Renal edema: characteristic, pathogenesis, differences from cardiac edema, treatment, photo

August 12, 2017 15:31 | Symptoms

Swelling on various parts of the body can occur for various reasons.It can be puffiness of cardiovascular etiology, liver pathology, unhealthy lifestyle and diet, traumatic factors or allergic exacerbations.But more often the cause of puffiness is renal structures, i.e.Edema is associated with kidney pathologies.

Renal edema is a characteristic of

Renal edema is a kind of swelling that occurs with kidney diseases.Most often this sign indicates the development of kidney failure.Such edema is difficult to diagnose, in terms of the fact that you can make mistakes in determining their causes, and, hence, in the further treatment of the disease. Kidney pathologies in medical practice are often enough, therefore, the puffiness of such etiology is also not uncommon.Kidneys are a kind of body filter.If some pathology develops in them, the filtration function is violated, the balance of substances in the body is disturbed, which as a result leads to puffiness.Usually, the restoration of filtration activity an

d correction of the blood composition leads to the disappearance or a significant decrease in edema.

Reasons for

Renal edema occurs for various reasons, which are conventionally divided into two classes.The first class of causes is the pathological mechanisms that cause the exit and accumulation of fluid in the intercellular space.The second class is the causes caused by renal pathologies, under which the above mechanisms operate.

Therefore, renal edema is most typical for such pathologies:

  • Amyloidosis.With pathology in the kidney accumulates protein - amyloid, it gradually clogs the membranes, preventing normal blood flow.All this reduces the filtration capacity of the kidneys, leading to the accumulation of toxins in the blood and fluid in the tissues.
  • Glomerulonephritis.This is an immune lesion of the glomerular renal apparatus.Immune complexes that provoke pathology are usually formed in the blood on the background of autoimmune and infectious pathologies like streptococcal angina, etc. The glomerular apparatus becomes inflamed under the influence of immune complexes, filtering is violated.
  • Renal failure is a violation of all renal functions, including water-electrolyte equilibrium and filtration, which is the cause of edema.
  • Tumor lesions.With some tumor formations there is a violation of renal activity, which negatively affects the filtration capacity.
  • Poisoning.Some heavy metals and toxic substances can accumulate in the body.Against the background of their toxic effects, normal cells die, replaced by connective tissue structures.As a result, kidney deficiency is formed, accompanied by edema.

In addition, the causes of puffiness may be due to nephropathy due to diabetes or pregnancy, systemic connective tissue pathologies, etc.

Development mechanism

Edemas are an excessive accumulation of water in the intercellular spaces.

In general, the pathogenesis of edema of kidney origin looks like this:

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  1. Increased filtration of proteins through membrane structures of the glomerular system.The code of proteins penetrates into the urine, they take away some of the liquid.However, the proteins are not reabsorbed, since their molecules are too large to seep through the tubular walls.
  2. Decreased filtration activity of the kidneys.Occurs in the background of various conditions, for example, with hypotension, when there is an activation of the hormonal system, which increases the reverse absorption of sodium in the kidney structures, which leads to fluid retention.
  3. Deficiency of protein compounds in the blood.Usually, this condition occurs due to the loss of protein in the urine, although this may be caused by a violation of protein formation in the liver.
  4. Increased capillary permeability.With such a violation, the fluid and the blood components flow freely into the space between the cells.Elevated vascular permeability is observed with glomerulonephritis, infectious kidney damage, with renal failure and other pathologies.Excessive concentration of sodium ions in the blood.
  5. .Such clusters are associated not only with sodium retention in the kidneys, but also with excessive intake of this substance from the outside, for example, when salt is misused.
  6. Increased flow of fluid.Many renal pathologies lead to slower filtration in the glomeruli.If the patient at the same time consumes excessive amounts of water, the liquid will inevitably accumulate in the tissues in the form of edema.

All mechanisms of development of renal edema are reduced to functional disorders in the kidneys.


Characteristics of renal edema, the mechanism of development, distinct from edema of cardiac origin
Characteristics of renal edema, the mechanism of development, distinct from edema of cardiac origin
At first, when the filtration activity of the kidneys is not significantly affected, edemas of renal origin appear in areas with a thin, delicate skin and loose fiber structure.Therefore, at the beginning of the pathology, puffiness predominates on the eyelids and face.They are manifested most in the morning hours, but soon pass. Similar symptoms can be considered the first signal indicating the development of pathology.

Then, with further development of the disease, insufficiency progresses, the swelling spreads to other parts of the body, and the hands begin to swell.Characteristic for renal edema is the pits - if you press on the swollen patch, then there is a dent, which passes in a few seconds.In some patients, such swelling is accompanied by sensations of soreness, stiffness, tension, or stiffness.

In the photo, renal edema on the face

Symptoms and mechanism of development of edema of kidney origin

If, and with such symptoms, the patient continues to ignore the disease, the kidney pathologies progress, the swelling spreads to the feet.In other words, the sequence of progression of renal edema is as follows: first the face swells, then the hands, then the legs.Additional signs for renal edema may be neurologic manifestations( drowsiness, migraine, arthralgia, myalgia and bone pain), urination disorders and pain in the kidney area.

On the photo edema of the legs with renal failure

Causes, Diagnosis and Treatment of Renal Edema

Diagnosis

Not all kidney pathologies are accompanied by edema, as not all edema is indicative of the development of kidney disease.Therefore, the appearance of puffiness requires a thorough differential diagnosis, in which the expert excludes other probable pathologies.

Research

To identify renal edema and determine their causes, patients are assigned the following studies:

  • Biochemistry and general laboratory blood tests.With edema, the overall picture of blood does not change, but biochemical analysis reports increased cholesterol and creatinine, uric acid and urea.Also, with protein biochemistry, protein deficiency and electrolyte disturbances are detected.
  • Detection of the rheumatic factor.Often glomerulonephritis occurs as a complication of angina of streptococcal origin.To confirm this diagnosis, you need to identify the rheumatic factor.
  • Biochemistry and general urine research.A characteristic feature in renal edema is proteinuria - when there is an increased protein content in the urine.A similar feature is characteristic for a variety of renal pathologies.Biochemical examination of urine shows that it lacks uric acid, creatinine urea, etc.
  • Dopplerography of renal vessels.A similar study is performed on an ultrasound machine.The specialist determines the presence of vascular pathologies and sclerotic zones, tumors in the kidney tissues, blood flow velocity, etc.
  • Functional tests of the kidneys.For the detection of pathology, samples like urine density determination, creatinine clearance or dilution test are conducted.These samples help determine the quality of filtration activity.

difference from cardiac edema

In Table contrast renal edema, edema of cardiac origin:

Symptom renal edema Heart edema
Upper part of the body, face, eyelids.Distribute from top to bottom. Shins, feet.In a supine position, lumbar edema appears.
Palpation Externally, edema is slightly paler, with palpation the temperature does not differ from other areas. In the place of puffiness, the skin is cyanotic and cold.
Mobility The site of the edema can move, that is, it is mobile. Puffiness is immovable, and with pressure on it you can feel pain.
Concomitant symptoms Characteristic of urinary disorders such as lumbar pain or decreased urine volume. Symptoms of cardiovascular problems such as chest pains and dyspnea, swelling of cervical localization, etc. are characteristic.
Urinalysis
Changes in urine composition( contains electrolytes and proteins).
Usually, there is no change in the urine.
Speed ​​of extinction Renal edema quickly disappear and quickly appear. Characterized by the slow formation of edema and its resorption.

Treatment

How to treat it can be said only after finding out the etiology of swelling.The paramount task is to eliminate the provoking factor.

In general, the treatment involves the following methods:

  • Treatment of the underlying pathology.It is necessary to eliminate the root cause of edema.
  • Diuretic preparations.They stimulate the removal of surplus fluids( Furosemide, Oxodolin, Ureit, Dichlorothiazide, Triamteren, Veroshpiron, etc.
  • Diet Therapy is aimed at the most gentle mode for the kidneys. In severe cases, bed rest is shown, at rest kidneys are easier to filter, which helps to eliminate swellingThe diet is case-specific, the patients are assigned a salt-free diet No. 7 or a diet number 7A limiting the intake of liquid and salt
  • Vascular strengthening agents( Ascorutin, etc.) They are prescribed not inBut only to those whose vessels are highly permeable
  • Means for the normalization of the water-electrolyte balance, using intravenous infusion infusions or droppers with solutions of certain salts

These remedies are extremely important for maintaining normal cardiac activity and preventing the elution of potassium.Controls the process of treatment of renal edema and their underlying cause of nephrology.The competent specialist in this case is extremely necessary to exclude all kinds of complications.