{"id":11,"date":"2021-10-30T10:36:00","date_gmt":"2021-10-30T10:36:00","guid":{"rendered":""},"modified":"2022-10-09T22:55:12","modified_gmt":"2022-10-09T22:55:12","slug":"linsuffisance-renale-tout-savoir-sur-linsuffisance-renale-aigue-ira-et-linsuffisance-renale-chronique-irc","status":"publish","type":"post","link":"https:\/\/avo6.com\/?p=11","title":{"rendered":"L’insuffisance R\u00e9nale"},"content":{"rendered":"
<\/div>\n
\n

\"insuffisance<\/a><\/strong><\/p>\n

Insuffisance R\u00e9nale Aigue (IRA)<\/strong><\/p>\n

D\u00e9finition\u00a0:<\/u><\/strong><\/p>\n

– Perte brutale et g\u00e9n\u00e9ralement r\u00e9versible, totale ou partielle des fonctions r\u00e9nales<\/p>\n

– Les causes et les m\u00e9canismes de l\u2019IRA sont tr\u00e8s vari\u00e9s<\/p>\n

– Mais elle provoque toujours un syndrome d\u2019ur\u00e9mie aigue<\/p>\n

Diagnostic biologique de l\u2019IRA\u00a0:<\/u><\/strong><\/p>\n

\u00e0\u00a0Le diagnostic de l\u2019IRA est essentiellement biologique<\/p>\n

    \n
  1. La r\u00e9tention azot\u00e9e\u00a0:<\/u><\/li>\n<\/ol>\n

    – Cr\u00e9atinine plasmatique\u00a0:<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0+ Elle augmente au cours de l\u2019IRA<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0+ Chez un sujet totalement anurique, elle peut augmenter de 200 \u03bcmol\/l par 24h<\/p>\n

    – Ur\u00e9e sanguine\u00a0:<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0+ El\u00e9vation constante au cours de l\u2019IRA<\/p>\n

    – Acide urique\u00a0:<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0+ C\u2019est un bon marqueur de l\u2019IRA\u00a0: car il y a baisse de la filtration glom\u00e9rulaire et augmentation de la s\u00e9cr\u00e9tion tubulaire<\/p>\n

      \n
    1. Diur\u00e8se\u00a0:<\/u><\/li>\n<\/ol>\n

      – En g\u00e9n\u00e9ral, l\u2019oligo-anurie est de r\u00e8gle dans les IRA<\/p>\n

      – Si diur\u00e8se inf\u00e9rieure \u00e0 100 ml\/24h\u00a0\u00e0\u00a0Dostach ou l\u00e9sion du parenchyme<\/p>\n

      – Il existe des formes d\u2019IRA \u00e0 diur\u00e8se conserv\u00e9e<\/p>\n

        \n
      1. Kali\u00e9mie\u00a0:<\/u><\/li>\n<\/ol>\n

        – L\u2019hyperkali\u00e9mie est le principal d\u00e9sordre \u00e9lectrolytique de l\u2019IRA<\/p>\n

        – Refl\u00e8te l\u2019impossibilit\u00e9 di rein \u00e0 excr\u00e9ter le K+<\/p>\n

        – Si [K +] > 6,5 mmol\/l\u00a0\u00e0\u00a0pronostic vital en jeu<\/p>\n

        – Le potassium Provient\u00a0:<\/p>\n

        \u00a0\u00a0\u00a0\u00a0\u00a0+ Une destruction cellulaire<\/p>\n

        \u00a0\u00a0\u00a0\u00a0\u00a0+ Sortie du K+ intracellulaire car acidose.<\/p>\n

          \n
        1. D\u00e9sordre acido-basique\u00a0:<\/u><\/li>\n<\/ol>\n

          – Au cours de l\u2019IRA le rein est incapable de\u00a0:<\/p>\n

          \u00a0\u00a0\u00a0\u00a0\u00a0+ Eliminer des ions H+<\/p>\n

          \u00a0\u00a0\u00a0\u00a0\u00a0+ R\u00e9g\u00e9n\u00e9rer les bicarbonates<\/p>\n

          – Ce qui cause une\u00a0\u00e0\u00a0acidose m\u00e9tabolique\u00a0:<\/p>\n

          \u00a0\u00a0\u00a0\u00a0\u00a0+ Compens\u00e9e par le system\u00a0\u00a0tampon et par le system respiratoire<\/p>\n

          \u00a0\u00a0\u00a0\u00a0\u00a0+ Le pH art\u00e9riel est g\u00e9n\u00e9ralement maintenu entre 7,30 et 7,35 avec des bicarbonates >15 mmol\/l<\/p>\n

            \n
          1. D\u00e9sordre phosphocalcique\u00a0:<\/u><\/li>\n<\/ol>\n

            – Pour l\u2019IRA on observe toujours\u00a0:<\/p>\n

            \u00a0\u00a0\u00a0\u00a0\u00a0+ Hyperphosphat\u00e9mie<\/p>\n

            \u00a0\u00a0\u00a0\u00a0\u00a0+ Hypocalc\u00e9mie<\/p>\n

            – Les valeurs du calcium et du phosphore se normalisent \u00e0 le reprise de la diur\u00e8se<\/p>\n

            Insuffisance R\u00e9nale Chronique (IRC)<\/strong><\/p>\n

            L\u00e9sions anatomiques progressives fonctionnelles irr\u00e9versibles des n\u00e9phrons<\/p>\n

              \n
            1. Etiologie\u00a0:<\/u><\/strong><\/li>\n<\/ol>\n

              – Les n\u00e9phropathies chroniques, acquises ou constitutionnelles, \u00e9voluent vers l\u2019IRC<\/p>\n

              – Les principales pathologies qui se compliquent par une IRC sont\u00a0:<\/p>\n

              \u00a0\u00a0\u00a0\u00a0 + N\u00e9phropathies glom\u00e9rulaire<\/p>\n

              \u00a0\u00a0\u00a0\u00a0 + N\u00e9phropathies interstitielles chroniques<\/p>\n

              \u00a0\u00a0\u00a0\u00a0 + N\u00e9phropathies vasculaires<\/p>\n

              \u00a0\u00a0\u00a0\u00a0 + N\u00e9phropathies constitutionnelles<\/p>\n

                \n
              1. Cons\u00e9quences\u00a0:<\/u><\/strong><\/li>\n<\/ol>\n

                –\u00a0\u00e0\u00a0Baisse de la filtration glom\u00e9rulaire (proportionnelle \u00e0 la r\u00e9duction n\u00e9phronique)<\/p>\n

                – Alt\u00e9ration progressive et d\u00e9finitive des fonctions tubulaires<\/p>\n

                –\u00a0\u00e0\u00a0Atteintes des fonctions endocrines<\/p>\n

                – R\u00e9tention de produits de d\u00e9gradation normalement \u00e9limin\u00e9s par les reins.<\/p>\n

                –\u00a0\u00e0\u00a0L\u2019augmentation de ces substances dans le sang refl\u00e8te le degr\u00e9 de L\u2019IRC<\/p>\n

                  \n
                1. Signes cliniques de l\u2019IRC\u00a0:<\/u><\/strong><\/li>\n<\/ol>\n

                  – Souvent discr\u00e8te et longtemps latente, son diagnostic est essentiellement biologique<\/p>\n

                  – Facile \u00e0 d\u00e9pister par les examens biologiques simples<\/p>\n

                  – Peut \u00eatre r\u00e9v\u00e9l\u00e9e devant l\u2019apparition de certains sympt\u00f4mes cliniques\u00a0:<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0 + \u0152d\u00e8me<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0 + Hypertension art\u00e9rielle<\/p>\n

                    \n
                  1. Diagnostic biologique de l\u2019IRC\u00a0:<\/u><\/strong><\/li>\n
                  2. R\u00e9tention azot\u00e9e\u00a0:<\/u><\/li>\n<\/ol>\n

                    – Cr\u00e9atinine\u00a0:<\/p>\n

                    \u00a0\u00a0\u00a0\u00a0 + Meilleur marqueur de l\u2019IRC en pratique<\/p>\n

                    \u00a0\u00a0\u00a0\u00a0 + Cr\u00e9at. > 180 \u03bcmol\/l\u00a0\u00e0\u00a050% des n\u00e9phrons d\u00e9truits<\/p>\n

                    \u00a0\u00a0\u00a0\u00a0 + Clairance de la cr\u00e9atinine, tr\u00e8s pratique dans l\u2019IRC<\/p>\n

                    – Ur\u00e9e sanguine\u00a0:<\/p>\n

                    \u00a0\u00a0\u00a0\u00a0 + Moins bon marqueur que la cr\u00e9atinine<\/p>\n

                    \u00a0\u00a0\u00a0\u00a0 + \u00c9l\u00e9vation de l\u2019ur\u00e9mie traduit le plus souvent une IR<\/p>\n

                    – Acide urique\u00a0:<\/p>\n

                    \u00a0\u00a0\u00a0\u00a0 + Hyperuric\u00e9mie d\u00e9r\u00e8gle dans\u00a0 l\u2019IRC<\/p>\n

                      \n
                    1. D\u00e9sordre phosphocalcique\u00a0:<\/u><\/li>\n<\/ol>\n

                      – Constants et augmentes avec la gravit\u00e9 et la dur\u00e9e de l\u2019IRC<\/p>\n

                      – Biologiquement, au cours de l\u2019IRC : + Hypocalc\u00e9mie<\/p>\n

                      \u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0+ Hyperphosphat\u00e9mie<\/p>\n

                      \u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0+ PAL et PTH augment\u00e9s<\/p>\n

                      – Urines\u00a0: Hyperphosphaturie et Hypocalciurie<\/p>\n

                      –\u00a0\u00e0\u00a0Atteinte osseuses\u00a0: + Hyperparathyro\u00efdie secondaire\u00a0\u00e0\u00a0ost\u00e9odystrophie r\u00e9nale<\/p>\n

                      \u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0+ Trouble du m\u00e9tabolisme de\u00a0la Vit D<\/span>\u00a0\u00e0\u00a0Ost\u00e9omalacie<\/p>\n

                        \n
                      1. Autres d\u00e9sordres biologiques\u00a0:<\/u><\/li>\n<\/ol>\n

                        – Trouble de l\u2019\u00e9limination hydrosod\u00e9e\u00a0: + Hyperhydratation et hyponatr\u00e9mie<\/p>\n

                        \u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0+ Apparaissent si la clairance cr\u00e9atinine<20ml\/min<\/p>\n

                        – Trouble de l\u2019\u00e9quilibre acido-basique\u00a0:<\/p>\n

                        \u00a0\u00a0\u00a0\u00a0 + Incapacit\u00e9 des reins \u00e0 \u00e9liminer les H+ lib\u00e9r\u00e9s par le m\u00e9tabolisme<\/p>\n

                        \u00a0\u00a0\u00a0\u00a0 +\u00a0\u00e0\u00a0Acidose m\u00e9tabolique (baisse du pH et des HCO3-).<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

                        Insuffisance R\u00e9nale Aigue (IRA) D\u00e9finition\u00a0: – Perte brutale et g\u00e9n\u00e9ralement r\u00e9versible, totale ou partielle des fonctions r\u00e9nales – Les causes…<\/p>\n","protected":false},"author":2,"featured_media":343,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0},"categories":[5],"tags":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts\/11"}],"collection":[{"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=11"}],"version-history":[{"count":3,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts\/11\/revisions"}],"predecessor-version":[{"id":570,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts\/11\/revisions\/570"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/media\/343"}],"wp:attachment":[{"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=11"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=11"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=11"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}