Sepsis kidney damage

Introduction to sepsis and kidney damage Sepsis refers to a systemic infection in which bacteria (pathogenic bacteria and conditional pathogens) invade the human blood circulation and grow and multiply in the blood to cause toxic symptoms. Generally, the onset is acute and the clinical manifestations are severe. Gram-positive bacteria sepsis is prone to migratory lesions, while Gram-negative bacteria are prone to septic shock. The pathogen itself can be particularly concentrated in certain tissues, causing meningitis, endocarditis, pneumonia, liver abscess, arthritis, etc., reticuloendothelial system and bone marrow reactive hyperplasia, resulting in increased splenomegaly and white blood cell counts in the surrounding blood. Patients with severe infection and long course of disease, lung, kidney, subcutaneous tissue and muscle may have metastatic abscess or vascular infective embolism. Serious disturbance of human metabolism can cause water, electrolyte metabolism disorder, acidosis and nitrogen blood. Symptoms, microcirculation is affected, it leads to septic shock, and the occurrence of sepsis-related renal dysfunction is also multi-factor, such as endotoxemia, renal hypoperfusion, and the role of nephrotoxic substances. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: acute renal failure, septic shock, renal abscess

Causes of sepsis and renal damage

(1) Causes of the disease

The human body's defense system can quickly eliminate the pathogenic bacteria entering the blood circulation, causing no sepsis, but the number of pathogenic bacteria is too high, the reproduction is too fast, the virulence is strong, and the body's resistance or body resistance is exceeded. Reduce, such as old age, infants and young children, long-term consumptive diseases, malnutrition, anemia, etc., pathogenic bacteria can easily grow and multiply in the blood, produce toxins, cause sepsis and sepsis, improper treatment of local infections If the abscess is not drained in time, the wound is not completely debrided, and foreign body or ineffective cavity may be left, which may also cause such systemic infection. As for the long-term application of adrenocortical hormone, anticancer drugs or other immunosuppressive agents, it can weaken the normal Defensive function, broad-spectrum antibiotics can change the original symbiotic state of bacteria, so that some non-pathogenic bacteria overgrow and multiply, which is also a factor that is conducive to sepsis. In sepsis and sepsis, the pathology of various tissues and organs of human body Change with the type of pathogenic bacteria, the course of the disease and the situation of the original infection, due to the action of toxins, heart, liver, kidney, etc. have turbid swelling, focal Death and steatosis, alveolar hemorrhage and pulmonary edema, even transparent membrane in the alveoli, capillary damage caused by bleeding spots and rash, the pathogen itself can be particularly concentrated in certain tissues, causing meningitis, endocarditis, pneumonia , liver abscess, arthritis, etc., reticuloendothelial system and bone marrow reactive hyperplasia, resulting in increased splenomegaly and white blood cell counts in the surrounding blood, patients with severe infection and long course, lung, kidney, subcutaneous tissue and muscle can be transferred Sexual abscess or vascular infective embolism, severe disturbance of human metabolism can cause water, electrolyte metabolism disorders, acidosis and azotemia, etc., microcirculation is affected, leading to septic shock, sepsis-related renal dysfunction is also Multi-factors, such as endotoxemia, renal hypoperfusion, and the role of nephrotoxic substances.

(two) pathogenesis

The pathogenesis of sepsis complicated with acute renal failure is related to the following factors:

1. Sepsis often causes circulatory function and respiratory failure. The vasoconstrictor substances (such as certain cytokines, platelet activating factor, endothelin and adenosine) are increased in reactivity, resulting in hemodynamic changes and renal blood flow reduction. It is one of the causes of sepsis complicated with renal failure. In addition, there are also non-hemodynamic factors, such as bacterial migration with blood to the kidney to cause kidney infection, and renal biopsy in patients with septic renal failure found in the kidney. There is a small abscess in the interstitial and renal tubules.

2. Septicemia complicated with renal failure has obvious neutrophil activation. The effect of neutrophils on acute renal failure is still controversial. Recently, it has been found that neutrophils increase in sepsis and can aggravate kidney. Ischemia and renal insufficiency, the mechanism is that neutrophil integrin interacts with endothelial cell intercellular adhesion molecule-1 (ICAM-1) to weaken the protection of renal blood vessels, in addition to neutrophils It can also destroy the endothelium and reduce NO synthesis. Promoting free radical production also aggravates ischemic acute renal failure.

3. Septicemia can cause rhabdomyolysis syndrome to account for about 7.1%, of which 69% are caused by Gram-positive bacteria, most of which have acute renal failure (68.5%), and the septicemia caused by Gram-negative bacteria does not occur. The rate of multiple organ failure (40%) was similar to that of Gram-positive bacterial sepsis (45.7%); indicating that the syndrome is only one of the factors leading to renal failure.

4. The role of cytokines Mariano et al found elevated levels of blood and urinary platelet activating factor (PAF) in patients with sepsis complicated with acute renal failure, which is closely related to the severity of renal failure and impaired renal function. Related to other cytokines (such as TNF IL-1, IL-6, IL-8), suggesting that PAF may be involved in mediated toxic shock and renal dysfunction in sepsis, recently found tumor necrosis factor- and gram The endotoxin released by the negative bacteria, a lipopolysaccharide (LPS) in the cell membrane, can induce apoptosis of glomerular endothelial cells.

Septicemia kidney damage prevention

1. Strengthen labor protection, avoid trauma and wound infection, protect the integrity and cleanness of skin and mucous membranes, skin blemishes, avoid needles or doses.

2. Do a good job of disinfection and isolation of hospital wards to prevent cross-infection of pathogenic bacteria and conditional pathogens in hospitals.

3. Rational use of antibiotics and adrenocortical hormones, pay attention to prevent dysbacteriosis, when there is infection of fungi and other resistant strains, timely adjustment and treatment should be used. In case of sepsis or kidney damage, strong anti-infective and symptomatic treatment should be adopted. It is an effective measure to prevent kidney damage.

Septicemia and renal damage complications Complications acute renal failure septic shock renal abscess

1. Gram-positive bacterial sepsis is mostly complicated by acute renal failure. For example, bacteria migrate to the kidneys to cause kidney sensation, and small abscesses may appear in the renal interstitial and renal tubules.

2. Septicemia caused by Gram-negative bacteria is often complicated by septic shock and multiple organ failure, and the proportion (40%) is similar to Gram-positive bacterial sepsis (45.7%).

Symptoms of sepsis and kidney damage Common symptoms Nausea sepsis High heat shock Blood pressure relaxation Relaxation heat toxemia Irregular heat liver splenomegaly inflammation

The main clinical manifestations are persistent high fever, chills, bacteremia, etc. Symptoms of septic renal dysfunction are similar to other infectious kidney diseases, and should be identified.

1. Primary inflammation: The primary inflammation caused by various pathogens is related to its distribution in the human body. The primary inflammation is characterized by local redness, swelling, heat, pain and dysfunction.

2. Toxic symptoms: frequent onset, often chills, high fever, fever is mostly relaxation or intermittent heat, can also be retained heat, irregular heat and bimodal fever, the latter more Gram-negative bacilli Caused by sepsis, fever accompanied by varying degrees of symptoms of toxemia, such as headache, nausea, vomiting, abdominal distension, abdominal pain, general discomfort, muscle and joint pain.

3. Rash: Seen in some patients, the most common points are found in the trunk, limbs, conjunctiva, oral mucosa, etc.

4. Joint symptoms: There may be large joint redness, swelling, heat, pain and limited mobility, and even complicated joint fluid, empyema, this situation is more common in Gram-positive cocci, meningococcal, Alcaligenes and other sepsis In the course of the disease.

5. Infectious shock: seen in 1/5 to 1/3 of patients with sepsis, manifested as irritability, rapid pulse, cold limbs, skin spots, decreased urine output and blood pressure, etc., and can occur DIC, is a serious poison Caused by blood.

6. Hepatosplenomegaly: generally only mild swelling.

7. The symptoms of septic renal dysfunction are similar to other infectious kidney diseases, including urea nitrogen, creatinine and abnormal urine changes.

Septicemia kidney damage examination

1. Blood picture: Most of the white blood cells are significantly increased, neutrophils increase, and there is a tendency of left nucleus shift. Even the total number of white blood cells does not increase or even decrease, which may indicate poor prognosis. During the recovery process after treatment, Lymphocytes and eosinophils were significantly elevated, progressive anemia.

2. Pathogen examination: In addition to blood culture, bacterial culture may separate pathogens from the lesion site and the diseased body fluid.

(1) Positive bacterial culture.

(2) bacterial smear: pus, cerebrospinal fluid, pleural effusion, ascites, sputum and other direct smear examination, can also detect pathogenic bacteria, a certain reference value for the rapid diagnosis of sepsis.

3. Septicemia combined with acute renal failure patients with elevated levels of blood and urine platelet activating factor (PAF), with significant neutrophil activation, neutrophils increased significantly, blood culture positive, kidney deficiency When blood causes renal insufficiency, there may be a typical laboratory change of renal insufficiency. There may be proteinuria in the urine test, and a few white blood cells and casts may be seen. The stool is more loose and contains a little mucus.

4. Renal biopsy: Renal biopsy in patients with septic renal failure found a small abscess in the renal interstitial and renal tubules.

5. Regular imaging, B-ultrasound, electrocardiogram and other tests can help to find the primary lesion.

Diagnosis and diagnosis of sepsis and renal damage

According to the diagnosis of clinical sepsis, combined with the clinical manifestations of renal failure, the positive results of the laboratory test can diagnose the disease. For patients suspected of being sepsis, blood and pus should be cultured for examination. If the bacteria obtained are the same, the diagnosis is made. Can be established, but many patients have received antibiotics before the occurrence of sepsis, often affecting the results of blood bacterial culture, so that a culture may not get a positive result, so several times a day to draw blood for bacterial culture The best time to draw blood is to predict the occurrence of chills. Before fever, the positive rate can be increased. If necessary, the bone marrow can be used for bacterial culture. For clinical manifestations that are very similar to sepsis and blood bacterial cultures are negative multiple times, anaerobic should be considered. The possibility of bacterial or fungal sepsis, for those suspected of having anaerobic septicemia, blood can be used for anaerobic culture, for those suspected of fungal sepsis, urine and blood fungi can be examined and cultured, and ophthalmoscopy is performed. In fungal sepsis, the retina and choroid of the fundus often have small, white shiny rounded ridges.

Septicemia should be differentiated from gastrointestinal infections, poisonous bacillary dysentery, severe typhoid fever, miliary tuberculosis, encephalitis and recessive local infections. Septicemia and renal damage should be differentiated from other infectious kidney diseases.

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