Uremic coma: emergency treatment, intensive care

The kidneys in the human body perform a very specific job. Their main function is elimination. The kidneys remove water and excess hydrophilic metabolites from the body, including toxic substances and waste, pumping and purifying the blood. This function is inextricably linked with the regulation of acid-base and water-salt balance, maintaining a normal quantitative level of osmotically active substances in the blood.

And if areas of kidney tissue cease to function normally, toxic substances begin to accumulate in the blood, which healthy kidneys remove from the body through urine.

An unconscious state caused by poisoning with endogenous toxins due to kidney failure (cessation of filtration and reabsorption) is called uremia or uremic coma. This is the terminal stage of serious kidney damage in the case of acute impairment of their function or the end of irreversible changes in the kidneys due to a long-term chronic process.

Epidemiology

The most common infectious and inflammatory pathology of the urinary organs, as evidenced by medical statistics, is pyelonephritis. According to pathological studies, this disease is detected in at least 6% of deceased people who underwent autopsy. According to various authors, pyelonephritis was detected in 18-30% of autopsies. It is believed that in half of the patients who died in a state of uremic coma, this pathology was the cause.

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Causes uremic coma

Most uremias develop with chronic renal dysfunction caused by long-term inflammation of the renal pelvis (pyelonephritis) or kidneys (glomerulonephritis), with multiple cystic formations in the kidneys or bilateral urolithiasis with periodic disturbances in the excretion and retention of urine. Chronic dysfunction of both kidneys develops with prostate adenoma and in diabetics. However, for any reason, the functioning areas of renal tissue can decrease to a size insufficient to remove accumulating toxic substances from the body. Uremia in chronic processes develops slowly, self-poisoning of the body occurs, increasing, often over many years. Congenital pathologies of the urinary organs can lead to the development of both acute and chronic uremia.

In addition, risk factors for the development of sudden uremic coma are conditions that cause the development of acute renal failure and are accompanied by circulatory disorders, both general and intrarenal:

• all kinds of poisoning (medicines, mushrooms, methyl alcohol, etc.);
• acute hemorrhage and anaphylaxis;
• dehydration;
• severe infectious diseases;
• alcoholism and, as a consequence, abuse of surrogate products and use of technical liquids.

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Pathogenesis

The main pathogenetic link in the mechanism of development of uremic coma is the increasing intoxication with metabolites, which in a healthy person are eliminated by the urinary organs. This leads to acid-base and water-electrolyte imbalance, changes in the protein composition of blood plasma, oxygen starvation of body tissues, in particular, the brain, leading to its edema.

The onset of uremia development is characterized by the accumulation of nitrogenous metabolites (residual nitrogen, urea and creatinine) in the blood; the level of increase in their serum content indicates the degree of renal dysfunction.

The next important episode of the pathogenetic process is a violation of the water-electrolyte balance, which manifests itself in the early stages by increased urine formation and excretion (polyuria). The function of the renal tubules is impaired and the kidneys lose the ability to concentrate urine. Later, urine excretion becomes scanty (oliguria) and stops altogether (anuria), which leads to the development of acidification of the body. A shift in the state of the blood and tissue fluid towards acidity (acidosis) causes oxygen starvation and hyperventilation syndrome.

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Symptoms uremic coma

This condition can occur in acute and chronic forms. Acute uremic coma is provoked by acute renal dysfunction during a period of insufficient urination (oliguria). At this point, there is a sharp jump in the blood content of nitrogen metabolism products (azotemia), the smell of ammonia appears from the patient's body, the water-electrolyte balance changes, and non-excreted water accumulates. Symptoms of heart failure occur - increased heart rate, rhythm disturbances, heart pain, dyspepsia, anemia, and cerebral edema may begin. In acute uremic coma, cerebral symptoms increase very quickly. Asthenic syndrome is followed by depressive syndrome, then hallucinations and delirium, followed by stupor and coma.

In chronic diseases, pre-comatose symptoms increase gradually as kidney tissue dies. The first signs of uremia are severe itching, increasing headache, cognitive and visual impairment, asthenia (severe fatigue, dizziness, daytime sleepiness, insomnia).

Symptoms of damage to the digestive organs and serous membranes are caused by substances that are eliminated not by the kidneys, but by the tissues of other organs - the mucous membrane of the gastrointestinal tract, the serous membrane of the abdominal cavity and heart, and the pleura.

Azotemia leads to skin itching, digestive disorders, encephalopathy, inflammation of the serous membrane of the heart, and anemia.

Dyspepsia is detected as a lack of appetite, often to the point of refusing to eat. The patient complains of dry mucous membranes in the oral cavity and a bitter taste, and the feeling of thirst is exacerbated. The patient's skin and mouth smell strongly of ammonia (urine). This smell is a characteristic symptom of uremic coma.

The development of the process causes the inability of the kidneys to retain Na (sodium), which leads to salt dystrophy (hyponatremia), the symptoms of which are general weakness, hypotension, the patient's skin loses elasticity, an increase in heart rate, and hemostasis.

At the stage of polyuria, the content of K (potassium) in the body decreases, which is manifested by muscle weakness, sometimes convulsive contractions, rapid breathing, pain in the heart area. Patients with increasing symptoms of uremia look specific - a swollen face with pale dry skin, scratches, hematomas and hemorrhages are observed on the face and visible parts of the body. Swelling of the legs, swelling and pain in the lumbar region are characteristic. Nosebleeds or, in women, uterine bleeding, symptoms of gastric or intestinal hemorrhage may be observed.

Patients experience decreased urination and increased edema, oligonuria is replaced by anuria. Intoxication increases, which is accompanied by a decrease in reactions from the nervous system, a stunned state, which can periodically be replaced by attacks of excitement, delirium and hallucinations. Often, with the development of a comatose state, a hemorrhagic stroke occurs. Acidosis always develops. The patient becomes increasingly indifferent, then depression of consciousness and coma begin.

Stages

The stages of a comatose state are classified according to the degree of impairment of consciousness:

1. The patient's reactions are inhibited, motor skills and responses are practically absent, contact is difficult, but possible (stunning).
2. The patient sleeps soundly, from which he can only be brought out for a very short period of time by applying a strong pain stimulus (stupor).
3. Complete loss of consciousness, no response to any stimuli. At the same time, profound respiratory dysfunction, circulatory and metabolic disorders (coma) are observed.

The assessment of the depth of consciousness impairment in coma is given by three signs: opening of the eyes, speech and motor reactions (Glasgow scale). The types of coma by severity are as follows:

• I – moderate (from six to eight points);
• II – deep (from four to five);
• III – terminal (extreme – the patient scores three points).

In a coma of the third degree, brain death is declared.

Chronic poisoning of the body contributes to the development of liver failure. In this case, ammonia, retained in the blood during the development of uremia, and phenols formed in the intestines, accumulate in the blood when renal excretion and liver function are impaired. These substances play a leading role in the pathogenesis of hepatic encephalopathy and, as a consequence, coma. Although, to date, the mechanisms of occurrence of such a phenomenon as uremic hepatic coma are still being studied. Cerebral edema against the background of severe renal and pulmonary failure, as well as a decrease in the volume of circulating blood becomes the cause of death in hepatic coma.

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Complications and consequences

Acute uremia with adequate treatment (hemodialysis) is curable in most cases, patients fully recover in about a year, sometimes in six months. However, if emergency care is not provided and dialysis is not available, a fatal outcome is observed in almost all cases.

The course of chronic pathology can be measured in years, while the patient's condition will be quite satisfactory. The most harmless, but unpleasant consequence is the smell of ammonia from the body and exhaled air. Constant intoxication does not pass without a trace for the body. The functioning of the liver, heart, nervous system, and bone marrow is gradually disrupted. Calcium loss leads to osteoporosis, anemia and thrombocytopenia lead to bleeding, the functions of the senses are disrupted - vision, smell, taste. Sometimes the circulation of toxins in the blood leads to cerebrovascular diseases. The most terrible complication of uremia is a deep coma and death of the patient.

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Diagnostics uremic coma

This condition is diagnosed based on symptoms, test results, instrumental diagnostic data, taking into account the patient’s medical history and interviews with close relatives.

The main diagnostic tests for uremic coma are blood tests. Its biochemical study provides an idea of the content of ammonia and ammonia compounds, creatinine, the indices of which will exceed the norm. The results of the analysis also determine the concentration level of the main electrolytes (Na, K, Mg, Ca).

The degree of disruption of the process of metabolism of organic substances is determined by a proteinogram (blood test for the level of protein and protein fractions), a blood test for the lipid spectrum and glucose level.

Urine analysis is not specific for uremic coma and indicates the presence of general chronic renal pathology. Proteins, traces of blood, and cylinders may be detected in urine, indicating an acidic environment. Urine has a low density in polyuria and a high density in oliguria.

Instrumental diagnostics are prescribed by a doctor if necessary. This is, first of all, an ultrasound examination of the kidneys. Electrocardiography, radiography, magnetic resonance imaging, computed tomography, ultrasound of the abdominal organs, etc. may be prescribed to diagnose the condition of other organs.

Based on research and laboratory analysis data, differential diagnostics are carried out with other conditions: hepatic, ketoacidotic coma and severe renal dysfunction.

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Treatment uremic coma

This condition requires emergency measures to prevent the patient's death. Emergency care for uremic coma consists of the following therapeutic measures. The patient's condition is assessed using the Glasgow scale. Then, first of all, resuscitation of the heart and lungs is performed, having restored their function, they try to maintain what has been achieved (oxygenation and mechanical ventilation, cardiac massage are used, if necessary). Vital signs are regularly monitored - pulse rate, presence of respiration, blood pressure. An electrocardiogram is made, emergency diagnostic procedures are carried out. The state of consciousness is periodically assessed during resuscitation measures.

The gastrointestinal tract is washed with a 2% sodium bicarbonate solution and saline laxatives are prescribed.

In case of salt deficiency, intramuscular injections of 0.25 l isotonic saline solution are prescribed. Excess sodium is neutralized with Spironolactone, a diuretic that does not remove potassium and magnesium ions, but increases the excretion of sodium and chlorine ions, as well as water. It selectively reduces high blood pressure and reduces urine acidity. It is contraindicated in anuria, liver failure, excess potassium and magnesium, and sodium deficiency. It can cause side effects on the digestive system, central nervous system, and metabolic processes. The daily dose is from 75 to 300 mg.

To reduce blood pressure, antihypertensive drugs are prescribed, for example, Capoten, which inhibits the enzymatic activity of the catalyst for the synthesis of angiotensin II (a hormone produced by the kidneys). It promotes relaxation of blood vessels, reduces blood pressure in them and the load on the heart. Arteries expand under the influence of the drug to a greater extent than veins. Improves blood flow to the heart and kidneys. Provides a decrease in the concentration of sodium ions in the blood. A daily dose of 50 mg of the drug reduces the permeability of the vessels of the microcirculatory bed and slows down the development of chronic renal dysfunction. The hypotensive effect is not accompanied by a reflex increase in heart rate and reduces the need for oxygen in the heart muscle. Dosage is individual depending on the severity of hypertension. Side effects - an increase in the level of protein, urea and creatinine, as well as potassium ions in the blood, acidification of the blood.

To eliminate acidosis, intravenous injections of Trisamine are prescribed, activating the functions of the blood system, maintaining its normal acid-base balance. The drug is administered slowly at a rate of 120 drops/min. The maximum daily volume of the administered substance should not exceed the calculated one - 50 ml per kilogram of the patient's body weight. Use can lead to respiratory depression, excess dose - to alkalization, vomiting, decreased glucose levels, arterial pressure. The drug is used with caution in renal failure.

Rehydration is stopped with infusion solutions: isotonic glucose in a volume of 0.3-0.5 l and sodium bicarbonate (4%) in a volume of 0.4 l. In this case, it is advisable to take into account both the individual sensitivity of the patient and the undesirable effects:

• glucose solution - in cases of diabetes;
• sodium bicarbonate - for calcium and chlorine deficiency, anuria, oliguria, edema and hypertension.

Normalization of protein metabolism is carried out with the help of Retabolil. It is administered intramuscularly at 1 ml of a 5% solution. The drug effectively activates protein synthesis, eliminates exhaustion, compensates for the deficiency of bone tissue nutrition, however, it has a moderate androgenic effect. In case of renal and hepatic dysfunction, caution is recommended.

Potassium deficiency is compensated by Panangin - it is believed that the active substances (potassium aspartate and magnesium aspartate), entering the cells thanks to aspartate, are incorporated into metabolic processes. Normalizes the heart rhythm, compensates for potassium deficiency. If the patient complains of dizziness, the dose of the drug is reduced. Slow intravenous infusion of the solution is prescribed: one or two ampoules of Panangin - per ¼ or ½ liter of isotonic sodium chloride or glucose solution (5%).

Increased potassium levels in the blood are treated with: 0.7 l of sodium bicarbonate solution (3%) and glucose (20%).

Persistent vomiting is stopped by intramuscular injections of Cerucal, 2 ml each, which has a normalizing effect on the muscle tone of the upper digestive tract. The antiemetic effect of the drug does not apply to vomiting of vestibular and psychogenic genesis.

An obligatory procedure that allows the body to be cleansed of accumulated toxic metabolic products, excess water and salts is the use of an artificial kidney machine (extracorporeal hemodialysis). The essence of the method is that arterial blood is passed through a system of filters (artificial semipermeable membranes) and returned to the vein. In the opposite direction, bypassing the filter system, a solution flows, similar in composition to the blood in a healthy body. The machine controls the transition of necessary substances into the patient's blood and harmful ones into the dialysate. When the normal blood composition is restored, the procedure is considered complete. This method has been used for a long time and has proven itself to be very effective in the treatment of acute or chronic uremia caused by both kidney dysfunction due to their insufficiency and in cases of acute exogenous intoxication.

If there is an infectious process, individual antibacterial therapy is prescribed.

Since the development of uremic coma occurs with increasing intoxication, anemia and oxygen starvation of tissues, the body needs vitamins. Usually prescribed are ascorbic acid, against which the immune system is strengthened, vitamin D, which prevents the development of osteoporosis, vitamins A and E, useful for dry, itchy and losing elasticity skin, B vitamins, necessary for hematopoiesis. Of these, pyridoxine (vitamin B6) is especially useful. Its deficiency contributes to the rapid accumulation of urea in the blood. Its level decreases very quickly with a daily intake of 200 mg of this vitamin. Recommended daily norms of vitamins: B1 - at least 30 mg, E - 600 units, natural vitamin A - 25 thousand units.

In addition, it is advisable to take lecithin (three to six tablespoons), as well as choline - four times a day: three times before meals and once before bed, 250 mg (one gram per day).

Nutrition also plays a positive role. It is necessary to consume at least 40 g of protein daily, otherwise the accumulation of urea is rapid. Moreover, preference should be given to plant proteins (beans, peas, lentils, bran). They do not contribute to the accumulation of sodium, unlike animal proteins. To normalize the intestinal microflora, it is recommended to consume fermented milk drinks.

Physiotherapy treatment can be used for preventive purposes and during the period of rehabilitation. Magnetic, laser, microwave and ultrasound therapy are used. Treatment methods are selected individually, taking into account the anamnesis, tolerance, and concomitant diseases. Physiotherapy improves blood circulation, has a thermal, physical and chemical effect on body tissues, stimulates the immune function, helps relieve pain, inflammation, and slows down degenerative processes.

Folk remedies

Alternative treatments used for preventive purposes can slow down the development of uremic coma and shorten the rehabilitation period.

In case of exacerbation of uremia and the impossibility of immediately calling an ambulance team, the following emergency procedures can be carried out at home:

• prepare a hot bath (42°C) and place the patient in it for 15 minutes;
• then do an enema with water with the addition of salt and vinegar (not essence);
• After the enema has taken effect, give a laxative, such as senna.

When providing assistance, it is necessary to periodically give the patient water or serum to drink. Alkaline mineral water helps well in such cases. Put a cold compress or ice on the head. In case of nausea and vomiting, you can give the patient pieces of ice to swallow or drink cold tea.

Traditional medicine recommends wrapping the patient in a cold wet sheet, claiming that such an action has helped save more than one life. If there really is no medical help, then it is done like this: spread a warm blanket on the bed, and on top of that - a sheet soaked in cold water and well wrung out. Lay the patient on it, wrap him in a sheet, then a warm blanket. Cover him with a warm blanket on top, especially trying to keep the patient's feet warm. The cramps should pass, and having warmed up, the patient falls asleep for several hours. There is no need to wake him up. If the patient's cramps start again upon awakening, it is recommended to repeat the wrap.

Prepare a mixture of seven parts of pepper cumin, three parts of white pepper and two parts of the root of the saxifrage crushed to a powder state. Take the powder, washing it down with rosehip decoction, three or four times a day. This remedy is considered a useful component of the complex treatment of patients, even on hemodialysis.

Prevention of the concentration of nitrogen compounds and other toxins in the blood is considered to be daily consumption in the summer of parsley and dill, celery, lovage, lettuce and onions, as well as radishes and radishes, cucumbers and tomatoes. It is good to eat cabbage, carrots and beets raw, and also cook dishes from these vegetables. It is useful to eat dishes from potatoes, pumpkin and squash. Fresh berries have a cleansing effect:

• forest – cranberries, strawberries, blueberries, lingonberries, blackberries;
• garden - strawberries, raspberries, gooseberries, plums, chokeberries and red rowans, grapes.

Watermelons and melons will be useful. In spring, you can drink birch sap without restrictions. In the autumn-winter period, the already mentioned vegetables and apples, oranges, grapefruits are consumed.

Recipe for normalizing water-salt balance: unpeeled oat grains are poured with water, brought to a boil and simmered, without allowing boiling, on a tiny fire for three to four hours. Then the still hot oats are rubbed through a colander. The resulting jelly should be eaten immediately, a little honey is allowed to be added.

In case of uremia and urolithiasis, herbal treatment is used. It is recommended to drink nettle infusion, which is prepared in the following ratio: 200 ml of boiling water - a tablespoon of crushed dry nettle leaves. First, it is infused for a quarter of an hour in a water bath, then for ¾ of an hour - at room temperature. Strain and drink a third of a glass before each meal (three or four times a day).

For chronic kidney problems, kidney stones and uremia, it is recommended to pour two teaspoons of goldenrod herb with a glass of cold boiled water, leave for four hours in a closed jar. Then strain and squeeze lemon juice to taste. Drink a quarter of a glass for a month four times a day before meals.

Grind and mix 15 g of bull grass and parsley roots, rose hips and juniper, add 20 g of blackcurrant leaves and heather flowers. Brew a dessert spoon of the herbal mixture with boiling water (200 ml) for five minutes and strain. Drink three times a day for a month. Contraindicated in acute kidney pathologies, ulcerative lesions of the gastrointestinal tract, pregnant women.

Grind and mix 30 g of smooth hernia and horsetail, birch leaves and bearberry. Pour a tablespoon of the herbal mixture into an enamel bowl and add a glass of water. Boil over low heat with the lid closed for about three minutes. Leave the decoction to infuse for another five minutes. Strain, cool to a warm state and take three times a day for a month. Take with caution in case of acute cystitis.

Summer recipe - infusion of fresh lilac leaves: chop lilac leaves, take two tablespoons, brew with 200 ml of boiling water, bring to a boil and leave in a warm place for two to three hours. Strain, squeeze lemon juice into the infusion to taste. Take one tablespoon before four main meals. The course of treatment is two weeks, then after two weeks you can repeat it. It is recommended to carry out such treatment all summer, while there are fresh lilac leaves. In the fall - get examined.

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Homeopathy

Homeopathic medicines can help prevent uremic coma, as well as promote rapid and high-quality restoration of health and elimination of its consequences.

Ammonia (Ammonium causticum) is recommended as a powerful stimulant of cardiac activity in uremia, when traces of blood, proteins and hyaline casts are observed in the urine. The characteristic symptom of its use is bleeding from the natural openings of the body, deep fainting.

Hydrocyanic acid (Acidum Hydrocyanicum) is also a first aid drug in the agony of uremic coma. However, the problem is that these drugs are usually not at hand.

In inflammatory kidney diseases, in particular, pyelonephritis or glomerulonephritis (which, if chronic, can ultimately lead to the development of uremic coma), the drugs of choice are Snake Venom (Lachesis) and Gold (Aurum). However, if kidney inflammation was preceded by tonsillitis, chronic tonsillitis has developed, then Sulfur Liver (Hepar sulfuris) or Mercury preparations will be more effective. Therefore, in order for homeopathic treatment to help, it is necessary to consult a qualified specialist.

For prophylactic purposes in chronic uremia, the complex homeopathic preparation Bereberis gommacord is recommended. It contains three plant components in different homeopathic dilutions.

Common barberry (Berberis vulgaris) – enhances the drainage function of the urinary organs, has an analgesic, anti-inflammatory effect, promotes the elimination of excess salts, the removal of calculus deposits and prevents their deposition.

Bitter gourd (Citrullus colocynthis) – activates blood supply to the abdominal organs, relieves spasms, has a neutralizing and diuretic effect, eliminates renal colic.

White hellebore (Veratrum album) – has a tonic and antiseptic effect, has a beneficial effect on the functioning of the central nervous system, and restores an exhausted body.

It is prescribed as a drainage agent for pathologies of the urinary organs, joints, liver, digestive tract and dermatological diseases.

Drops are taken by patients over 12 years of age. Drop 10 drops into a container containing 5-15 ml of water and drink, trying to hold it in the mouth as long as possible. The drug is taken three times a day, a quarter of an hour before meals or an hour after.

The daily dose can be diluted in 200 ml of water and taken in small sips throughout the day.

To relieve acute conditions, a single dose of 10 drops is taken every quarter of an hour, but not more than two hours.

Side effects and interactions with other drugs have not been identified.

Complex homeopathic drops Galium-Heel act at the cellular level. It is one of the main drainage agents for the lung parenchyma, heart muscle, kidneys and liver. It is prescribed for detoxification of the body, for dyspeptic phenomena, renal dysfunction, kidney stone disease, as a diuretic, for bleeding, exhaustion, cerebral, cardiovascular and respiratory pathologies. Contains 15 components. Side effects have not been recorded. Contraindicated in case of individual sensitization.

It is used at any age. For children 0-1 year old, the recommended dose is five drops; 2-6 years old – eight drops; over six and adults – ten. To relieve acute symptoms, a single dose is taken every quarter or half an hour for one or two days. The maximum daily dose is 150-200 drops. The duration of treatment is one or two months.

The specificity of this homeopathic remedy suggests its use at the initial stage of treatment as monotherapy (or in combination with Lymphomyosot - a drug for cleansing the lymphatic system). It is recommended to prescribe the main drugs that affect the functioning of organs after a ten- to fourteen-day period from the start of drainage treatment. If it is impossible to postpone taking the organotropic drug, it is allowed to take Galium-Heel simultaneously with it. It is recommended to start taking this drug at the initial stage of the disease, when there are no pronounced clinical symptoms and complaints are minor, since by draining tissues, it prepares for the effective action of organotropic drugs, both homeopathic and allopathic. As a result, the effectiveness of treatment increases.

Lymphomyosot is a homeopathic preparation containing 16 components. Enhances lymph flow, relieves intoxication, swelling and inflammation, reduces exudation, activating cellular and humoral immunity. Available in drops and injection solution. Contraindicated in case of hypersensitivity to the ingredients. Be careful with thyroid pathologies. Skin allergic reactions may occur in rare cases.

The drops are dissolved in water (10 ml) and held in the mouth for absorption as long as possible, three times a day before meals half an hour or an hour after. Patients aged 12 and older are given 10 drops, infants - one or two, from one to three years - three, from three to six - five, from six to 12 - seven.

To relieve acute conditions, a single dose is taken every quarter of an hour, but not more than 10 times. Then switch to the usual dose.

In case of hyperthyroidism, take half the dosage corresponding to your age, increasing it daily by one drop and bringing it up to the age norm.

In severe cases, an injection solution is prescribed. A single dose is one ampoule and is used from the age of six. Injections are made two or three times a week intramuscularly, subcutaneously and intravenously, and at acupuncture points.

Oral administration of the solution from the ampoule is also possible; to do this, its contents are diluted in ¼ glass of water and drunk throughout the day at equal intervals, holding the liquid in the mouth.

Echinacea compositum CH is a complex homeopathic medicine containing 24 components.

Indicated for infectious and inflammatory processes of various genesis, including pyelitis, cystitis, glomerulonephritis, decreased immunity and intoxications. Contraindicated for active tuberculosis, blood cancer, HIV infection. Sensitization reactions (skin rashes and hypersalivation) are possible. Prescribed intramuscularly, one ampoule from one to three injections per week. In rare cases, an increase in body temperature may be observed as a result of immune stimulation, which does not require discontinuation of the drug.

Ubiquinone compositum, a multicomponent homeopathic preparation that normalizes metabolic processes, is prescribed for hypoxia, enzyme and vitamin-mineral deficiency, intoxication, exhaustion, tissue degeneration. The action is based on the activation of immune protection and restoration of the functioning of internal organs due to the components contained in the preparation. It is produced in ampoules for intramuscular administration similar to the previous remedy.

Solidago compositum C is prescribed for acute and chronic pathologies of the urinary organs (pyelonephritis, glomerulonephritis, prostatitis), as well as to stimulate urine output. Relieves inflammation and spasms, increases immunity, promotes recovery, and also has a diuretic and disinfectant effect, which is based on the activation of one's own immunity. It is available in ampoules for intramuscular administration similar to the previous product.

In case of vitamin absorption disorders, for regulation of oxidation-reduction processes, detoxification and restoration of normal metabolism, Coenzyme compositum is used. It is produced in ampoules for intramuscular injection, the principle of its action and application is similar to the previous means.

Surgical treatment

In case of irreversible changes in kidney tissue, to avoid a fatal outcome, there is only one way out - kidney transplantation. Modern medicine practices organ transplantation from another person.

This is a rather complicated and expensive operation, but it has already been performed many times and successfully. The indication for transplantation of this organ is the terminal stage of chronic renal dysfunction, when the organ's work is simply impossible, and the patient is awaiting death.

To maintain life while awaiting transplantation, patients are on chronic hemodialysis.

There are no uniform contraindications for transplantation; their list may differ in different clinics. An absolute contraindication is a cross-immunological reaction with donor lymphocytes.

Almost all clinics will not undertake surgery on an HIV-infected patient.

The operation is not performed in the presence of cancerous tumors, however, after their radical treatment, in most cases, a transplant can be performed after two years; for some types of neoplasms - almost immediately, for others - this period is extended.

The presence of active infections is a relative contraindication. After curing tuberculosis, the patient is under medical observation for a year, and if there is no relapse, he will undergo surgery. Chronic inactive forms of hepatitis B and C are not considered a contraindication to surgical intervention.

Decompensated extrarenal pathologies are relative contraindications.

The patient's lack of discipline during the preparatory stage may be the reason for refusing him an organ transplant. Also, mental illnesses that will not allow him to follow strict medical instructions are contraindications to transplantation.

In diabetes mellitus, which leads to terminal renal dysfunction, transplantation is being performed and is becoming increasingly successful.

The optimal age for this operation is considered to be 15-45 years. In patients over 45 years old, the likelihood of complications increases, mainly vascular embolism and diabetes.

Prevention

The main preventive measure is a healthy lifestyle, avoiding, if possible, injuries and poisoning, severe infectious diseases, as well as their careful treatment. People with congenital and chronic pathologies of the urinary system, diabetes, are recommended timely diagnosis and therapy to prevent exacerbations. All this will help to avoid serious renal dysfunctions.

An important place in preventive measures to prevent the development of uremic coma is occupied by the prevention of congenital kidney pathologies, the search for heredity markers and prenatal diagnostics, especially in high-risk married couples.

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Forecast

Uremic coma, which develops as a result of acute cessation of kidney function, is characterized by rapid progression and a high percentage of reversibility (from 65 to 95% of cases of survival). Most patients after the rehabilitation period have restored their ability to work and returned to normal life. Exceptions (fatal outcome) are particularly severe degrees of damage and the lack of the possibility of extrarenal purification.

In case of prolonged anuria from five days to a week, the cause of death may be excess potassium, excess water, acidosis. Uncontrolled arterial hypertension, circulatory disorders and other cardiovascular pathologies significantly complicate the clinical course and cast doubt on the favorable prognosis.

The life of a patient in the terminal stage of uremic coma can be extended only by using an artificial kidney machine. Regular hemodialysis procedures increase the life expectancy of patients with chronic uremia by up to 20 years or more (the known maximum was 22 years).

An organ transplant operation is performed in critical cases when renal replacement therapy is ineffective and there are no other options to save life. It allows to increase life expectancy by 10-15 years. During this entire period, recipients must carefully follow medical recommendations and take immunosuppressants, which have many side effects. A kidney transplant operation is a priority in the treatment of children, since hemodialysis negatively affects their development.

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