Metastatic calcifications

Pathoanatomical studies were dominated by focal, so-called, metastatic calcifications in the soft tissues and internal organs. Much more often, calcification was determined in patients with CRF that were long treated by programmed hemodialysis, in comparison with patients who received only symptomatic therapy . The frequency of focal calcifications in the lungs is not the same in different studies. They were found in 10–70% of patients on programmed hemodialysis, and the extent of this lesion increased as the duration of dialysis treatment increased. . Calcium is deposited in the fibro-altered basement membrane of the alveolar septa, sometimes of the small bronchi in the form of linearly arranged granules and clumps inside the alveoli and bronchioles. The appearance of calcium deposits causes an inflammatory reaction with the subsequent development of fibrosis. It is important to note that metastatic pulmonary calcification may be an important etiological factor for pulmonary dysfunctions . Slightly less often, calcium in the form of individual clusters or single foci are found in soft tissues, most often in muscles.

The lifetime diagnosis of focal lung calcium is extremely difficult . When radiography of the chest, it is usually impossible to detect it because of the very small size of calcium deposits. The gentle shading arising from their combination with significant fibrosis of the alveoli and interstitium is usually mistakenly interpreted as pulmonary edema or pneumonia .

A peculiar pulmonary edema with characteristic radiological changes, rapid regression during dehydration was singled out into an independent syndrome. It is called uremic pulmonary edema . In the domestic literature, the term “nephrogenic pulmonary edema” is usually used .

Along with specific changes, many specialists have noted the accession of frequent infectious lesions of the bronchopulmonary and in patients with CRF . Fetal and interstitial forms of pneumonia are most common in hemodialysis treatment.

The most common and available methods for diagnosing pulmonary changes in chronic renal failure include radiography . Diagnosis of such clinically sluggish current lesions as uremic pneumonitis with the help of routine X-ray morphological methods of examination is very difficult. Meanwhile, while progressing, these lesions inevitably lead to impaired respiratory and non-respiratory functions of the lungs, aggravating the severity of the patients’ condition. There are extremely few works devoted to the use of such highly informative methods of radiation diagnostics as X-ray computed tomography in patients with CRF .

The morphological pulmonary changes described above in patients with chronic kidney disease, of course, lead to gross disorders of the function of external respiration. These include restrictive, obstructive disorders, deterioration of the diffusion capacity of the lungs and changes in the nature of ventilation . These disorders occur in various combinations, they may be transient, but they tend to increase and stabilize as the CRF progresses. A number of authors associate functional respiratory disorders with the development of uremic pneumonitis.

It is quite obvious that the first symptoms of pathological changes in the lungs in chronic renal failure are functional disorders, and assessment of respiratory function in the early stages of the development of a lesion is often the only way to diagnose. But the method of spirography has very limited possibilities in registering local, characteristic of the initial stages of uremic lung dysfunctions, since spirography, as is known, gives an integral (generalizing) indicator and local dysfunctions due to good compensatory lung capabilities, as a rule are not caught. Diagnostics of the earliest and, therefore, non-spread functional, yet reversible disorders is the key to adequate correction of the changes that have occurred.

AND ABOUT. Maslova (2002) conducted a comprehensive study of the bronchopulmonary system of patients with chronic kidney disease (patients with MM were not included in this study) using zonal x-ray densitometry, computed tomography and electronic x-ray tomography. The author has concluded that already in the initial period of the development of CRI, there are violations of the physiological regularity of the increase in ventilation in the apical-basal direction; as CRF progresses, zonal ventilation disorders are aggravated, mainly due to a decrease in ventilation in the middle zones (functional zones of the Vessel); when transferring patients with chronic renal failure to programmed hemodialysis with the elimination of overhydration in them, the indicators of general and regional ventilation improve; However, with an increase in the duration of dialysis treatment, a regular decrease in regional and integral lung ventilation indices was established, which is explained by the progression of lung lesions;computed tomography is essentially a verifying method of radiation examination of the chest and abdominal organs in patients with chronic renal failure, the sensitivity of CT in the detection of pulmonary changes in patients with chronic renal failure shats more than 25 times .

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