Main causes of kidney dysfunction: symptoms and treatment recommendations. On the ambiguities in the criteria for determining the degree of impairment of body functions during MSE. What needs to be improved at the legislative level

FROM THE COURTROOM:

On ambiguities in the criteria for determining the degree of impairment of body functions when providing public services for conducting medical and social examination

On September 3, 2012, my son once again applied for public services for medical and social examination (hereinafter referred to as MSE) to Bureau No. 5 of the Federal State Institution MSE for the Novosibirsk Region (hereinafter referred to as NSO). At the MSE commissions, specialists from Bureau No. 5, Staff No. 4 and 2 GB ITU for NSO refused to recognize the need for measures of social assistance, protection and rehabilitation (recognizing him as disabled) in the presence of a complex set of diseases: (list of diseases).

Section III of the order of the Ministry of Health and Social Development of the Russian Federation No. 295n dated April 11, 2011 “On approval of the Administrative Regulations for the provision of public services for conducting medical and social examination” (hereinafter referred to as the “Regulations”) determines the timing and sequence of actions (administrative procedures) when conducting a medical and social examination in in order to improve the quality of public service provision and create comfortable conditions for receiving it.

Degree of dysfunction the body is characterized by various indicators and depends on kind functional disorders and methods their definitions.

Firstly, in the inspection reports and decisions of Bureau No. 5, Formations No. 4 and 2 GB of the FGU ITU for the Novosibirsk region not defined p.p. 10.2-10.13 the degree of severity of disorders of body functions caused by a complex set of diseases (list of diseases), symptoms of disorders are simply described in the reports.

To the main types of dysfunctions of the human body in accordance with clauses 3, 4 of the order of the Ministry of Health and Social Development of the Russian Federation No. 1013n dated December 23, 2009 “On approval of classifications and criteria used in the implementation of medical and social examination of citizens by federal institutions of medical and social examination” (hereinafter referred to as the “Order No. 1013n") include:

Violations of mental functions (perception, attention, memory, thinking, intelligence, emotions, will, consciousness, behavior, psychomotor functions);

Disorders of language and speech functions (oral (rhinolalia, dysarthria, stuttering, alalia, aphasia) and written (dysgraphia, dyslexia), verbal and non-verbal speech, voice formation disorders, etc.);

Impaired sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);

Violations of static-dynamic functions (motor functions of the head, torso, limbs, statics, coordination of movements);

Violations of circulatory functions, ..... metabolism and energy, internal secretion, immunity;

Violation of body functions is determined by comprehensive assessment various indicators and is characterized by four degrees of their severity:

1st degree - minor violations,

2nd degree - moderate violations,

3rd degree - severe disturbances,

4th degree - significantly pronounced violations.

Based on clause 7 of “Order 1013n” degree of limitation of basiccategories of human life activity are determined based on an assessment of their deviation from the norm, corresponding to a certain period (age) of human biological development.

ITU inspection reports contain information only on clause 10.1 about analysis of violations body (minor disturbances) according to mental functions based on the application of the following objective methods: “10 words of Luria”, “Schulz table, method of excluding objects, Luscher’s projective method.

Not included in the acts analysis of other violations body functions p.p. 10.2-10.13 specified in paragraph 3 of “Order No. 1013n”, determination of any indicators of these disorders in a complex of diseases (list of diseases) , based on an assessment of deviations from the norm in the biological development of a healthy person.

In acts the methods used to determine quantitative and qualitative level severity indicators(minor, moderate, severe) any dysfunction of the body pp. 10.2-10.13 (except for mental dysfunction - clause 10.1) associated with diseases (list of diseases).

FOR EXAMPLE, when describing symptoms (complaints) of dysfunctions of the body in reports: (list of symptoms of diseases) NOT DEFINED what violations these symptoms are (minor, moderate, severe), based on what standards their deviations are determined for (list of diseases), using what objective methods.

In acts absent description existing standards(in particular, norms of presence (disease symptom), norms of quantity (symptoms of disease), norms of presence (symptom of disease), corresponding to the biological development (age 26 years) of a person, and rating scales(slight, moderate, pronounced) functional deviations body, from these norms.

Secondly, based on clause 56 of the “Regulations”, at the request of the son, no additional examinations were carried out to determine rehabilitation potential and forecast. In the direction (form No. 088/у-06) Polyclinic No.…. these indicators are defined as short And doubtful. In 2011, Polyclinic No.... in the direction to the ITU also indicated that the rehabilitation potential and prognosis are “uncertain and doubtful.” In ITU acts in 2011, the rehabilitation potential and prognosis were replaced with “favorable”. In 2011, my son suffered a severe form of the disease again and, according to a CT scan of the brain, he has new lesions and secondary tumors that affect his health.

The question arises of how ITU commissions determine the feasibility and need for citizens to carry out rehabilitation and social protection measures and develop individual rehabilitation programs (IPR) without definition rehabilitation potential and prognosis development of diseases?

According to the “Regulations”, the head of the ITU GB can invite an employment service specialist with an advisory vote to the meeting of Composition No. 2 of the ITU GB. According to the son’s statement, the specialist was not invited to the ITU commission. He was sent to the employment center to conduct a selection of professions taking into account contraindications on diseases, but in the referral to the employment center, ITU specialists did not indicate either diseases or contraindications for them. Therefore, in the conclusion of the employment center, a list of professions is defined without taking into account diseases and contraindications on them. The son sent a letter about this to GB ITU. This claim to determine the list of professions without taking into account contraindications for diseases was left unaddressed. In turn, the employment center responded to such a claim and sent a letter to his son inviting him to re-select professions, taking into account the order of the Ministry of Health and Social Development of the Russian Federation No. 302n dated April 12, 2012.

Repeated selection of professions determined that, despite secondary specialized education (manager), the son was recommended to pursue professional activities in the field of specialties that do not require qualifications, such as packer, labeler, and packer. At the same time, the work mode (full or part-time), the level of tension and the volume of work performed are uncertain.

“Order No. 1013n” determines that the ability to perform labor activity (in accordance with the requirements for the content, volume, quality and conditions of work) 1st degree is the ability to perform labor activity in normal working conditions upon reduction of qualifications, heaviness, tension and (or) reduction in the amount of work, inability to continue working in the main profession while maintaining the opportunity to perform lower-skilled work under normal working conditions.

Requirements for the procedure were violated provision of public services for conducting MSE: failure to determine rehabilitation potential and prognosis when establishing the need for measures of social assistance, protection and rehabilitation; determination of ability to work and selection of professions failure to take into account contraindications for diseases; the severity of the dysfunction of the body has not been determined, clauses 10.2-10.13 in connection with diseases (list of diseases); indicators not specified, on the basis of which the severity of violations can be determined; no methods specified, with the use of which the indicators and severity of disturbances in body functions can be determined.

Third, During 2009-2012, Polyclinic No. ..... when filling out form No. 088/u-06 for referral to MSE, monitored the dynamics of my son’s health, taking into account a complex set of diseases (list of diseases). In February 2011, the referral to the ITU indicated that the last attack was in 2007, despite the fact that the Polyclinic No.... The son provided copies of emergency calls in 2010; in addition, in 2010 he had 75 seizures.

Conclusions of Bureau No. 5, Compositions 4 and 2 GB ITU on NSO are not comprehensive assessment of various indicators of dysfunction of the body, do not contain information about the severity disorders of body functions associated with a complex of diseases (list of diseases) based on existing standards corresponding to a certain period (age) of human biological development. Currently, my son cannot work due to frequent manifestations of the above symptoms; he does not receive treatment at Polyclinic No. .... at the place of residence of any treatment that contributes to his social adaptation and rehabilitation.

Response from ITU GB on NSO to numerous requests does not contain answers essentially to all questions posed; on time a copy of the act was not provided examination by Composition No. 2; no explanations given for ITU decisions Compositions 4 and 2 based on existing standards and methods for determining dysfunctions of the body in a complex of diseases; not explained, why additional examinations were not carried out to determine the rehabilitation prognosis and potential; again indefined a list of professions, taking into account contraindications for diseases and the degree of ability to work.

The procedure for conducting public services in accordance with the “Regulations” and regulations has been violated - not defined(clauses 10.2-10.12) degree of severity (minor, moderate, severe) of impaired body functions due to diseases; not defined rehabilitation potential and disease prognosis; the ability to work has been determined taking into account contraindications for diseases (list of diseases).

Not defined existing norms corresponding to a certain period (age) of human biological development; not defined the degree of disability as a result of diseases based on an assessment of deviations from these existing norms corresponding to a certain period (age 26 years) of biological development.

No substantive answers given to all questions regarding requests regarding information about health status, examination methods, and the degree of impairment of body functions as a result of a complex set of diseases.

Copy of the act examination by Composition No. 2 GB ITU for NSO provided only after two months, after the court sends a copy of the statement of claim to the ITU GB for NSO.

In order to ensuring transparency, objectivity ITU decisions and improving quality and efficiency medical and social expert services , quantification definitions degree of severity of diseases leading to disruption of body functions and restrictions of the main categories of life activity of varying degrees, a statement of claim was sent to the court to recognize the decision of the ITU GB on NSO as illegal due to non-compliance with the requirements for conducting an ITU.

To be continued…….

Shalamova Yu.V.,

Just a citizen who, after 4 years of disability, refused the humiliating procedure of the next examination 5 times, because... I'm retiring in six months...

P.S. But this cannot be done by my son at 26 years old, sick since birth, who has neither qualified medical care, nor proper dispensary registration and rehabilitation in order to recover, nor the right to social protection and rehabilitation.

EPIDEMIOLOGY OF DISABILITY

Disability indicators, being an important medical and social criterion of public health, characterize the level of socio-economic development of society, the ecological state of the territory, and the quality of preventive measures taken.

The word “disabled” comes from the Latin invalidus – weak, infirm. Disabled it is generally accepted that a person who has a health disorder with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of life activities and necessitating his social protection.

Under disability understand social insufficiency due to health problems with a persistent disorder of body functions, leading to limitation of life activity and causing the need for its social protection.

Thus, disability is a social deficiency. What is social disadvantage? Social disadvantage – these are the social consequences of a health disorder, leading to limitation of life activities, the inability (in whole or in part) to fulfill a person’s usual role in social life and causing the need for social protection.

The cause of disability is a health disorder with a persistent disorder of body functions, i.e. impairment of physical, mental and social well-being due to loss, disorder, anomaly of the physical, mental or anatomical structure or function of the human body.

3.1. Main causes of disability :

1. Disability due to a general illness is the most common cause of disability, except for cases directly related to occupational diseases, work injury, military trauma, etc.

2. Disability due to work injury is established for citizens whose disability occurred as a result of health damage associated with an industrial accident.

3. Disability due to occupational disease established for citizens whose disability occurred as a result of acute and chronic occupational diseases.

4. Disability since childhood: a person under the age of 18 who is recognized as disabled is assigned the status of “disabled child”; upon reaching the age of 18 years or older, these persons are determined to have “disability since childhood.”

5. Disability among former military personnel is established for diseases and injuries associated with the performance of military duties.

6. Disability due to radiation disasters is established for citizens whose disability occurred as a result of the liquidation of accidents at the Chernobyl nuclear power plant, PA Mayak, etc.

The degree of impairment of body functions is characterized by various indicators and depends on the type of functional impairment, methods for their determination, the ability to measure and evaluate the results. The following disorders of body functions are distinguished:

· disorders of higher mental functions (mental disorders, other psychological disorders, speech, language disorders);

· disorders of the senses (visual disorders, auditory and vestibular disorders, disorders of smell, touch);

· motor disorders;

· visceral and metabolic disorders, nutritional disorders;

· disfiguring disorders;

· violations associated with general reasons.

· Based on a comprehensive assessment of various parameters, taking into account their qualitative and quantitative values, three degrees of dysfunction of the body are distinguished:

1st degree – slightly expressed dysfunction;

2nd degree – moderately severe dysfunction;

3rd degree – pronounced and significantly expressed dysfunction.

As follows from the definition, disability leads to limitation of life activities, i.e. to the complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work activities. Thus, the main criteria for life activity that disability limits are:

· ability for self-service, i.e. the ability to cope with basic physiological needs and use common household items;

· ability to move, i.e. the ability to walk, run, move, overcome obstacles, control body position;

· ability to learn, i.e. the ability to perceive knowledge (general education, professional, etc.), mastery of skills (social, cultural and everyday);

· ability to orient, i.e. the ability to independently navigate the environment through vision, hearing, smell, touch, thinking and adequately assess the situation using the intellect;

· ability to communicate, i.e. the ability to establish and develop contacts between people through perception, understanding of another person, and the possibility of exchanging information;

· the ability to control one’s behavior, i.e. the ability to sense oneself and behave correctly in everyday situations.

Depending on the degree of deviation from the norm of human activity due to health impairment, the degree of limitation of life activity is determined. In turn, depending on the degree of disability and the degree of impairment of body functions, a person recognized as disabled is determined by the degree of disability.

The kidneys are a significant paired organ of the human urinary system. Despite their small size (about the size of a fist), they perform two main vital functions. The first is the absolute filtration of blood and fluid from unnecessary substances, the second is its removal from the body simultaneously with harmful products and toxins. Impaired kidney function can lead to serious pathologies and diseases. In order to prevent such consequences, it is necessary to understand the principle of operation of the mechanism, the causes of the failure, symptoms and diagnostics, as well as learn how to normalize the functioning of the system.

Causes of poor kidney function

Kidney dysfunction can occur for various reasons, ranging from congenital to acquired. A congenital disorder most often occurs when the disease is hereditarily transmitted from mother to child or when the formation of an organ is disrupted during intrauterine development.

On a note! Acquired pathologies are influenced by many reasons, for example, lifestyle or other diseases that a person has.

The main and most common reasons include the following, which provoke and cause severe renal dysfunction:

1. Alcohol abuse. Alcohol causes dehydration of the body, which causes the blood to thicken. As a result, the organ receives a colossal load and is forced to work in emergency mode.
2. Smoking. Due to the fact that toxic substances enter the human body along with tobacco smoke, the kidneys are forced to take on a double blow and speed up their performance in order to quickly cleanse the blood.
3. Obesity. People suffering from this problem are more at risk of dysfunction, because from excess fat tissue certain components begin to form and be released, which lead to a decrease in tone in the blood vessels. At this time, excess fat contributes to mechanical pressure on the organs of the urinary system, making it difficult to perform basic duties.
4. Rapid weight loss. Since the kidneys are located in a protective capsule of fat, a sharp decrease in weight leads to a thinning of this layer, which makes it vulnerable to external factors.
5. Hypothermia. A common cause of acute.
6. Diabetes. A heavy load due to high blood sugar leads to exhaustion of the system.
7. Hypertension. High blood pressure has an unfavorable effect on the condition of the renal vessels, which damages them and leads to disruption of the entire urinary system.
8. Unhealthy food. Fast food, processed foods and soda are the main health hazards.
9. Promiscuous sexual activity. Without the use of contraceptive methods, incoming infections affect the entire existing system and lead to inflammation of the paired organ.
10. Late pregnancy. In the literal sense of the word, the kidneys do the work for two, hence the overload occurs, the expectant mother suffers from dysfunction and edema.

Symptoms of urinary system dysfunction

Each person knows his usual state, the nature of the discharge, and any change should raise questions and suspicions.

Why don't the kidneys work well? The following are signs of poor kidney function:

1. Pain in the lumbar region.
2. High blood pressure. This fact indicates that the organ cannot cope with the removal of salt and water. This point applies to those who do not have problems with blood pressure.
3. Sleep disturbance. Insomnia is a companion to poor functioning of the paired organ and can act in tandem with respiratory arrest during sleep.
4. Apathy, loss of strength, lethargy. This is due to an increase in toxins in the blood vessels.
5. Deterioration of skin condition. Pale and dry skin indicate a change in the condition of the kidneys, as the water and salt balance is disturbed.
6. Modification of urination patterns. An increase or decrease in the amount of urine excreted is observed.
7. Presence of blood in urine.
8. Presence of foam. In connection with renal failure, it is revealed what causes bubbles and foam to form.
9. Decreased appetite, nausea and vomiting. These signs are justified by high intoxication.
10. Puffy look. Caused by excess fluid and loss of protein.
11. Muscle cramps. This happens due to deprivation of the body of potassium and sodium.
12. Swelling of the legs.

Symptoms of kidney disease are expressed by a number of signs, and it is not always possible to predict their sequence. According to statistics, kidney pathologies are observed among 3.5% of the population.

Consequences of renal dysfunction

If the kidneys are not working well, then the problem must be solved urgently and radically in order to prevent disastrous consequences. Some of them include:

1. Kidney failure. It represents a complete or partial loss of the ability to form and excrete produced urine. This results in disturbances in the balance of water, salt, acid and alkali, which disrupts other systems in the body. It is customary to distinguish between acute and chronic kidney failure. The first is characterized by a sudden onset, namely the absence of urine. The second is a gradual decrease in the urinary portion until it is absent.
2. Due to the problematic production of secreted fluid, the body is forced to accumulate toxins, which is fraught with poisoning by the products of its own vital activity. All this eventually kills an important organ. As soon as the work comes to naught, the patient loses his life.
3. Changes in the shape of the ureters. The usual outflow of urine from the body is disrupted, toxic poisoning appears, decomposition of the kidneys occurs and, as a result, the organ refuses to function.
4. During pregnancy, the importance of treatment is extremely high due to the risk of natural abortion.
5. There is a high probability of acquisition, which causes pronounced discomfort to the owner.
6. Spontaneous or.
7. Due to the presence of unnecessary impurities in the blood, the susceptibility to diseases such as and increases.
8. If you ignore treatment in the future, urine will stop flowing into the bladder. The body will not cleanse itself of toxins and waste products generated.

On a note! In order to avoid these consequences, you should carefully listen to the slightest changes in your body.

Diagnostics of kidney function

What to do if kidney function is poor or what to do if

Recommendations for the treatment of diseases of the urinary system

Treatment of kidney diseases should be done under the supervision of experienced and qualified doctors who will know the characteristics of the patient’s body. However, you can improve their condition on your own by following some recommendations:

1. Limit your intake of salt, meat and exclude canned food and fast food.
2. Monitor your weight by choosing a healthy diet.
3. Include more liquid in your diet in the form of water, tea, compote.
4. Give up bad habits and limit alcohol consumption.
5. Include physical activity. If visiting the gym is impossible for some reason, then walking or avoiding the elevator would be an excellent substitute.
6. Limit the use of painkillers.
7. Use protective agents against heavy metals, paints and solvents.
8. Dress warmly to avoid hypothermia.
9. Monitor blood pressure, sugar and cholesterol levels.
10. Regularly undergo basic tests to monitor your health.

· Minor violations:

1. reduction in muscle strength to 4 points with a full range of active movements;

2. shortening of the limb by 2-4 cm;

3. muscle wasting up to 5% of normal;

4. a slight increase in tone (with cerebral palsy) of the spastic type, incoordination of movements in the hyperkinetic form, which does not significantly affect the walking pattern;

5. electromyographic decrease in integrated (total) activity when walking by 10-25%.

· Moderate violations:

Difficulties in independent movement are identified, the duration of walking without fatigue is limited, the time spent on walking increases, which is due to

1. moderate (up to 3 points) decrease in muscle strength (for the gluteal and calf muscles up to 3 points);

2. muscle wasting by 5-9% of normal;

3. limitation of the amplitude of active movements in the hip, knee and ankle joints (15-20°);

4. moderate increase in muscle tone of the spastic type or muscle hypotonia with pathological (flexion, extension, adduction) settings in the joints during verticalization and walking, incoordination of movements in the hyperkinetic form, but with the ability to rely on a limb without auxiliary devices;

5. reduction (redistribution) of bioelectrical activity of muscles when walking by 25-50%;

6. moderate (30-40%) decrease in step length, walking tempo and rhythmicity coefficient;

7. the presence of shortening of the limb from 4 to 6 cm, failure of the osteoarticular system, necessitating the use of special orthopedic devices that improve the static-dynamic abilities of the affected limb.

For moderate functional impairments, additional support on a cane is possible.

· Expressed disorders.

With severe functional impairments, walking is usually possible either with outside help or with the use of special orthopedic devices, which is due to:

· Shortening of the limb by 7-9 cm;

· limitation of active movements in the hip (7-10%), knee (8-12%), ankle (6-8%) joints with a pronounced decrease in muscle strength up to 2 points;

· a pronounced increase (or decrease in flaccid paresis) of tone, leading to pathological settings and deformations (flexion, flexion-abduction or adduction contracture of the hip joint over (15-20°), extension at an angle over 160°, flexion-extension contracture of the knee joint more than 30 °, ankylosis of the joint in a vicious position of varus, valgus over 20-25°, equinus deformity of the foot at an angle of over 120°, calcaneal deformation of the foot at an angle less than 85°), pronounced discoordination with hyperkinesis. Ability to walk using complex orthopedic devices and additional support on crutches, walkers, or with assistance.

· A decrease in bioelectrical activity when walking by more than 55-75%, a decrease in step length by more than 50-60%, a decrease in walking tempo by more than 70%, and a decrease in rhythm coefficient by more than 40-50%.

· Significantly expressed disorders.

With significantly pronounced dysfunctions caused by flaccid or spastic paralysis, significant (over 50-60°) contractures of the joints, their ankylosis in vicious positions, verticalization of the patient and independent walking with outside help and the use of modern prosthetics is impossible. Electromyographic and biomechanical studies are not advisable.

The manual outlines general aspects of arthrology (structure and function of joints, classification of major joint diseases, methods of diagnosis and treatment of joint diseases, assessment of joint dysfunction), clinical features, diagnostics, differential diagnosis of the most common osteoarticular pathologies - osteoporosis, osteoarthritis, rheumatoid arthritis , ankylosing spondylitis, psoriatic arthritis, gout, paraneoplastic arthritis and lesions of the periarticular apparatus. The book reflects the features of articular pathology in old age. Modern literature information and a description of our own experience in using traditional and non-traditional methods of pathogenetic therapy for the pathology under discussion are presented, and the basics of medical and social examination for joint diseases are outlined.

Book:

Degree of severity of disturbance of static-dynamic function in pathology of the musculoskeletal system

Moderate disturbances of static-dynamic function are diagnosed in patients with moderate or severe joint contracture (reduction in range of motion by 21–34%), which, as a rule, is combined with damage to other joints and the spine without neurological manifestations. Constant, varying degrees of severity, lameness. When walking, the patient uses support, but not constantly; without rest, he can walk up to 1–1.5 km. Reduction in thigh circumference due to muscle wasting by 3–5 cm. Reduction in walking pace to 45–55 steps per minute.

A pronounced violation of the static-dynamic function is characterized by pronounced or significantly pronounced contractures of the joints (amplitude is reduced by 35% or more), dysfunction of the spine. Patients are forced to constantly use additional support: a cane or crutches. Severe lameness; you can walk 0.5 km without rest. Reduction in thigh circumference due to muscle wasting to 6 cm or more. Reduce your walking pace to 25–35 steps per minute.

A significantly pronounced violation of the static-dynamic function is determined by a sharp violation of the function of the joints with difficulties when changing posture, when trying to get out of bed or chair independently. It is possible to move with the help of others or in a wheelchair.