Pesticide poisoning nephropathy

　　1. Etiology:Long-term or improper use and contact with various pesticides can cause poisoning and lead to renal damage.

　　2. Pathogenesis:At present, it is not clear, and it may be related to the large accumulation of acetylcholine in the body after poisoning, which causes respiratory and circulatory disorders, systemic dehydration, shock, and renal vascular spasm, leading to renal ischemia and hypoxia, as well as direct damage to the kidney by toxic substances or their metabolites excreted through the kidney.

　　Mainly complicated with systemic multiple organ failure.

　　Multiple organ failure (MOF) is a clinical syndrome with a variety of etiologies, complex pathogenesis, and extremely high mortality rate. MOF refers to the syndrome of dysfunction or even failure of two or more organs in the body after severe damage (such as severe diseases, trauma, surgery, infection, shock, etc.). MODS is an acute systemic organ dysfunction closely related to stress.

　　Renal manifestations are generally not severe, mainly proteinuria and microscopic hematuria, with mild renal insufficiency, and extrarenal manifestations are more obvious, mainly dizziness, blurred vision, fatigue, profuse sweating, abdominal pain, tremors, and in severe cases, generalized convulsions, incontinence of urine and feces, pulmonary edema. Visible, the pupils are constricted, the mouth and nostrils can see a large amount of white frothy secretion, and a garlic-like smell can be detected.

　　Strictly control the dosage and method of medication, and pay attention to personal protection. During the medication period, attention should be paid to self-sensation, and in case of discomfort symptoms, it should be timely to leave the scene, handle the toxic substances, and closely monitor the changes in routine urine, urine enzymes, and renal function to prevent renal toxic damage. Pay attention to urine, blood, reasonable use of medication, treatment of diseases, care for the liver and kidney, and promote the functional recovery of the body. Actively prevent the occurrence of diseases.

　　1. Urinalysis

　　Visible proteinuria and microscopic hematuria, occasionally with cylindruria.

　　2. Blood cholinesterase (cholinesterase, CHE) activity determination

　　It can be found that the activity of CHE is reduced, and the degree of poisoning and prognosis can be judged according to the activity of CHE.

　　3. Identification of organic phosphorus pesticides

　　The organic phosphorus pesticide decomposition products in the patient's vomit, secretions, and urine can be measured to identify the type of poison, and renal pathology is mainly characterized by tubular injury, with tubular cell degeneration, swelling, and necrosis.

　　Due to the fact that pesticides can cause kidney function to decline after stimulating the kidneys, it is necessary to avoid eating or using drugs or foods that affect kidney function at this time. In terms of diet, it is advisable to eat light and easily digestible foods as the mainstay, eat more fresh vegetables and fruits appropriately, avoid eating cold, spicy, and刺激性 foods, avoid overeating and overdrinking, and avoid eating too much fat and protein-rich foods.

　　I. Treatment

　　Currently, some detoxifying drugs can be used for specific treatment, but clinical treatment is mainly symptomatic, such as timely gastric lavage, enhanced diuresis, and the use of adrenal cortical hormones, and dialysis treatment if necessary.

　　The specific method is:

　　1. Rapid removal of poison:Immediately leave the scene of poisoning, rinse contaminated skin with large amounts of clean water or soap water, and perform gastric lavage, catharsis, and other repeated measures.

　　2. Use of解毒drugs:Commonly used are anticholinergic agents such as atropine, which should be used in high doses and repeatedly, by intramuscular or intravenous injection; cholinesterase reactivators such as pralidoxime (Pralidoxime), chloridoxime (Chlorophenoxime) are all effective.

　　3. Symptomatic Treatment:Maintain respiratory function, urgently treat shock, acute pulmonary edema, and cardiac arrest, and critically ill patients can receive blood transfusion or blood exchange to supplement cholinesterase and ensure renal blood flow, preventing renal failure. Patients with renal failure should be treated according to renal failure protocols.

　　II. Prognosis

　　If the disease is quickly removed, timely symptomatic treatment is given, including gastric lavage, diuresis, and injection of detoxifying drugs, most lesions are reversible. If timely treatment is given, the prognosis is still good, but if the causative drug is not determined in time and the patient is not cleaned of the poison at the scene or treatment is not timely, kidney function can continue to deteriorate, and some patients may die from acute renal failure.