Overview
Sepsis is a systemic infection in which bacteria (pathogenic and conditionally pathogenic) invade the human blood circulation and grow and multiply in the bloodstream to cause toxemia-like symptoms. It usually has an acute onset and severe clinical manifestations, mainly manifested by persistent high fever, chills, and bacteremia. Gram-positive bacteria sepsis is prone to migratory foci, while Gram-negative bacteria are prone to infectious shock. The symptoms of septic renal impairment are similar to those of other infectious renal diseases.
Etiology
Increased reactivity of vasoconstrictor substances (e.g., certain cytokines, platelet-activating factor, endothelin, and adenosine) in sepsis, with the resulting hemodynamic changes and decreased renal blood flow, is one of the causes of renal failure complicating sepsis. In addition to this, there are also non-hemodynamic factors, such as bacterial migration with the bloodstream to the kidneys causing renal infections, and in patients with septic renal failure renal biopsies have revealed microscopic abscesses in the renal interstitium and renal tubular lumen. The development of sepsis-associated renal impairment is also multifactorial, such as endotoxemia, renal hypoperfusion, and the effects of nephrotoxic substances.
Symptoms
The main clinical manifestations are persistent high fever, chills, bacteremia, etc. Symptoms of septic renal impairment are similar to those of other infectious renal diseases, and should be distinguished.
1. Primary inflammation
Primary inflammation caused by various pathogenic bacteria is related to their distribution sites in the human body. Primary inflammation is characterized by local redness, swelling, heat, pain and dysfunction.
2. Symptoms of toxemia
The onset of the disease is rapid, often with chills, high fever, fever is mostly flaccid fever or intermittent fever, but also can be presented in the auditory fever, irregular fever and bimodal fever, the latter is mostly due to gram-negative bacillus sepsis. The fever is accompanied by different degrees of toxemia symptoms, such as headache, nausea, vomiting, abdominal distension, abdominal pain, body discomfort, muscle and joint pain.
3. Rash
It is seen in some patients, with petechiae being the most common, mostly distributed on the trunk, limbs, conjunctiva, oral mucosa and so on.
4. Joint symptoms
Redness, swelling, heat, pain and limitation of movement of large joints may occur, and even complicate joint cavity effusion and pus accumulation. This condition is mostly seen in the course of sepsis with gram-positive coccus, meningococcus, alkali producing bacillus and so on.
5. Infectious shock
It is seen in 1/5~1/3 of sepsis patients, manifested by agitation, rapid pulse, cold extremities, skin florid, decreased urine output and blood pressure, etc. Disseminated intravascular coagulation (DIC) can occur, which is caused by severe toxemia.
6. Hepatosplenomegaly
Generally only mildly enlarged.
7. Septic renal damage
Symptoms of renal impairment are similar to those of other infectious renal diseases, and there may be increased urea nitrogen, creatinine and abnormal changes in urine.
Examination
1. Blood picture
The total number of leukocytes mostly increases significantly, neutrophils increase, and there is a tendency of left shift of the nucleus. Occasionally, the total number of leukocytes does not increase, or even decreases, which may indicate a poor prognosis, and in the process of recovering from the treatment, the lymphocytes and eosinophils increase significantly, and the anemia is progressive.
2. Pathologic examination
In addition to blood culture, pathogenic bacteria may be isolated from the lesion site and lesion fluid.
(1) Positive bacterial culture
(2) Bacterial smear Direct smear examination of pus, cerebrospinal fluid, pleural effusion, ascites, petechiae, etc. can also detect pathogenic bacteria, which is of some reference value for rapid diagnosis of sepsis.
3. Blood and urine routine examination
Patients with sepsis combined with acute renal failure have elevated levels of platelet-activating factor (PAF) in blood and urine, obvious activation of neutrophils, obvious increase of neutrophils, positive blood culture, typical laboratory changes of renal insufficiency when renal ischemia leads to aggravation of renal insufficiency, proteinuria can be found in urine test, and a few leukocytes and tubular pattern can be seen, and the feces are more dilute and contain a little mucus. The feces are dilute and contain a little mucus.
4. Renal biopsy
Renal biopsy in patients with septic renal failure reveals tiny abscesses in the renal interstitium and tubular lumen.
5. Routine imaging tests
Ultrasound, electrocardiogram, etc. can help to detect the primary lesion.
Diagnosis
The disease can be diagnosed according to the clinical diagnosis of sepsis, combined with the clinical manifestations of renal failure and the positive results of laboratory tests.
Treatment
1. General symptomatic treatment
Bed rest, strengthen nutrition, supplement appropriate amount of vitamins. Maintain water, electrolyte and acid-base balance. If necessary, give blood transfusion, plasma, human albumin and human gammaglobulin. Physical hypothermia can be given in case of high fever, and sedatives can be given in case of irritability. Improvement of renal function is needed for the improvement and cure of sepsis.
2. Treatment of primary disease
Timely selection of appropriate antibacterial drugs is the key to treatment. Attention should be paid to the early, adequate amount and bactericidal agents; generally two antibacterial drugs combined application, rapid intravenous administration of the main; the first dose should be large, pay attention to the half-life of the drug, divided into doses; the course of treatment should not be too short, generally more than 3 weeks, or 7-10 days after the fever subsides before stopping the drug as appropriate.
3. Treatment of local lesions
Septic foci, whether primary or migratory, should be punctured or incised and drained in time on the basis of appropriate and sufficient amount of antibiotics. Purulent pleurisy, joint abscess, etc. can be injected with local antibacterial drugs after puncture and drainage. Surgery should be considered for biliary and urinary tract infections with obstruction.