Nephrology: diseases — симптомы, диагностика и лечение

Arterial hypertension is a persistent increase in blood pressure from 140/90 mmHg. Art. and higher. It is the most common chronic disease in the world and a leading cause of strokes, heart attacks and kidney failure. The insidiousness of hypertension is that for many years it does not give any sensations: a person feels normal with a pressure of 160/100 and learns about the disease after a vascular accident. That is why it is called the “silent killer”, and the only way to detect it is to regularly measure your blood pressure, and not wait for symptoms.

Hydronephrosis is an expansion of the renal collecting system due to impaired urine outflow. Hydronephrosis itself is not a disease, but a consequence: somewhere on the way from the kidney to the bladder there is an obstacle. The danger is that the kidney slowly and often painlessly loses its tissue - a person may not be aware of the problem for years until a significant part of the organ’s function is lost.

A kidney cyst is a rounded cavity with fluid inside the kidney tissue. This is one of the most common incidental findings on ultrasound: with age, simple cysts are found in a significant proportion of people and in most cases do not require any treatment. The key task of the doctor is to distinguish a harmless simple cyst from a complex cystic formation, which may hide a tumor.

Diabetic foot syndrome is damage to the tissues of the foot in a person with diabetes that occurs due to a combination of two processes: nerve damage and poor blood supply. The most insidious thing here is the absence of pain. With diabetic neuropathy, the foot loses sensation, and a callus, abrasion from a new shoe, a burn from a heating pad, or a pebble in a shoe goes unnoticed until an ulcer forms in its place. People are accustomed to trusting pain as an alarm signal, but with diabetes this signal is turned off - and that is why examining the feet with one’s own eyes every evening becomes not a hygienic habit, but a full-fledged medical procedure. The vast majority of amputations due to diabetes are preceded by an ulcer, which could be noticed in time.

Chronic kidney disease is a gradual and irreversible decline in kidney function that occurs without any symptoms for many years. The kidneys have a huge margin of safety: complaints appear when more than half of their capacity has already been lost. Therefore, CKD is detected not by how you feel, but by two simple tests - blood creatinine with calculation of GFR and determination of protein in the urine.

Amyloidosis is a group of diseases in which altered proteins lose their normal shape, stick together into insoluble fibers and are deposited in tissues. These deposits gradually displace working cells, and the organ ceases to cope with its function. Most often, the kidneys, heart, liver, nerves and intestines are affected, so the complaints are very different: swelling and protein in the urine, shortness of breath with slight exertion, numbness of the feet, diarrhea, unexplained weight loss. Because of this diversity, the diagnosis is often made late. It can only be confirmed by a biopsy with a special staining of the tissue, and treatment depends on the type of amyloid, so determining the form of the disease is a mandatory step.

Kidney amyloidosis is a disease in which amyloid is deposited in the kidney tissue: an abnormal protein with a special structure that the body cannot break down. The deposits gradually replace the normal structures of the glomeruli, and the kidney begins to lose protein in the urine. The typical picture is increasing edema, massive proteinuria and a decrease in protein levels in the blood. Amyloidosis is rarely isolated: more often it is part of a systemic process associated with chronic inflammation, blood diseases or hereditary syndromes. The diagnosis is confirmed only by a biopsy with a special stain, so if there is persistent protein in the urine, the examination cannot be postponed.

Protein in the urine, or proteinuria, is the excretion of protein in the urine in an amount exceeding the norm. Healthy kidneys retain large blood proteins, so protein is almost undetectable in a routine urine test. A one-time small increase is often temporary: after intense exercise, during temperature, stress, long standing, or improper analysis. Persistent proteinuria is one of the early signs of kidney damage in diabetes mellitus, hypertension, glomerulonephritis and other diseases, and for a long time it may not cause any complaints. Therefore, if a protein is detected, the analysis is repeated, and if confirmed, the cause is looked for. Early detection can slow the progression of chronic kidney disease.

Kidney pain is a common complaint, which in fact is not always due to kidney disease. Real kidney pain is felt deeper than the muscles, in the side and under the lower ribs, often radiates to the groin and along the ureter, does not depend on posture and does not go away with warm-up. Its most common causes are urinary tract stones and acute pyelonephritis, less often - a cyst, impaired urine outflow, trauma. Much more often the lower back is bothered by the muscles and spine: this pain intensifies with movement and changes with changes in body position. Simple tests - urine analysis and ultrasound - help to distinguish one from the other, and sudden unbearable pain requires urgent help.

Calcifications in the kidneys are deposits of calcium salts in the kidney tissue, which the ultrasound doctor describes as hyperechoic inclusions. Most often they are found by chance, during an examination for another reason, and by themselves they do not hurt. Single small inclusions are often the result of inflammation or scar changes and do not require treatment. Multiple deposits in the pyramids of the kidneys are called nephrocalcinosis: this is no longer an independent disease, but a sign of impaired calcium metabolism - hyperparathyroidism, excess vitamin D, renal tubular acidosis, the consequences of certain medications. It is important to distinguish calcifications from stones in the calyces and pelvis and be sure to understand the reason so that deposits do not build up.