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Symptoms of polycystic kidney disease
Last reviewed: 23.04.2024
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Polycystic kidney symptoms have varied. They depend on the age of the patient, the number and size of cysts, the integrity of the organ parenchyma. The most common symptoms of polycystic kidney are pain in the lumbar and epigastric region, cardiovascular disorders, macrogematuria, palpable enlarged kidneys, thirst, polyuria and other symptoms of kidney failure.
Pain in the lumbar region in 40-70% of cases appears relatively early, and with age it is noted in 90% of patients. In the overwhelming majority of patients, it has a non-permanent, intermittent nature. The intensity of pain depends on the degree of disturbance of urodynamics and microcirculation in the kidney and the severity of pyelonephritis.
Pain in the epigastric region arises from the pressure of the enlarged kidneys on the intra-abdominal organs and from the tension of the ligamentous apparatus of the kidneys. Dyspeptic disorders in combination with pain are often mistaken for acute gastrointestinal diseases, which sometimes serves as an excuse for unjustified urgent laparotomy. Cardiovascular disorders are manifested by pain in the heart, headache, dizziness. In 70-75% of patients with polycystic kidneys symptomatic arterial hypertension with high diastolic arterial pressure (over 110 mm Hg) is observed, that is, in the majority of patients with arterial hypertension is malignant.
The degree of severity of hypertension depends on the ischemia of the renal tissue as a result of compression of the kidney parenchyma by the cysts, which leads to its atrophy and increased intrarenal pressure. In addition, developing pyelonephritis followed by asymmetric replacement of renal parenchyma with connective tissue aggravates renal dysfunction. In 70-75% of patients in the study of the fundus, retinopathy is determined.
Thirsty and polyuria are observed as symptoms of chronic renal failure of various stages. In the hot season, patients with polycystic kidneys drink up to 3-4 liters of fluid and secrete up to 2-2.5 liters per day. Thirst and polyuria characterize the impaired concentration ability of the kidneys.
Macrogematuria as a symptom of polycystic kidney disease is detected in 30-50% of patients, often it is short-lived, total and, as a rule, is not accompanied by life-threatening anemization of the body. The source of bleeding is more often the forixes, in which stagnant processes leading to papillitis develop. In most patients, macrohematuria can be eliminated with anti-inflammatory therapy, haemostatic drugs, rest. In rare cases, with significant hematuria, surgical intervention is necessary.
The kidneys in polycystic disease increase in 70-80% of patients, who often themselves probe the enlarged kidneys. Often there are mobile polycystic kidneys that are easily palpable through the anterior abdominal wall, have a tuberous, sometimes painful, surface.
[Complications of polycystic kidney disease
Complications of polycystic kidneys are very diverse and numerous, often they lead to death. A.V. Lulko et al. (1978) identified the following groups of complications: urological, neurological, nephrogenic hypertension. Urologic complications include pyelonephritis, urolithiasis, suppuration of cysts, hemorrhages in their cavity, and others. In addition, polycystic kidneys can be affected by neoplasms, tuberculosis.
The adherence of pyelonephritis in polycystic kidney causes the adherence of arterial hypertension, severe renal failure, significantly accelerating their occurrence. Neurological complications include intracerebral hemorrhage as a result of high hypertension. Seizures occur with hypocalcemia. Intoxication caused by a violation of nitrogen metabolism affects the metabolism of nerve cells. Hypertension is a constant companion of polycystic kidney disease in the stage of decompensation.
In the clinical course of polycystosis, several periods are distinguished. THEM. Thalmann (1934), E. Bell (1950), M.D. Javad-Zade (1975) distinguish five stages, N.A. Lopatkin and A.V. Lyulko (1987) in its classification - 3 stages: compensated, or subclinical; subcompensated; decompensated, or uremic.
For a compensated, or subclinical, stage characterized by a slow, latent flow, a slight dull pain in the lumbar region; In most patients, blood pressure does not increase, the functional capacity of the kidneys is slightly reduced.
The subcompensated stage is characterized by such symptoms of polycystic kidney as thirst, headaches. Fast fatigue of patients, dry mouth, nausea. Increased blood pressure, decreased ability to work. All these phenomena are associated with developing kidney failure.
In the decompensated stage of the disease, the symptoms of polycystic kidney and subcompensation are more pronounced and more severe. All patients are disabled. The functional state of the kidneys is strongly inhibited, their filtration and concentration ability is violated; significantly increases the concentration of urea, creatinine in the blood serum. In most patients, hypertension takes a malignant form, persistent anemia appears.