Symptoms of chronic renal failure, stages, treatment methods, drugs

Renal failure
ICD-10N 17 17. -N 19 19.
ICD-10-KMN19
ICD-9584 584 - 585 585
ICD-9-KM586, 404.12 and 404.13
Diseasesdb26060
MeshD051437

Renal failure - a syndrome of a violation of all kidney functions, leading to a disorder of water, electrolyte, nitrogen and other types of metabolism. There are acute and chronic renal failure.

There are 3 stages of increased severity of renal failure (risk, damage, failure) and 2 results (loss of kidney function, terminal renal failure). In childhood, the criteria for these stages are as follows:

Acute renal failure

Acute renal failure (ARF) may be the result of shock (traumatic, burn, blood transfusion, hemorrhagic, hypovolemic, etc.), toxic effects on the kidney of some poisons (for example, mercury, arsenic, mushroom poison) or drugs, infections, acute kidney diseases (nephritis, pyelonephritis, etc.), impaired patency of the upper urinary tract. The main signs of acute renal failure: oliguria - anuria (daily urine is less than 400-500 ml), a delay in the body of nitrogenous toxins, disturbances in water-electrolyte and acid-base balance, cardiovascular activity, anemia, etc. In acute renal failure, most cases are reversible and within 2 weeks (less often 1-2 months), diuresis is restored. Treatment is aimed at eliminating the causes of acute renal failure (shock, intoxication, etc.) and metabolic disorders. To prevent and combat uremia, hemodialysis or other methods of extrarenal blood purification are used. Recovery with recovery occurs after 3-12 months.

CRF criteria

The diagnosis of chronic renal failure is made if the patient has one of two options for renal impairment for 3 months or more:

  • Damage to the kidneys with a violation of their structure and function, which are determined by laboratory or instrumental diagnostic methods. In this case, GFR may decrease or remain normal.
  • There is a decrease in GFR of less than 60 ml per minute in combination with or without kidney damage. This indicator of the filtration rate corresponds to the death of about half of the kidney nephrons.

What it is?

Chronic renal failure (CRF) is an irreversible violation of the filtration and excretory functions of the kidneys, up to their complete cessation, due to the death of renal tissue. CRF has a progressive course, in the early stages it manifests itself as a general malaise. With an increase in chronic renal failure - severe symptoms of intoxication: weakness, loss of appetite, nausea, vomiting, swelling, skin - dry, pale yellow. Suddenly, sometimes to zero, diuresis decreases.

In the later stages, heart failure, a tendency to bleeding, pulmonary edema, encephalopathy, uremic coma develop. Hemodialysis and kidney transplant are indicated.

Chronic renal failure

Chronic renal failure (CRF) may result from kidney diseases (chronic diffuse glomerulonephritis, chronic pyelonephritis, renal amyloidosis, etc.), dynamic or mechanical disorders of the urinary tract (kidney stone disease, narrowing of the urethra, etc.), cardiovascular and collagen diseases, endocrine disorders (eg, diabetes mellitus), etc. It is accompanied by general weakness, sleep disturbances, itching, dyspepsia, anemia, high and persistent hypertension, electrolyte disturbances, in later tadii - polyuria (which is replaced by oliguria), polyneuritis finally azotemia, uremia. Treatment in the initial phase consists of treating the underlying disease leading to chronic renal failure, and prescribing nephroprotective drugs (inhibitors of the renin-angiotensin-converting enzyme), correcting blood pressure and lipid metabolism, prescribing a low-protein diet (necessarily under the control of nutritional status) with sodium restriction, symptomatic therapy. With the addition of disorders of mineral and hormonal metabolism characteristic of chronic renal failure (hyperparathyroidism), anemia, medications are prescribed for their correction. In the terminal phase of chronic renal failure, renal replacement therapy is used - chronic hemodialysis, peritoneal dialysis, kidney transplantation.

What leads to chronic renal failure

Almost any chronic kidney disease without treatment sooner or later can lead to nephrosclerosis with kidney failure to function normally. That is, without timely treatment, the outcome of any kidney disease such as CRF is just a matter of time. However, cardiovascular pathologies, endocrine diseases, systemic diseases can lead to renal failure.

  • Kidney diseases: chronic glomerulonephritis, chronic pyelonephritis, chronic tubulointerstitial nephritis, kidney tuberculosis, hydronephrosis, polycystic kidney disease, kidney cancer, nephrolithiasis.
  • Urinary tract pathologies: urolithiasis, urethral stricture.
  • Cardiovascular diseases: arterial hypertension, atherosclerosis, including renal angiosclerosis.
  • Endocrine pathologies: diabetes.
  • Systemic diseases: renal amyloidosis, hemorrhagic vasculitis.

Classification of chronic renal failure

There are several stages of chronic renal failure. The latent phase of the disease usually does not produce clear symptoms. You can detect them by conducting a series of in-depth clinical studies. In this case, proteinuria is noted, as well as a decrease in glomerular filtration within 50-60 ml / min.

When the compensated stage of the disease occurs, chronic renal failure, the manifestation of its symptoms allow certain conclusions to be drawn. The patient gets tired faster, his mouth constantly dries up. Urine volume increases, and density, on the contrary, decreases. You can observe an increase in the amount of urea, creatinine, and glomerular filtration is reduced to 49-30 ml / min.

With an intermittent stage, the symptoms of the disease cannot be ignored. Chronic renal failure progresses, various complications join. A steady increase in creatinine levels is noted, acidosis is observed, glomerular filtration drops to a value of 29-15 ml / min.

In the terminal stage, individual periods are distinguished:

  1. Diuresis of more than one liter per day. The glomerular filtration rate is 14-10 ml / min, diuresis of more than one liter is observed for 24 hours.
  2. Less urine is excreted, the daily volume is reduced to 0.5 liters. There are signs of fluid retention, hypercalcemia, hypernatremia, decompensated acidosis occur.
  3. The symptoms are brighter. Often there is heart failure, congestion is observed in the lungs and liver.
  4. The expressed uremic intoxication, hyponatremia, hyperkalemia, hypermagnesemia, hypochloremia are fixed. Heart failure progresses, polyserositis joins, liver dystrophy occurs.

General information

Chronic renal failure (CRF) is an irreversible violation of the kidneys. It occurs due to the progressive death of nephrons.

In this case, the urinary system is disrupted, uremia develops under the influence of the accumulation of toxins after nitrogen metabolism - urea, creatinine and uric acid.

In chronic insufficiency, a large number of structural units of the organ die and their connective tissue is replaced.

This provokes irreversible renal dysfunctions that prevent the blood from cleansing from decay products, and the production of erythropoietin, which is responsible for the formation of red blood elements, for the elimination of excess salt and water, is also disrupted.

The diagnosis of chronic renal failure is made when the disorders do not stop for three months or longer. Even with a small manifestation of an imbalance, the doctor should carefully monitor the patient in order to improve prognosis of the disease and, if possible, prevent irreversible changes.

General information

Chronic renal failure (CRF) - an irreversible violation of the filtration and excretory functions of the kidneys, up to their complete cessation, due to the death of renal tissue. CRF has a progressive course, in the early stages it manifests itself as a general malaise. With an increase in chronic renal failure - severe symptoms of intoxication: weakness, loss of appetite, nausea, vomiting, swelling, skin - dry, pale yellow. Suddenly, sometimes to zero, diuresis decreases. In the later stages, heart failure, pulmonary edema, a tendency to bleeding, encephalopathy, and uremic coma develop. Hemodialysis and kidney transplant are indicated.

Etiology and pathogenesis

The most common causes of chronic renal failure are chronic kidney disease, which is characterized by a slow destruction of the active parenchyma of the kidneys and its replacement with connective tissue. Chronic renal failure is the final stage of diseases such as chronic pyelonephritis, chronic glomerulonephritis, urolithiasis. In some cases, chronic renal failure occurs due to damage to the vessels of the kidneys with atherosclerosis and diabetes mellitus. Quite rarely, the cause of chronic renal failure is hereditary diseases: polycystic kidney disease, hereditary nephritis, and other diseases.

Damage to organs and systems in chronic renal failure

Blood changes. Chronic renal failure causes a decrease in hemoglobin levels. Hemopoiesis is inhibited, the life expectancy of red blood cells is reduced. There may also be a deterioration in blood coagulability, a decrease in prothrombin level, and thrombocytopenia occurs.

The reaction of the heart and lungs. In most patients, hypertension, myocarditis, pericarditis can be observed. Congestive heart failure occurs, and in the advanced case, uremic pneumonitis.

Complications of the nervous system. In the early stages of the central nervous system, such changes as sleep disturbance, problems with concentration of attention may occur, confusion in the mind, inhibited reactions are possible, hallucinations begin in difficult cases, the patient raves. Peripheral polyneuropathy is also observed.

Changes in the digestive tract. During the first phases, appetite often decreases, and the mouth dries up. Over time, stomatitis occurs, constant nausea, ending with vomiting, frequent belching. An irritated mucosa leads to manifestations of enterocolitis, atrophic gastritis. As a result, surface ulcers of the intestine and stomach arise, often provoking bleeding.

Problems with the musculoskeletal system. With chronic renal failure, various forms of osteodystrophy often occur: osteoporosis, fibrous osteitis, osteosclerosis, osteomalacia. Diseases can be manifested in arthritis, compression of the vertebrae, unexpected fractures, skeletal deformities, muscle pains that render to the bones.

Changes in the immune system. Chronic renal failure is often accompanied by lymphocytopenia. Due to inhibition of the body's defenses, various purulent-septic complications develop.

How does chronic renal failure develop?

The process of replacing the affected glomeruli of the kidney with scar tissue is simultaneously accompanied by functional compensatory changes in the remaining ones. Therefore, chronic renal failure develops gradually with the passage of several stages in its course. The main reason for pathological changes in the body is a decrease in the rate of blood filtration in the glomerulus. The glomerular filtration rate is normally 100-120 ml per minute. An indirect indicator by which to judge GFR is blood creatinine.

  • The first stage of chronic renal failure - initial

At the same time, the glomerular filtration rate remains at the level of 90 ml per minute (normal version). There is evidence of kidney damage.

It suggests kidney damage with a slight decrease in GFR in the range of 89-60. For the elderly, in the absence of structural damage to the kidneys, such indicators are considered the norm.

In the third moderate stage, GFR drops to 60-30 ml per minute. In this case, the process occurring in the kidneys is often hidden from the eyes. There is no bright clinic. Possible increase in urine output, a moderate decrease in the number of red blood cells and hemoglobin (anemia) and associated weakness, lethargy, decreased performance, pale skin and mucous membranes, brittle nails, hair loss, dry skin, decreased appetite. Approximately half of patients have an increase in blood pressure (mainly diastolic, i.e. lower).

It is called conservative, as it can be restrained by drugs and, like the first, does not require blood purification by hardware methods (hemodialysis). In this case, glomerular filtration is maintained at a level of 15-29 ml per minute. Clinical signs of renal failure appear: severe weakness, decreased ability to work against anemia. Increased urine output, significant urination at night with frequent nightly urges (nocturia). Approximately half of patients suffer from high blood pressure.

The fifth stage of renal failure is called terminal, i.e. the ultimate. With a decrease in glomerular filtration below 15 ml per minute, the amount of urine excreted (oliguria) drops until it is completely absent in the outcome (anuria). All the signs of poisoning the body with nitrogenous slag (uremia) appear on the background of disturbances in water-electrolyte balance, damage to all organs and systems (primarily the nervous system, heart muscle). With this development of events, the patient’s life directly depends on the dialysis of the blood (cleansing it bypassing broken kidneys). Without hemodialysis or a kidney transplant, patients die.

Causes of CRF

Chronic renal failure can result in chronic glomerulonephritis, nephritis in systemic diseases, hereditary nephritis, chronic pyelonephritis, diabetic glomerulosclerosis, renal amyloidosis, polycystic kidney disease, nephroangiosclerosis and other diseases that affect both kidneys or a single kidney.

Reasons for development

The development of chronic kidney failure is preceded by more serious factors than salt abuse or banal hypothermia. The main causes of the onset are an existing urinary tract disease. But in some clinical cases, the infection present in the human body may not be associated with the kidneys, despite the fact that it ultimately affects this paired organ. Then CRF is defined as a secondary disease.

Diseases leading to kidney failure:

  1. Glomerulonephritis (especially chronic form). The inflammatory process covers the glomerular apparatus of the kidneys.
  2. Polycystic The formation of multiple vesicles inside the kidneys is cysts.
  3. Pyelonephritis. Inflammation of the renal parenchyma, which is of bacterial origin.
  4. The presence of congenital or acquired (post-traumatic) malformations.
  5. Nephrolithiasis The presence of multiple or single stony deposits inside the kidneys - calculi.

The disease develops against the background of such infections and conditions:

  1. Diabetes mellitus insulin-dependent type.
  2. Damage to connective tissue (vasculitis, polyarthritis).
  3. Viral hepatitis B, C.
  4. Malaria.
  5. Uric acid diathesis.
  6. Increased blood pressure (arterial hypertension).

Also, regular intoxication with drugs (for example, uncontrolled, chaotic drug intake), chemicals (work in the paint and varnish industry) predisposes to the development of chronic renal failure.

Treatment

Treatment of chronic renal failure is primarily aimed at eliminating the causes that cause this condition. Measures to combat shock, dehydration, hemolysis, intoxication are applicable. Patients with acute renal failure are transferred to the intensive care unit, where they receive the necessary help. Due to the fact that in acute renal failure, the function of both kidneys is suddenly and completely impaired, the only effective treatment is extracorporeal blood purification using hemodialysis or peritoneal dialysis.

In the early stages of chronic kidney disease, nephroprotective treatment, diuretics are used. With the development of terminal renal failure (uremia), hemodialysis, peritoneal dialysis is used, with encephalopathy, osteopathy and myopathy: plasmapheresis, hemoperfusion, hemosorption, depending on the initial etiopathogenetic factor, and predominant renal failure syndromes. In toxic etiology, most often hemodialysis, in combination with complexones, antidotes, intestinal dialysis, absorbents, depending on the poison). In case of anemia: erythropoietin preparations, red blood cell transfusion. In diabetic etiology: insulin preparations, glurenorm, hypothiazide (* mainly in cases of diabetes insipidus, indapamide).

With rheumatological etiology: glucocorticoids (prednisone), cyclophosphamide. For uremic gout: allopurinol. For arthropathies and osteopathies: Nifedipine, verapamil, vitamin D3, Delagil. With pulmonary edema: inhalation of oxygen on alcohol (in a mild case), boomex (bumetanide) - with moderate chronic kidney disease, mannitol (in acute mon) In post-dialysis renal syndrome of restless legs: bromocriptine. For secondary uremic pseudo-epileptic seizures: carbamazepine (in mild cases). With polyneuropathies (in mild cases of insufficiency): pyridoxine. In postdialysis encephalopathy: deferoxamine (desferal).

In renal angiopathies: aminophylline (in mild cases, more often with OPN), enalapril, ramipril, lisinopril, chimes, dopamine, sulodexide. In renal cardiomyopathies: propranolol, metoprolol, digoxide. In secondary hypoxia: Trimetazidine

Pathogenesis

The pathogenesis is based on the progressive death of nephrons. At first, renal processes become less effective, then renal function is impaired. The morphological picture is determined by the underlying disease. Histological examination indicates the death of the parenchyma, which is replaced by connective tissue. The development of chronic renal failure is preceded by a period of suffering from chronic kidney disease lasting from 2 to 10 years or more. The course of kidney disease before the onset of CRF can be divided into several stages. The definition of these stages is of practical interest, since it affects the choice of treatment tactics.

Symptoms

Symptoms of chronic renal failure are as follows:

  1. Appearance of patients. There will be practically no characteristic external signs until the moment when there is a pronounced decrease in glomerular filtration of organs. Then it will be possible to visualize the following violations:
    • The pallor of the skin due to anemia, which is gradually increasing. Violations of the water-electrolyte balance lead to increased dryness of the skin. For the same reason, the skin loses elasticity, it is possible to acquire icteric color,
    • Subcutaneous hematomas often begin to occur. A bruise appears without a previous injury or bruise,
    • There are scratches on the skin of patients, which are caused by severe painful itching,
    • The face becomes very swollen. Edema spreads to the extremities, to the stomach,
    • Muscle tone decreases, they become flabby, which affects their functionality. This negatively affects the person's ability to work. Muscle twitches and cramps against a background of clear consciousness are explained by a drop in the level of calcium in the blood,
    • The skin remains dry even at a time when the patient is experiencing severe excitement or stress.
  2. Violations of the nervous system. Patients become lethargic, sleep poorly at night, and feel tired and overwhelmed during the day. Cognitive functions suffer, in the first place - memory and attention. The ability to learn and perceive information is deteriorating. Often patients complain of a cold in the extremities, a tingling sensation, and “goose bumps”. This is due to a disorder of the peripheral nervous system. As the pathological process progresses, motor disorders in the upper and lower extremities are observed.
  3. Urinary system. The volume of urine in the initial stages of the development of the disease increases, and the patient often goes to the toilet at night. With the development of insufficiency, the volume of urine excreted becomes smaller, edema continues to increase, and complete anuria is possible.
  4. Violations of the water-salt balance. The thyroid gland begins to produce parathyroid hormone in large volumes. As a result, phosphorus levels increase and calcium levels drop. This causes frequent spontaneous fractures amid softening of bone tissue.
    • There is constant thirst, the patient’s mouth is dry,
    • With a sharp rise from the place there is a darkening in the eyes, muscle weakness. This is due to leaching of sodium from the body,
    • Against the background of excess potassium in the blood, muscle paralysis increases,
    • Possible respiratory failure,
    • The water-salt balance is essential for the functioning of the organism as a whole. Malfunctions can lead to serious problems in the work of the heart, up to its stop.
  5. Nitrogen imbalance. If the glomerular filtration rate drops below 40 ml per minute, the patient has signs of enterocolitis. Against the background of an increase in the level of urea and uric acid in the blood, as well as with an increase in creatinine, an ammonia odor will emanate from the patient's mouth, and joint lesions will begin to develop.
  6. Manifestations of the cardiovascular system. The function of hematopoiesis suffers, which is expressed in anemia, lethargy, increased fatigue and weakness.
    • Pericarditis and myocarditis develop,
    • Blood pressure rises
    • There are pains in the heart of a dull and aching nature, shortness of breath increases, the heart rate is disturbed,
    • Acute heart failure is a complication of renal failure and can provoke the death of the patient.

At a late stage of renal failure, a uremic lung develops. Interstitial edema is growing, a bacterial infection is associated, which is associated with a decrease in immunity.

As for the digestive system, its work is disrupted. Appetite disappears, nausea and vomiting may occur. Often, the salivary glands and the mucous membrane of the oral cavity react with inflammation. Sometimes patients reach the stage of anorexia due to aversion to food. Uremia causes stomach and intestinal ulcers, which can be complicated by bleeding. Acute hepatitis also often accompanies uremia.

Appearance of patients

Appearance does not suffer until the stage when glomerular filtration is significantly reduced.

  • Due to anemia, pallor appears, due to water-electrolyte disturbances, dry skin.
  • As the process progresses, yellowness of the skin and mucous membranes appears, and their elasticity decreases.
  • Spontaneous hemorrhages and bruises may appear.
  • Scratching of the skin causes scratching.
  • The so-called renal edema with puffiness of the face, up to the widespread type of anasarca, is characteristic.
  • The muscles also lose their tone, become flabby, which causes fatigue to increase and the ability to work of patients to fall.

Classification and types

Chronic kidney failure is classified into several types in accordance with the severity of symptoms:

  1. Latent CRF - Symptoms hardly develop. The patient only feels a little tired. Often the diagnosis is made by examining a completely different problem.
  2. Compensated CRF - the volume of urine separated increases greatly - exceeds 2 liters per day, in the morning mild swelling is formed.
  3. Intermittent - severe fatigue develops, it interferes with a normal lifestyle, dry mouth and muscle weakness appear.
  4. Terminal - characterized by a sharp change in mood, the functioning of the immune system is greatly impaired. There is a dysfunction of other internal organs except the kidneys, most of the lungs and heart. The smell of urine is felt from the patient’s oral cavity - this is one of the main diagnostic signs of a dangerous course of failure.

Diagnosis of chronic renal failure

Diagnosis of chronic renal failure allows observation of glomerular filtration and creatinine and urea levels. Zimnitsky's test allows you to detect isohypostenuria. An obligatory measure is an ultrasound of the kidneys to assess changes in their size and thickness of the parenchyma. Echodopplerography of the vessels of the kidneys makes it possible to determine a decrease in the main and intraorgan blood circulation in the kidneys. Nephroscintigraphy is prescribed, which provides data on the speed and amount of accumulation of radiopharmaceuticals in each kidney.

They try to avoid X-ray contrast methods, because most drugs in this case can provoke intoxication. The risk in connection with such studies is not justified, because due to a decrease in excretory function, it is not possible to see the full picture of the urinary tract.

Nervous System Disorders

This is manifested by lethargy, night sleep disorders and drowsiness during the day. Decreased memory, learning ability. As the CRF increases, marked inhibition and disorders of the ability to memorize and think appear.

Violations in the peripheral part of the nervous system affect the chilliness of the limbs, tingling sensations, crawling ants. In the future, motor disorders in the arms and legs join.

The nature of the clinical picture

Many patients with chronic renal failure do not complain of pathological symptoms, because for the first time in the body, compensation is made even for severe deterioration of the kidneys.

Obvious manifestations of the disease develop only in its last stages.

The kidneys have a huge potential for compensatory disorders, sometimes they work much more than a person needs for normal life.

A small violation of the functioning of the body is diagnosed only with blood and urine tests. In this case, the doctor suggests passing a regular examination to track pathological changes in the organ.

The treatment process requires relief of symptoms and prevention of subsequent deterioration. When, even with correction, the kidney function deteriorates, it manifests itself:

  • weight loss, lack of appetite,
  • swelling in the ankles, hands due to fluid retention,
  • hard breath,
  • the presence of protein in urine and blood tests,
  • frequent urination, especially at night,
  • itchy skin
  • muscle cramps
  • pressure increase
  • nausea,
  • male erectile dysfunction.

Similar symptoms are characteristic of other diseases. In any case, if one or more signs are found, you need to visit a doctor.

Stages of the course

Substitution of glomeruli with connective tissue is first accompanied by partial organ dysfunction and compensatory changes in healthy glomeruli. Thus, failure develops in stages under the influence of a decrease in glomerular filtration rate.

  1. initial stage. Glomerular filtration rate (GFR) per minute equals 90 ml - this is the norm. But along with this, there is already kidney damage.
  2. Second stage - suggests damage and a slight decrease in speed to 60 - 89 ml per minute. For older people, these indicators can be considered normal.
  3. Third - moderate disturbances are observed in the kidneys, and GFR reaches 30-60 ml per minute. But the pathological process is almost hidden, there is no obvious symptomatology, only a slight increase in urination, a slight decrease in the concentration of red blood cells and hemoglobin in the blood can be noted. This provokes weakness, impairment of working ability, blanching of the skin, mucous membranes, brittle nails, hair, dry skin and a deterioration in appetite. In almost 50% of cases, an increase in the lower diastolic pressure is noted.
  4. Fourth - terminal. Glomerular filtration per minute decreases to 15 ml, urine volume also decreases, to a complete absence. At the same time, all the symptoms of poisoning by nitrogenous slag develop, the nervous system and myocardium are affected. Vital activity depends entirely on the timely conduct of blood purification on the device - without the help of the kidneys. Without a hemodialysis procedure and an emergency transplant, a person dies.
  5. Pataya stage - conservative, because it can be restrained by taking medications, and it does not yet involve the implementation of hemodialysis on the device. But the filtration rate per minute is only 15 - 29 ml.

The manifestations of insufficiency also develop, namely:

  • severe weakness
  • poor performance due to anemia,
  • an increase in urine volume,
  • frequent urination at night,
  • rise in blood pressure.

Complications

CRF is characterized by increasing disorders of all organs and systems. Blood changes include anemia due to both inhibition of hematopoiesis and a reduction in red blood cell life. Clotting disorders are noted: an increase in bleeding time, thrombocytopenia, a decrease in the amount of prothrombin. From the side of the heart and lungs, arterial hypertension is observed (in more than half of patients), congestive heart failure, pericarditis, myocarditis. In the later stages, uremic pneumonitis develops.

Neurological changes in the early stages include distraction and sleep disturbance; in the later stages, lethargy, confusion, and in some cases, delusions and hallucinations. From the peripheral nervous system, peripheral polyneuropathy is detected. From the gastrointestinal tract in the early stages, a deterioration in appetite, dry mouth. Later, belching, nausea, vomiting, stomatitis appear. As a result of mucosal irritation, the excretion of metabolic products develops enterocolitis and atrophic gastritis. Superficial ulcers of the stomach and intestines are formed, often becoming sources of bleeding.

On the part of the musculoskeletal system, various forms of osteodystrophy (osteoporosis, osteosclerosis, osteomalacia, fibrous osteitis) are characteristic of chronic renal failure. The clinical manifestations of renal osteodystrophy are spontaneous fractures, skeletal deformities, compression of the vertebrae, arthritis, pain in the bones and muscles. On the part of the immune system, chronic lymphocytopenia develops in chronic renal failure. A decrease in immunity causes a high incidence of purulent-septic complications.

Special nutrition

Patients with chronic renal failure should follow a diet. It consists in reducing protein intake.With glomerular filtration less than 50 ml / min, up to 40 g of protein per day is allowed, with a glomerular filtration level of less than 20 ml / min, only up to 25 g of protein per day is permissible. Salt is consumed at a minimum (no more than three grams per day), and with a strong increase in blood pressure, it is completely excluded from the diet. Nutrition should be high-calorie, must contain amino acids. They are taken in the form of special additives, they also just eat chicken eggs, consume fish oil, part of the protein is replaced by soy.

Water-salt balance

  • salt imbalance is manifested by increased thirst, dry mouth
  • weakness, darkening in the eyes with a sharp rise (due to sodium loss)
  • excess potassium explains muscle paralysis
  • respiratory failure
  • heart rate, arrhythmias, intracardiac blockages up to cardiac arrest.

Amid increased parathyroid hormone production, parathyroid hormone appears high levels of phosphorus and low levels of calcium in the blood. This leads to softening of the bones, spontaneous fractures, skin itching.

Diagnostic methods

The diagnostic process is carried out on the basis of a careful study of the clinical picture and medical history. The patient must undergo the following examinations:

  • Ultrasound of the kidneys
  • echodoplerography of the vessels of the organ,
  • nephroscintigraphy,
  • general and detailed blood test,
  • general urine analysis.

All these diagnostic methods help the doctor establish the presence and stage of chronic renal failure, choose the right treatment and significantly alleviate the patient's condition.

Symptomatic therapy

Osteodystrophy arising from chronic renal failure is corrected by taking vitamin D, calcium gluconate. At the same time, the threat of calcification of the internal organs, provoked by large doses of vitamin D in combination with hyperphosphatemia, is taken into account. They fight with the latter, taking almagel, subject to mandatory control over the level of phosphorus and calcium in the blood.

The acid-base composition is adjusted with a 5% solution of sodium bicarbonate, it is administered intravenously. Oliguria is treated with various drugs (lasix). He, along with traditional medicines, is used to normalize blood pressure.

Anemia requires iron, androgen, and folic acid. Red blood cell transfusions are prescribed with a significant drop in hematocrit. Particular attention is required to dosage of drugs. It varies, starting from the derivation method. Ampicillin, penicillin, sulfonamides, zeporin, methicillin are taken in an amount reduced by half. Some drugs are contraindicated, for example, polymyxin, neomycin, monomycin, nitrofuran derivatives. They are not prescribed due to the risk of complications.

Heart failure is sometimes corrected by glycosides. Drugs are used carefully, in a significantly reduced dosage.

Hemodialysis is indicated for intermittent stages of chronic renal failure. Normalizing the patient’s condition with his help, he is transferred to conservative therapy. Especially effective have been courses of plasmapheresis.

The terminal stage involves symptomatic treatment. In cases of lack of positive dynamics, they resort to regular hemodialysis, which is carried out up to three times a week. It is important that the presence of complications makes the effect of hemodialysis less significant; it is also sometimes a contraindication to a kidney transplant.

Therapies

The methods of treatment completely depend on the stage of development of chronic renal failure and its causes. At first, outpatient treatment is carried out, that is, it is not necessary to go to the hospital.

But for prevention, planned hospitalization is implemented - at least 1 time per year in order to conduct complex examinations.

The treatment of chronic renal failure is always monitored by a general practitioner, who always sends a nephrologist if necessary.

This complex allows you to prevent the progression of the disease and damage to blood flow.

Nitrogen Imbalance

They cause the growth of blood creatinine, uric acid and urea, as a result of:

  • with GFR less than 40 ml per minute, enterocolitis develops (damage to the small and large intestine with pain, bloating, frequent loose stools)
  • ammonia breath
  • secondary articular lesions of the gout type.

Organ transplant

A stable improvement in the condition and quality of life occurs only after successful hemodialysis treatment or after organ transplantation. The decision to use such methods is made by specialists.

Before the operation, the patient is sometimes given not hemodialysis, but peritoneal dialysis. The surgeon places a catheter in the abdominal cavity, he delivers a dialysis solution. This allows you to remove excess water, harmful substances.

Kidney transplant operations are common in modern medicine. They save hundreds of lives annually. Not all measures are possible. A transplant operation cannot be performed in the presence of the following diseases:

  • pulmonary tuberculosis,
  • exacerbation of peptic ulcer,
  • extrarenal active infection,
  • atherosclerosis (with severe signs),
  • malignant tumors
  • chronic hepatitis, cirrhosis,
  • AIDS,
  • some diseases of the cardiovascular, respiratory systems,
  • mental disorders.

Many diseases and conditions can be a relative contraindication to surgery. Among them, malignant hypertension and some systemic diseases. Before the operation, the patient undergoes a full examination, which eliminates any contraindications. Not only clinical studies are needed, but also consultations of various specialists. As for the material, the cadaveric kidney is most often used, but donors in kinship are also sometimes involved.

The rehabilitation period after the operation is responsible because of a combination of unfavorable factors: harm caused by the terminal stage of chronic renal failure, significant drug therapy (including immunosuppressive), and a transplanted organ rejected by the body. All this requires constant monitoring by health workers.

Surgery itself is well tolerated. The processes are restored quickly enough, provided that the transplanted kidney is endowed with good functions. But sometimes rejection, obstruction of the urinary tract and other complications can occur.

Organ rejection is the most famous complication that can occur immediately after surgery or some time after it. It can be acute, over-acute, accelerated or chronic. Most patients encounter one of the types. Therefore, after a transplant, immunosuppressive therapy is required, lasting up to six months.

Sometimes, among other complications, infectious and surgical occur. Among the latter, the most common are urological. Also, as complications, disturbances in the work of the cardiovascular system, gastrointestinal tract, mineral metabolism, and neoplasms may develop. The treatment of complications depends on the time of their detection. If the changes are nonspecific, signs that allow you to determine the presence of complications do not occur immediately.

The prognosis in this case depends on a combination of several factors: the nature of the course of the underlying disease that provoked chronic renal failure, the severity of clinical manifestations, complications, especially infectious from the cardiovascular system, are of great importance.

Among the latter can be identified:

  • drugs (heroin and cocaine in particular),
  • alcohol,
  • poisoning with lead, cadmium or other toxic metals,
  • drug poisoning (in particular, analgesics),
  • consequences of radiation infection.

The mechanism of appearance, stages of development and symptoms of CKD

Chronic kidney disease develops for a long time, from several months to several years, depending on the course of the underlying disease, the degree of its treatment, as well as the general condition of the body. It is characterized by a loss in the ability of the kidneys to remove excess water from the body, and with it some low molecular weight substances. This is expressed in a decrease in the rate of blood filtration in the glomerulus, which is a consequence of the death of nephrons. At the same time, the affected kidney reduces the production of erythropoietin, which leads to disorders in the hematopoiesis system - a decrease in the production of red blood cells.

Due to the slowing of blood filtration, uremic toxins, beta-2-microglobulin, cytokines and other substances accumulate in the body.

Common drugs and traditional approaches

The treatment process in chronic renal failure in the first stages of the lesion is based on drug therapy. She helps:

  • normalize high blood pressure,
  • stimulate urine production,
  • to prevent the occurrence of autoimmune processes when the body begins to attack itself.

It turns out to achieve such effects using:

  • hormone-based drugs
  • erythropoietins - they eliminate the effects of anemia,
  • preparations with calcium and vitamin D - they help strengthen the skeletal system and prevent fractures.

With a more serious lesion, other methods are implemented:

  1. Hemodialysis for cleansing and filtering blood. It is realized outside the body through the apparatus. Venous blood is supplied into it from one hand, it undergoes purification and returns through a tube in the other hand. This method is implemented for life or until organ transplantation.
  2. Peritoneal dialysis - The process of blood purification by normalizing the water-salt balance. It is carried out through the abdominal section of the patient, where a special solution is first injected, and then sucked back. Organ transplantation. In this case, it is very important that the organ take root.

The cardiovascular system

  • firstly, it responds with an increase in blood pressure
  • secondly, heart lesions (muscles - myocarditis, pericardial sac - pericarditis)
  • dull pains in the heart, heart rhythm disturbances, shortness of breath, swelling on the legs, enlarged liver appear.
  • with an unfavorable course of myocarditis, the patient may die against the background of acute heart failure.
  • pericarditis can occur with the accumulation of fluid in the pericardial sac or precipitation of uric acid crystals in it, which, in addition to pain and expansion of the borders of the heart, when listening to the chest gives a characteristic (“funeral”) pericardial friction noise.

Forecast and Prevention

The prognosis for chronic renal failure is always serious. Sustainable rehabilitation and a significant extension of the life span is possible with timely hemodialysis or a kidney transplant. The decision on the possibility of carrying out these types of treatment is made by transplantologists and doctors of hemodialysis centers. Prevention provides for the timely detection and treatment of diseases that can cause chronic renal failure.

Diet and nutrition for chronic renal failure

To reduce the manifestation of the symptoms of the disease, the doctor will prescribe a special nutritional program for the patient. A diet for chronic renal failure involves eating foods that contain fats and carbohydrates. Proteins of animal origin are strictly prohibited, and plant proteins are in very limited quantities. The use of salt is completely contraindicated.

When drawing up a nutrition program for a patient with chronic renal failure, the doctor takes into account such factors:

  • stage of the disease
  • progression rate
  • daily loss of protein with diuresis,
  • the state of phosphorus, calcium, as well as water-electrolytic metabolism.

In order to reduce the concentration of phosphorus, dairy products, white rice, legumes, mushrooms and muffins are prohibited. If the primary task is to regulate the balance of potassium, it is recommended to abandon the content of dried fruits, cocoa, chocolate, bananas, buckwheat, and potatoes in the diet.

Chronic kidney disease has three stages:

  1. Latent, or initial. External symptoms are usually absent. Glomerular filtration rate (GFR) drops to 40-60 ml / min. Accurate diagnosis is possible only by clinical methods. At this stage of manifestation, the symptoms of CKD / CRF can be attributed to other diseases. There are five “masks” (ie, signs of external similarity in the aggregate) with other diseases: osteopathic, hypertonic, asthenic, gouty, anemic. The stage is characterized by polyuria - an increase in the volume of urine excreted with a decrease in its density, and nocturia - the release of more urine at night than during the day, anemia and hypertension.
  2. Conservative, or intermittent. GFR 15-40 ml / min, asthenic syndrome, weight loss, loss of appetite, which can lead to anorexia, are manifested. At this stage, conservative drug treatment is used to slow the progression of the disease in order to maintain residual kidney function for as long as possible.
  3. Terminal or terminal. Polyuria is replaced by oliguria, i.e. a sharp reduction in the amount of urine excreted per day (up to 500 ml per day). If untreated, oliguria passes into anuria - an almost complete reduction in urination. At this stage, the body’s overhydration develops, potassium, sodium, magnesium and phosphorus, as well as some other substances, cease to be excreted.

The complex of these factors at the terminal stage leads to grave consequences. Arterial hypertension increases, hypertension (left ventricular heart failure) develops, and vision decreases sharply. This may be accompanied by pulmonary edema. At the same time, the patient due to anemia has complaints of muscle weakness, increased fatigue, and drowsiness. Muscles become flabby (convulsive contractions are possible), uremic enterocolitis develops, resulting in diarrhea. Appetite falls, a person complains of nausea and vomiting, often itchy skin. Possible nosebleeds or internal bleeding due to the formation of ulcers (for example, on the surface of the stomach).

Bone tissue suffers. Symptoms of osteodystrophy, i.e. decrease in bone strength, which leads to accidental fractures, arthritis, skeleton deformation, vertebra shape change. This causes a pronounced pain syndrome.

Immunity drops sharply due to a decrease in the number of lymphocytes, which leads to an increase in the likelihood of sepsis.

External signs of the terminal stage are the strong smell of ammonia from the patient's mouth, the skin becomes pale with a yellow tint (as with jaundice). Traces of scratching and bruising are visible.

Chronic renal does not sufficiently affect the central nervous system. At the latent and compensated stages, patients become distracted, can hardly concentrate. At the terminal stage, confusion develops and a decrease in the rate of reactions, hallucinations are possible in some cases.

Prevention

  1. Refuse alcohol. If you still drink alcohol, follow the measure. Western doctors believe that for a healthy woman under 65, the norm should not exceed one drink, and for a healthy man - no more than two drinks per day. Alcohol is generally not recommended for the elderly, sick and pregnant.
  2. Follow drug instructions. When using any medications, including aspirin, ibuprofen, paracetamol, follow the manufacturer's instructions. Taking large doses of medication can damage your kidneys. If you already had kidney disease, consult your doctor before taking any medications.
  3. Maintain a healthy body mass.If you have problems with being overweight, start playing sports and control your diet. Obesity not only increases the risk of kidney problems, but also contributes to diabetes, leads to hypertension, reduces the duration and quality of life.
  4. Give up cigarettes. If you are a smoker, consult your doctor about current methods for removing nicotine addiction. Pills, a nicotine patch, psychotherapy, and support groups can help you quit.
  5. Watch your health. Do not run infectious diseases that can affect your kidneys over time.

It is recommended that patients with this disease visit the resorts: Truskavets, Zheleznovodsk, Yevpatoriya, Berezovsky mineral waters and others.

Progressive factors

The following external factors affect the development of chronic renal failure:

  • the progression of the underlying disease, determining the rate of nephrosis of the nephrons,
  • hypertension
  • proteinuria
  • high levels of phosphorus and sodium, as well as protein in food,
  • bad habits,
  • hyperparathyroidism
  • pregnancy.

Folk methods

At home, in order to alleviate the condition, they use recipes of traditional medicine.

They help normalize kidney function, cleanse blood, relieve swelling and restore urine flow.

Before starting treatment, you must definitely have the approval of a doctor so as not to harm your condition even more.

Diagnostic Methods

Diagnosis of CKD is possible by symptomatic, laboratory, and instrumental methods. Renal failure can be suspected by nocturia and polyuria, hypertension in combination with anemia and symptoms of gastroenteritis. To confirm the diagnosis, such laboratory methods are used as:

  • Zimnitsky test
  • Reberg test,
  • blood creatinine analysis.

To finally confirm the diagnosis, ultrasound of the kidneys and ultrasound of the renal vessels are used.

Herbal Fees

Herbs effectively relieve the symptoms of deficiency. To obtain funds, you should mix the roots of parsley, cones from juniper, field horsetail. 250 ml of water is added to this mixture and boiled in a container with a closed lid for 2 minutes, then insist another 5 minutes and filter.

You need to drink the broth 3 times a day, without skipping, preheating. Such therapy is carried out for a month.

Chronic renal failure: stages, pathophysiology.

This process is chronic, which means it develops gradually, step by step. Since there is a replacement process, normal tissue of the kidney, on the scar. In addition to reducing glomerular filtration, pathological changes appear in other organs.

To date, 4 stages of the pathological process are distinguished in the development of chronic renal failure:

    The first stage is latent. She is primary. For the latent stage of chronic renal failure, such changes are characteristic. By name, it is clear that there are no severe symptoms. Any changes can be detected using laboratory or instrumental methods. The filtration ability of the kidneys reduces to the level of 55-65 ml / min. Sometimes in a general urinalysis, protein can be detected.

At the initial stage of chronic renal failure, anemia develops, the prevalence of nighttime diuresis over daytime, an increase in daily diuresis of more than 2 liters per day. The initial stage of chronic renal failure is also characterized by increased pressure, asthenia, symptoms of gout, in the form of arthralgia, etc. That is, all symptoms are not specific.

  • The second stage is compensated. The patient complains of general weakness, fatigue, thirst. Total daily diuresis increases, and urine density decreases. Filtration is reduced to 54-31 ml / min. In the blood, an increased content of urea and creatinine is determined. The blood also contains a large number of nitrogen metabolism products. Patients get tired quickly, their appetite is reduced, they can eat for days on end, their body weight decreases, up to the development of an anorexic state.
  • The third stage is called intermittent. The clinical picture is growing rapidly. All the same symptoms come to light, they only occur in waves, then to a greater or lesser extent. Glomerular filtration ranging from 30 to 15 ml / min. Creatinine levels are even higher. Metabolic acidosis is detected in the blood.
  • The last stage is terminal. It distinguishes 4 periods:
    • Daily diuresis of more than 1 liter per day. Filtration ability is reduced, and fluctuates at the level of 13-10 ml / min.
    • The amount of urine is reduced to 500 ml per day. Blood levels of sodium and potassium are elevated. There are signs of fluid accumulation in the body.
    • Symptoms of the terminal stage of chronic renal failure are more and more pronounced. The first signs of heart failure appear. Congestive changes in the internal organs, most pronounced in the lungs and liver.
    • The terminal stage of chronic renal failure is characterized by intoxication syndrome, due to poisoning of the body with substances that are not removed from it, due to poor kidney function.
  • There is also another classification of chronic renal failure. It consists of three stages:

    • Compensation, an analogue of the latent stage.
    • Chronic renal failure, decompensation stage - an analog of the intermittent stage
    • The last stage, uremia is an analogue of the terminal.

    Chronic renal failure, stages of creatinine:

    • The initial stage - the presence of creatinine in the blood is in the range from 0.1 to 0.8 mmol / L. This stage is also called latent, often reversible. The latent stage of chronic renal failure is characterized by a decrease in the level of GFR only to 49-59 ml / min.
    • Azotemic stage - creatinine concentration is 0.8 - 1.3 mmol / L.
    • Uremic or terminal - more than 1.3 mmol / l.

    Chronic renal failure, degrees:

    Recently, it was decided to update the concept of CRF as a chronic kidney disease, which has five degrees:

    • 1 Stage CRF.
    • 2 Stage CRF.
    • 3a Stage CRF.
    • 3b Stage CRF.
    • 4 Stage CRF.
    • 5 Stage CRF

    Starting from 1 and ending with stage 3a, these steps can be called “latent”. Starting from stage 3b, the patient begins to worry about malfunctions in the functioning of the kidneys, the above symptoms appear.

    Chronic renal failure of the 4th degree is characterized by even lower functioning of the patient's kidneys, manifestations of anemia and diseases of the musculoskeletal system.

    The fifth and final stage of chronic renal failure is nothing more than an analogue of the terminal stage. The functioning of the kidneys is minimized and the patient needs replacement therapy.

    As can be seen from the classifications of chronic renal failure, the path from the latent stage to the terminal stage is quite large. The terminal stage of the disease can be avoided thanks to timely examinations, competent treatment, relief of the underlying disease, which can develop into a chronic one. Infectious diseases should be prevented in order to prevent complications associated with it. An important factor is replacement therapy, or a healthy kidney transplant.

    Dietary prescriptions

    Nutrition in chronic renal failure is an important treatment stage, regardless of the severity of the disease. It involves:

    • the use of high-calorie foods, low-fat, not too salty, not spicy, but enriched with carbohydrates, which means potatoes, sweets and rice can and should even be consumed.
    • should be steamed, baked,
    • eat in small portions 5-6 times a day,
    • include less protein in your diet,
    • do not consume a lot of fluid, its daily volume is not more than 2 liters,
    • give up mushrooms, nuts, legumes,
    • limit the intake of dried fruits, grapes, chocolate and coffee.

    The beginning of the fight against chronic renal failure is always the regulation of diet and water-salt balance

    • Patients are advised to eat with a limited intake of protein within 60 grams per day, the predominant use of vegetable proteins. With the progression of chronic renal failure to stage 3-5, the protein is limited to 40-30 g per day. At the same time, they slightly increase the proportion of animal proteins, preferring beef, eggs and low-fat fish. The egg and potato diet is popular.
    • At the same time, the consumption of products containing phosphorus is limited (legumes, mushrooms, milk, white bread, nuts, cocoa, rice).
    • Excess potassium requires a reduction in the use of black bread, potatoes, bananas, dates, raisins, parsley, figs).
    • Patients have to do with a drinking regimen at a level of 2-2.5 liters per day (including soup and drinking tablets) in the presence of severe edema or non-stopable arterial hypertension.
    • It is useful to keep a food diary, which facilitates the calculation of protein and trace elements in food.
    • Sometimes specialized mixtures enriched in fats and containing a fixed amount of soy protein and micronutrient-balanced are introduced into the diet.
    • Along with the diet, patients may also be shown an amino acid substitute, Ketosteril, which is usually added with GFR of less than 25 ml per minute.
    • A low-protein diet is not indicated for exhaustion, infectious complications of chronic renal failure, uncontrolled arterial hypertension, with GFR less than 5 ml per minute, increased protein breakdown, after operations, severe nephrotic syndrome, terminal uremia with damage to the heart and nervous system, poor diet tolerance.
    • Salt is not limited to patients without severe arterial hypertension and edema. In the presence of these syndromes, salt is limited to 3-5 grams per day.

    Therapy for children

    For the treatment of chronic renal failure in a child, homeostatic dietary agents are required.

    To begin with, the biochemistry of urine and blood is implemented to quickly establish the need for potassium, water, proteins and sodium.

    Treatment involves slowing down the rate of filling the kidneys with nitrogen breakdown products. At the same time, maintaining the acid-base balance and electrolyte balance is required.

    When the clearance indicators are too low, water can only be drunk fractionally, a constant monitoring of the sodium content in the blood is carried out.

    With hypocalcemia, oral administration of calcium, intake of vitamin D is required. In advanced cases, dialysis is realized. Hemodialysis is required until the issue of organ transplantation is resolved and it is not performed.

    Causes of Chronic Renal Failure

    The main reasons, in addition to heredity, are various inflammatory processes in the kidney tissue. The pathogenesis of chronic renal failure is characterized by the gradual development of the disease, the death of nephrons and, subsequently, renal failure. Therefore, you must always keep your eyes open and take appropriate measures in case of detection of these processes.

    Causes of anemia in chronic renal failure.

    Due to impaired hematopoietic functions of the kidneys, the secretion of hemoglobin decreases, its level in the blood drops, the patient feels a general malaise. In addition to hemoglobin, there is a decrease in the number and lifetime of red blood cells. The function of blood coagulation is impaired. The last stages of chronic renal failure are characterized by internal bleeding in the gastrointestinal tract.

    Chronic renal failure has several stages. Depending on these stages, as well as symptoms, medical workers have the opportunity to make the right diagnosis in time to increase the chances of success in stopping the ailment.

    • Latent.
    • Compensated.
    • Intermittent.
    • Terminal.

    Consequences and difficulties

    The main difficulty in diagnosing and treating chronic renal failure is that pathology does not appear in the first stages of development. Almost all patients seek help with advanced forms of insufficiency by the presence of concomitant complications in the body.

    The consequences of an incorrect approach in the treatment or neglect of the CRF process include:

    • uremia - self-poisoning by decay products, while there is a risk of uremic coma - loss of consciousness, serious deviations in the respiratory system and blood circulation,
    • complications in the work of the heart and blood vessels: heart failure, ischemia, myocardial infarction, palpitations, pericarditis,
    • a steady increase in blood pressure over 139/89 mm Hg, which can not be corrected,
    • acute forms of gastritis,
    • complications as a result of dialysis organization: hypertension, anemia, violation of the sensitivity of the hands and feet, improper absorption of calcium and brittle bones,
    • decreased libido.

    Preventative measures

    Renal failure often accompanies diabetes mellitus, glomerulonephritis and hypertension, so doctors monitor these people very carefully, they are additionally observed by a nephrologist.

    All people at risk who have even minimal kidney problems should constantly:

    • monitor blood pressure,
    • do an electrocardiogram
    • to do an abdominal ultrasound,
    • take general urine and blood tests,
    • comply with the doctor's recommendations regarding lifestyle, nutrition and work.

    For the prevention of kidney damage, chronic renal failure, or with an advanced form of the disease to severe stages, timely treatment of any disorders in the work of the body, constant monitoring of the condition by the doctor is required.

    Diagnosis of chronic renal failure tests

    Blood and urine tests are taken to diagnose and monitor chronic renal failure. Based on the concentration of creatinine and urea in the blood, the attending physician has a great opportunity to make the correct diagnosis for his patient.

    Chronic renal failure, a blood test makes it clear what stage of the disease takes place at the time the results are obtained. The essence of the analysis is to determine the concentration of creatinine, the final product of metabolic reactions between muscle and other tissues, as well as hemoglobin, red blood cells and so on. In a general blood test, anemia is detected, i.e. a decrease in the content of red blood cells and hemoglobin, which carry oxygen to cells and tissues. The erythrocyte sedimentation rate increases, and the number of leukocytes increases. These two indicators indicate the development of the inflammatory process in the body.

    Be sure to determine the coagulation ability of blood, in order to predict and prevent in advance, such a formidable complication as bleeding, especially of internal organs, most often of the gastrointestinal tract.

    Chronic renal failure urine analysis describes the first stages of the underlying disease. As kidney failure progresses, a urinalysis is not able to provide any important information. In the urine, protein, white blood cells and red blood cells are found.

    Correction of water-electrolyte disturbances

    carried out in the same way as the treatment of acute renal failure. The main thing is to rid the patient of dehydration against the background of a restriction in the diet of water and sodium, as well as the elimination of blood acidification, which is fraught with severe shortness of breath and weakness. Solutions are introduced with bicarbonates and citrates, sodium bicarbonate. A 5% glucose solution and Trisamine are also used.

    Hemodialysis

    With a critical decrease in glomerular filtration, blood purification from nitrogen metabolism substances is carried out by the hemodialysis method, when slags pass into the dialysis solution through the membrane. The “artificial kidney” apparatus is most often used, peritoneal dialysis is less commonly performed when the solution is poured into the abdominal cavity, and the peritoneum plays the role of the membrane. Hemodialysis in chronic renal failure is carried out in a chronic mode. For this, patients go for several hours a day to a specialized center or hospital.In this case, it is important to timely prepare the arteriovenous shunt, which is prepared with GFR 30-15 ml per minute. Since GFR falls below 15 ml, dialysis is started in children and patients with diabetes mellitus, with GFR less than 10 ml per minute, dialysis is performed in other patients. In addition, indications for hemodialysis will be:

    • Severe intoxication with nitrogenous products: nausea, vomiting, enterocolitis, unstable blood pressure.
    • Treatment-resistant edema and electrolyte disturbances. Cerebral edema or pulmonary edema.
    • Marked blood acidification.

    Contraindications to hemodialysis:

    • coagulation disorders
    • persistent severe hypotension
    • tumors with metastases
    • decompensation of cardiovascular disease
    • active infectious inflammation
    • mental illness.

    Kidney transplant

    This is a fundamental solution to the problem of chronic kidney disease. After this, the patient has to use cytostatics and hormones for life. There are cases of repeated transplants, if for some reason the graft is rejected. Renal failure during pregnancy with a transplanted kidney is not an indication for interrupting gestation. pregnancy can be carried out before the required period and is allowed, as a rule, by caesarean section at 35-37 weeks.

    Thus, Chronic kidney disease, which has replaced the notion of “chronic renal failure”, allows doctors to more quickly see the problem (often when external symptoms are still absent) and respond with the start of therapy. Adequate treatment can prolong or even save the patient's life, improve his prognosis and quality of life.

    Watch the video: ABCs of Kidney Disease. Treatment Options for End-Stage Renal Disease (February 2020).