Uremical coma: emergency care, intensive care

Kidneys in the human body perform a very definite work. Their main function is eliminating. The kidneys remove water from the body and excess hydrophilic metabolites, including toxic substances and slags, pumping and purifying the blood. This function is inextricably linked regulation of acid-base and water-salt balance, maintenance of a normal quantitative level of osmotically active substances in the blood.

And if the areas of the kidney tissue cease to function normally, then toxic substances start to accumulate in the blood, which healthy kidneys are excreted from the body with urine.

The unconscious state caused by poisoning with endogenous toxins due to renal failure (cessation of filtration and reabsorption) is called uremia or uremic coma. This is the terminal stage of a serious renal failure with acute impairment of their function, or a final of irreversible changes in the kidneys due to the long-running chronic process.

Epidemiology

The most common infectious and inflammatory pathology of urinary organs, as evidenced by medical statistics, pyelonephritis. According to the data of pathoanatomical studies, this disease is detected in at least 6% of the dead, subjected to autopsy. The maximum pyelonephritis was found, according to different authors, in 18-30% of autopsies. It is believed that half of the patients who died in the state of uremic coma, its cause was precisely this pathology.

[1], [2],

Causes of the uremic coma

Most uremia develops with chronic kidney dysfunction caused by prolonged inflammation of the renal pelvis (pyelonephritis) or kidneys (glomerulonephritis), with multiple cystic kidneys or bilateral urolithiasis with periodic impairment of excretion and urinary retention. Chronic dysfunction of both kidneys develops with prostate adenoma and in diabetics. However, for any reason, the functioning areas of the kidney tissue can be reduced to a size insufficient to remove from the body accumulating toxic substances. Uremia with 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 uremia and chronic.

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

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

[3]

Pathogenesis

The main pathogenetic link in the mechanism of development of uremic coma is the increasing intoxication of metabolites, which in a healthy person are eliminated by the urinary organs. This leads to acid-alkaline 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 is characterized by the accumulation of nitrogen 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 disturbance of the water-electrolyte equilibrium, which is manifested in the early stages by increased urination and excretion (polyuria). The renal tubular function is impaired and the kidneys lose the ability to concentrate urine. Later, urination becomes meager (oliguria) and stops at all (anuria), which leads to the development of acidification of the body. The displacement of the blood and tissue fluid towards acidity (acidosis) causes oxygen starvation and hyperventilation syndrome.

[4], [5]

Symptoms of the uremic coma

This condition can occur in acute form and in chronic. The acute form of uremic coma is provoked by acute renal dysfunction in the period of inadequate urination (oliguria). At this moment, a sharp jump in the blood content of the products of nitrogen metabolism (azotemia) is observed, an odor of ammonia from the patient's body appears, the water-electrolyte balance changes, and not excreted water accumulates. There are symptoms of heart failure - increased heart rate, rhythm disturbance, heart pain, dyspepsia, anemia, brain swelling may begin. In acute uremic coma, cerebral symptoms grow very rapidly. Behind the asthenic syndrome follows depressive, then - hallucinations and delirium, followed by copulation and coma.

In chronic diseases, precomatomy symptoms increase with the death of kidney tissue, gradually. The first signs of uremia development are severe itching, headache, cognitive and visual disorders, asthenia (severe fatigue, dizziness, daytime drowsiness, 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 mucosa of the gastrointestinal tract, the serous membrane of the abdominal cavity and heart, pleura.

Azotemia leads to skin itching, digestive disorders, encephalopathy, inflammation of the serosa of the heart, anemia.

Dyspepsia is detected as a lack of appetite, often until the refusal of food. The patient complains of the dryness of the mucous membrane in the oral cavity and the taste of bitterness, the sensation of thirst is aggravated. From the skin and the mouth of the patient strongly smells of ammonia (urine). This smell with uremic coma is a characteristic symptom.

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 its elasticity, there is an increase in heart rate, hemostasis.

At the stage of polyuria, the K (potassium) content in the body decreases, which is manifested by weakness in the muscles, sometimes convulsive contractions occur, breathing becomes more frequent, pains appear in the heart zone. Patients with a growing symptomatology of uremia look specifically - swollen face with pale, dry skin, on the face and visible parts of the body there are bruises, bruises and hemorrhages. Characterized by edema of the legs, swelling and soreness in the lumbar region. There may be bleeding from the nose or in women - uterine, symptoms of gastric or intestinal hemorrhage.

Patients decrease urinary output and swelling, oligonuria is replaced by anuria. Intoxication is intensified, which is accompanied by a decrease in reactions from the nervous system, a deafened condition that can periodically be replaced by bouts of excitement, delirium and hallucinations. Often, with the development of a coma, a hemorrhagic stroke occurs. Acidosis always develops. The patient becomes more and more indifferent, then the oppression of consciousness and coma begins.

Stages

Stages of a coma state are classified according to the degree of impairment of consciousness:

1. The reactions of the patient are inhibited, motor skills and responses are practically absent, contact causes difficulties, but it is possible (stunning).
2. The patient sleeps with a sound sleep, from which it can be removed only for a very short period of time, applying a strong pain stimulus (sopor).
3. Complete loss of consciousness, no response to any stimuli. In this case, deep violations of the respiratory function, circulatory and metabolic disorders (coma) are observed.

An estimate of the depth of the disturbance of consciousness in coma is given by three features: eye opening, speech and motor reactions (the Glasgow scale). Kinds of comes by severity are as follows:

• I - moderate (from six to eight points);
• II - deep (from four to five);
• III - terminal (transcendental - the patient is gaining three points).

With a coma of the third degree, the death of the brain is established.

Chronic poisoning of the body contributes to the development of liver failure. In this case, ammonia, retained in the blood with the development of uremia, and the phenols that form in the intestine, in violation of renal excretion and hepatic function accumulate in the blood. These substances are given a leading role in the pathogenesis of hepatic encephalopathy and, as a consequence, coma. Although, to date, the mechanisms of the occurrence of such a phenomenon as uremic hepatic coma are still being studied. Edema of the brain on the background of severe renal and pulmonary insufficiency, and also - a decrease in the volume of circulating blood becomes the cause of death in a hepatic coma.

[6], [7], [8]

Complications and consequences

Acute uremia with adequately carried out treatment (hemodialysis) in most cases is curable, patients are fully restored in about a year, sometimes - for six months. However, in the absence of emergency care and lack of dialysis, in almost all cases a lethal outcome is observed.

The course of chronic pathology can be estimated for years, while the patient's condition will be completely satisfactory. The most innocuous, however, unpleasant consequence is the smell of ammonia from the body and the exhaled air. Constant intoxication does not pass without a trace for the body. Gradually disrupted the work of the liver, heart, nervous system, bone marrow. Loss of calcium leads to osteoporosis, anemia and thrombocytopenia lead to bleeding, impaired sensory functions - sight, 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.

[9], [10], [11], [12],

Diagnostics of the uremic coma

This condition is diagnosed by symptomatology, analysis results, instrumental diagnosis data, taking into account the patient's anamnesis and interviews of close relatives.

The main ones in the diagnosis of uremic coma are blood tests. Biochemical study of it gives an idea of the content of ammonia and ammonia compounds, creatinine, whose indices will exceed the norm. The level of concentration of the main electrolytes (Na, K, Mg, Ca) is also determined based on the analysis results.

The degree of disruption of the metabolism of organic substances determines the proteinogram (a study of blood levels of protein and protein fractions), a blood test for lipid spectrum and glucose level.

Urinalysis is not specific for uremic coma and indicates the presence of a common chronic kidney pathology. In the urine can be determined proteins, traces of blood, cylinders, talking about an acidic environment. Urine has a low density in polyuria, and high in oliguria.

Instrumental diagnosis is prescribed by a doctor if necessary. This is, first of all, ultrasound examination of the kidneys. For the diagnosis of the condition of other organs, electrocardiography, radiography, magnetic resonance imaging and computed tomography, ultrasound of the abdominal cavity organs, and the like can be prescribed.

According to research and laboratory tests, differential diagnosis is performed with other conditions: hepatic, ketoacidotic coma and severe renal dysfunction.

[13], [14], [15]

Treatment of the uremic coma

This condition requires the use of emergency measures to prevent the death of the patient. Emergency care for uremic coma consists of the following therapeutic measures. The patient's state is assessed according to the Glasgow scale. Then, first of all, they carry out resuscitation of the heart and lungs, restoring their work, try to keep the achieved (apply, if necessary, oxygenation and mechanical ventilation, cardiac massage). Regularly monitor the vital indicators - the pulse rate, the presence of breathing, blood pressure. They make a cardiogram, carry out emergency diagnostic procedures. Periodically in the process of resuscitation measures assess the state of consciousness.

The rinsing of the gastrointestinal tract is carried out with a 2% solution of sodium bicarbonate, salt purgatives are prescribed.

With salt deficiency, intramuscular injections of an isotonic saline solution of 0.25L are prescribed. Excess sodium is neutralized by  Spironolactone  , a  diuretic that does not excrete potassium and magnesium ions, but increases the excretion of sodium and chlorine ions, as well as water. It is selective at elevated pressure, its ability to reduce, reduces the acidity of urine. Contraindicated in anuria, liver failure, excess potassium and magnesium, sodium deficiency. May cause side effects on the part of the digestive system, central nervous system and metabolic processes. Assign a daily dose of 75 to 300 mg.

To reduce blood pressure, antihypertensives are prescribed, for example,  Kapoten, which  inhibits the enzymatic activity of the catalyst for the synthesis of angiotensin II (a hormone produced by the kidneys). Promotes relaxation of blood vessels, reduces blood pressure in them and stress on the heart. Arteries expand under the influence of the drug to a greater extent than the veins. Improves blood flow of the heart and kidneys. Provides a decrease in the concentration of sodium ions in the blood. The daily dose of the drug 50 mg reduces the permeability of the vessels of the microcirculatory bed and slows the development of chronic renal dysfunction. The hypotensive effect is not accompanied by a reflex increase in the pulse and reduces the need of the heart muscle in oxygen. Dosage is individual, depending on the severity of hypertension. Side effects - increased levels 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, which activate the functions of the blood system, which maintains its normal acid-base balance. The drug is injected slowly at a rate of 120 drops / min. The greatest daily volume of the injected substance should not be more than the calculated volume - 50ml per kilogram of the body weight of the patient. Application can lead to depressing respiratory function, exceeding the dose - to alkalization, vomiting, lowering glucose, blood pressure. The drug with renal failure is used cautiously.

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. Thus it is desirable to consider both individual sensitivity of the patient, and undesirable effect:

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

Normalization of protein metabolism is carried out with the help of  Retabolil. It is injected intramuscularly with 1 ml of a 5% solution. The drug effectively activates protein synthesis, eliminates depletion, compensates for nutritional deficiencies in bone tissue, however, it has a moderate androgenic effect. It is recommended that caution be exercised in renal and hepatic dysfunction.

Potassium deficiency is compensated by  Panangin  -  it is believed that the active substances (potassium asparaginate and magnesium asparaginate), entering the cells due to aspartigite, are poured into the metabolic processes. Normalizes heart rhythm, compensates for potassium deficiency. At complaints of the patient on a giddiness - reduce a dose of a preparation. A slow intravenous infusion of the solution is prescribed: one or two ampoules of Panangin - by ¼ or ½ liter of isotonic sodium chloride solution or glucose (5%).

Elevated levels of potassium in the blood stop: 0.7 liters of sodium hydrogen carbonate solution (3%) and glucose (20%).

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

A mandatory procedure that allows you to purify the body of accumulated toxic products of metabolism, excess water and salts, is the use of an artificial kidney apparatus (extracorporeal hemodialysis). The essence of the method is that the arterial blood is passed through a system of filters (artificial semipermeable membranes) and returned to the vein. In the opposite direction, bypassing the system of filters, a solution similar to the composition of blood in a healthy body flows. The device controls the transfer of essential substances into the blood of the patient and the harmful ones into dialysate. When the normal blood composition is restored, the procedure is considered complete. This method has been used for a long time and proved to be very effective in the treatment of acute or chronic uremia caused by both impaired renal function in case of their deficiency and in cases of acute exogenous intoxications.

In the presence of 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, ascorbic acid is prescribed, against which the immunity, vitamin D, which hinders the development of osteoporosis, vitamins A and E, useful for overdried, itchy and losing skin elasticity, vitamins B, necessary for hemopoiesis. Of these, pyridoxine (vitamin B6) is particularly useful. Its deficiency contributes to the rapid accumulation of urea in the blood. Her level decreases very quickly with a daily intake of 200 mg of this vitamin. Recommended daily intake of vitamins: B1 - minimum 30mg, E - 600 units, natural vitamin A - 25tys units.

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

Food also plays a certain positive role. It is necessary to consume at least 40 g of protein daily, otherwise the accumulation of urea is rapid. And it is necessary to give preference to vegetable proteins (beans, peas, lentils, bran). They do not contribute to the accumulation of sodium, as opposed to animals. To normalize the intestinal microflora, it is recommended to drink sour milk drinks.

Physiotherapeutic treatment can be used for preventive purposes and during the period of restorative treatment. Applicable magnetic, laser, microwave and ultrasound therapy. Methods of treatment are selected individually taking into account anamnesis, tolerability, concomitant diseases. Fizprotsedury improve blood circulation, have a thermal, physical and chemical effect on body tissues, stimulate the immune function, promote the removal of pain, inflammation, slowing down of dystrophic processes.

Alternative treatment

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

With the worsening of uremia and the inability to immediately call an ambulance team at home, the following urgent procedures can be performed:

• prepare a hot bath (42 ° C) and put the patient there for 15 minutes;
• then make the enema water with the addition of salt and vinegar (not essences);
• after the enema has acted, give a laxative, for example, senna.

When assisting, it is necessary to periodically water the patient with water or serum. Alkaline mineral water helps in such cases. Put a cold compress or ice on your head. With nausea, and also - vomiting, you can swallow slices of ice or drink cold tea.

Alternative medicine recommends wrapping the patient in a cold wet sheet, claiming that such an action helped save more than one life. If you really do not get any medical help, then it's done like this: a warm blanket is spread on the bed, on top is a sheet soaked in cold water and well wrung out. Put the patient on it, wrap the sheet, then with a warm blanket. From above, too, cover with a warm blanket, especially try to keep the feet of the patient warm. The cramps should pass, and after warming, the patient falls asleep for several hours. Do not wake him up. If on awakening the cramps in the patient begin again, the wrap is recommended to be repeated.

Prepare a mixture of ground to powder state seven parts of peppermint, three parts of white pepper and two parts of the root of the rock-thigh femora. Take the powder by washing it with a rosehip broth, three times or four times a day. Such a drug is considered a useful component of complex treatment of patients even on hemodialysis.

Prevention of the concentration of nitrogen compounds and other toxins in the blood is the daily consumption of parsley and dill, celery, lovage, lettuce and onions in the summer, as well as radishes and radish, cucumbers and tomatoes. In its raw form, it is good to eat cabbage, carrots and beets, and cook dishes from these vegetables. It is useful to eat dishes from potatoes, pumpkins and zucchini. Purifying effect of fresh berries:

• forest - cranberries, strawberries, blueberries, cranberries, blackberries;
• garden - strawberry, raspberry, gooseberries, plum, ashberry and red, grapes.

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

The recipe for normalization of the water-salt balance: unpeeled oats grains are poured with water, brought to a boil and tantalized, not allowing boiling, on a tiny fire for three or four hours. Then another hot oats are wiped through a colander. The resulting jelly must be eaten immediately, it is allowed to add a little honey.

With uremia, urolithiasis is treated with herbs. It is recommended to drink infusion of nettle, which is prepared in the ratio: 200ml of boiling water - a tablespoon of crushed dried nettle leaves. His first quarter of an hour insists on a water bath, then ¾ hours - at room temperature. Strain and drink a third of the glass before each meal (three or four times a day).

For chronic disorders of kidney function, kidney stone disease and uremia, it is recommended to pour two teaspoons of golden rosew grass with a glass of cold boiled water, to insist for four hours in a closed jar. Then drain and squeeze the juice from the lemon to taste. Drink a quarter of a cup for a month four times a day before eating.

Grind and mix 15g of the roots of bovine grass and parsley, hips and juniper fruits, add to them 20g of black currant leaves and heather flowers. Brew a dessert spoon of vegetable mixture with boiling water (200ml) 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 30g grass herb smooth and horsetail field, birch leaves and bearberry ordinary. A tablespoon of the plant mixture is poured into enameled dishes and filled with a glass of water. With the lid closed, boil over a small fire for about three minutes. The broth is insisted for another five minutes. Filter, cool to a warm state and take three times a day for a month. With acute cystitis, take with caution.

Summer recipe - infusion of fresh lilac leaves: chop the leaves of lilac, take two tablespoons, brew with boiling water in a volume of 200ml, bring to a boil and insist in the heat for two or three hours. Strain, squeeze into the infusion of lemon juice to taste. Take one tablespoon before four main meals. The course of admission is two weeks, then two weeks later you can repeat it. Such treatment is recommended to be spent all the summer while there are fresh leaves of lilac. In the autumn - to be surveyed.

[16], [17], [18], [19], [20]

Homeopathy

Homeopathic remedies can help prevent uremic coma, as well as contribute to the rapid and qualitative recovery of health and the elimination of its consequences.

Ammonium causticum (Ammonium causticum) is recommended as a potent stimulant of cardiac activity with uremia, when traces of blood, proteins and hyaline cylinders are observed in the urine. A characteristic symptom of its use are bleeding from the natural openings of the body, a deep faint.

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

In inflammatory diseases of the kidneys, in particular, pyelonephritis or glomerulonephritis (which during chronicization can lead to the development, ultimately, of uremic coma), the drugs of choice are Snake venom (Lachesis) and Gold (Aurum). However, if the inflammation of the kidneys was preceded by tonsillitis, chronic tonsillitis developed, then the Sulfur Liver (Hepar sulfuris) or Mercury preparations will be more effective. Therefore, for homeopathic treatment to help, you need to contact a qualified specialist.

For preventive purposes with chronic uremia, a comprehensive homeopathic preparation,  Beriberis gommakord, is recommended. It consists of three plant components in different homeopathic dilutions.

Barberry common (Berberis vulgaris) - strengthens the drainage function of the urinary organs, has an analgesic, anti-inflammatory effect, promotes the elimination of excess salts, the excretion of calculous deposits and prevents their deposition.

Pumpkin bitter (Citrullus colocynthis) - activates the blood supply to the peritoneum, relieves spasms, has a neutralizing and diuretic effect, eliminates renal colic.

Chemeritsa white (Veratrum album) - has a toning and antiseptic activity, it has a beneficial effect on the work of the central nervous system, restores the exhausted organism.

Assigned as a drainage, with pathologies of the urinary organs, joints, liver, digestive tract and dermatological diseases.

Drops are taken by patients older than 12 years. Pour 10 drops into a container containing 5-15ml of water, and drink, trying to hold in your mouth longer. The drug is taken three times during the day for a quarter of an hour before meals or an hour after.

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

For relief of acute conditions, a single dose of 10 drops is taken every quarter of an hour, however, no more than two hours.

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

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

It is used at any age. Children 0-1 years of age recommended dose of five drops; 2-6 years - eight drops; older than six and adults - ten. For relief of acute symptoms, a single dose is taken every quarter or half an hour for one or two days. The greatest daily dosage is 150-200 drops. Duration of admission is one or two months.

The specificity of this homeopathic remedy assumes its use at the initial stage of treatment as monotherapy (or in combination with Lymphomyosot - a drug for purifying the lymphatic system). Reception of the basic preparations influencing functioning of organs, it is recommended to appoint after a ten-fourteen day time interval from the beginning of drainage treatment. If it is not possible to postpone the administration of an organotropic drug, it is allowed to take Galium-Heel simultaneously with it. This drug is recommended to start taking in the initial phase of the disease, when there are still no significant clinical symptoms and complaints are minor, as draining tissues, it prepares for effective exposure to organotropic drugs, both homeopathic and allopathic. As a result, the effectiveness of treatment is increasing.

Lymphomyosot is a  homeopathic preparation containing 16 components. Strengthens the lymph drainage, removes intoxication, edema and inflammation, reduces exudation, activating cellular and humoral immunity. Issued in drops and solution for injection. Contraindicated in case of hypersensitivity to ingredients. With pathologies of the thyroid gland, exercise caution. In rare cases, skin allergic reactions can be observed.

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

For the relief of acute conditions, a single dose is taken every quarter of an hour, however, no more than 10 times. Then they switch to the usual reception.

With increased function of the thyroid gland take half the dosage corresponding to age, increasing it daily by one drop and bringing it to the age norm.

In severe cases, a solution for injection is prescribed. Single dose is one ampoule and is used from the age of six. Injections are done two or three times within a week by intramuscular sub- and intradermal, intravenously and acupuncture points.

Oral administration of the solution from the ampoule is also possible, for this purpose, its contents are diluted in ¼ cup of water and drunk throughout the day at regular intervals, retaining the liquid in the mouth.

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

It is shown in infectious and inflammatory processes of various genesis, including pyelitis, cystitis, glomerulonephritis, immunity decline and intoxication. Contraindicated with active tuberculosis, blood cancer, HIV infection. Possible reactions of sensitization (skin rashes and hypersalivation). It is prescribed intramuscularly for one ampoule from one to three injections per week. In rare cases, there may be an increase in body temperature as a consequence of stimulation of immunity, which does not require the withdrawal of the drug.

Ubiquinone compositum, a multicomponent homeopathic preparation, normalizing metabolic processes, is prescribed for hypoxia, enzymatic and vitamin-mineral deficiency, intoxication, exhaustion, tissue degeneration. The action is based on the activation of immune defense and restoration of the functioning of internal organs due to the components contained in the preparation. Produced in ampoules for intramuscular injection is similar to the previous agent.

Solidify compositum C  is prescribed for acute and chronic pathologies of urinary organs (pyelonephritis, glomerulonephritis, prostatitis), as well as to stimulate the excretion of urine. It removes inflammation and spasms, increases immunity, promotes recovery, and also - has a diuretic and disinfectant effect, which is based on the activation of its own immunity. Produced in ampoules for intramuscular injection is similar to the previous agent.

If the absorption of vitamins is impaired, Coenzyme compositum is used to regulate oxidation-reduction processes, detoxify and restore normal metabolism  . It is produced in ampoules for intramuscular injection, the principle of its action and application is similar to the previous ones.

Surgery

With irreversible changes in the kidney tissue, in order to avoid a fatal outcome, there is only one way out - kidney transplantation. Modern medicine practices organ transplant from another person.

This is a rather complicated and expensive operation, but it has already been carried out repeatedly and successfully. Indication for the transplantation of this organ is the terminal stage of chronic renal dysfunction, when the organ's work is simply impossible and the patient is expecting death.

To save life in anticipation of transplantation, patients are on chronic hemodialysis.

There are no single contraindications for transplantation, their list may differ in different clinics. Absolute contraindication is a cross immunological reaction with donor lymphocytes.

Practically in all clinics they will not undertake to operate the HIV-infected patient.

The operation is not performed in the presence of cancer tumors, however, after their radical treatment, in most cases it is possible to perform transplantation two years later, with some types of tumors - almost immediately, with others - this period is prolonged.

The presence of active infections is a relative contraindication. After curing tuberculosis within a year the patient is under the supervision of doctors, and in the absence of relapse, he will undergo an operation. 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 at the preparatory stage may be the reason for his refusal to transplant the organ. Also, mental illness, which will not allow you to comply with strict medical prescriptions, are contraindications to transplantation.

With diabetes, which leads to terminal kidney dysfunction, transplantation is carried out and increasingly successful.

The optimal age for this operation is 15-45 years. In patients older than 45 years, the likelihood of complications increases, mainly vascular embolism and diabetes.

Prevention

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

Important role in preventive measures to prevent the development of uremic coma is the prevention of congenital kidney pathologies, the search for heredity markers and prenatal diagnosis, especially in high-risk couples.

[21], [22], [23], [24], [25]

Forecast

The uremic coma, which develops as a result of acute renal cessation, is characterized by rapid progression and a high percentage of reversibility (65 to 95% survival rates). Most of the patients recovered from their rehabilitation after a rehabilitation period and returned to normal life. Exceptions (death) are particularly severe degrees of damage and the lack of the possibility of extrarenal cleansing.

With prolonged anuria from five days to a week, the cause of death can be a surplus of potassium, excess water, acidosis. Significantly complicate the clinical course and call into question the favorable prognosis of uncontrolled arterial hypertension, circulatory disorders and other cardiovascular pathologies.

To prolong the life of the patient in the terminal stage of uremic coma is possible only by applying the apparatus of an artificial kidney. Regular hemodialysis procedures increase the life expectancy of patients with chronic uremia for up to 20 years or more (the known maximum was 22 years).

The organ transplant operation is performed in critical cases, when replacement renal therapy is not effective and there are no other options for preserving life. It allows you to increase life expectancy by 10-15 years. During this period recipients should carefully follow the doctor's recommendations and take immunosuppressors that have a lot of side effects. The operation of kidney transplantation is a priority in the treatment of children, since hemodialysis negatively affects their development.

[26], [27], [28], [29]