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Pneumoconiosis pulmonary heart disease complicated by acute renal failure in 1 case

Penicillin) antibiotics, hormones, cough, asthma, blood pressure and other medication, nutritional support and oxygen therapy at the same time strengthening the patient's condition did not improve clinical, hold breath worse, not supine. Section 5d, oliguria (24h urine volume of about 200m1), blood gas analysis: pH7.282, PCOz4.63kPa, PO212.10kPa, K2.2mmol / L, HCO [16.0mmol / L, ABE9.6mmol / L, SBE9 .6 mmol / L, blood urea 49.4mmol / L, creatinine 872 ~ mol / L. Considered for acute renal failure, metabolic acidosis. Then adjust the treatment to protect renal function,[link widoczny dla zalogowanych], strengthen the anti-infection, oxygen therapy, to correct acid-base balance, rational use of diuretics. Section 6d, no urine, blood gas analysis: pH7.022, PCO25.38kPa, PO210.88kPa,[link widoczny dla zalogowanych], ABE18.7mmol / L,[link widoczny dla zalogowanych], SBE19.0mmol / L, K2.4mmol / L, HC0710mmol / L, blood urea 62.8mmol / L , creatinine 1090p. mol / L, WBC 17.9 × 109 / L. Section 7d, still no urine, further aggravating the disease, pale coma, call it can be, blood pressure, as 8/6kPa, in shock early verdict, anti-shock therapy, in 5:00,9:00,16:00 have upper gastrointestinal bleeding occurred 3 times, and finally 2O: O0 circulatory and respiratory failure and death. 2 discussion + North China Coal Medical Education (Internship) Hospital pneumoconiosis pulmonary heart disease complicated with renal failure was 3.7 ~ 37.3. Pneumoconiosis pulmonary heart disease of many heart and lung failure caused by renal failure, the patients without obvious heart and lung failure (only mild swelling of both lower limbs) in the case, the occurrence of acute renal failure and ultimately death, combined with the literature and clinical analysis as follows: ① a long history of patients with coal workers pneumoconiosis, Ⅲ only reached 14 years of history, due to severe lung damage caused by chronic hypoxia and carbon dioxide retention, reflex caused by renal vasoconstriction, renal blood flow reduction, lead to renal damage. ② patients with pulmonary heart disease and chronic obstructive pulmonary disease, and there is a history of recurrent pulmonary infection, illness caused by repeated exacerbations, often accompanied by acid-base imbalance and electrolyte imbalance, particularly acidosis, leading to impaired renal function. ③ 4 years in patients with a history of hypertension, antihypertensive treatment is not for the system, leading to renal arteriosclerosis, kidney damage. ④ older patients suffering from various chronic diseases, there is a history of repeated application of multiple drugs, most drugs affect kidney function, such as aminoglycoside antibiotics,[link widoczny dla zalogowanych], anti-TB drugs. ⑤ free silica to lung blood and lymphatic system into the kidney. Animal experiments and clinical studies confirm silica can cause irreversible renal toxicity]. ⑥ CWP patients with autoimmune diseases also result in kidney damage in the pathological changes, such as the glomerular basement membrane thickening, adhesions 2]. The role of these factors, patients with impaired renal function, on the one hand because there is a strong compensatory effect of the kidney, the other hand, kidney function may damage people's homes so check blood urea 6.0mmol / L, creatinine 148p. mol / L, urine (a), the clinical performance of non-renal failure. However, due to lung infection in patients not controlled in time, resulting in further aggravate the disease, deterioration of renal function in these factors on the basis of damage, because of: ① Pseudomonas aeruginosa in patients with sputum culture, bacterial toxins acting on the kidneys. ② patients in critical condition, the combination of multiple drugs adverse effects on the kidneys. ③ patients not eating may cause hypovolemia induced renal blood flow. ④ internal environment of the disorders, oliguria when, pH7.3 as acidosis, pH7. O2, anuria. These factors have contributed to renal function in patients with functional impairment by the shift to organic damage, leading to the occurrence of acute renal failure, development, and eventually death. Patients with acute renal failure, the timely adjustment of treatment programs to protect renal function, strengthen the anti-infection, oxygen therapy, to correct acid-base balance, rational use of diuretics. Hemodialysis is an effective method of treatment of acute renal failure, but the patients were in critical condition and due to economic factors but not for dialysis treatment, which may also be the ultimate treatment failure in patients with one of the reasons.
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