ANURY (anuria; grech, an-of otritsa. wetting +uron) — the termination of intake of urine in a bladder.
Distinguish the following types And.
Arenalny anury it is observed at an aplasia of kidneys at newborns or as a result of wrong removal of the only kidney.
Prerenalny anury arises more often owing to insufficient inflow of blood to kidneys (shock, heart failure) or its complete cessation (fibrinferments of an aorta, the lower vena cava, renal arteries or veins) and also as result of a hydropenia (blood loss, a profuse diarrhea, pernicious vomiting).
Insufficient inflow of blood to kidneys causes ischemia that leads to a necrosis of an epithelium of tubules, and further — to development of dystrophic changes in a renal parenchyma.
Renal anury (secretory) results from considerable defeat of a renal parenchyma, to-rogo is the cornerstone of an anoxia, the caused various reasons (intoxication, poisoning with organic poisons, salts of heavy metals etc.). In a pathogeny renal, as well as prerenalny, forms A. the main role is played by an anoxia. Distinction between these types And. is that the prerenalny form develops owing to ischemia and a circulator anoxia, and renal — owing to a gistotoksichesky anoxia. Morphological and functional changes in kidneys at prerenalny and renal And. are similar.
Subrenal anury (prerenal, excretory, obturatsionny) results from disturbance of outflow of urine from upper uric ways. Bilateral stones of kidneys, a prelum of ureters, wrong bandaging of ureters are a tumor the most frequent reason of it during operation.
Except the specified types And., some clinical physicians distinguish still reflex and peripheral and reflex and renal A. Reflektorno-perifericheskaya A. arises at action of irritants from various systems of an organism on absolutely healthy kidneys (e.g., at bougieurage of an urethra, immersion in a cold water etc.). Reflex and renal And. arises reflex owing to transfer of irritation from a sore kidney at obturation of its ureter on healthy (a renorenal reflex). In a pathogeny so-called reflex And. disturbance of blood circulation in a kidney therefore this look lies And. it can be carried to prerenalny.
Allocate also intoksikatsionny and traumatic A. Intoksikatsionnaya A. is a consequence of heavy general intoxication (e.g., sepsis, impassability of intestines, a hepato-renal syndrome); can be prerenalny or renal. Traumatic And. — manifestation of a syndrome of crush, crush also is prerenalny.
And. develops gradually at hron, diseases of kidneys and sharply when before its emergence functional capacity of kidneys was normal.
Prerenalny and renal And. are a sign of an oligoanurichesky stage of an acute renal failure. In the first days of a disease the condition of the patient can be satisfactory that depends on compensatory function of other bodies and systems participating in maintenance of constancy of internal environment of an organism. If And. develops against the background of a septic state, heavy bruises, extensive burns, the forecast is heavy from the very beginning of a disease.
At arenalny, prerenalny and renal forms A. disturbance of a homeostasis as a result of switching off of function of kidneys is observed. Disturbance of a homeostasis is shown by a number of the symptoms depending generally on change of azotovydelitelny and water and electrolytic functions of kidneys. Since 3 — the 4th day And. there are symptoms of uraemic intoxication that is followed by an azotemia, a giperkreatininemiya, disturbance of water and electrolytic balance and acid-base balance. At And. hyper - or a hydropenia, various disturbances of level of content of electrolytes, in particular potassium, towards its increase or reduction can be observed. And. always is followed by acidosis. At patients loss of appetite, nausea, vomiting is observed. Thirst, dryness in a mouth, a xeroderma are display of an extracellular hydropenia. At big losses of electrolytes thirst can be absent. On 5 — the 6th day And. there are symptoms of defeat of c. N of page: adynamy, headaches, muscle pains, drowsiness, sometimes excitement, crazy states. Disturbance of water and electrolytic balance of an organism causes changes of cardiovascular system against the background of hypo - or hyperpotassemias. If to the patient is able And. necessary help will not be given, on 10 — the 12th day comes death at the phenomena of the general intoxication.
At subrenal And. urine ceases to come to a bladder owing to obturation of upper uric ways. More often it occurs at occlusion of ureters stones. At subrenal And. uraemic intoxication (see Uraemia) develops much later, than at other forms. It is enough to recover a passage of urine at least on the one hand as an azotemia and other manifestations And. are liquidated. Subrenal And., resulting from obturation of upper uric ways, is followed by pain in lumbar area in the form of renal colic or the aching pains if And. developed gradually as a result of a prelum of ureters a tumor.
The diagnosis and the differential diagnosis
the Diagnosis is made on the basis of lack of urine in a bladder (is defined by catheterization) and symptoms of uraemic intoxication. It is necessary to differentiate And. from an acute ischuria, at a cut symptoms of a renal failure can be also observed. At differential diagnosis of different types And. the anamnesis is of great importance (the poisonings, diseases promoting emergence And., existence of pains in lumbar area) which allows to resolve an issue of its form (renal, subrenal etc.). With at least insignificant amount of urine (10 — 30 ml) its research allows to establish the reason And. (gemoglobinovy glybk at hemolitic shock, a myoglobin at a syndrome of crush etc.).
For differential diagnosis subrenal And. it is necessary to resort to tool and radiological methods of a research. Catheterization of ureters helps to make the correct diagnosis. Allocation of plentiful amount of urine on the catheter entered into a pelvis, or detection of an obstacle specifies in both ureters on subrenal (excretory, obturatsionny) And. If catheters freely manage to be entered on height of 30 — 32 cm and urine on them is not emitted, it indicates a prerenalny or renal form A.
Catheterization of ureters should be combined with a survey X-ray analysis, and if necessary — with a retrograde piyeloureterografiya after introduction on a catheter of 3 — 5 ml of radiopaque substance. Lack of changes on a piyeloureterogramma excludes subrenal And.
Treatment depends on a look, the reasons and manifestations And. At subrenal And. the main are the measures directed to recovery of the broken passage of urine: catheterization of ureters, an early operational grant in the form of a piyelonefrostomiya (see. Nephrostomy , Pyelostomy ). At arenalny, prerenalny and renal forms A. treatment of the patient shall be performed in the renal center (see) equipped with the equipment for carrying out dialysis (see. Hemodialysis , Artificial kidney , Peritoneal dialysis ).
If at subrenal And. a condition of the patient extremely heavy owing to uraemic intoxication, before an operative measure it is necessary to carry out a hemodialysis and after that to resort to piyelo-or nephrostomies. Considering weight of a condition of the patient, operation should be made on the most functionally capable kidney (pains in the corresponding half of lumbar area indicate the most functionally capable kidney).
At subrenal And. it is possible to define function of a kidney by means of a radio isotope renografiya (see. Renografiya radio isotope ); existence of a secretory piece of a curve indicates sufficient functional reserves of body. At prerenalny, renal forms A. as manifestation acute or hron, a renal failure the basic in treatment is recovery to standard of water and electrolytic balance, elimination of a hyperazotemia. For this purpose apply disintoxication therapy: intravenous administration of 10 — 20% of solution of glucose to 500 ml, 200 ml of 2 — 3% of solution of sodium bicarbonate. At And. it is not necessary to enter to the patient in total more than 700 — 800 ml of liquid a day since it is dangerous because of a possibility of development of a heavy extracellular overhydratation. Administration of the specified solutions should be combined with a gastric lavage and siphon enemas.
At And., the mercury caused by poisoning with drugs, use is shown Unithiolum (see). Unithiolum is appointed subcutaneously and intramusculary on 1 ml of 5% of solution for 10 kg of weight, in the first days by 3 — 4 injections, in the next days on 2 — 3.
All patients with an acute renal failure shall be treated in the renal center where use of devices of extracorporal dialysis is possible if necessary. The indication for use of «an artificial kidney» at And. serve: electrolytic disturbances, especially a hyperpotassemia, a giperkreatininemiya, an azotemia (content of urea in blood serum of 300 mg of % and above), an extracellular overhydratation. Use of a hemodialysis considerably reduced lethal outcomes at A. Odnako sometimes there is a need for renal transplantation (see).
An anury at children
At children, as well as at adults, arenalny, prerenalny, renal and subrenal forms A are observed., but the mixed forms meet more often.
Prerenalny And. it is noted at acute went. - kish. frustration, especially at children of chest age. At pernicious vomiting and a profuse diarrhea water and electrolytic exchange is broken, develops eksikoz, the hypovolemia also is broken blood supply of kidneys. The similar state can develop at the child in summertime at high temperature of air, at plentiful sweating and insufficient reception of liquid. Here it is necessary to carry cases physiological And. newborns, when in the first days after the birth the child has no mocheotdeleniye in connection with insufficient amount of the received liquid or its big loss with excrements. At babies And. can develop at a hemolitic disease of newborns (see). At this disease And. develops against the background of hemolitic anemia and thrombocytopenia. At duration And. from several days to two weeks the forecast serious.
Renal And. at children of early age arises at an acute vein thrombosis of kidneys, an acute hemorrhagic cortical necrosis of kidneys (see. Hemorrhagic cortical necrosis of kidneys), at defeat of the tubular device of kidneys, at various poisonings.
At children of advanced age renal And. it is observed at diffusion pathological processes in kidneys ( Glomerulonephritis , acute tubulonekroz, etc.). At a diffusion glomerulonephritis the anuretic phase develops on the first week of a disease and is liquidated at the correct treatment within several days.
Differential diagnosis renal And. it is necessary for establishment of the correct treatment; she is possible at the accounting of data of the anamnesis and clinical disease, and also germinated previous researches partial functions.
Treatment And. comes down to elimination of the reasons which caused it. In the presence of a considerable azotemia hold medical events, as at an acute renal failure (see).
Bibliography: Pytel A. Ya. About a pathogeny of an anury, Urology. No. 1, page 4, 1955; P y-tel A. Ya. and the Goal is also bitter also YS. D. Acute renal failure, Chisinau, 1963; they. An acute renal failure, the Management on a wedge, the Urals., under the editorship of A. Ya. Pytel, page 633, M., 1969, bibliogr.; Coal in R. K. Reflex anury, M., 1953, bibliogr.; Brun C. Acute anuria, Copenhagen, 1954, bibliogr.; R yo n at i-V a m about s F. and. Babies A. Anuria, therapeutical experiences, Budapest, 1972.
Yu. A. Pytel; V. P. Lebedev, E. I. Shcherbachova (ped.).