Kidney nephrocalcinosis military service. Pefrocalcinosis: why calcifications appear in the kidneys and how this pathology is treated

  • Date: 19.10.2019

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Many different factors of the environment in which humanity lives, provokes the occurrence of metabolic changes in the body. As a result of such violations, new compounds are formed, which eventually accumulate in certain organs and lead to the development various diseases.

Renal nephrocalcinosis - what is it?

Nephrocalcinosis is a pathological inflammatory process, which is characterized by diffuse precipitation of calcium phosphate salts on the walls of the renal tubules or in their parenchyma itself.

This disease often develops as a result of a violation of calcium metabolism in the human body for any reason. Calcium salts crystallize and are deposited in the tissues of organs, mainly in the renal tissue, sclerosis (scarring) develops. Nephrocalcinosis in almost all variants of development leads to kidney failure(chronic).

Types of pathogenetic aspects of the development of the disease

There are two types of nephrocalcinosis, which are classified according to etiological factors:

  • With the development of sclerosis and the deposition of calcium elements on the previously unchanged renal parenchyma, one can speak of the primary form of nephrocalcinosis;
  • In the secondary form of the disease, the sediment is fixed on the scar tissue of the kidney. This type of nephrocalcinosis begins simultaneously both from the cortical part and from the epithelium of the tubules.

According to the localization of calcifications in the kidney, the disease is classified:

  • Cortical nephrocalcinosis (calcium deposits are formed mainly in the cortical layer of the kidney);
  • Medullary (calcium precipitates in the areas of the renal pyramids).

The formation of calcium phosphate and its fixation in the kidneys is due to hypercalcemia and hypercalciuria (increased calcium concentration in the blood and urine). Due to the increased load, the kidneys cannot cope with their basic functions; sediment is fixed inside the epithelial cells of the renal tubules.

Then come dystrophic changes epithelium, calcium salts pass into the interstitial part of the renal tissue or into the lumen of the tubules, blocking them (cylinders). In the parenchyma, metastatic foci of calcium fixation provoke activation immune system, which leads to the replacement of normal kidney tissue with connective tissue.

Inflammatory changes occur due to blockage of the tubules of the kidneys and disruption of the normal passage of urine. Often as a complication, pyelonephritis occurs, as well as hydronephrosis of the kidney.

Deposition of calcium salts in the kidney

Causes

Causal factors in the development of primary nephrocalcinosis:

  1. Increasing the intake of calcium in the human body. The cause may be congenital tubulopathy in children, neonatal nephropathy, Burnett's syndrome and Lightwood-Fanconia, some other diseases.
  2. Pathological conditions in which calcium is heavily excreted from the bones: osteoporosis, hormonal imbalance (hyperparathyroidism), metastatic processes in the bone system and multiple myeloma, increased hormone levels thyroid gland.
  3. Increasing the level of vitamin D in the body, which is responsible for increasing the concentration of calcium in the blood.

Reasons for the development of a secondary form of nephrocalcinosis:

  1. Acute violation blood supply to the cortical layer of the kidneys.
  2. Radiation damage to the kidneys.
  3. Toxic effect on the body of mercury.
  4. Overdose or use of excessive amounts of phenacetin, sulfonamides.
  5. Abuse of various diuretics.
  6. Violations associated with changes in the acid-base balance of the blood.

Signs and symptoms

Nephrosclerosis and precipitation of calcium salts in the kidney parenchyma can have many different clinical manifestations.

First of all, there are signs of calcium intoxication of the body:

  • Nausea, bouts of vomiting;
  • Weakness and malaise, feeling thirsty;
  • Headaches and pains in the region of the heart;
  • Violations heart rate, changes in the ECG (shortening the period of contraction of the heart);
  • Itching skin, dryness and signs of peeling;
  • The joints are deformed, painful sensations appear in them when moving;
  • The motility of the intestines and stomach is disturbed, this causes painful abdominal cramps and constipation.
  • emotional lability;
  • Signs of hypertension may appear;

If the tubules of the kidneys and their epithelial cells, then there are painful sensations in the lumbar region, pyelonephritis or hydronephrosis may develop.

In case of blockage urinary tract appear Clinical signs urolithiasis.

Due to pathological calcification of the tubules of the kidneys, their sensitivity to the influence of antidiuretic hormone decreases, as a result, the following symptoms appear:

  • Persistent decline osmotic pressure urine;
  • Increase in daily diuresis;
  • Polydipsia (resulting from intense thirst).

Diagnostics

Necessary laboratory and instrumental methods for diagnosing kidney nephrocalcinosis:

  1. Nephrocalcinosis on early stages its development has practically no clinical manifestations. On the early stages the development of the disease most informative method diagnosis, but the most invasive is kidney biopsy using a puncture technique.
  2. Ultrasound examination (ultrasound) is considered a fairly informative method for diagnosing kidney calcification in the early stages. On the obtained image, when scanning in various planes and sections, one can see a symptom of perimedullary rings of high echogenicity. Also, kidney nephrocalcinosis ultrasound examination expressed the following signs: (with cortical form) linear hyperechoic neoplasms or diffuse nature of the inclusion.
  3. Radiography and CT are effective already in the late stages of calcification development, when triangular pyramids or linear calcifications in the cortical layer of the kidney are clearly visualized in the picture.
  4. To determine the etiological and pathogenetic conditions for the development of the disease in children and adults, blood and urine are taken to determine the content of calcium and phosphorus in them.
  5. Held general analysis biological fluids(urine and blood), their biochemistry and the Sulkovichka test (calciuria level).
  6. It is very important to evaluate functional state kidneys, for this, creatinine clearance is determined, the level of alkaline phosphatase is assessed.
  7. In order to determine the form of the disease (primary or secondary), the level of parathyroid hormone in the patient's blood is examined.

On the video, signs of early kidney nephrocalcinosis:

Treatment

The attending physician, having fully studied all the results of the patient's studies, prescribes drug treatment, the purpose of which is to eliminate the root cause of the disease:

  • With severe dehydration of the body and violation of the acid-base balance, it is necessary to carry out intravenous drip infusion of solutions (sodium or potassium citrate, potassium aspartate, sodium bicarbonate or sodium chloride).
  • If hypercalcemia is not significant, treatment is acceptable folk remedies, which necessarily include a diet.
  • Assign the intake of B vitamins orally or in injectable form.
  • With progression of renal failure or development coma perform hemodialysis.
  • A solution of magnesium sulfate or sodium phosphate is administered intravenously for hypercalcemia.
  • It is possible to prescribe hormonal medicines(prednisolone or thyrocalcitonin).
  • When signs of pyelonephritis appear, the corresponding this disease treatment.

Features of diet therapy

To lower the level of calcium in the blood, it is very important to exclude following products nutrition: sunflower oil, mustard, sesame, different kinds cheeses. Do not eat wheat flour, bran, almonds, dairy products, oatmeal.

You should adhere to diet number 7, which causes the removal of toxins from the body.

From folk methods treatment of kidney diseases can be noted strawberries, strawberry leaves in the form of a decoction. The decoction is taken orally for about 10 days daily.

Gooseberries, viburnum and sea buckthorn have a good effect (anti-inflammatory and diuretic effect).

Prepared decoction for warm sitz baths from birch leaves and sage improves blood circulation in the vascular bed of the kidneys, relieves inflammation.

Prohibited foods for kidney nephrocalcinosis

Forecast

With the progression of renal nephrocalcinosis, the prognosis for the future is unfavorable, since the development of renal failure and uremia is inevitable. With early diagnosis of the disease and proper treatment the prognosis for the development of the disease is more favorable. It is impossible to cure nephrocalcinosis with folk remedies, so it is very important to see a doctor in time.

Source: gidmed.com

Nephrocalcinosis

What is Nephrocalcinosis -

Nephrocalcinosis- a disease that belongs to the group of calcifications. Calcinosis, also known as calcareous degeneration, is a form of pathology of calcium metabolism in the body: calcium salts precipitate from liquids (they were dissolved in liquids) and precipitate, deposited in the interstitial tissue and in cells.

Nephrocalcinosis is a variant of metastatic calcification, in which calcium salts are diffusely deposited in the kidney tissue, which causes their inflammatory and sclerotic changes and.

Types of nephrocalcinosis according to clinical manifestations:

  • primary
  • secondary

In the primary, no changes in the kidneys are observed, and in the secondary, kidney pathology occurs along with the processes of precipitation of calcium salts. Nephrocalcinosis can occur, for example, in alkaline milk syndrome or Burnett's syndrome. It is likely in children who are switched from natural feeding to cow's milk with herbal supplements. Read more about the reasons below.

What provokes / Causes of Nephrocalcinosis:

Among the causes of primary nephrocalcinosis are:

  • conditions in which too much calcium enters the body (family and idiopathic hypercalcemia newborns, Burnett syndrome, Lightwood-Fanconi syndrome, sarcoidosis, excessive intravenous administration of calcium salts)
  • conditions in which calcium is mobilized from the bones (tumors of bones and some organs, multiple myeloma, tumor metastases in the bone, postcastration and corticosteroid osteoporosis, postmenopausal osteoporosis, multiple bone fractures, Paget's disease, neuroplegia, immobilization, thyrotoxicosis)
  • hypophosphatasia (impaired calcium binding in the bones)
  • oxalosis, calciphylaxis, in which calcium is deposited in tissues that are not normally needed there
  • tubulopathies and various diseases that occur with acidosis (chronic tubular acidosis of Battler - Albright, transient tubular acidosis of Lightwood, Lowe's oculocerebrorenal syndrome, glucose-phosphate aminoaciduria de Toni - Debre - Fanconi, hyperchloremic acidosis,)

Secondary nephrocalcinosis: causes

Among the most probable causes called:

  • radiation nephrosclerosis
  • ischemic cortical necrosis of the kidneys
  • abuse of sulfonamides, thiazide diuretics, phenacetin, ethacrynic diuretics, anthranil diuretics
  • uncontrolled use
  • mercury salt poisoning

Nephrocalcinosis can be caused by renal and extrarenal disorders of the acid-base balance. It is mainly metabolic and respiratory acidosis, in rare cases it is a metabolic alkalosis. With these diseases, the level of calcium in the blood rises, its excretion in the urine increases. The degree of calciuria can be a maximum of 400-600 milligrams in 24 hours.

Pathogenesis (what happens?) during Nephrocalcinosis:

The pathogenesis of calcifications

The matrix for calcium salts inside cells is lysosomes and mitochondria. Outside the cells, these are collagen and elastic fibers plus glycosaminoglycans of the main substance of the interstitial tissue. Calcium salts may be deposited in the form of grains, limestone pockets, which are distributed more or less in different occasions. In areas with lime, bone tissue can form, and around it there will be inflammation and a fibrous capsule.

In the pathogenesis of calcinosis, local and common factors. Therefore, the forms of calcification, in addition to the criterion of the location of calcifications, are distinguished according to pathogenetic factors. Calcification can be metastatic, metabolic and dystrophic, which is also known as (petrification).

Pathogenesis of nephrocalcinosis

An abnormally large influx of calcium occurs to the kidneys, it accumulates in the epithelial cells of the human kidneys. When there is too much intracellular calcium, cell dystrophy occurs. The deposited calcium enters the interstitial space or into the lumen of the tubules. In this process, cylinders are formed that block the tubules, so they dilate and atrophy. Salt deposits in the interstitium cause a lymphoproliferative reaction, then it occurs.

With nephrocalcinosis, infection and the formation of stones occur, because this disease becomes the source of pyelonephritis and / or hydronephrosis. The pathogenesis of primary nephrocalcinosis in children and adults is characterized by the fact that first there is a lesion proximal nephron, and the glomerulus and distal are affected later. If nephrocalcinosis is secondary, then calcium is deposited simultaneously in the distal nephron.

Symptoms of Nephrocalcinosis:

With nephrocalcinosis, there is usually an underlying disease. Therefore, two groups of symptoms appear at once, as well as concomitant hypercalcemia. Calcium toxicity causes the following symptoms:

  • fatigue
  • general weakness
  • vomit
  • dry skin
  • thirst
  • constipation
  • joint deformity
  • joint pain
  • mental instability
  • keratoconjunctivitis
  • seizures
  • shortening of the duration of systole on the electrocardiogram

With kidney damage, when the transport of substances in the tubules is disrupted and their sensitivity to antidiuretic hormone is lost, the following occur:

  • isosthenuria
  • polyuria
  • seizures are likely renal colic(when stones pass)
  • pain in the lumbar region

Often there are persistent changes in the urinary sediment, it contains a large number of bacteria, leukocytes, salt casts and erythrocytes. Later, edema is fixed, arterial hypertension. During this period, as a rule, symptomatic and laboratory signs kidney failure.

Complications:

  • Chronic renal failure
  • Obstructive uropathy
  • Stones in the kidneys

Diagnosis of Nephrocalcinosis:

Diagnosis of nephrocalcinosis at the stage of its appearance is based on the information obtained from the basis of a puncture biopsy of the kidney. Such a method as plain radiography is relevant only in severe cases, when calcification of the renal pyramids is significantly expressed.

To approximately determine the degree of calciuria, diagnosticians sometimes use the Sulkovich test. To clarify the cause of the disease, examine the patient's urine and blood for calcium and phosphorus, determine the activity of parathyroid hormone in the blood, alkaline phosphatase. Urinary excretion of hydroxyproline, acid-base balance, clearance and phosphate should be determined.

Nephrocalcinosis in the diagnosis is distinguished from a spongy kidney, in which the cystic spaces are filled with a condensate of calcium salts.

Treatment for Nephrocalcinosis:

It is necessary to eliminate the cause of calcium metabolism disorders in the body as soon as possible. With severe dehydration, infusions are made of a solution of bicarbonate or sodium citrate, potassium citrate and aspartate in case of acidosis, and in case of alkalosis, infusions of sodium chloride and ammonium are made.

If hypercalcemia is moderately severe, the patient is advised to follow a diet with foods that contain little or no calcium. Vitamin B6 and an infusion of magnesium sulfate solution are attributed. The treatment of acute hypercalcemia consists in the infusion of a solution of magnesium sulfate, sodium phosphate, sodium EDTA. Doctors may prescribe an injection or prednisone.

Treatment of progressive renal failure is mandatory with hemodialysis. It is important to adequately treat pyelonephritis, which causes progression of kidney failure. In secondary nephrocalcinosis, it is important to identify and treat the underlying disease, which acts as an etiological factor.

Forecast at effective treatment good at the beginning of the illness. An unfavorable prognosis in patients with progressive nephrocalcinosis, because in advanced cases, uremia occurs, threatening the health and life of the patient.

Prevention of Nephrocalcinosis:

  • You should get the optimal amount of calcium (no more and no less) with daily meals.
  • Do not take calcium supplements without a doctor's prescription.
  • It is important to treat on time.
  • If suspicious symptoms and any health problems appear, you should immediately contact a general practitioner, family doctor or a highly specialized doctor.

Which doctors should you contact if you have Nephrocalcinosis:

Nephrologist

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Algodysmenorrhea (dysmenorrhea)
Algodysmenorrhea secondary
Amenorrhea
Amenorrhea of ​​pituitary origin
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Ovarian apoplexy
Bacterial vaginosis
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genital tuberculosis
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germ cell tumors
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Interstitial nephritis
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Intestinal-genital fistulas of inflammatory genesis
Colpitis
Myeloma nephropathy
uterine fibroids
Genitourinary fistulas
Violations of the sexual development of girls
Hereditary nephropathies
Urinary incontinence in women
Myoma node necrosis
Incorrect positions of the genitals
Nephropathy of pregnancy
nephrotic syndrome
Nephrotic syndrome primary and secondary
Acute urological diseases
Oliguria and anuria
Tumor-like formations of the uterine appendages
Tumors and tumor-like formations of the ovaries
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Acute renal failure
Acute glomerulonephritis
Acute glomerulonephritis (AGN)
Acute diffuse glomerulonephritis
Acute nephritic syndrome
Acute pyelonephritis
Acute pyelonephritis
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Focal nephritis
Paraovarian cysts
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  • Stages of development of pathology

Nephrocalcinosis of the kidneys is called the deposition of calcium salts in a scattered manner in the tissues of the kidneys. This disease, related to calcifications (better known as renal dystrophy), is characterized by the presence of disturbances in the processes of calcium metabolism. Calcium salts contained in the liquids in the dissolved state settle and are deposited in the intercellular environment of the kidney and directly in its cells.

Kidney nephrocalcinosis is usually accompanied by inflammatory and sclerotic changes in combination with renal failure. Doctors singled out only two stages of the disease: primary nephrocalcinosis, which occurs in a kidney that has not yet been subjected to any structural changes, as well as secondary, in which deposits of calcium salts occur with subsequent modifications of the structure of the tissue of the organ.

There are two main stages of the disease: primary and secondary, which have different symptoms.
Primary nephrocalcinosis is characterized by:

  • violation in the bones of the process of Ca binding;
  • active release of Ca from bones;
  • tumor changes in a number of organs and skeletal system;
  • metastasis malignant neoplasms bone tissue;
  • corticosteroid and postcastration osteoporosis;
  • hyperparathyroidism;
  • numerous injuries in many bones at the same time;
  • osteomyelitis;
  • thyrotoxicosis and others;
  • pathologies leading to the accumulation of excess calcium in tissues and its deposition;
  • conditions causing the ingestion of excess calcium into the body;
  • a variety of disease states, the course of which causes acidosis.

Features of the secondary stage The occurrence of secondary nephrocalcinosis of the kidneys is due to:

  • misuse of amphotericin;
  • mercury fumes;
  • uncontrolled use of phenacetin, anthranil and thiazide diuretics, sulfonamides and ethacrine diuretics;
  • ischemic cortical necrosis of the kidneys. Due to the fact that during the development of the disease, the underlying disease and hypercalcemia, which is accompanying, are distinguished, two categories of symptoms are distinguished.

Signs caused by excess calcium: malaise, weakness, increased fatigue, nausea and vomiting, drying of the skin, constant thirst, pain and shaped changes in the joints, convulsions, nervous disorders, violations of the processes of digestion of food, a change in the systolic wave on the cardiogram, keratoconjunctivitis. Pathological changes in the structure of the body and the cessation of their normal functioning leads to:

  • short-term attacks of renal colic;
  • polyuria;
  • painful sensations in the lumbar region;
  • isosthenuria;
  • polydipsia.

Sometimes, in addition to the listed symptoms, specialists identify in large quantities erythrocytes, leukocytes, bacteria and salt formations in the composition of the urinary sediment. At later stages, arterial hypertension, edema, and proteinuria are found in the patient.

Back to index

Therapeutic procedures and preventive measures

To prevent the development of kidney nephrocalcinosis, it is necessary to monitor the amount of calcium supplied with fluids consumed. It should remain within the normal range. Do not use calcium-containing drugs without consulting a doctor. It is required to pay due attention to the ailments associated with the excretory system, in time to seek help from a specialist.

Timely detection of the disease guarantees half the success in further treatment.

At the initial stages, nephrocalcinosis is diagnosed using a method such as needle biopsy kidneys. In a more serious condition, they resort to survey radiography, which helps to detect salt neoplasms in the inner region of the kidneys. To identify the detailed causes of the pathology, a blood and urine test is prescribed to detect Ca and P, some hormones and other substances in them.

With kidney nephrocalcinosis, treatment is facilitated by the rapid elimination of the causes that caused disturbances in the metabolic processes of calcium in the body.

In the simplest cases, treatment is based only on dietary restrictions, namely, the doctor requires that foods containing calcium be excluded from the diet for a while. Severe dehydration is treated with infusions of sodium citrate and bicarbonate solution. Asparaginate and potassium citrate will help to cope with acidosis, and preparations of sodium chloride and ammonium will relieve alkalosis. The attending physician prescribes hemodialysis in cases with progressive renal failure.

Self-treatment attempts are strictly prohibited. With kidney nephrocalcinosis, treatment with folk remedies is inappropriate, since in medical literature there are no specific recommendations in the fight against this disease. By observing the correct diet and doctor's recommendations, you can forget about this disease forever.

The kidneys are a vulnerable organ that is susceptible to various infections, injuries and colds.

Therefore, it is necessary to constantly monitor their health and, if any problems appear, immediately engage in treatment.

The kidneys remove all excess substances from the body with urine, clearing it of unfavorable compounds, so the stability of their work is important.

Features of calcifications

With disturbed metabolic processes, calcium salts, calcifications, are deposited in the renal parenchyma.

These are the most common, which are areas of dead kidney tissue covered with a dense precipitate of calcium salts.

They form in the zone of infiltration inflammation.

Often the development of calcifications is observed with concomitant diseases.

Most often, single calcifications are not associated with oncology, and multiple formations may indicate the appearance of tumors of malignant origin.

This kind of deposits are formed with tabulopathy, Graves' disease, cystinosis, vitamin D deficiency,.

Kidney calcification is typical for athletes who consume large amounts of protein.

At the same time, there are no symptoms of kidney damage, and the pathology can be detected as a result of medical examination and ultrasound.

Varieties of deposits

The condition that characterizes the appearance of calcifications in the urine is called nephrocalcinosis, which is primary and secondary:

  1. In case of impaired development and congenital diseases of the urinary organs, when the tubules are affected (tubulopathy), calcium precipitates in the papilla zone and the filtration processes worsen. Such a phenomenon is called primary nephrocalcinosis, it is characterized by calcium deposits in the proximal region of the nephron.
  2. Secondary nephrocalcinosis is formed with sclerosis, ischemic necrosis of the renal tissues as a result of a tumor process or vascular pathology. Sometimes it manifests itself with mercury poisoning or an excess of drugs (ethacrine diuretics and amphotericin B). In this case, calcium accumulates in all parts of the nephron.

Features of the clinical picture

The disease can be asymptomatic (if calcification does not reduce the filtration capacity of the kidneys and there is no obstruction of the ureter).

In other situations, the symptoms of kidney calcification are:

  • general malaise;
  • violation of the digestive tract;
  • constipation;
  • pain in the joints;
  • rapid fatigue;
  • dizziness;
  • decreased appetite and sleep.

These symptoms are associated with blockage of the urinary tract by stones.

Also, small and can be detected in the urine. A large mass can block the lumen in the ureter, causing severe pain and appearance.

At in large numbers calcifications and with an increase in their size, the following symptoms appear:

Diagnostic methods

To determine the deposition of certain deposits in the kidneys, the doctor can use x-ray examination.

Due to the fact that the consistency of the stone is similar to the bone, on x-ray a dense stone-like formation is clearly visible.

A more detailed study can be carried out using magnetic resonance or. In this case, the exact parameters and location of the calcification are determined.

In the early stages effective method research is considered puncture, since with the help of x-rays and ultrasound it is not possible to see pathological changes.

Required for the most part to identify concomitant kidney disease.

The doctor also prescribes blood and urine tests for the concentration of this component. Parathyroid hormone and vitamin D levels are required.

A biochemical study of blood and urine is carried out, which reveals the presence of phosphorus and calcium, acid-base balance, alkaline phosphatase activity and excretion of hydroxyproline with urine.

On MRI, calcifications in the parenchyma of the right kidney

What can and should be done?

The main goal of treatment is to eliminate the factors that provoke kidney calcification.

To normalize the volume of calcium, the following methods are used:

  • citrate and sodium bicarbonate are introduced;
  • with alkalosis, sodium chloride (ammonium) is prescribed (to change the balance to alkaline environment), with acidosis, potassium aspartate (citrate) is introduced (to change the balance to an acidic environment);
  • B vitamins;
  • nutrition with a limited intake of calcium ions in the body.

When the process is running, an organ transplant or a program is carried out, which is an extrarenal blood purification. This is an efferent way of extracorporeal detoxification.

Nutrition Features

Diet with calcifications in the kidneys is of paramount importance.

To reduce the intake of calcium in the body, the consumption of sunflower seeds, mustard, sesame seeds is limited.

Also, do not eat:

The main nutrition corresponds to the treatment table No. 7 (to reduce extractive components and accelerate the removal of toxins).

Salt is excluded, cilantro, cinnamon, citric acid, cumin are added to the diet.

Also, the following measures are used to remove salts:

  • the use of diuretics and herbs (but the volume of fluid does not increase);
  • the use of anti-inflammatory drugs, since excreted salts cause pain, irritating the mucous membrane.

Preventive measures

There are no basic principles for the prevention of calcification, since there are so many reasons for the appearance of a pathological process.

But doctors advise to carry out timely and complex treatment inflammatory and infectious diseases.

You have to watch your diet quality products and controlling the composition of drinking water. You also need to keep active image life.

The recovery period depends on the stage of the pathological process.

Basically, at the initial stages, therapy becomes effective, but with the development of renal failure and progression, severe complications with the appearance that without surgery can lead to death.