Sodium hydrocarbonate 8.4% w / w cap Dozi rozrahunok according to the formula: X = BE * 0.3 * vaga (kg);

Sodium chloride 0.9% i.v. cap 500 ml or 10% 20 ml i.v. 1-2 times in addition - until the deficiency of BCC is stored;

Furosemid 200-400 mg IV through Perfusor, before the control of weathering dyuresis;

Dopamine 3 mcg / kg / hv in / in the cap extending for 6-24 years, before the control of the arterial vise, the frequency of the heart is very fast -2-3 dobi;

Adsorbix 1 capsule x 3 times a day - under the control of creatine level.

Transfer of pre-daddish licars(Less than 100% immobility rate):

Norepinephrine, Mesotone, Refortan, Infezol, Albumin, Coloids and Crystalline Roses, Freeze-Frozen Plasma, Antibiotics, Blood Transfusion Drugs, and Insu;

Methylprednizolone tablets 4 mg 16 mg

Cyclophosphamide, powder for preparation for intravenous administration of 200 mg;

Torasemid tablets 5, 10, 20 mg;

Rituximab, bottle for internal infusions 100 mg, 500 mg;

Human immunoglobulin normal, 10% for infusions, 100 ml.

Medication for treatment, which is to be repaired at the stage of unadulterated assistance:

Buy a lot of legends, hypertensive crisis, sudominal syndrome.

Інші vidi lіkuvannya

diabetic therapy

If it is necessary to carry out RRT in case of AKI, the patient should go from 2 to 6 days, until the function is updated.

When patients are diagnosed with acute respiratory tract infections, I will switch to nirk therapy after the next meal:

If it’s more beautiful to use substitution therapy?

What kind of ZPT slid vikoristovuvati?

What kind of access is more beautiful?

Yaky ryven to the clearing of the razchinnikh speeches slid dotrimuvatisya?

ear of RRT

absolute show before the sessions of substitution therapy with AKI є:

Growing level of azotemia and destruction of duresis according to the recommendations of RIFLE, AKIN, KDIGO.

Clinical manifest uremic intoxications: asterixis, pericardial vipit or encephalopathy.

uncorrected metabolic acidosis(NS<7,1, дефицит оснований -20 и более ммоль/л, НСОЗ<10 ммоль/л).

Hypercalculation> 6.5 mmol / L і / abnormal changes in the EKG (bradyarrhythmia, dissociation of the rhythm, increasing the electrical conductivity of a severe stage).

Hyperhydration (anasarca), resistant to drug therapy (diuretics).

Until the next day for sessions of substitution therapy Increase in nitrogen and blood creatine levels without obvious signs of convalescence, if there is a real threat to the development of critical manifestations of severe toxicity.

Shown before the "Nirkovo Pidtrimka" methods of substitution therapyє: the lack of secondary eating, the appearance of a birth in case of congestive heart failure, і the appearance of an adequate hydraulic balance in a patient with a polyorganic deficiency.

For the triviality of therapy See these types of RRT:

Intermittent (redistribution) methods of RRT are trivial for no more than 8 years with a break longer, less triviality for a Chergov session (in the middle of 4 years) (div. MEM hemodialis stationary)

Advanced methods of RRT (RRPT), designed to replace the function of nirok for three hours (24 years and more). PZPT is cleverly subdivided into:

Semi-prolonged 8-12 years (div. MEM semi-prolonged hemo- (dia) filtration)

Prolonged 12-24 years (div. MEM promoted hemo- (dia) filtration)

Post_yni more dobi (div. MEM post_yna hemo- (dia) filtration)

Criteria for the choice of PZPT:

1) Renal:

AKI / PON in ailments with an important cardiorespiratory deficiency (HIM, high doses of inotropic symptoms, recurrent interstitial legends, gostre Legeneve poshkojennya)

AKI / PON on aphid hypercatabolism (sepsis, pancreatitis, mesenteric thrombosis, etc.)

2) Pozanirkovykh shown before CRRT

Ob'amna re-entanglement, prevention of infusion therapy

septic shock

ARDS aborisik ARDS

important pancreatitis

Massive rhabdomyoliz, opikova ailment

Hyperosmolar Komi, preclampsia of vaginites

RRT method:

Hemodialis intermittent and progression

Most of the low-flow hemodialysis (MNGD) (slow low effective dialysis - SLED) in case of AKI - the ability to control the patient's hydraulic balance without the need for hemodynamics for a longer short period of time (6-8 years - 16-24 years).

Prolonged vino-venous hemophiltraction (PGF),

Continuing of the veno-venous hemodiaphiltraction (PVVGDF).

According to the recommendations of KDIGO (2012 r), for CRRT, substitute heparin for heparin on the basis of the IGD on the basis of the IHD (as opposed to heparin). The whole type of anticoagulation is even more corystic in patients with heparin and induction of thrombocytopenia and / or high risk of bleeding (disseminated intravascular coagulation syndrome, coagulopathy), if systemic anticoagulation is absolutely contraindicated.

The continuation of the venous-venous hemophiltraction (PHF) is an extracorporeal circuit with a blood pump, high-flow or high-porosity dialyzer, and a different age.

Prolongation of the venous-venous hemodiafiltration (PVVGDF) - an extracorporeal circuit with a blood pump, high-flow or high-porosity dialer, as well as with significant and dynamic changes.

For the rest of the data, it is recommended to use bicarbonate (NOT lactate) in the capacity of a buffer for RRT in patients with OPP, especially in patients with OPP and circulatory shock, as well as in case of shock.

Table 8.

stable

unstable

IGD

CRPT

In case of acute respiratory tract infection, vikoristovuyut in yakosti alternative peritoneal dialis (PD)... The technique of finishing the procedure is simple, and for good health it does not require high qualifications of personnel. You can also be victorious in situations where there is no way to carry out IGD or RZPT. PD testimony to patients with minimal catabolism for wits, if the patient doesn’t obstruct the life of the display to dialogue. Price is an ideal option for patients with unstable hemodynamics. For a short-hour dialysis, a rigid dialysis catheter should be inserted into the empty space through the anterior cross-section at an interval of 5-10 cm below the umbilicus. To carry out the exchange of infusion into the empty 1.5-2.0 l of the standard peritoneal dialysis line. Can be accelerated to include intestinal perforation before the hour of catheter insertion and peritonitis.

Gostriy PD gives a number of passages in pediatric practice, as we will grow up to patients with OPP and PZPT. (Div. Protocol "Peritoneal dialogue").

In case of toxic AKI, sepsis, hepatic deficiency due to hyperbilirubinemia, it is recommended to carry out plasma exchange, hemosorption, plasma absorption from the presence of a specific sorbent.

Hirurgic involvement:

Installation of ship access;

Conducting extracorporeal methods of treatment;

Usunennya obstructions of secular nobles.

Post-renal therapy

Likuvannya postrenal AKI encourage the obovazkovoj participation of the urologist. The main thing is that the therapy is - yakomoga shvidshe put down the destructiveness in the current of the battle, so that the unstoppable poeshkojennya of the nirka can be found. For example, in case of obstruction of hypertrophy of the anterior mucosa, the Foley catheter is effectively inserted. You can, know the therapy with alpha-adrenergic blockers, or surgery is not visible in front of the throat. If the obstruction of the genital system is located on the level of the urethra of the abdominal wall, ask to complete the installation of a transurethral catheter. With a large amount of obstruction of the secular paths, it is necessary to apply a percutaneous nephrostomy. Tsi come in and start to produce an additional renewal of diuresis, a decrease in the intratubular vise and renewal of glomerular filtration.

As soon as a sick person has no XXN, a mother on uvaz, such a patient has a development of XXN, and the next step is to follow the Practical Recommendations of KDOQI. "

Patients with risky development of OPP (OPP) are guilty of being spontaneously controlled by creatine and volume control. It is recommended to be ill-advised to divide into groups according to the stage of development of the OPP. It is a duty to lay down among the singing bureaucrats. In the first place, the patients are guilty of being guilty for revealing the wereworse causes of APP, so that they can inaccurately put down the factor (for example, post-renal).

At the polyclinic stage of writing a whiskey to the stationary: before the regime (weary overcooling, stress, physical overwhelming), children; completion of the treatment (sanation of the diagnosis of infection, antihypertensive therapy) of the dispensary for 5 years In case of preservation of extrarenal symptoms for more than 1 month (arterial hypertension, embryo), severe cutaneous syndrome, or severe ones, it is necessary to carry out biopsies, such as therapy of acute discomfort.

Klinika of the Republican Rivnya (diagnostics of OPP in case of appropriate SPON for diagnostics of "folding" patients, for faster PCI, pislyaoperatsіyne, etc.)

Stagnation of prolonged hemophiltraction, hemodiaphiltraction, hemodialysis. Plasma exchange, plasmasorbts_ya - for shown.

Stabilization of the body, vasopressor stabilization, stabilization of serum, creatine, acid-base and water-electrolyte balance.

In case of sparing anuriy, nabryak, amid azotemia, the transfer to the hospital of the regional chi mish ryvnya, with the presence in the classroom of a piece of equipment (not just simple therapy aparats, but for food production)

With caution and RRT modes, patients with OCD are guilty of some patients from THPN (XXN 5 stage), which is on the programmed dialogue.

A group of drugs in the absence of ATC, which can become stagnant during drug use

hospitalization

Shown for hospital

Special groups of patients for the development of OPP:

information

Dzherela and Literature

1. Protocols to send the Expert for the sake of the RCHR MHSD RK, 2014
   1. 1) Gostre nirkovy poshkojennya. Navchalnyy pos_bnik. A.B.Kanatbaeva, K.A.Kabulbaev, E.A. Karibaev. Almaty 2012.2) Bellomo, Rinaldo, et al. "Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group." Critical care 8.4 (2004): R204. 3) KDIGO, AKI. "Work Group: KDIGO clinical practice guideline for acute kidney injury." Kidney Int Suppl 2.1 (2012): 1-138. 4) Lewington, Andrew, and Suren Kanagasundaram. "Renal association clinical practice guidelines on acute kidney injury." Nephron Clinical Practice 118.Suppl. 1 (2011): c349-c390. 5) Cerdá, Jorge, and Claudio Ronco. "THE CLINICAL APPLICATION OF CRRT-CURRENT STATUS: Modalities of Continuous Renal Replacement Therapy: Technical and Clinical Considerations." Seminars in dialysis. Vol. 22. No. 2. Blackwell Publishing Ltd, 2009. 6) Chionh, Chang Yin, et al. "Acute peritoneal dialysis: what is the 'adequate'dose for acute kidney injury?" Nephrology Dialysis Transplantation (2010): gfq178.

information

III. Organizational aspects of the PROTOCOL

List of rosters in the protocol:

1) Tuganbekova Saltanat Kenesovna - Doctor of Medical Sciences, Professor of AT "National Science Medical Center", defender of the General Director of Science, head post-graduate nephrologist of the Ministry of Health and Social Development of the Republic of Kazakhstan;

2) Kabulbaev Kairat Abdullaevich - Doctor of Medical Sciences, Professor of the RSE at the REM “Kazakh National Medical University imeni S.D. Asfendiyarova ", the curriculum vitae of the module of nephrology;

3) Gaypov Abduzhappar Erkinovich - candidate of medical sciences AT "National Scientific Medical Center"

4) Nogaybaeva ASEM Tolegenovna - AT "National Science Cardiohirurgic Center", a nephrologist, a doctor of a laboratory for extracorporeal hemocorrection;

5) Zhussupova Gulnar Darigerovna - candidate of medical sciences AT "Medical University Astana", clinical pharmacologist, assistant of the Department of Foreign and Clinical Pharmacology.

Ordering for the presence of a conflict of interest:Відсутнє.

reviewer:
Sultanova Bagdat Gazizovna - Doctor of Medical Sciences, Professor of AT "Kazakh Medical University of Uninterrupted Education", Head of the Department of Nephrology and Hemodializu.

Letting the minds look at the protocol: re-examination of the protocol in 3 ways і / abo, when new methods of diagnostics / treatment appear with a greater level of proof.

Attached files

Uwaga!

• Engage in self-care, you can make your own health wrong.
• Information posted on the MedElement website and in the mobile supplements "MedElement", "Lekar Pro", "Dariger Pro", "Disease: the assistant of the therapist", it is impossible and not guilty to replace it with a consultation. Obov'yazkovo zvertata to the medical establishment for the manifestation of some illnesses or symptoms.
• Vibir of lykarskiy zasobіv and їkh dozuvannya, is guilty of negotiations with Fakhіvts. Tilki lіkar can denote the needs of the wicked and the third dose to the urge to become ill and become the organism of the sick person.
• Site of MedElement and mobile supplements "MedElement", "Lekar Pro", "Dariger Pro", "Disease: assistant of the therapist" є with information and information resources. The information, distributed on this site, is not guilty of vikoristovuvatisya for self-change the sign of a likar.
• The editorial board of MedElement does not bear any indications for being healthy, or for material, as a result of the victories given to the site.

Likuvannya of hospitality nirkova lack of need to work with the therapy of the main ailment, її wiklikalo.

For an assessment of the step of attaching birth to the patient's body, it is well known. For a more accurate definition of the level of hydration, a comprehensive infusion therapy and indication, it is necessary to install a catheter in the central vein. Slid also vrahovuvati dobovy dyurez, as well as the arterial grip of a sick person.

In case of prerenal hospitality, it is necessary to renew the BCC and normalize the arterial grip.

For the elimination of renal hospitality and lack of deficiency, vicious speech of the lycarian and non-drug nature, as well as for those who are ill, it is necessary that detoxification therapy be carried out earlier. Bazhano vrahovuvati the molecular weight of toxins, so they responded to the deficiency, and the clarity of the capacity of the method of effective therapy (plasmapheresis, hemosorption, hemodiafiltration and early hemodialysis).

In case of post-renal gross deficiency, it is necessary to carefully drain the urinary tract for the renewal of an adequate cut. When choosing the tactics of operative involvement in the minds of the state of mind, prior to the operation, information about the sufficient function of the contralateral control is required. It’s not so harsh that it’s not so easy to see if it’s a bit of a bad thing. Before the hour of the stage of polyuria, to develop, as a rule, when draining, it is necessary to control the balance of life in the body of the sick and the electrolyte storage of blood. The polyuric stage of hostile deficiency can be manifested by hypokalemia.

Medication for treatment of hostile deficiency

In case of non-sagging passages along the intestinal tract, adequate enteral feeding is necessary. If you are unhappy with the need for drinks, fats, carbohydrates, vitamins and mineral speech, you should be satisfied with the help of internal food. For the urahuvannya of the turn of the glomerular filtration, the blend should be surrounded by up to 20-25 g for doba. The calorie content of food is required to be at least 1500 kcal / day. The amount of birth, which is necessary for the ailing, before the development of the polyuric stage, start, go through the debriefing for the first addition and additional 500 ml.

Most of the foldability in the history of the patient was given to the patient of the guest with a nirk disability and urosepsis. By the same token, two types of intoxicating uremic and gniynoy are meaningfully slowed down, as well as the forecast for life and weariness. In case of ailments, it is necessary to preserve the current methods of detoxification (hemodiaphiltraction, plasmapheresis, indirect electrochemical oxidation of blood), antibacterial blood preparations for the results of similar bacteriological

The treatment of a sick person with hemodialysis (or modified by hemodialysis) cannot serve as contraindications until the operative treatment of the sickness, or acceleration, has been brought to the point of hospitable disability. The ample opportunity to monitor blood loss and medication correction allows you to detect the risk of bleeding every hour of surgery and during the period of surgery. For carrying out the effective therapy, anticoagulants of a short period of time, for example, sodium heparin, can be neutralized with an antidote - protamine sulfate; as a coagulant, sodium citrate can also be vicorized. To control blood larynx, let the blood pressure last until the active thromboplastin hour is active and the amount of fibrinogen in the blood is determined. The method of blood loss for the hour is not determined.

Likuvannya to the development of the polyuric stage of the development of loop diuretics, for example, furosemide up to 200-300 mg for additional use.

To compensate for the processes of catabolism, anabolic steroids are used.

In case of hypercalculation, intravenous administration of 400 ml of 5% glucose content from 8 OD to insulin is shown, as well as 10-30 ml of 10% calcium gluconate content. If you do not enter coriguvati hyperkalemia by conservative methods, then the ailing is shown to carry out an extra hemodialysis.

Promptly eliminating the hostile deficiency

To replace the function of nirok in the period of oliguria, you can choose a method of purifying blood:

• hemodialis;
• peritoneal dialis;
• hemofiltration;
• hemodiafiltration;
• low-flow hemodiafiltration.

In case of multiple organ deficiencies, it is better to fix low-flow hemodynamics.

Likuvannya hospitality nirkovoi lack: hemodializ

Indicated for carrying out hemodialysis or modification in case of chronic and hospitality of normal deficiencies. In case of elimination of hostile deficiencies, the frequency, the triviality of the procedure, the amount of filtration and the storage of the dialogue is taken individually at the moment of looking around, before the skin treatment session. Likuvannya by hemodialisom prodovzhuyut, not admitting an increase in the blood instead of the blood 30 mmol / l. In case of a virulent negative blood creatine concentration, the concentration of blood creatine decreases earlier, the concentration of blood is lower, and there is a positive predictive sign.

Extras indicated for carrying out hemodialysis (first modification):

• "Nekerovana" hyperkalієmiya;
• hyperhydration is rotated;
• hyperhydration of the leg tissue;
• important uremic intoxication.

Plans are shown for carrying out hemodialysis:

• in the place of blood in the blood more than 30 mmol / l or / or the concentration of creatine, which is 0.5 mmol / l;
• changes in clinical signs of uremic toxicity (such as uremic encephalopathy, uremic gastritis, enterocolitis, gastroenterocolitis);
• overhydration;
• bending acidosis;
• hyponatrієmіya;
• shvidke (lasting decilkoh days) build-up instead of uremic toxins in the blood (an additional growth in the place of sechovine, which changes 7 mmol / l, and creatine - 0.2-0.3 mmol / l) and / or a decrease in

At the present stage of polyuria, the need for treatment with hemodialysis of the fall is necessary.

There may be a contraindication before the implementation of the eferent therapy:

• afibrinogenetic bleeding;
• unprecedented surgical hemostasis;
• parenchymal bleeding.

There is a court access for conducting a double-way catheter, insertion into one of the central veins (pidclavicular, jugular or stegnova).

Gostra nirkova deficiency (arrester)

Gostra nirkova lack(ARF) - tse klіnіko-bіohіmіchny syndrome, yaky harakterizuєtsya Shvidky znizhennyam perevazhno ekskretornoї funktsії nirok (protyagom Godin abo dnіv), scho klіnіchno proyavlyaєtsya zmenshennyam shvidkostі klubochkovoї fіltratsії, zbіlshennyam vmіstu in krovі nitrous metabolіtіv, zmіnami obsyagu pozaklіtinnoї rіdini, rozladami acid-base that elektrolіtnogo homeostasis.

Classification. Prerenal, renal and postrenal arresters are considered for reasons and mechanisms of development.
In addition, the OPN does not often appear on the oliguric and neo-historical disadvantages, but in the case of the oliguric OPN, there are some period of time: the period of cob development polyuirii, period of use.
However, such a clear periodization of an ulcer can be spared only in case of gastric tubular necrosis (OTN).

Ethiology. Domina OTN - 45%; prerenal vapors are 21%; Surge arrester, which can be developed on aphids of HNN ("surge arrester on HNN") - 13%; obstruction of secular nobles - 10%; parenchymal disease nirok-4.5%; OTIN - 1.6%. A part of the forehead pathology becomes deprived of 1%.

Causes of prerenal ARF:
- stanzas, tied to changes in the post-sacrifice of the ridini (Vozh);
- hypovolemia (nirkovi vtrati ridini - diuretics, osmotic diuresis with diabetes, supra-nirkoval zalosis; infiltrating through the intestinal tract and shkiry, as well as blood loss, whether any ethology; overrun of hepatitis in the intestinal tract pancreatitis, peritonitis);
- a decrease in the heart vikidu (heart failure, cardiogenic shock, heart valve disease, myocardial pathology, arrhythmia, BODY, pericardial tamponade, etc.);
- impairment of physical activity with systemic and nircovim support in case of hypotension, sepsis, hypoxemia, anaphylaxis, ill 2 and IFN, hyperstimulation syndrome of patients; nirkovo vasoconstriction, blockade of the synthesis of prostaglandins, hypercalcism;
- hypoperfusion of nirok in the case of impairment of nirkovojudine autoregulation in connection with overwhelming dilatation of arterioles in case of congestive ACE inhibitors, blockers of ATj receptors in angiotensin II (A II); - Syndrome of adipose blood viscosity (mi Elom, macroglobulinemia, polycythemia).

Reasons for renal arrester:
- hospitality tubular necrosis in case of impaired hemodynamics (heart surgery, sepsis), toxic infusion of antibiotics, which replace iodine from radiopaque drugs, anesthetics, immunosuppressants from cytostatics, antibiotics;
- mіoglobіnovy rabdomіolіz: m'yazova trauma іnfektsії, polіmіozit, metabolіchnі torn down, gіperosmolyarna coma dіabetichny ketoadіdoz, Virage gіperkalієmіya, gіpernatrієmіya, gіponatrієmіya, gіpofosfatemіya, gіpertireoz, a temple gіpertermіya, vpliv etilenglіkolyu, CO, rtutі chloride, priyah lіkіv (fіbrati statins , opioid, amphetamine), congenital ailments (myazova dystrophy, carnitine deficiency, Mac Ardl's ailment);
- gemolіz i hemoglobinuria: malyarіya, mehanіchna destruktsіya eritrotsitіv at ekstrakorporalnih tsirkulyatsії abo metalevih prostheses, posttransfuzіynі reaktsії, gemolіz іnshoї etіologії, heat stroke, opіki, defіtsit glucose-6-fosfatdegіdrogenazi that INSHI eritrotsitarnі fermentopatії, Markіafavi-Mіkele syndrome vpliv organіchnih rechovin (anіlіn , phenol, chinin, glucerin, benzene, phenol, hydralazine), remove coma;
- gostry tubulointerstitial nephritis: allergic (when taking p-lactam, trimethoprim, sulfanilamidiv, ingibitoriv cyclooxygenase, diuretic, captopril, rifampicin); infectious (bacterial - gostry pylonephritis, leptospirosis and in.; virgin, fungal); with leukemia, lymphomas, sarcoidosis; idiopathic;
- prohіdnostі sudin torn down (bіlateralny stenosis nirkovoї arterії vnaslіdok thrombosis / embolії, venous thrombosis nirkovih; ateroembolіya, trombotichna mіkroangіopatіya, gemolіtiko uremіchny syndrome trombotichna trombotsitopenіchna purpura, pіslyapologovy thrombosis, ASF, DIC, sklerodermіya, CUG, postradіatsіynі porazki, vaskulіti);
- glomerulopathies: OGN, BPGN (ANTSA-associyovany vasculitis, malimmune GN), IgA nephropathy, MzPGN, lupus nephritis, Shenlein-Genokh's ailment, zmishana krioglobu Ginnem, khasvoroba;
- cortical necrosis, abruptio placentae, septic abortion, DIC.

Causes of postrenal ARF:
- obstruction of sevodia: sechokam'yana ailment, thrombi, papillary necrosis, puffiness, delayed zzovni (puffin, retroperitoneal fibrosis), ureterocele, iatrogenic ligation of the sequel;
- obstruction of the cuticle: neurogenic cuticle, good prostatic hyperplasia, sechoam'yana ailment, thrombi, puffiness, diverticulosis of the cuticle;
- obstruction of the urethra: fimosis, stricture of the urethra, congenital urethral valves.

Klinichna picture. CLINICALLY OPN can be manifested in viglyadі decіlkoh options:
1. Latent (neoliguric arrester) - characterized only by laboratory changes (azotemia and decreased GFR), but the volume of cut in patients does not change.
Instead of creatine (Cgr) and nitrogen (Ur) in the bloodstream, there are traditionally most available indicators in clinical practice, such as markers of lowering GFR, such a rank that allows the level of concentration of the standard.
More importantly with the level of GFR corelyu Sgr. On the other hand, it’s a matter of memory, but the promotion of Cgr is not tied to the PN branch.
There is a tendency towards massive improvement of creatine with small transversely dark muscles in children with rhabdomyolysis and blockade of the tubular secretion with trimethoprim and cimetidine. At a higher concentration of creatine and blood in the blood, the growth of GFR in the world decreases, proportionally, approximately in the ratio of 1:60 (in mmol / l).

A disproportionate increase in sectomy in syrovatz blood can be promoted with a decreased struma in the distal nephron in the fall of prerenal acute renal failure or postrenal obstruction of secular paths. In addition, increasing the concentration of creatine can be consumed by a fever, congested GCS and tetracycline, as well as overwhelmingly.

Neoliguric є from 20-30% to half of the budget in the guest's nirkovo disadvantage.
A neoliguric version of a bowl of bugs in case of stagnation of aminoglycosides and radiopaque drugs, if you want to develop with a very low level of normal function, be it ethiology.
The neoliguric arrester is less friendly than the prognosis, and it is tied with less rotational morphological and functional changes of the nirk fabric.
In cich aids, the GFR is 2-3 times higher, the incidence of azotemia is less in the context of oliguric ailments.
Naturally, the need for substitution therapy among neolіguric ailments is much lower.

2. Oligo- and anuria.
Oliguria - a reduction in the amount of a dobovy slaughter less than 400 ml.
The development of oliguria should be reduced either about the inclusion of large glomeruli in robots, or about the increased decrease in GFR in the skin of them.
Anuria occurs with a decrease in urine output less than 50 ml / day.
The development of this symptom is most often tied to the general obstruction of the secular paths, as well as to the progressive glomerulonephritis, cortical necrosis and infarctions of nirok. Cherguvannya oliguria and polyuria allows the admittance of a piece of sech obstruction.

3. The greater the clinical symptomatology of the main ailment is important, when the acute renal failure has wicked. The polyetiology of the ARF transmission of symptoms of symptoms in Denmark is a sign of a decrease in the function of nirok.

4. Razgornut PN (uremia, anemia, deselectrolithemii, metabolic acidosis). The severity of the clinical symptoms of the uremic syndrome and the associated stagnation with it, as well as the deterioration of the partial functions of the nerves, lie down every hour of the occurrence of acute renal failure, the rapid development of the disease, and is the main reason for the development. Call the turn of azotemia and uremia to represent the fact of an unfortunate diagnosis of arrester arrester and associated with an unfavorable prognosis.

Uremic symptoms include: itching, tediousness, blues, damage to the central nervous system, right up to a coma, development of pleurisy and pericarditis. Uremіya, yak usually suprovodzhuєtsya rozvitkom nedokrіv'ya, metabolіchny acidosis elektrolіtnі torn down mi (hyperkalemia gіperfosfatemієyu, chastіshe pomіrnoї hypocalcemia gіponatrієmієyu i, i rіdshe gіperkaltsієmієyu gіpernatrієmієyu) gіpergіdratatsієyu (Especially when znizhennі dіurezu).
However, the process of acceleration in this case can be found in the case of the other main types of surge arresters. Skin z cikh stanіv vimagає with caution and free korektsії.

Diagnostics.
In the diagnosis of hospitality nirkova shortcomings, it is important to take into account several principles - quality, inconsistency and consistency, which is less important and practical.
Early diagnostics of any OPN option will allow you to quickly study conservatively, to help the development of severe uremia and acceleration, the need for OST, to be able to change the prediction of tissue prognosis. That is, when cautioning for ailments, as to lie down to the group, then regularly carry out screening of diagnostics until the indicators of the functional stan-

Practical robots have the highest level of sensitivity to the type of OPN, their ethology.
It is necessary for mothers on your mind, that the unprecedented diagnosis of prerenal ARF is fraught with the formation of renal.
Early diagnosis of post-renal ARF allows you to immediately minimize the obstruction of the secular paths using operative methods.

The main stages of arrester diagnostics in case of a decrease in GFR and / or azotemia:
1. Pidtverdzhennya azotemia, lowering GFR, ie. PN.
2. Differential diagnosis of GNN and HNN.
3. Carrying out differential diagnostics of pre- and postrenal ARF.
In case of prerenal acute renal failure, the correction of hypovolemia, systemic hemodynamics is maximally quick. In the development of post-renal arrester, obstruct the secular paths.
4. In case of pre and postrenal acute renal failure, clarify the etiology of renal acute renal failure (pathology of nirkovy nerves, tubular necrosis, cortical necrosis, Otinia, glomerulopathy).
At the cutaneous stage of diagnostics, it is necessary to check the nutritional status of the patient prior to the new therapy (RRT).

Diagnostics of prerenal ARF
Prerenal azotemia in the first place should be tolerated in case of manifestation of conditions, which can lead to hypovolemia and general clinical symptoms.
Of great importance in the whole stage, the interpretation of the analysis of the section is correct. Normal analyzes or insignificant changes in the first place allow to allow for the presence of prerenal acute renal failure, at that time, as proteinuria, a change in the cell’s warehouse, the cylinder of the brain is thinking about the background of nirkov’s pathology.
On the given stage of diagnostics, it is worthwhile to assign nyrc indexes, as I can give you a hundred additional help in the range of options for OPN, and in the first place of prerenal OPN and OTN.
In the majority of patients with prerenal arresters, the ratio of Ur / Cr in the blood of more than 60: 1 was improved.< 1 % и < 20 ммоль/л.
Indicator EF Na volodya is sufficiently sensitive and specific for diagnostics of prerenal ARF.
However, the memory, which lowered EF Na, can be found in the range of OTN with immune glomerulopathies, in the cob stages (first year) of obstruction of the urinary pathways, with OTN, which slows down the absorption of X-ray contrast.
In some part of the ailments with OTN and neolіguric form of the arrester, the discarded fraction of sodium also seems to be low (< 1%).
The value of EF Na will be shifted during development of prerenal arrester on aphids of preexisting CNI, or in case of stagnation of loop diuretics.

In cich vipads, the residual diagnosis of acute renal failure is established ex juvantibus (meaning the improvement of the indicators of nitrogen-visual function for the reduction of hypovolemia).
In ailments with a chronic lack of adaptability to the degree of hypovolemia, there is a decrease in the number of circulating tubulointerstitial changes.
Nareshty, EF Na in patients with prerenal ARF can build up in situations of osmotic duresis, for example, with diabetic ketoacidosis or intravenous glucose.
In cychicals, more diagnostic information can be given for the chlorine concentration in the section (U Q).

Thus, at a significant part of patients at the stage of diagnostics of prerenal acute renal failure, symptoms of absolute or obvious hypovolemia can appear, and, apparently, get an early diagnosis.
In general, it is necessary to carefully consider conservative treatment, directing on the correction of the BCC, stabilization of the arterial vise, and improvement of the heart wikidum (SV).
An hour's ear of therapy, from one side, is not very diagnostic, and it seems to be quick to update the disease and decrease in azotemia on the smallest of the aforementioned addiction, it’s insanely indicative of the acne of prerenal ARF.
On the other hand, the renewal or improvement of the low-level perfusion reduces the risk of other changes to the low-quality fabric and you can use the OTN development.

Diagnostics of options for renal arresters
Basic options of true renal arrester.
Hostrium tubular necrosis.
Prerenal surge arrester and ischemic OTN may be devel- oped by the external mechanisms and are involved in different stages of one and the same process.
Ischemic OTN is a sign of impairment of systemic hemodynamics and hypovolemia. On the basis of prerenal acute renal failure in times of great tissue hemodynamics, none at all, when there is more trivial exposure, which leads to the development of tubular necrosis, in order to correct the systemic hemodynamic function of polyphenomenon.
The development of OTN can be tied with multiple canaliculi exogenous and endogenous nephrotoxic injections. The most common reasons for the remaining are likarsky problems.

In the diagnosis of the given variant of the OPN, there is a significant value of the link between the development of a hostile deficiency, an hourly drug intake, triviality, a total dose and critical concentration in the blood. Hostry tubulointerstitial nephritis.

There are many options for renal arresters in the transition to a large number of failures in a number of cases.
Overcoming ailments are most often susceptible to systemic symptoms of allergies - hyperthermia, arthralgia, erythema.
Laboratory data for eosinophilia in blood.

An important acquaintance of the Otinia of lykarskoy ethology є advancing in the place of eosinophilia in the battle.
It also means that there are no other types of dressings for OTN development with the likarsky lesions, the tactics of the treatment of how to develop from the therapy of Otinia likarskoy ethiology.
That is, in every moment of opportunity, to carry out differential diagnostics between different mills and docily carry out morphological preliminaries of nirk tissue.
In such a rank, the biopsy of nirka is shown in any kind of renal OPN with an unrelated residual ethology.
Diagnostics Otinia is also guilty but linked with the shock of the other ethiological factors - infections, blood ailments, VKV, the treatment of nirk transplant in patients with transplanted nirkoy. Glomerulopathies are the cause of the hostile deficiency.

A number of illnesses of nirk glomeruli can lead to the development of a hostile nirk deficiency.
The dose for the ciu form of acute renal failure is guilty of being diagnosed with changes that are characteristic of the pathology of the glomeruli. Debauchery of such ailments is guilty to include a number of parameters, which allow specifying a specific disease, such as a non-mediated fault of glomerular disease. With vasculitis with glomerulopathies, it is necessary to read the antinuclear factor, ANCA, AT to GBM, LE cellini, blood supply, complement, cryoglobulin, rheumatoid factor, form 50, HbsAg, anti HCV.
In case of plasma discrasion - lung lancers, immunoglobulins, Ben-Jones blocks, proteinogram.

When vstanovlennі dіagnozu arresters tlі glomerular hvorob abo vaskulіtu for ostatochnoї dіagnostiki neobhіdne Venue of termіnovoї bіopsії nirok, indications to yakoї in ARF Je: postupove cob vіdsutnіst yavnoї zovnіshnoї reason proteїnurіya bіlshe 1 g / day, gematurіya, sistemnіst klіnіchnih proyavіv, trivaly perіod olіgurії / anuria (10-14 days).
In this case, the morphological advancement of nirk fabric is necessary in the first place, for the inclusion of options for BPGN.
Timely diagnostics and immunosuppressive therapy in the center of non-human pathology allows the sutta to give a long-term development of CNI.
In case of priming for adolescents on BPGN and in the presence of a visibility of morphological preliminaries or indications prior to the biopsy test, an empirical immunosuppressive therapy may be indicated.

Oklyuziya sudin nirok.
Diagnostics of bilateral occlusion of great sudins nirok (arteries and veins) vimagus included in the program for the treatment of the sick person with the deficiency of the dopplerography of the sudin nirok as a screening method.
The residual diagnosis is established by angiography.

Ailments of other sufferers, who need to bring them to a hostile nirkova deficiency (div. Ethiology), in order to carry out general diagnostics, as described in the previous sections of the website and numerical instructions.

Cortical necrosis of zooming to important lesions of the glomeruli and tubules.
It develops in rare and head dressings with obstetric pathology - in the placenta.
Denmark can also accelerate sepsis and disseminated intravascular coagulation.
Cortical necrosis can be diagnosed with the development of a stiff anuria. Pidtverdzhennya in the state period can only be recognized with morphological predictions.
Clinically, the diagnosis can be established retrospectively, in every day
OTN stretching 1-1.5 m / sec.

Diagnostics of postrenal ARF.
A dose on the obstruction of secular nobles is guilty of nocturia, calculi, signs of IMP, chickpea, prostate, gnawing, symptoms of nirkovy colic, pain in the suprapubic area.

For the screening of the appearance of the young obstructions of the secular nobles with the development of the hostile nirk drawback in the greater number of vipads, it is necessary to reach the ultrasonic level of nirok and slash microscope.
When there are typical signs of enlargement of the calyx-pelvic system and in cases of fall, on post-renal acute renal failure, it is necessary to repeat the ultrasound scan after 24 hours.

In a specific skin disease, especially in case of adolescence for obstructive acute renal failure on the basis of oncological pathology, information about the age of secular nobles can be given by a computer tomography or magnetic resonance imaging. Stagnation of radiological methods for vii tichny obstructions (dynamic scintigraphy) is justified in case of apparently spared nirc blood flow, in which case it is possible to perekonatya for additional dopplerography nirok.

Methods for diagnostics with parenteral injections of X-ray contrast agents in vikoristovuvatsya not guilty, the odor can fix a pre-existing nephrotoxic infusion.
It is a sign of admittance, which, in case of non-significance, is taken into account in obstruction of the current paths and the need for additional diagnostics and in the inclusion of these options, but not guilty of ARF.

Likuvannya. Therapy of prerenal ARF to lie down as a result of the ARF of the cause - hypovolemia, low SV, a decrease in the peripheral vascular support.
Correction of the change in the BCC. Ozotonic range of NaCl є with a choice for larger patients with hypovolemia, which called for the development of prerenal arrester.
However, large amounts of intravenous NaCl injected can lead to the development of hyperchloremic metabolic acidosis, especially in ailments with preservation of urine output and defecation (for a waste of bicarbonate).
Therefore, when metabolic acidosis becomes hyperchloremic, infusion therapy should be corrected due to Ringer's lactate, some of the lactate itself is metabolized in the oven into bicarbonate and allowing the control of growth and development.

Another alternative to the physiological solution is the hypotonic solution of NaCl with additional bicarbonate (for example, 0.25-0.45% NaCl + 50-100 meq sodium bicarbonate).

In the minds of an insignificant BCC deficiency and in the development of hypernatria, there is a lack of hypotensive growth of NaCl.
Hypertension of NaCl can be very effective in case of acute renal failure on the basis of a traumatic condition, or even a small amount of the drug can be severely affected by an increase in the volume of blood pressure due to an active change in the volume of intravascular disease. For example, in the form of crystalloids of coloidal growth, including hydroxides of seethyl starch (HES), dextran and gelatin, it is not recommended for prerenal acute renal failure.
Unimportant to efficacy in the development of hypovolemia, the growth of coloid osmotic (oncotic) blood pressure can lead to a slight decline in GFR.

At the development of pre-acute renal failure on the basis of a severe hemorrhagic shock, it is natural to fix the introduction of blood preparations. As soon as it is not available, the therapy of the first crocus is the introduction of crystals (izotonic sodium chloride), and if there is an absence of an effect in the systemic hemodynamics of non-alcoholic coloids and albumen.
In case of pre-renal arrester on a few hypoalba Minnem and overruns in the third space (empty, pediatric klitkovin), it is shown to come in, to lead until an effective arterial lassing of blood is brought in

Variations of peripheral and empty embryos with hypoalbuminemia are often resistant to treatment with diuretics. In addition, the isolation of diuretics in cich illnesses can result in an increase in hypovolemia and azotemia.

Timing effect can be eliminated with combined intake of furosemide and albumin at a dose of 50 g / day.
Doses of furosemide can vary from 40 to 1000 mg / day. The stagnation of the albumin of the sutta will reduce the diuretic effect of sechogenic ones, to lead to an increase in deiuresis, a decrease in the mass of til, and, it is even more important, to a decrease, or even to the allowance of prerenal azotemia.
Closely 90% of the introduced furosemide is associated with albumin, which, with hypoalbuminemia, changes the growth of sechogenesis in the court and post-vascular space.

The addition of albumin to the end of the hourly reduction of the oncotic clutch of blood plasma and the development of a child from the interstitial space to increase the delivery of furosemide to the third receptor in the same type of blood. So, in patients with hypoalbuminemia with monotherapy with furosemide in the sech it became 7-12% of the administered dose.
Combined therapy with furosemide and albumen is increased to 24-30%.

Korekts_ya low heart wikidu.
Likuvannya are guilty, but they are directed to the increase of the SV and the decrease in the number of people. The tactics of increasing the size of the SV polyagu in the reduction of the increase in post-mortem volume for additional diuretics or ultrafiltration (UV); polypsychotics of the heart for the suction of inotropic drugs in abo (i) peripheral vasodilators.
The stagnation of diuretics (zokrem, furosemida) should be reduced to a decrease in the endocardial volume of the lymph node and the increase in subendocardial perfusion.
In addition, in the course of furosemide therapy, the heart's function is quickly felt in the process of lowering the grip of the wedge of the legene capillaries.

Theoretically, the elimination of loop diuretics can lead to a critical decrease in the value of LSH and ST decline.
To that, the introduction of diuretics can be used to control the water balance, CVP.

Some of the ailments with circulating CH and ARF may be able to reach a low CB high level of endogenous vasopressors and practically resistant to therapy with sechogenic, inotropic agents and vasodilators.
In general, there can be an ultrafiltration (UV) device, which can lead to an improvement in dyuresis and a reduction in drug therapy and a decrease in the level of blood circulation.

Інші ailments with ey or hypervolemia on aphids of low SV, it is necessary to lead to the development of pre-ARF, - IM, pericardial tamponade, massive embolism of the legacy artery.
In cich vipadkah it allowed prerenal azotemia to lie down, in the first place as a result of the main process.
Correction of stan_v with lowering of the peripheral vessel support.
Victory is in the range of low-toned NaCl solutions.
The effectiveness of the storage of non-alcoholic colossal differences and albumen has not been reported.

Prerenal azotemia often trap in ailments with cirrhosis and other liver disease, accelerating liver failure and ascites.
Tsim ailing is shown to be intermixed with NaCl.
Sechogіnnі efficaciously tolerate ascites in 73% of the ailments. However, stimulation of dyuresis (furosemide + spironolactone) can lead to the destruction of the functional stance of nirok.
In general, for the use of vibrations, infusion of albumin in a dose of 40 g intravenously at once with Paracentesis (4-6 liters per session).
Paracentesis with the introduction of albumin allows the rapidity of the term of the hospital.
To that, a second paracentesis and albumen have become vicious in the form of cob therapy in case of hepatic insufficiency, which is affected by ascites (both in case of manifestation, and due to the presence of prerenal azotemia); additional therapy should be carried out sechoginnym.

To prevent the loss of function of nirok during paracentesis in patients with swelling ascites, the introduction of dextran (dextran 70) is shown.
The completeness of dopamine storage for vasodilatation of the nirk arterial bed with prerenal ARF has not been completed in this hour.

Likuvannya renal arrester.
ARF of ischemic and nephrotoxic etiology.
Corrections of the BCC and water-electric breakdowns should be carried out with salt breaks, and some experimental data on the change in the severity of OTN on aphids before being added with sodium chloride.
The principles of storing crystals are analogous to those in the treatment of prerenal ARF (div. Nizche).

The insane significance in the prevention of OTN is the protection of the vibration of diagnostic procedures and drugs, as well as the potential for nephrotoxicity, the monitoring of the sick person, especially to be taken into account to the group of patients
The traditional methods of drug prophylaxis have been reduced to the intake of osmotic and loop diuretics, as well as to dopamine.
Earlier, it was respected that diuretics for the reduction of the disease can cause obstruction of the tubules, which is often associated with the decrease in GFR with OTN. Nadal, prote, it has been demonstrated that both loop diuretics, and manitol do not volodyne prophylactic powers, but do not infuse the development of OTN into the forecast of an open OTN.

At the same time, it is possible to transform the oliguric version of the OTN into the neo-cultural one, in such a rank, to reduce the need for OTN.
I use low doses of manitol in low doses (15-25 g), bolus or dropwise introduction of furosemide, which is effective only at the early stages of OTN.
When there is an increase in the duresis of the therapy with these diuretics, there is no need to prolong the intake and increase the dosage.
This can lead to unnecessary inheritances - hyperosmolar coma, pancreatitis, deafness.
In addition, with the introduction of manitol at high doses, especially with a decrease in durez, a high rhizic develops a lot of legends.
Result ostannіh rozrobok, in addition chislі i danі Metanalіz, pіdtverdili scho zastosuvannya furosemіdu in patsієntіv of nayavnіstyu OPN abo Visoko rizikom її rozvitku not robit sushestvenno vplivu on vnutrіshnolіkarnyanu letalnіst, neobhіdnіst away priznachennya PTA of the following seansіv gemodіalіzu that kіlkostі patsієntіv Zi stіykoyu olіgurієyu.

At the same hour, a high dose of a loop diuretic, which tends to become stagnant in patients with a severe deficiency, was associated with varying increases in the risk of ototoxicity of the given drug.
Systemic hemodynamic damage is a dominant reason for OTN, which is mainly due to the stabilization of circulatory disorders, AT and the improvement of regional normal blood circulation.
The first step is to look for help to improve the BCC and to fix systemic vasopressors. The area of ​​storage of vasopressor agents, as a rule, is more often septic shock, and more often it is an etiology. Published before the present hour about the stagnation of vasopressors in patients with septic shock and prerenal acute renal failure, for the time being, it is not allowed to give recommendations on the victorious group of medications for non-hematologic systemic control

In practice, for the treatment and improvement of the guest's deficiency in important patients, dopamine is widely used in doses of 0.5-2 mcg / kg / hv. standard "3 μg ​​/ kg / xv) for 6 years.

In singing situations, an hour of infusion can be improved, or not more than 24 years old. It is possible to positively infuse dopamine for the overcoming of a severe deficiency, to interfere with a decrease in blood flow and a decrease in tubular Na transport through the activation of DA1 receptors. However klіnіchnі viprobuvannya not viyavili іstotnogo values ​​іnfuzії dopamіnu in profіlaktitsі i lіkuvannі OTN ymovіrno have zv'yazku of aktivatsієyu not tіlki retseptorіv DAl type, and the second іnshih retseptorіv (DA2 adrenergіchnih i) nіvelyuyut pozitivnі efekta Perche for nirkovoї gemodinamіki i kanaltsevoї reabsorbtsії natrіyu ...

It is not included, but fenoldapam, a selective agonist of DA1 receptors, can be more cinnamon in OTN therapy.

The Russian Nephrology of Denmark is a little vidomy drug.
There is still no absolute evidence of the effectiveness of the substance in acute renal failure therapy;
Not broken і schemes of yogo zasosuvannya.
For example, for the prophylaxis of X-ray contrast of nephropathy, it is necessary to smell the sign for 15 min-12 h (!) Up to 0-12 (!) Godin for the procedure with a shvidkistu 1 μg / kg / min.
On the other side, it is shown in a number of pretreatments (including subordinate cases, randomized and placebo controls), infusion of noradrenaline is more effective as a result of stabilization of systemic hemodynamics.
Theoretically, the deterioration of the regional blood circulation in the organs of the black emptying is theoretical, but adrenergic stimulation in case of stagnation of noradrenaline did not know the main diagnosis.
Zastosuvannya adrenaline is shown in vipadkas, if the viciousness of the other fresh agents does not give a good increase in the arterial grip.
Dobutamine can be effective in reducing the risk of internal carnial mortality in case of early signs of septic shock in ailments, but it is not positive for both diuresis and creatine cleansing. The role of an effective vasopressor in prerenal acute renal failure can be claimed for a long time ago in the clinical practice of vasopresin (ADH), which in older prerenal patients with septic shock effectively introduced the systemic arterial pressure

In any case, there is a need for prospective follow-up, as they could clarify the situation with the vibration of vasopressors in the presence of important category of ills. Oskіlki specific therapy of acute renal failure, tied with the infusion of nephrotoxic agents, is practically not broken up, preventing the deterioration of the function of nirok є with an external stone in the presence of ailments.

The basic principle is prophylaxis for a sparing regimen of medications for the treatment of factors, quick correction of all factors has evolved, and for the development of a healthy deterioration of the function.
In a number of patients early on, proactively and proactively come in, you can readily develop and update the prognosis of ARF.

A quick transition on the road

The head, who is guilty of virginity, is simply and promptly advises about the mechanisms of development, symptoms, and about the principle of deception like hospitality, as well as chronically unremarkable deficiencies in women and in men. The folding of the field lies in the fact that, with the insane similarity of the processes, there is a great difference between the guests and the chronic nirk deficiency.

Evidence of a woman's inadequacy is of some kind as a person of a dumb person. Nirkas, as an organ, do not conceal the state of affairs in budov and functions. To that the women can booty particular reasonsїї viniknennya, which are dumb at the cholovikіv.

For example, in case of vaginosis the uterus "vidzhima" sechovid, the expansion of the bowl-bowl system of nirok, and to develop. Ale vagіtnіst - tse a short period, and, as a rule, nirkova lack of simply does not rise up.

Even coarsely, alefully, a chronic stance with ailments can be reduced with a slight forgetfulness, with an altogether "adequate" patient with atherosclerosis of the brain, and a lack of gosstruction - with a stroke, or an insult. In this vipadku, everything here will be іnshim - lіkuvannya rozrahovanie for years, all the principles and protocols of the patient's management will be special. And, well b, all-new chronic destructions went to the state.

The versatility of the field lies in the fact that there is an OPN, and for the gostra nirkov deficiency is a price, which may not be tied to nirkami, but to winicati on a person's general health.

Why the tset of the winners, and grows, understandably lower, more briefly about those, as the pratsyuє is normal nirka, sob buv the sound of the wicked go.

trochi of physiology

You will ring to the thought, but you will see a whole lot of shelter, a small part of it, and moreover, a lot of blood has recently been called. Osvita sechі yde in kіlka etapіv:

• In the cortical ball of the nirka, in the glomeruli of the nephrons (at the structural - functional unit of the nirka), there is a post-primary filtration of blood.

Її normal fluidity - 120 ml / min. Ale lyudin cannot be allowed to see the first thing, I am cutting it, ossicles and obsyag sklav bi is close to 200 liters for the doba. Apparently at the same time, the person is guilty of the bullet for the whole hour, keep the same obsyag.

Zrozulylo, so far as people are busy with drinking and drinking, the people didn’t spend an hour, and they didn’t go to land from the seas. That cut needs to be concentrated - in those nephron dishes, the cut is concentrated 100 times, and in such a view, it is consumed in the cut.

Apparently, in addition to concentration, even more important processes are seen, for example, reabsorption or reabsorption from the primary filtrate into the roof of richly important connections, for example, glucose, as it just passed through the first phase. Concentration of the great vitratic energy.

In such a rank, nirkas are the tse of organisms, which induce homeostasis, so that the inner middle is becoming organisms. In addition to participating in water and salt exchange, you can take a share of hundreds of young spoluks, as well as take part in the virobred children (for example, eritropoietins, which stimulate blood formation).

In a bag, I can easily cut it, as I see everything that does not follow, and does not skip the "deficiency", for example, a block. But if there is a lack of a lack of mechanics, the mechanisms will break, and if a patient has a lack of a cordon, the channel will be smuggled into drugs and smuggled, and unplanned. Well also nirkova lack?

Informations of hospitality and chronic nirkova deficiencies

OPN (guest nirk deficiency) and chronic nirk deficiency (for chronic nirk deficiency) is called the deterioration of the homeostatic function of nirok. In case of a hostile disadvantage, it can develop only once in a few years, and in times of HNN, it can be progressively rocked.

• It’s the fact that with ARF it’s most often “not to blame” - because the stink does not cope with the func-

Chronic nirkova disadvantage - the tsestan, with any winnie the nirkas, and see "viprobuvannya reserves." In case of chronic nirkovy shortcomings, the general development allows you to compensate, go in and out of your time, and in the bag it takes a trivial hour to take the funcion out for the rest of the day, without contamination for life.

So, apparently, there are 2 million of nephrons in the nirkas. If it’s half of the nagine (which is equal to one nirka), then maybe there are no signs of ailment. If only 30% of nephrons are lost in nirkas, and the indicator of filtration in the fall is three, up to 40 ml / hv, then there are key signs of chronic nirk deficiency.

• A fatal threat to the life of a vine is when 90% of the nephrons are bent.

Gostra nirkova lack of - well tse take?

Syndrome of nirkovo deficiency in the form of hospitality is developed in one patient per 5000 vipadkiv. Tse nebagato, vrahoyuchi spontaneous character of vyniknennya. Ale, on the other side, in the great regional or regional center with the population of 1 million. Cholovik will still be close to 200 patients stretching out to the rock, but the price is a lot.

From the history of nutrition, it is possible to establish that in 90% of cases of ARF occurred in the middle of the 20th century, as an accelerated criminal abortion. In this day, acute renal failure is being developed in the other fields of medicine, and the most frequent manifestation of the syndrome of multiple organ failure. development:

• Prerenal ARF (tobto prerenal) - 50%.

Prerenal surge arrester protects against increased safety functions. Ale arrhythmias, rizni shocks, embolism of the legendary artery, and the lack of heart, simply cannot prevent the "supply of a vice" in the system of nirok.

Also, acute renal failure develops with enlarged sudin (with allergic shock, or anaphylaxis, with sepsis). Evidently, if the body is aware of a significant debridement (bleeding, heavy carry), then there is a process of making up to the elementary instability of a filtration debridement.

• Renal (gostre poshkojennya nefroniv);

For statistics, mayzhe all renal acute renal failure is subject to either ischemia or intoxication of nephrons. In most cases, with a large number of broken winches, there is a tubular necrosis, so that it is "considered" to the apparatus of the concentration of the sech. For example, this is the type of arrester of the disease when there is a massive, reliable product in the roof of the blood loss (myoglobin) with the syndrome of tricky depressurization, or crash syndrome, it is not bargaining for deciduous compression tests.

It is also a reason to serve as deyaki liks (antibiotics - aminoglycosides), non-steroidal anti-fumes, for x-ray contrast, captopril.

In 1998, there were a few descriptions of vipadocs, if after a single administration of cefuroxime (antibiotic from a group of cephalosporins), the patient had developed gastric bilateral necrosis. As a result, I won 1.5 years of life on hemodialysis, and the camp was transformed only after a nirka transplant.

• Post-renal (post-renal, collapsed into section) - 5%.

The whole type of OPN is ridko, and can be diagnosed with ailments without evidence, in an old age and mentally ill. Supravodzhutsya anurієyu (less than 50 ml for doba). The reason - stones, adenoma, cancer and іnshi lead to obturation in any case, from the urethra to the end of the passage through the slaughter.

Symptoms of a hostile deficiency

The surge arrester is developed by stages. For a positive result, the price is: pochatkova, oliguric stage, renewal of deiurez and oduzhannya.
There are no specific symptoms of a hostile deficiency. You can see offensive signs:

• collapse, or a decrease in the arterial grip;
• oliguria (a change in the number of sechs);
• nudity, diarrhea, abdominal pain, loss of life;
• anemia;
• hyperkalієmiya;
• development of acidosis and "acidification" of blood, the appearance of Kussmaul's galaslive dikhannya.

The line of hospitality and lack of lack is even more variable. So, hypercalypsemia in case of great diagnoses, anemia - in case of severe hemolysis, sudom and fever, fatigue - in case of septic shock. In such a rank, the arrester against the mask of reason.

The main indicators will be the growth of the blood on a small decrease in the number of blood.

Likuvannya hostile nirkova lack

Seemingly, recurrent shocks (cardiogenic, opic, painful, infectious - toxic, anaphylactic) are the cause of acute renal failure in 90% of cases.

To that, the fight against shock permits and permits arresters. For the sake of keeping a volume of circulating blood, flanking the necessary calories, carrying out blood transfusions, ensuring a child-free child. In the case of severe disorders, hematologic disorders.

In case of infections and sepsis, dialis should be combined with hemosorption, ultraviolet irradiation of blood. In case of blood ailments, which lead to anemia, plasmapheresis is vicious.

Likuvannya hospitality nirkovoi lack of - the price of mystery, some of the likars are constantly encumbered in their abilities. So, in case of infectious - toxic shock, which is an inoculation to a hostile nirkova deficiency, it is necessary to cope with infectious diseases better, if the stagnation of effective medications is limited, there are some toxic

forecast

As a rule, in case of isolated deficiencies, the lethality does not overtake 10-15%, even though it grows up to 70% in summer, on the lowest heart and liver deficiencies, reaching up to 100% in the case of the obvious deficiencies, however

In quiet, hto see, the function of newcomers will increase, for the winter data, in 30-40% of cases. If you talk about more rapid progress, then the most often diagnosed pelonephritis, due to the congestion of this hour of hospitable nirkovoi lack.

Chronic nirkova lack of - well, tse so?

Nowadays, it is becoming increasingly vicious with CHNI, the result of which is a uremic coma, with a "burial ring of uremic", which is without a mediocre symptom. This is how they called the rough, shrieking noise of rubbing the pericardium, which is the name for the ailments in the terminal stage of HNN.

It is the fault of the fact that this is the case, as it was established in many cases of drops in the blood, it was not seen by nirkami and was deposited in the eyes of inorganic crystals in all organisms, including in the emptying of the pericardium.

Obviously, in this hour, such symptoms, and especially when they appear, are practically not susceptible to - an even chronic shortcoming can be brought to the point. Yaki cause to wick HNN?

Reasons for the diagnosis of HNN

The main problem is to produce up to CHN, to fend off glomeruli nirok, filtrauchі pervinnu I cut, and tubules. Likewise, one can marvel at the resulting fabrics on nirok, or interstitial, in some kind of nephron.

Likewise, HNN wicks rheumatic ailments, feuding with the resulting tissue, communicating ailments and congenital anomalies of nirok. I will make my "contribution" to the battle against the obstruction of the secular nobles. Axis deyakі z tsikh zahvoryuvan:

• glomerulonephritis, chronic pyelonephritis, interstitial nephritis;
• systemic scleroderma, hemorrhagic vasculitis;
• diabetes, amiloidosis;
• polycystosis nirok, congenital hypoplasia;
• malignant nirkov hypertension, stenosis of the nirkovy arteries;

Glomerulosclerosis lies at the heart of the nephron lesion in chronic nircovy deficiency, for no reason. The glomerulus is neglected, replaced with a full tissue. At the blood of the vine is uremia, tobto, roughly, it seems, "uremia".

Sensitive, uremic toxins (sechovina, creatinine, parathyroid hormone, beta microglobulin) destroy the organisms accumulated in organs and tissues.

Symptoms of Chronic Nircovis Disability

Symptoms of chronic nyrcological deficiency in women and men, however, can be repaired with a water-salt exchange.

With the help of the KhNN, the chotiri stages are developed:

1) Latent, yak will see a cob of water - salt solutions.

To fix everything at the early stages of HNN:

• Isosthenuria and hypostenuria. I can't concentrate on Nirka. Cutting "lasts" only up to the thickness of 1010-1012, and in case of hypostasis, vzagal, up to 1008.
• Nіkturіya, for perevazhannya nіchny obsyagu slaughter over the day. Healthy nephroni will be rewarded, and will turn into a "nichnu change". Tse vinikє, for example, to that, at night, there is a spasm of sudin nirok;
• Polyuria. The number of sections grows, compensating for the shortage of "quality". In the thermal stage of non-malignant deficiency, the number of cut drops to 600-800 ml for extra, which is indicated for carrying out the dialogue.

2) I am compensated for the fact that I can cope with it and oliguria is dumb.

Everything should be brought up to salt visnazhennya - a weakness, a decrease in a vice. Ale have ailing ailments of soda, navpaki, viklikє pidvischennya arterial vise. Sleep will also be destroyed, appetite will decrease.

Disease, headache, shkiri sverb_zh, zapamorochennya, depression. Decrease in temperature, bleeding. Catching calories and magnes to produce weakness, rupture of the robot's heart, drowsiness.

3) Intermittent (coli), if there is a period of oliguria and the growth of accumulation of ions in plasma.

Spraga, nudota, blues, unacceptable gusto in mouth, stomatitis and the smell of amiaku are most common. Shkira Blida, dry and dry. Vinikak tremor of fingers.

At the flared stage of CHNN, anemia is often found, splinters in nirkahs are swirled, which is poured into the synthesis of erythrocytes. The clinical picture depicts azotemia, so that it accumulates in the organism of products in the blood exchange.

4) Thermal.

Vinikє encephalopathy. Memory will collapse, vinikє bezonnya. There is a weakness of the muzzles, difficulties in going through the gatherings. Then there is a painful sensation of shkiri, paresthesia, a child's bleeding, and nasal bleeding.

In important cases, there is a lump of lightness, chronic heart failure, myocardial dystrophy develops. Progresuє ("goose bump", oniminnya, pain), to sink, or to know the scent and relish.

The problem is that it can lead to an additional slump and develop a stunned and uremic coma. When sick, there is a strong smell of amiaku.

Lіkuvannya chronіchnoі nirkovoі deficiency + dіeta

Oskilki KhNN was trivial, then even on the cob stages it is necessary to live all the calls: the process of the day, the mode, the ability to carry out the dialogue and the second calls. Patients who are guilty are relieved of physical problems (to reduce catabolism), it is recommended to move on a fresh occasion. The basis of the lykuvannya є is correct.

dyeta

Lіkuvannya chronії nіrkovoi deficiencies To fix it from the correct choice of food:

• grabbing a shot, 4-5 times per day;
• it is necessary to interlace the blocks up to 50-70 grams for dobu;
• to prevent energy consumption for fat and carbohydrates;
• regulation of salt exchange (cooking salt).

At the likuvalny kharchuvanny for KhNN isnu. At the cob stage, to finish the children No. 7, and in case of bends, the vicorists turn to the children No. 7a, or 7b (20 and 40 gr. Bilka in dobu).

In the case of the harvest, it is worthwhile to do a lot of vlashtovuvati rozvantazhvalny days: rice - compote, in carbohydrate apple - sugar, cartopliana. I draw the cartoplin into a syrupy viglyad and vimochuyut, to reduce the amount of calories.

At a total of 50% of the dobovy dose, the bile is guilty of folding easily swallowed bricks (lilac or yachny). And the axis of meat, riba, poultry, beans, peas and chocolate must be included. Do not pick up marshmallows, marshmallows, honey and caramel. Prototype shows dried fruits (crusty), so that the stench can remove excess calories.

Fat is given in viglyadі rose oil. The amount of kitchen salt is strictly limited and does not change 8 g for doba. There is a bit of birth in the life that is drunk to lie down because of the patient's desires, and it is not guilty of overriddening him.

Preparations for the treatment of chronic nyrcological deficiencies

Preparations for the treatment of nirkovo deficiency are symptomatic in nature. We will not look at the sickness that was brought up to the CHNN. For many patients, serioznіlіki, for example, hormones and cytostatics can be recognized. Should it be necessary to take drugs for the correction of vasne HNN, then they should be admitted to:

• hypotensive drugs in the presence of malignant hypertension;
• diuretics and heart glucosides in case of impaired heart pumping function and development of congestive heart failure;
• sodium hydrocarbonate for the suppression of acidosis,
• drugs for anemia;
• tediousness for tediousness and blues ("Cerucal");
• enterosorbent for azotemia reduction (Enteros-gel);
• intestinal permeability, klizmi.

In the case of chronic hemodialysis in the Danish hour, he is a "routine" for extracorporeal methods of detoxification: hemosorption, plasmapheresis, as additional methods, chronic hemodialysis, or the device "piece nirka". It allows you to preserve life and the activity of patients, and to check for transplantation of nyrka, if indicated.

Ale science does not stand on the point. In 2010, a prototype was made to implant a piece nirka, and not far from the hour, if it is possible to create a nirku of people anew, vikoristovuchi yogo stovburovі clitini, as well as a connective tissue base.

forecast

We took in the wild rice depriving the surface of food, linked to the reasons, symptoms and diseases of chronic nirkovy deficiency. Headache, it is necessary to remember that CNN is a nonspecific syndrome that can develop when you are ill.

Only the possibility of breaking the main ailment gives a chance for stabilization to become a patient. In addition, it is necessary to have a pathological condition, the ability to carry out a dialogue and the prospect of a nirka transplant.