How to live with chronic renal failure. Appearance of patients. Treatment of the disease with traditional methods

Definition

Chronic renal failure (CRF) is the final stage of various first or secondary chronic kidney diseases, which leads to a significant decrease in the number of active nephrons due to the death of most of them. With chronic renal failure, the kidneys lose the ability to perform their excretory and incretory functions.

Causes

The most important causes of CKD (more than 50%) in adulthood are diabetes and hypertension. Therefore, they can often be detected by a general practitioner, family doctor, endocrinologist or cardiologist. In the presence of microalbuminuria and if CKD is suspected, patients should be referred to a nephrologist for consultation and treatment adjustment. Having reached the GFR level< 30 мл/мин/1,73 м 2 , пациенты обязательно должны консультироваться с нефрологом.

In nephrology, there are 4 groups of risk factors that influence the development and course of CKD. These are factors that may influence the development of CKD; factors that initiate CKD; factors that lead to the progression of CKD and risk factors for the final stage of CKD.

Significant progress has now been made in uncovering pathogenetic mechanisms progression of chronic kidney disease. Wherein Special attention is given to the so-called non-immune factors (functional-adaptive, metabolic, etc.). Such mechanisms operate to varying degrees in chronic kidney damage of any etiology; their significance increases as the number of active nephrons decreases, and it is these factors that largely determine the rate of progression and outcome of the disease.

Symptoms

1. Damage to the cardiovascular system: hypertension, pericarditis, uremic cardiopathy, disorders heart rate and conductivity, acute left ventricular failure.

2. Neurotic syndrome and damage to the central nervous system:

• uremic encephalopathy: symptoms of asthenia (increased fatigue, memory impairment, irritability, sleep disturbance), symptoms of depression (depressed mood, decreased mental activity, suicidal thoughts), phobias, changes in character and behavior (weakness of emotional reactions, emotional coldness, indifference, eccentric behavior) , disturbance of consciousness (stupor, stupor, coma), vascular complications (hemorrhagic or ischemic strokes);
• uremic polyneuropathy: flaccid paresis and paralysis, other changes in sensitivity and motor function.

3.Gastrointestinal syndrome:

• damage to the mucous membranes (cheilitis, glossitis, stomatitis, esophagitis, gastropathy, enteritis, colitis, stomach and intestinal ulcers);
• organic lesions of the glands (mumps, pancreatitis).

4.Amemic-hemorrhagic syndrome:

• anemia (normochromic, normocytic, sometimes erythropoietin deficiency or iron deficiency), lymphopenia, thrombocytopathy, minor thrombocytopenia, pale skin with a yellowish tint, dryness, signs of scratching, hemorrhagic rash (petechiae, ecchymosis, sometimes purpura).

5. Clinical manifestations caused by metabolic disorders:

• endocrine disorders (hyperparathyroidism, impaired libido, impotence, inhibition of spermatogenesis, gynecomastia, oligo- and aminorrhea, infertility);
• pain and weakness of skeletal muscles, cramps, proximal myopathy, ossalgia, fractures, aseptic bone necrosis, gout, arthritis, intradermal and measured calcifications, deposition of urea crystals in the skin, ammonia odor from the horn, hyperlipidemia, carbohydrate intolerance.

6.Immune system disorders: tendency to intercurrent infections, decreased antitumor immunity.

Timely identification of patients with impaired renal function is one of the main factors determining treatment tactics. Indicators of increased levels of urea and creatinine oblige the doctor to further examine the patient in order to establish the cause of azotemia and prescribe rational treatment.

Signs of chronic renal failure

1.Early signs:

• clinical: polyuria with nocturia in combination with hypertension and normochromic anemia;
• laboratory: decreased concentrating ability of the kidneys, decreased filtration function of the kidneys, hyperphosphatemia and hypocalcemia.

2.Late signs:

• laboratory: azotemia (increased creatinine, urea and serum uric acid);
• instrumental: reduction of the cortex of both kidneys, reduction in the size of the kidneys according to ultrasound or plain uroroentgenogram;

• Calt-Cockrof method;
• classic, with determination of the concentration of creatinine in plasma, its daily excretion in urine and minute diuresis.

Note : Most precise methods determination of GFR is radiological with inulin iothalamate, DTPA, EDTA. Can be used:

Persistent normochromic anemia in combination with polyuria and hypertension should alert the doctor to the possibility of chronic renal failure in the patient. The following most informative tests help in differential diagnosis: determination of the maximum relative density and osmolarity of urine, the value of CF, the ratio of urea and creatinine in the blood, radionuclide data.

A decrease in the RF reserve (functional renal reserve - FR) due to nephropathy is considered as an early sign of impaired renal filtration function. U healthy person after an acute load of protein or CP increases by 10-39%. A decrease or complete absence of FNR indicates hyperfiltration in functioning nephrons and should be regarded as a risk factor for the progression of chronic renal failure.

Depression of the maximum relative density of urine below 10 18 in the Zemnitsky test next to a decrease in CF (daily diuresis of at least 1.5 liters) below 60-70 ml/min. and the absence of FNR indicate initial stage of chronic renal failure.

According to the differential diagnosis of acute renal failure, chronic renal failure is indicated by a history of kidney damage, polyuria with nocturia, stable hypertension, as well as a decrease in the size of the kidneys according to ultrasound or x-ray of the kidneys.

Diagnostics

Patients with chronic kidney disease (chronic kidney failure) need to undergo various tests for treatment. Patients are referred for diagnosis if they have symptoms such as, for example, signs of anemia, swelling, urine odor, hypertension, and also for patients diabetes mellitus a mandatory check by a specialist is required.

Laboratory tests play an important role in treating symptoms of chronic renal failure. An important substance that determines the presence of a problem in the kidneys: creatinine. Determining creatinine is one of many routine tests. This is followed by blood and urine tests to determine kidney function. Using this information, you can calculate the so-called creatinine clearance, which allows you to accurately diagnose kidney function and thus prescribe the necessary treatment.

Other imaging modalities are also used to diagnose chronic renal failure: these include - ultrasonography, computed tomography (CT) and X-ray contrast studies. In addition, such studies allow you to monitor the progress of chronic renal failure.

Prevention

Conservative treatment of chronic renal failure

Conservative remedies and treatment measures are used at degrees I-II and (level CF< 35 мл/мин.). На III-IV degrees resort to renal replacement therapy (chronic hemodialysis, peritoneal dialysis, hemosorption, kidney transplantation).

The principles of conservative treatment of chronic renal failure include:

• rational diet;
• ensuring water-salt and acid-base balance;
• control blood pressure to avoid both an increase and a sharp decrease;
• correction of renal anemia;
• prevention of hyperparathyroidism;
• the use of procedures and drugs that remove nitrogenous waste from the gastrointestinal tract;
• treatment of osteodystrophy and acute infectious complications of chronic renal failure.

Rational diet and ensuring water-salt and acid-base balance

The choice of diet is determined by the degree of chronic renal failure and is based on the restriction of protein, sodium and liquid in the daily diet. The diet should be low in protein, low in calories and high in calories (not less than 2000 kcal/day).

Malobilkov diet (MBD)

Significantly improves the patient's condition with chronic renal failure and slows down the progression of chronic renal failure. First, even before the azotemic stage, at an EF level of 40 ml/min, it is recommended to reduce protein intake to 40-60 g per day. At stages I-II of chronic renal failure, you should consume 30-40 g of protein per day. And only if the EF decreases to 10–20 ml/min. and an increase in serum creatinine to 0.5-0.6 mmol/l. A rigid MBD is useful when the amount of protein is reduced to 20-25 g per day. In this case, the total calorie content is maintained mainly by carbohydrates, and instead of essential amino acids, special supplements are recommended. However, due to the high cost of these drugs in our country, patients are often advised to eat one egg per day.

A 1:3 mixture of eggs and potatoes has a ratio of essential amino acids close to the optimal ratio. If proteinuria is significant, the amount of protein in the diet is increased according to this loss, at the rate of one chicken egg for every 6 g of urine protein. Patients with chronic renal failure are recommended to replace half of the required daily protein soy supplements and add fish oil.

The effectiveness of MBD is assessed by a decrease in uremic intoxication, dyspeptic symptoms, a decrease in the level of phosphates, urea, creatinine, the absence of hypoalbuminemia, hypotransferinemia, lymphopemia, hyperkalemia, stability of blood pH and bicarbonate levels.

Contraindications to MBD:

• a sharp decline residual function (RF< 5мл/мин.);
• acute infectious complications of chronic renal failure;
• anorexia, cachexia (body weight< 80%);
• uncontrolled (malignant) hypertension;
• severe nephrotic syndrome;
• uremia (oliguria, pericarditis, polyneuropathy).

Patients with chronic renal failure without extrarenal manifestations of nephrotic syndrome, cardiovascular failure and with correctable hypertension receive 4-6 g of salt per day.

Calcium-rich foods (cauliflower, cucumber and orange juices) and alkaline mineral waters are introduced into the diet.

The amount of liquid must match daily diuresis at the level of 2-3 l., which helps to reduce the reabsorption of metabolites and their excretion.

With a decrease in urine formation, fluid intake is adjusted depending on diuresis: it is 300-500 ml. exceed the amount of urine excreted over the previous day, the occurrence of oligo- or anuria, which leads to overhydration of the body, use chronic hemodialysis.

During treatment of chronic renal failure, correction of electrolyte disturbances is necessary. Potassium metabolism disorders are unsafe for the patient's life. For hypokalemia, potassium chloride is prescribed.

Urologist

Natalia: 03/08/2014
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Chronic renal failure (CRF) is a term that covers all degrees reduced function kidney disease, from mild to moderate to severe. ESRD is a global public health problem. Worldwide, there is an increase in morbidity with poor outcomes due to the high cost of treatment.

What is chronic renal failure

Chronic kidney failure (CRF), or as new terminology calls it, chronic kidney disease (CKD), is a type of disease in which there is a gradual loss of organ function over a period of months or years. In the early stages there are often no symptoms. They appear later, when the functioning of the organ is already significantly impaired. CKD is more common among older people. But while younger patients with chronic kidney failure typically experience progressive loss of kidney function, about a third of patients over 65 with CKD are stable.

The disease is associated with the death of the main functional units of the kidney - nephrons. Their place is filling connective tissue. As there is more scar tissue inside the organ than functioning tissue, kidney failure progresses directly, which can most likely lead to the decline of kidney activity.

CKD is associated with an increased risk cardiovascular diseases and is the ninth leading cause of death in the United States.

In 2002, an organization called the National Kidney Foundation (USA) developed international classification and definition of CKD. According to it, chronic renal failure is determined based on:

• signs of kidney damage;
• reducing the glomerular filtration rate (GFR - the rate at which the kidneys filter blood) to less than 60 ml/min/1.73 m2 for at least 3 months.

Whatever the underlying cause, when the loss of nephrons - the functional units of the kidney - reaches a certain point, the remaining ones also begin the process of irreversible sclerosis, which leads to a gradual decrease in GFR.

Classification and stages

The different stages of chronic renal failure reflect the five stages of the disease, which are classified as follows:

1. Stage 1: kidney damage with normal or increased GFR (> 90 ml/min/1.73 m2).
2. Stage 2: moderate decrease in GFR (60–89 ml/min/1.73 m2).
3. Stage 3a: moderate decrease in GFR (45–59 ml/min/1.73 m2).
4. Stage 3b: moderate decrease in GFR (30–44 ml/min/1.73 m2).
5. Stage 4: severe decrease in GFR (15–29 ml/min/1.73 m2).
6. Stage 5: Renal Failure (GFR)<15 мл/мин/1,73 м 2 или диализ).

At the stage of the first two stages of CKD, the glomerular filtration rate is not decisive for diagnosis, because it can be normal or borderline. In such cases, the diagnosis is established by the presence of one or more of the following markers of kidney damage:

• albuminuria, or proteinuria - protein excretion in the urine (> 30 mg/24 hours);
• abnormal urine sediment;
• electrolyte and other pathologies caused by disorders of the tubular system;
• kidney tissue damage;
• structural abnormalities detected during imaging studies;
• history of kidney transplantation.

Hypertension is a common feature of CKD, but should not be considered an indicator of CKD in itself, since increased blood pressure also common among people without CKD.

When determining the stage of the disease, it is necessary to consider the indicators of GFR and albuminuria together, and not separately. This is necessary to improve the predictive accuracy of CKD assessment, namely when assessing risks:

• general mortality;
• cardiovascular diseases;
• end-stage renal failure;
• acute renal failure;
• progression of CKD.

Clinical manifestations caused by low kidney function usually appear in stages 4–5. Stages 1–3 of the disease are often asymptomatic.

Causes of chronic kidney disease

Diseases and conditions that cause chronic kidney disease include:

Additional factors that increase the risk of the disease include:

• cardiovascular diseases;
• obesity;
• smoking;
• hereditary predisposition to kidney disease;
• abnormal kidney structure;
• old age.

Symptoms of the disease

Usually, before the onset of stages 4–5 of CKD, the patient does not have clinical manifestations of endocrine/metabolic disorders or disturbances in water and electrolyte balance. There are the following patient complaints that suggest kidney disease and dysfunction:

• pain and discomfort in the lumbar region;
• change in the appearance of urine (red, brown, cloudy, foamy, containing “flakes” and sediment);
• frequent urge to urinate, imperative urge (it is difficult to endure the urge, you must immediately run to the toilet), difficulty urinating (sluggish stream);
• decrease in the daily amount of urine (less than 500 ml);
• polyuria, disruption of the process of urine concentration by the kidneys at night (regular urge to urinate at night);
• constant feeling of thirst;
• poor appetite, aversion to meat foods;
• general weakness, malaise;
• shortness of breath, decreased exercise tolerance;
• increased blood pressure, often accompanied by headaches and dizziness;
• chest pain, heart failure;
• skin itching.

The terminal stage is one of the last in chronic renal failure; it is characterized by a complete loss of functionality of one or both kidneys. With it, uremia develops - poisoning of the body with its own metabolic products. Its manifestations include:

• pericarditis (inflammatory damage to the lining of the heart) - can be complicated by cardiac tamponade (impaired heart contractions due to fluid accumulation), which can lead to death if undiagnosed and untreated;
• encephalopathy (non-inflammatory brain damage) - can progress to coma and death;
• peripheral neuropathy (impaired transmission of nerve impulses) - leads to a malfunction of certain organs, tissues, muscles;
• gastrointestinal symptoms - nausea, vomiting, diarrhea;
• skin manifestations - dry skin, itching, bruising;
• increased fatigue and drowsiness;
• weight loss;
• exhaustion;
• anuria - a decrease in the daily volume of urine to 50 ml;
• erectile dysfunction, decreased libido, lack of menstruation.

Research also shows that 45% of adult patients develop a depressive state, which has somatic manifestations (shaking hands, dizziness, palpitations, etc.). Depression of this kind usually appears against the background of diseases of the internal organs.

Video: signs of kidney dysfunction

Diagnostic methods

Diagnosis and treatment of chronic kidney disease carried out by a nephrologist. Diagnosis is based on medical history, examination and urinalysis combined with measurement of serum creatinine levels.

It is important to differentiate ESRD from acute renal failure (ARF) because ARF may be reversible. With chronic renal failure, there is a gradual increase in serum creatinine (over several months or years), in contrast to a sudden increase in this indicator with acute renal failure (from several days to several weeks). Many patients with CKD have pre-existing kidney disease, although a significant number of patients develop the disease for unknown reasons.

Laboratory methods

The following laboratory tests are used to make a diagnosis:

1. Rehberg test - is intended to determine GFR using a special formula, into which the volume and time of urine collection in minutes, as well as the concentration of creatinine in the blood and urine are substituted. For analysis, blood is taken from a vein (in the morning on an empty stomach), as well as two hour-long portions of urine. If the GFR results in less than 20 ml/min per 1.73 m², this indicates the presence of CKD.
2. Biochemical blood test - taken from a vein, the following indicators indicate the disease:
   • serum creatinine more than 0.132 mmol/l;
   • urea more than 8.3 mmol/l.

If less than 50% of nephrons have died, chronic renal failure can only be detected by functional load. Additional laboratory tests used in the diagnosis of CKD may include:

• Analysis of urine;
• basic metabolic panel - a blood test that shows the body's water and electrolyte balance;
• checking the level of albumin (protein) in the blood serum - in patients with CKD this indicator is reduced due to malnutrition, loss of protein in the urine or chronic inflammation;
• blood lipid test - patients with CKD have an increased risk of cardiovascular disease.

Imaging studies

Imaging tests that may be used to diagnose chronic kidney disease include the following:

People with CKD should avoid x-rays that require intravenous contrast material, such as an angiogram, intravenous pyelogram, and some types of CT scans, because these may cause more kidney damage.

Treatment options for chronic kidney disease

Early diagnosis, treatment of the underlying cause, and implementation of secondary preventive measures are mandatory for patients with chronic kidney disease. These steps can delay or stop the progression of the pathological process. Early referral to a nephrologist is extremely important.

Depending on the underlying cause, some types of chronic kidney disease are partially treatable, but in general there is no specific cure for kidney failure. Medical service patients with CKD should focus on the following:

• delaying or stopping the progression of CKD;
• diagnosis and treatment of pathological manifestations;
• timely planning of long-term renal replacement therapy.

Treatment options for CKD vary depending on the cause. But kidney damage can continue to worsen even if an underlying condition, such as high blood pressure, is controlled.

Drug therapy for early stage disease

Treatment of complications includes the use of the following groups of drugs:

1. Medications for high blood pressure. Kidney disease is often associated with chronic hypertension. Medicines to lower blood pressure—usually angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs)—are prescribed to preserve kidney function. Be aware that these medications may initially reduce organ function and alter electrolyte levels, so frequent blood tests will be needed to monitor the condition. The nephrologist prescribes a diuretic (diuretic) and a low-salt diet at the same time.
2. Medicines to lower cholesterol levels. People with chronic kidney disease often suffer from high levels bad cholesterol, which may increase the risk of heart disease. In this case, the doctor prescribes medications called statins.
3. Drugs for the treatment of anemia. In certain situations, the nephrologist recommends taking the hormone Erythropoietin, sometimes with the addition of iron. Erythropoietin increases red blood cell production, which reduces fatigue and weakness associated with anemia.
4. Medicines to minimize swelling (diuretics). People with chronic kidney disease often suffer from excess fluid accumulation in the body. This can lead to swelling in the legs and high blood pressure. Diuretics help maintain fluid balance in the body.
5. Medicines to protect bones. Your doctor may prescribe calcium and vitamin D supplements to prevent bone brittleness and reduce the risk of fracture. Phosphate binders are sometimes necessary to reduce the amount of phosphate in the blood and protect blood vessels from damage by calcium deposits (calcification).

Specific names of drugs patients with chronic renal failure prescribed by a nephrologist individually. At regular intervals, control tests are required to show whether the kidney disease remains stable or is progressing.

Photo gallery: drugs prescribed for renal failure

Captopril - effective remedy to normalize blood pressure and reduce proteinuria Losartan normalizes blood pressure and improves kidney function in case of chronic kidney failure
Renagel binds phosphates in digestive tract, reducing their concentration in the blood serum and protecting blood vessels from calcification Erythropoietin stimulates the production of red blood cells, helping in the treatment of anemia

Treatment of late stage chronic kidney disease

When the kidneys can no longer cope with the elimination of waste and fluid on their own, this means that the disease has entered the final (terminal) stage of chronic renal failure. At this point, dialysis or organ transplantation become vital.

Dialysis

Dialysis is a lifelong extrarenal procedure to cleanse the blood of toxins and excess fluid. There are two options for doing this:

Video: hemodialysis and peritoneal dialysis

Kidney transplant

Kidney transplantation is a method of replacement therapy for patients in the terminal stage of CKD, which consists of replacing the recipient's damaged kidney with a healthy donor organ. A donor kidney is obtained from a living or recently deceased person.

Various approaches to kidney transplantation have been developed:

As with any organ transplant, the kidney recipient will have to take medications throughout his life that suppress the body's immune response to prevent transplant rejection.

It has been proven that a kidney transplant not only significantly improves the quality of life of a patient with chronic renal failure, but also increases its duration (compared to chronic hemodialysis).

Video: treatment of stages 4–5 of chronic kidney disease

Traditional methods

People suffering from kidney failure should not take any supplements on their own without consulting a doctor. Herbs and nutrients are metabolized differently, and if you have bad kidneys, some home remedies may actually make the situation worse. But if the treating nephrologist approves of the use of traditional methods, then some of them may be useful for maintaining health and preventing diseases of the kidneys and other digestive organs (for example, the liver).

Thus, parsley decoction is considered an ideal remedy for cleansing the kidneys and is used for home treatment diseases of the urinary system. Parsley is a rich source of vitamins A, B and C, as well as thiamine, riboflavin, potassium and copper. Its decoction improves overall health and reduces the level of toxins in the blood, whether as a preventative measure or as a treatment to slow the progression of the disease. Parsley is also an excellent diuretic, flushing harmful substances from the body.

Preparation of the decoction:

1. Grind 2-3 tbsp. spoons of parsley leaves.
2. Add 0.5 liters of water and bring to a boil.
3. Cool and strain the broth.

There are many herbal teas that are often prescribed to treat kidney disease. The most common and recommended are:

• green;
• bilberry;
• from marshmallow;
• from purple sapling;
• from dandelion.

These are some of the most effective herb varieties. They are rich in antioxidants and detoxifying compounds that have a beneficial effect on kidney function. Making tea in the classic way at the rate of 1 teaspoon of dry plant per 250 ml of boiling water.

Cranberry juice - the most famous home remedy to treat kidney problems. This product is widely available and tastes good. Organic compounds, found in cranberries, are very effective in reducing the severity of kidney infections. It is recommended to drink 2-3 glasses of cranberry juice during periods of inflammation. This is also a good prevention method. Method for preparing a healing drink:

1. Mash 250 g cranberries in a bowl.
2. Strain the resulting juice through cheesecloth.
3. Pour 1 liter of water over the berry juices and boil for 5 minutes.
4. Strain the broth and mix with juice, you can add honey to taste.

Photo gallery: traditional methods of treating kidney failure

Parsley decoction is a popular remedy for cleansing the kidneys Blueberry tea removes excess fluid from the body Dandelion has a strong diuretic effect
Posonnik purpurea helps get rid of swelling and high blood pressure Cranberry juice is effective against kidney infections

Diet food

Principles dietary nutrition for chronic kidney disease:

• Selecting and preparing foods with less salt to control blood pressure. In the daily diet it should not exceed 3–5 g, which is approximately equal to 1 teaspoon. It should be borne in mind that salt is added to many finished products or semi-finished products. Therefore, fresh foods should prevail in the diet.
• Eating the right amount and types of protein. In the process of protein processing, toxins are formed, which are removed from the body by the kidneys. If a person eats more protein food than he needs, this puts a lot of stress on these organs. Therefore, protein foods should be consumed in small portions, preferring mainly plant sources, for example, beans, nuts, and grains. It is recommended to minimize animal protein, namely:
  • red meat and poultry;
  • fish;
  • eggs;
  • dairy products.

Features of treatment in pregnant women

Chronic kidney disease is rare during pregnancy. This is because many women with kidney failure are either beyond their limits. childbearing age, or are secondary infertile, which is associated with uremia. Most women who become pregnant and have mild renal dysfunction do not experience negative influence pregnancy on your own health.

But according to research, approximately 1-7% of women of childbearing age undergoing dialysis treatment still manage to become pregnant. The survival rate of infants is about 30–50%. Spontaneous abortion rates range from 12–46%. Increased survival was observed in children of women who received dialysis ≥ 20 hours per week. The study authors concluded that increasing dialysis time may improve outcome, but prematurity remains a leading cause of neonatal mortality and likely contributes high frequency long-term medical problems in the surviving infant.

As for pregnancy after a kidney transplant, women have such chances provided that the transplant is successful (there are no signs of renal failure or transplant rejection) after at least two years. The entire pregnancy takes place under conditions of strict medical supervision and the development of a treatment regimen that will be correctly combined with immunosuppressants to avoid possible complications:

• anemia;
• exacerbation of urinary tract infections;
• late toxicosis of pregnancy;
• transplant rejection;
• delayed fetal development.

Prognosis and complications

The life prognosis of patients with chronic renal failure depends on many individual factors. The cause of kidney failure has a major impact on the outcome of the disease. The rate at which kidney function declines depends directly on the underlying disorder causing CKD and how well it is controlled. People with chronic kidney disease are at higher risk of dying from a stroke or heart attack.

Unfortunately, in most cases, chronic kidney failure will continue to develop regardless of treatment.

The life expectancy of a patient who refuses dialysis or kidney transplantation in favor of conservative treatment is no more than a few months.

If just a few years ago the life expectancy of a patient on dialysis was limited to 5–7 years, today the world's leading developers of artificial kidney devices claim that modern technologies allow a patient to live on hemodialysis for more than 20 years, while feeling well. This, of course, is subject to diet, daily routine, and healthy lifestyle.

But only a successful organ transplant provides the opportunity for a more fulfilling life and no dependence on dialysis. A transplanted kidney functions on average for 15–20 years, then a second operation is required. In practice, one person can undergo 4 kidney transplants.

Prospects for the treatment of chronic kidney disease

Regenerative medicine has the potential to complete cure damaged tissues and organs, offering solutions and hope for people with conditions that are beyond repair today. In particular, new therapeutic strategies for tissue repair have recently emerged, and one of the most promising approaches is the use of stem cells to reduce injury in chronic kidney disease.

Although there is currently no cure for kidney failure and progressive kidney disease, there have been promising results from stem cell therapy for kidney damage.

Stem cells are immature cells of the body that are capable of self-renewal, division and, if properly activated, transform (differentiate) into functional cells of any organ, including kidneys. Most of them are found in the bone marrow, as well as in adipose and other tissues with a good blood supply.

This means that a group of stem cells taken from fat deposits in the body can be activated and used to repair kidney cells and tissue damaged by chronic or acute disease. After transplantation of so-called mesenchymal stem cells, there is a significantly slower progression of CKD, which reduces the need for dialysis and kidney transplantation.

Much more research is needed, but it is clear that stem cells can help stop the progression of pathology and improve healing. In the future, stem cells are planned to be used to reverse the damage done to the kidneys.

Prevention

To reduce the risk of developing chronic kidney disease, you must first follow the rules of a healthy lifestyle, in particular:

• Follow instructions for using over-the-counter medications. Overdosing on painkillers such as Aspirin, Ibuprofen and Paracetamol can cause kidney damage. Taking these medications is even more prohibited if you already have kidney disease. To ensure safe long-term use For any medicine that is freely available in pharmacies, it is recommended that you consult your doctor first.
• Maintain a healthy weight. The absence of excess body weight is the key to optimal load on all organs, including the kidneys. Physical activity and reducing calorie intake are factors that directly affect maintaining optimal weight.
• Quit smoking. This habit can lead to new kidney damage and worsening of existing conditions. A smoker should consult a doctor to develop a strategy for quitting tobacco. Support groups, counseling and medications will help such a person stop in time.
• Monitor blood pressure. Hypertension is the most common cause of kidney damage.
• Be treated by a qualified physician. If you have a disease or condition that potentially affects your kidneys, you should promptly contact a professional for detailed diagnosis and treatment.
• Control blood sugar levels. About half of people with diabetes develop chronic kidney disease, so these people should have their kidneys checked regularly, at least once a year.

Chronic renal failure is a serious disease that inevitably reduces the quality of life over time. But today there are treatment options that can slow the progression of this pathology and significantly improve prognosis.

What is chronic renal failure (CRF), and what stages of CRF are known based on creatinine? Chronic renal failure is an irreversible impairment of kidney function. The kidneys are responsible for removing many harmful metabolic products, regulating blood pressure and acid-base balance in the body.

The development of chronic renal failure occurs gradually. At the beginning of the disease there may be no clinical symptoms or they are uncharacteristic for a given disease (for example, arterial hypertension). To determine the stage of the disease, classification by glomerular filtration rate (GFR) is used.

Impaired kidney function can occur either as a result of a sudden triggering of a damaging factor or as a result of a long-term pathological process. In the first case, acute renal failure is diagnosed, which can result in complete impairment of health within several months, complete destruction of the structures of this organ.

If the kidney is damaged gradually due to the impact of a long-term pathological process lasting at least 3 months, then chronic disease develops with the most severe consequences: severe and advanced stage of renal failure, requiring therapy with hemodialysis.

Among the main factors affecting the functioning of the kidneys, first of all, we can highlight: disorders of the blood supply, specific and nonspecific inflammatory processes and immunological factors that are toxic to the kidneys, urinary tract diseases, and chronic diseases such as diabetes and hypertension.

Diagnostic methods

The main criteria for laboratory assessment of kidney function are: the amount of filtered plasma per unit time, creatinine level and diuresis, that is, the amount of urine produced.

In addition, during the course of chronic renal failure, the patient deals with anemia and thrombocytopenia, hyperphosphatemia, hypocalcemia and hypercalcemia, impaired blood volume regulation, most often with the development arterial hypertension and acidosis. Loss of protein leads to numerous disorders associated with its deficiency - endocrine disruptions or immunodeficiency.

Symptoms of the disease

The main ones include:

• weakness, fatigue, malnutrition;
• low body temperature;
• impaired hydration of the body;
• change in the amount of urine excreted;
• decreased immunity.

Initially, the renal glomeruli undergo hypertrophy. This means that the kidney increases in size. However, terminal stage Chronic renal failure (uremia) is characterized by small kidney size.

As the disease progresses, toxins - products of protein metabolism - accumulate in the blood, resulting in an increase in the concentration of creatinine in the blood serum, which poisons the entire body.

Stages of the chronic form

Classification of chronic renal failure:

1. Kidney diseases with normal GFR - latent stage (GFR 90 and > 90 ml/min).
2. Early stage (GFR 60-89 ml/min).
3. Middle stage (GFR 30-59 ml/min).
4. Severe stage (GFR 15-29 ml/min).
5. End stage (uremia) - GFR below 15 ml/min.

The development of chronic renal failure occurs gradually, and when the glomerular filtration rate is below 15 ml/min, renal replacement therapy is required. As GFR declines, symptoms and complications appear. various organs and systems.

Each classification has its own clinical picture.

Stage I - clinical manifestations depend on the underlying disease (eg, diabetes, hypertension). Blood pressure often increases. At this stage, the cause should be determined and risk factors for kidney disease should be addressed.

At stage II, susceptibility to dehydration and urinary tract infections increases. Often coexists with vitamin D deficiency, which stimulates the parathyroid glands to secrete parathyroid hormone and develop secondary parathyroid hyperfunction. Some patients experience anemia, mainly caused by decreased production of erythropoietin in the kidneys.

On Stage III polyuria, nocturia occur, that is, night urination and increased thirst. Half of the patients develop arterial hypertension. Many patients have anemia, which can cause weakness, decreased physical activity, and easy fatigue.

Stage IV chronic renal failure is characterized by symptoms of severe severity. There is discomfort on the part gastrointestinal tract: loss of appetite, nausea and vomiting. Arterial hypertension occurs in more than 80% of patients. Many suffer from left ventricular hypertrophy and heart failure.

At stage V of end-stage renal failure, the symptoms that arise affect almost all organs and systems. Patients require renal replacement therapy (dialysis therapy or kidney transplantation), which causes regression of most symptoms of uremia.

Therapeutic measures

In the event of a sudden loss of kidney function, the main goal is to eliminate its cause, for example, replenishing fluid loss in a state of dehydration, treating heart failure, restoring patency of the urinary tract and blood vessels. Strict monitoring of mineral balance, especially serum potassium concentration, is required. It is very important to consider the degree of kidney failure when taking medications, especially those taken chronically. To avoid serious complications and ensure regeneration of damaged organ parenchyma, renal replacement therapy is used.

Chronic renal failure is an irreversible process, depending largely on the type of underlying disease, the coexistence of other diseases, and the age and gender of the patient. Unfavorable factors are: male gender, smoking, hyperlipidemia and the amount of proteinuria. Treatment is aimed primarily at the underlying disease, the main goals being:

• normalization of blood pressure;
• equalization of glycemic levels in diabetes mellitus;
• treatment of hyperlipidemia;
• equalization of water-electrolyte imbalances;
• stopping taking drugs and substances with neurotoxic effects;
• treatment of concomitant diseases;
• prevention and treatment of complications, in particular anemia.

In addition, it is necessary to strive to reduce protein loss in urine, up to optimal value below 0.3 g/day, for this purpose drugs from the group of inhibitors and receptor blockers are used. To reduce blood cholesterol levels, the patient must take statins, fibrates and lifestyle changes. Ultimately, if chronic renal failure has reached stage 5 of the disease, the patient is treated with hemodialysis.

Carrying out a hemodialysis procedure

When the GFR level decreases to a value of 15-20 ml/min/1.73 m2, the patient undergoes hemodialysis. Indications for the use of dialysis are the following life-threatening conditions:

• uremic pericarditis;
• severe phase of arterial hypertension;
• chronic symptoms of nausea and vomiting;
• concentration >12 mg/dL or urea >300 mg/dL.

Hemodialysis is carried out using special apparatus, popularly called an “artificial kidney”, it provides a simultaneous flow of blood and fluid, dialysate, separated by a semi-permeable membrane, through which metabolism is possible according to the principle of diffusion (concentration difference) and ultrafiltration (pressure difference). Thus, the blood is cleansed of harmful metabolites and toxic compounds. The process lasts about 4-5 hours and is carried out mainly 3 times a week.

During a hemodialysis procedure, the patient receives heparin to prevent blood clotting.

Doctors' opinions on the issue are always different, however, the average life expectancy is 20 years. Are often found in medical practice cases where patients live more than 35 years.

Kidney transplant

A kidney transplant is the only way to completely cure chronic renal failure. The operation entails a significant improvement in the quality of life in persons previously treated with dialysis. Unfortunately, kidney transplantation requires tissue compatibility from a living or deceased donor. Therefore it is often necessary long time waiting for surgery. Individuals whose serum creatinine concentration exceeds 6 mg/dL require an organ transplant. After surgery, patients must take immunosuppressive drugs and steroids to prevent organ rejection. Contraindications for surgery are serious organ diseases such as cancer, as well as age and atherosclerosis.

It is necessary to constantly monitor kidney function after surgery. According to the latest research data, after 5 years after surgery, about 80% of transplanted organs perform their functions. Unfortunately, the number of transactions performed is 3 times less than the number of people on the waiting list.

Modern medicine manages to cope with most acute kidney diseases and curb the progression of most chronic ones. Unfortunately, until now, about 40% of renal pathologies are complicated by the development of chronic renal failure (CRF).

This term means the death or replacement by connective tissue of part of the structural units of the kidneys (nephrons) and irreversible impairment of the kidneys’ functions to cleanse the blood of nitrogenous wastes, produce erythropoietin, which is responsible for the formation of red blood elements, remove excess water and salts, and reabsorb electrolytes.

The consequence of chronic renal failure is a disorder of water, electrolyte, nitrogen, acid-base balance, which entails irreversible changes in the state of health and often becomes the cause of death in terminal chronic renal failure. The diagnosis is made when disorders are registered for three months or longer.

Today, CKD is also called chronic kidney disease (CKD). This term emphasizes the potential for development severe forms renal failure even at the initial stages of the process, when the glomerular filtration rate (GFR) has not yet been reduced. This allows for more careful attention to patients with asymptomatic forms of renal failure and improves their prognosis.

Criteria for chronic renal failure

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

• Damage to the kidneys with disruption 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 rate of filtration corresponds to the death of about half of the nephrons of the kidneys.

What leads to chronic renal failure

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

• Kidney diseases: chronic glomerulonephritis, chronic tubulointerstitial nephritis, renal tuberculosis, hydronephrosis, polycystic kidney disease, nephrolithiasis.
• Pathologies of the urinary tract: urolithiasis disease, urethral strictures.
• Cardiovascular diseases: arterial hypertension, atherosclerosis, incl. angiosclerosis of the renal vessels.
• Endocrine pathologies: diabetes.
• Systemic diseases: renal amyloidosis, .

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, passing through 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 normal glomerular filtration rate is 100-120 ml per minute. An indirect indicator by which one can judge GFR is blood creatinine.

• The first stage of chronic renal failure is initial

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

• Second stage

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

• Third stage

On the third moderate stage GFR drops to 60-30 ml per minute. At the same time, the process occurring in the kidneys is often hidden from view. There is no bright clinic. There may be an increase in the volume of urine excreted, 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. About half of the patients experience an increase in blood pressure (mainly diastolic, i.e. lower).

• Fourth stage

It is called conservative because it can be controlled by medications and, like the first, does not require blood purification using hardware methods (hemodialysis). At the same time, glomerular filtration is maintained at a level of 15-29 ml per minute. Appear Clinical signs renal failure: severe weakness, decreased ability to work due to anemia. The volume of urine excreted increases, significant urination at night with frequent urges at night (nocturia). Approximately half of patients suffer from high blood pressure.

• Fifth stage

The fifth stage of renal failure is called terminal, i.e. final. When glomerular filtration decreases below 15 ml per minute, the amount of urine excreted drops (oliguria) until it is completely absent in the outcome of the condition (anuria). All signs of poisoning of the body with nitrogenous wastes (uremia) appear against the background of water-electrolyte imbalance, damage to all organs and systems (primarily the nervous system, heart muscle). With this development of events, the patient’s life directly depends on blood dialysis (cleaning it bypassing non-functioning kidneys). Without hemodialysis or kidney transplantation, patients die.

Symptoms of chronic renal failure

Appearance of patients

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

• Due to anemia, pallor appears, due to water and electrolyte disturbances, dry skin.
• As the process progresses, yellowness of the skin and mucous membranes appears and their elasticity decreases.
• Spontaneous bleeding and bruising may occur.
• This causes scratching.
• Characterized by so-called renal edema with puffiness of the face, up to the common type of anasarca.
• The muscles also lose tone and become flabby, which causes fatigue to increase and the ability of patients to work decreases.

Nervous system lesions

This is manifested by apathy, night sleep disorders and daytime sleepiness. Decreased memory and learning ability. As chronic renal failure increases, severe inhibition and disturbances in the ability to remember and think appear.

Disturbances in the peripheral part of the nervous system affect the limbs with chilliness, tingling sensations, and crawling sensations. In the future they will join movement disorders in the arms and legs.

Urinary function

She first suffers from polyuria (increased urine volume) with a predominance of nighttime urination. Further, chronic renal failure develops along the path of a decrease in urine volume and the development of edematous syndrome until the complete absence of excretion.

Water-salt balance

• salt imbalance manifests itself increased thirst, dry mouth
• weakness, darkening of the eyes when standing up suddenly (due to sodium loss)
• Excess potassium may cause muscle paralysis
• breathing problems
• slowing of heartbeats, arrhythmias, intracardiac blockades up to cardiac arrest.

Against the background of increased production of parathyroid hormone by the parathyroid glands, high level phosphorus and low blood calcium levels. This leads to softening of the bones, spontaneous fractures, and itchy skin.

Nitrogen balance disorders

They cause an increase in blood creatinine, uric acid and urea, resulting in:

• when GFR is less than 40 ml per minute, enterocolitis develops (damage to the small and large intestines with pain, bloating, frequent loose stools)
• ammonia odor from the mouth
• secondary articular lesions such as gout.

The cardiovascular system

• firstly, it responds by increasing blood pressure
• secondly, damage to the heart (muscles - pericarditis, pericarditis)
• appear dull pain in the heart, heart rhythm disturbances, shortness of breath, swelling in the legs, enlarged liver.
• If myocarditis progresses unfavorably, the patient may die due to acute heart failure.
• pericarditis can occur with the accumulation of fluid in the pericardial sac or the loss 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.

Hematopoiesis

Against the background of a deficiency in the production of erythropoietin by the kidneys, hematopoiesis slows down. The result is anemia, which manifests itself very early in weakness, lethargy, and decreased performance.

Pulmonary complications

characteristic of late stages of chronic renal failure. This uremic lung - interstitial edema and bacterial pneumonia against the backdrop of a decline in immune defense.

Digestive system

She reacts with decreased appetite, nausea, vomiting, inflammation of the oral mucosa and salivary glands. With uremia, erosive and ulcerative defects stomach and intestines, fraught with bleeding. Acute hepatitis is a frequent accompaniment of uremia.

Kidney failure during pregnancy

Even a physiologically occurring pregnancy significantly increases the load on the kidneys. In chronic kidney disease, pregnancy aggravates the course of the pathology and can contribute to its rapid progression. This is due to the fact that:

• During pregnancy, increased renal blood flow stimulates overexertion renal glomeruli and the death of some of them,
• deterioration of conditions for reabsorption of salts in the renal tubules leads to losses of high volumes of protein, which is toxic to renal tissue,
• increased functioning of the blood coagulation system contributes to the formation of small blood clots in the capillaries of the kidneys,
• worsening arterial hypertension during pregnancy contributes to glomerular necrosis.

The worse the filtration in the kidneys and the higher the creatinine numbers, the more unfavorable the conditions for pregnancy and its gestation. A pregnant woman with chronic renal failure and her fetus face a number of pregnancy complications:

• Arterial hypertension
• Nephrotic syndrome with edema
• Preeclampsia and eclampsia
• Severe anemia
• and fetal hypoxia
• Delays and malformations of the fetus
• and premature birth
• Infectious diseases of the urinary system of a pregnant woman

To resolve the issue of the advisability of pregnancy for each specific patient with chronic renal failure, nephrologists and obstetricians-gynecologists are involved. In this case, it is necessary to assess the risks for the patient and the fetus and correlate them with the risks that the progression of chronic renal failure every year reduces the likelihood of new pregnancy and its successful resolution.

Treatment methods

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

• Patients are recommended to eat a diet limiting their protein intake to 60 grams per day and predominantly consuming plant proteins. As chronic renal failure progresses to stage 3-5, protein is limited to 40-30 g per day. At the same time, the proportion of animal proteins is slightly increased, giving preference to beef, eggs and lean fish. The egg-potato diet is popular.
• At the same time, the consumption of foods containing phosphorus (legumes, mushrooms, milk, white bread, nuts, cocoa, rice) is limited.
• Excess potassium requires reducing the consumption of black bread, potatoes, bananas, dates, raisins, parsley, figs).
• Patients have to manage with a drinking regimen of 2-2.5 liters per day (including soup and taking pills) in the presence of severe edema or intractable arterial hypertension.
• It is useful to keep a food diary, which makes it easier to track the protein and microelements in food.
• Sometimes specialized mixtures, enriched with fats and containing a fixed amount of soy proteins and balanced in microelements, are introduced into the diet.
• Along with the diet, patients may be prescribed an amino acid substitute - Ketosteril, which is usually added when GFR is less than 25 ml per minute.
• A low-protein diet is not indicated for malnutrition, infectious complications CRF, uncontrolled arterial hypertension, with GFR less than 5 ml per minute, increased protein breakdown, after surgery, 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.

Enterosorbents

They can somewhat reduce the severity of uremia by binding in the intestines and removing nitrogenous wastes. This works in the early stages of chronic renal failure with relative preservation of glomerular filtration. Polyphepan, Enterodes, Enterosgel, Activated carbon, are used.

Treatment of anemia

To relieve anemia, Erythropoietin is administered, which stimulates the production of red blood cells. Uncontrolled arterial hypertension becomes a limitation to its use. Since iron deficiency may occur during treatment with erythropoietin (especially in menstruating women), therapy is supplemented with oral iron supplements (Sorbifer Durules, Maltofer, etc., see).

Bleeding disorder

Correction of blood clotting disorders is carried out with Clopidogrel. Ticlopedin, Aspirin.

Treatment of arterial hypertension

Drugs for the treatment of arterial hypertension: ACE inhibitors(Ramipril, Enalapril, Lisinopril) and sartans (Valsartan, Candesartan, Losartan, Eprosartan, Telmisartan), as well as Moxonidine, Felodipine, Diltiazem. in combinations with saluretics (Indapamide, Arifon, Furosemide, Bumetanide).

Phosphorus and calcium metabolism disorders

It is stopped with calcium carbonate, which prevents the absorption of phosphorus. Lack of calcium - synthetic vitamin D preparations.

Correction of water and electrolyte disorders

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

Secondary infections in chronic renal failure

This requires the prescription of antibiotics, antiviral or antifungal drugs.

Hemodialysis

With a critical decrease in glomerular filtration, blood purification from substances of nitrogen metabolism is carried out by hemodialysis, when waste products pass into the dialysis solution through a membrane. The most commonly used device is an “artificial kidney”; less commonly, peritoneal dialysis is performed, when the solution is poured into the abdominal cavity, and the peritoneum plays the role of a membrane. Hemodialysis for chronic renal failure is carried out in a chronic mode. For this, patients travel for several hours a day to a specialized center or hospital. In this case, it is important to prepare an arteriovenous shunt in a timely manner, which is prepared at a GFR of 30-15 ml per minute. From the moment the GFR drops to less than 15 ml, dialysis begins in children and patients with diabetes mellitus; when the GFR falls below 10 ml per minute, dialysis is carried out 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.
• Severe blood acidification.

Contraindications to hemodialysis:

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

Kidney transplant

This is a radical 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 termination of pregnancy. pregnancy can be carried to the required term and is resolved, as a rule, caesarean section at 35-37 weeks.

Thus, Chronic kidney disease, which today has replaced the concept of “chronic renal failure,” allows doctors to see the problem in a more timely manner (often when there are still no external symptoms) and respond by starting therapy. Adequate treatment can prolong or even save the patient’s life, improve his prognosis and quality of life.

What is it - kidney failure is serious functional disorder kidneys, which leads to water, electrolyte and acid-base imbalance in the body.

Renal failure is characterized by a sharp decrease in the amount of urine excreted by the kidneys, up to its complete absence for a long time.

As a result, the functioning of all internal human organs is disrupted. Lack of adequate and timely treatment can lead to irreversible kidney damage, which will become a real threat to human life.

Causes of kidney failure

There are two forms of kidney failure: acute and chronic. They differ in their manifestations and treatment methods. Acute renal failure (ARF) sometimes becomes chronic.

AKI can occur as a result of shock of various origins, the harmful effects of poisons and toxic substances, infections, kidney diseases, medicines. ARF has a classification that is differentiated depending on the manifestations of the syndrome.

Thus, acute renal failure is divided into:

Chronic renal failure (CRF) most often develops as a result of diseases of the kidneys and urinary tract, as well as endocrine and cardiovascular diseases. This condition is characterized by the slow death of kidney tissue until its complete destruction.

Moreover, in chronic renal failure there are four stages of its development:

Both acute and chronic renal failure have their own symptoms and manifestations.

Acute renal failure develops gradually, going through several stages in its development, which are characterized by a certain set of symptoms.

There are four stages of acute renal failure:

1) For the first, initial stage of acute renal failure characterized by mild symptoms. Clinical manifestations relate to the cause of acute renal failure, for example, symptoms of poisoning due to exposure to a poison or symptoms of an underlying disease. Thus, the primary specific symptom of acute renal failure is only a decrease in the amount of urine excreted. This condition can last for several days, during which signs of intoxication may appear with abdominal pain, mild swelling and pale skin.

2) Second stage noted further development oliguria up to anuria - complete inability of the kidneys to produce urine. Symptoms become more severe due to the accumulation of urea in the blood. So, arrhythmia appears. hypertension. tachycardia. Sometimes convulsions occur. A person’s reactions are inhibited and drowsiness occurs. In addition, extensive swelling appears, including swelling of the optic disc. From the gastrointestinal tract (GIT), the patient may suffer from nausea, vomiting and diarrhea.

3) The third stage is recovery. The person begins to feel better due to the fact that kidney function gradually returns to normal. Symptoms of intoxication disappear, normal functioning of all internal organs is restored. The recovery period depends on the degree of kidney damage, the causes of acute renal failure and the adequacy of treatment.

4) Sometimes experts highlight fourth stage. by which we mean the entire range of processes aimed at restoring the functionality and condition of the kidneys to their original parameters. In general, the recovery period can last several months.

Symptoms of chronic renal failure

Symptoms also develop in stages. Chronic renal failure is characterized by gradual kidney damage with slowly progressing symptoms. So, a person can suffer from chronic renal failure for several months or even years.

1) For the latent stage of chronic renal failure characterized by mild symptoms. Clinical manifestations are largely related to the underlying disease that caused the development of chronic renal failure. As chronic renal failure develops, a person may begin to suffer from increased fatigue, which will be especially noticeable during high physical activity, weakness, drowsiness and dry mouth, which will increase the person’s need for drinking water. Polyuria may develop - an increase in the volume of urine excreted by the kidneys.

2) Next stage- stage of clinical manifestations, the name of which speaks for itself. Functional failures in the functioning of the kidneys appear, which is expressed in a sharp decrease in the amount of urine excreted. This entails a change in blood composition, which will be visible in tests. Weakness and general fast fatiguability the patient is progressing. Appears constant dryness in the mouth and thirst. From the gastrointestinal tract, symptoms such as nausea, stomach pain, and bad breath appear. Diarrhea and vomiting are possible. Due to a severe decrease in appetite, a person can lose significant weight. Neurological disorders also appear, which are expressed in insomnia, headaches and apathy. There may be problems with the cardiovascular system, which will result in arrhythmia and tachycardia. In addition, pain in bones and joints may occur.

3) The next stage is the stage of decompensation, which is characterized by the addition of additional secondary symptoms. Since a person with chronic renal failure in most cases has severe sore throats, pharyngitis and acute respiratory diseases, complications may develop, including pneumonia and pulmonary edema. In addition, a number of other complications may occur, the occurrence of which depends on the person’s condition.

4) The last stage of chronic renal failure is marked by many symptoms that greatly impair a person’s quality of life. The final stage is characterized by a general decrease in mood combined with neurological symptoms. Severe swelling appears, the skin becomes yellowish tint. Urine that is not excreted by the kidneys is excreted through sweat, which explains the constant unpleasant odor from a person suffering from chronic kidney disease.

From the gastrointestinal tract, vomiting, heartburn and diarrhea can be observed. Severe intoxication of the body occurs, which leads to functional disorders in the functioning of other organs. Thus, a person’s production of necessary hormones decreases, general immunity, which leads to development various diseases that a person is not able to cope with on his own. Without treatment, changes in internal organs eventually become irreversible, leading to death.

Treatment of kidney failure

Acute renal failure is a reversible process. Treatment consists primarily of eliminating the cause of acute renal failure, which will avoid further negative effects on the kidneys. This is achieved by intensive care. Normal kidney function is restored through hemodialysis or peritoneal dialysis, which allows the kidneys to fully recover. The prognosis for acute renal failure is favorable in most cases.

Treatment chronic renal failure depends on the general condition of the person, on the causes of chronic renal failure and on the advanced state of the disease. Therapy is carried out aimed at treating the root cause of chronic renal failure, as well as aligning all metabolic processes in the human body.

Therapy should also be aimed at slowing the progression of kidney damage. The success of treatment largely depends on the person, that is, on how responsibly he approaches the implementation of all the doctor’s instructions. On last stage Chronic renal failure requires regular dialysis or healthy kidney transplantation.

The prognosis of chronic renal failure is quite favorable if treatment is started in the initial stage or stage of clinical manifestations. The prognosis of end-stage renal failure depends on the possibility of kidney transplantation. If such an opportunity exists, then this gives a person a chance for a significant extension of life, which will be practically no different from the life of healthy people.

Which doctor should I contact for treatment?

If, after reading the article, you suspect that you have symptoms characteristic of this disease, then you should consult a urologist.

Prognosis for life with end-stage chronic renal failure

End-stage chronic renal failure ceased to be a death sentence from the moment blood purification devices appeared and began to be improved, replacing renal functions. But even with effective and complete treatment, the life expectancy of a person in the terminal stage of chronic renal failure is limited to the next 10–15 years. No doctor can say exactly how long a person with non-functioning kidneys will live.

Periods of end-stage chronic renal failure

The reasons for the significant deterioration functional state kidneys with the formation of chronic renal failure - are a sharp decrease in the number of nephrons in the parenchyma. Most often, their death occurs against the background of a complicated course of chronic kidney diseases, in which proper treatment was not carried out or there were deep anatomical and functional damage to the kidneys.

Regardless of the causative factors, the terminal stage of chronic renal failure is divided into several periods:

Determining the exact condition of the patient is required to select treatment tactics: in periods 1 and 2, there are still opportunities for use effective methods therapy. In the 3rd and 4th periods, when irreversible changes occur in vital organs, it is extremely difficult to hope for positive dynamics of treatment.

Basic treatment methods

All therapeutic measures in the terminal stage of chronic renal failure are carried out in a hospital setting and are divided into conservative and surgical methods. The vast majority of patients will require all possible options therapy for renal failure, which will be used in stages.

Conservative treatment

The main methods used in all patients in the last stage of chronic renal failure include diet therapy and antitoxic effects on the blood.

1. Detoxification. Terminal chronic renal failure is characterized by a sharp deterioration in the functioning of the kidneys to cleanse the body of toxins and harmful substances formed in the process of life. Basic treatment involves mandatory blood detoxification. The doctor will prescribe various options for droppers, with the help of which it will be possible to partially remove toxic substances, replacing the work of diseased kidneys.

Dialysis

Any conservative treatment methods for chronic renal failure, especially in the terminal stage, are not effective enough. It is optimal to use modern treatment methods that almost completely replace lost kidney function. For chronic renal failure, the main type of therapy is dialysis, the essence of which is to pass fluid through a special filter to separate and remove harmful substances. Dialysis can be used at any stage of the terminal stage.

2. Peritoneal dialysis. The inner surface of the abdomen consists of peritoneum, which is a natural filter. It is this property that is used for constant and effective dialysis. With the help of surgery, a special catheter tube is placed inside the abdomen, which contains a dissolving liquid (dialysate). Blood flowing through the vessels of the peritoneum releases harmful substances and toxins that are deposited in this dialysate. The solvent fluid needs to be changed every 6 hours. Changing the dialysate is technically simple, so the patient can do it independently.
3. Hemodialysis. For direct blood purification in the treatment of chronic renal failure, an “artificial kidney” device is needed. The technique involves taking blood from a sick person, cleaning it through the filter of the device and returning it back to vascular system body. The effectiveness is much higher, so it is usually necessary to carry out a procedure lasting 5-6 hours 2-3 times a month.

Kidney transplant

Surgical treatment for kidney transplantation is carried out only in periods 1 and 2 of the clinical course of end-stage chronic renal failure. If at the examination stage the doctor discovered severe and irreversible changes in vital organs (heart, liver, lungs), then there is no point in doing a kidney transplant. In addition, surgery is contraindicated for severe pathologies. endocrine system, mental illness, stomach ulcers and the presence acute infection anywhere in the body.

The selection of a donor kidney is of great importance. The best option is a close relative (mother, father, brother or sister). If there are no relatives, you can try to get a donor organ from a person who suddenly died.

Medical technologies make it possible to perform a kidney transplant without any particular difficulties, but the main thing is not the operation at all, but further treatment to prevent rejection of the transplanted organ. If everything went well and without complications, then the prognosis for life is favorable.

Any treatment for terminal chronic renal failure has the main goal of restoring basic renal functions. IN initial period terminal stage of the disease, it is best to perform a kidney transplant, especially if all vital organs are fully functioning. For cardiopulmonary and liver failure, the doctor will prescribe various dialysis options. A prerequisite for therapy is adherence to a diet and regular detoxification courses. The result of complex therapeutic effects will be the maximum long-term preservation human life.

Kidney failure: how to treat, what diet and nutrition

Renal failure is a pathological condition of the kidneys in which they do not fully perform their work to the required extent as a result of any disease. This process leads to a change in the constancy of the body’s self-regulation, and as a result, the functioning of its tissues and organs is disrupted.

Renal failure can occur in acute (ARI) and chronic (CRF) forms.

The causes of kidney failure vary depending on the form of the disease. There are several reasons that cause acute renal failure:

4. Prerenal, that is, the disease is caused by heart failure, collapse, shock, severe arrhythmias, a significant reduction in circulating blood volume (possibly in case of blood loss).
5. Renal, in which the death of the renal tubules is caused by the action heavy metals, poisons, alcohol, drugs or due to insufficient blood supply to the kidney; sometimes the cause is acute glomerulonephritis or tubulointerstitial nephritis.
6. Postrenal, that is, as a result of acute bilateral blockage of the ureters due to urolithiasis.

The causes of chronic renal failure are considered chronic glomerulonephritis and pyelonephritis, systemic diseases, urolithiasis, neoplasms in the urinary system, diseases with impaired metabolism, vascular changes (high blood pressure, atherosclerosis) and genetic diseases.

Symptoms of the disease

Signs of renal failure depend on the severity of changes in renal function, the duration of the disease and the general condition of the body.

There are four degrees of acute renal failure:

7. Signs of renal failure in the initial phase: decreased amount of urine, decreased blood pressure, increased heart rate.
8. The second phase (oliguric) consists of reducing the amount of urine or until its production stops. The patient's condition becomes serious, as almost all body systems are affected and a complete metabolic disorder occurs, which threatens life.
9. The third phase (restorative or polyuric) is characterized by an increase in the amount of urine to a normal level, but it almost does not remove any substances from the body except salts and water, so in this phase there remains a danger to the patient’s life.
10. Renal failure of the 4th degree consists in the normalization of urine output, kidney function returns to normal after 1.5-3.5 months.

Signs of kidney failure in people who have a chronic form include a significant decrease in the amount of working kidney tissue, which leads to azotemia (increased levels of nitrogenous substances in the blood). Since the kidneys can no longer cope with their work, these substances are eliminated in other ways, mainly through the mucous membranes of the gastrointestinal tract and lungs, which are not designed to perform such functions.

Renal failure syndrome quickly leads to the development of uremia, when self-poisoning of the body occurs. There is an aversion to eating meat, attacks of nausea and vomiting, a regular feeling of thirst, a feeling of muscle cramps and bone pain. A jaundiced tint appears on the face, and the smell of ammonia is felt when breathing. The amount of urine excreted and its density are greatly reduced. Kidney failure in children follows the same principles as in adults.

Complications of the disease

End-stage renal failure is caused by a complete loss of kidney function, which causes toxic products to accumulate in the patient's body. Terminal renal failure provokes complications such as gastroenterocolitis, myocardial dystrophy, hepatorenal syndrome, and pericarditis.

Hepatorenal failure means progressive oliguric renal failure secondary to liver disease. With hepatorenal syndrome, vasoconstriction occurs in the cortical region of the kidneys. This syndrome in cirrhosis is considered as the last stage of development of the disease, which leads to the retention of water and sodium ions.

Diagnostic methods

Diagnosis of kidney failure includes determining the amount of creatinine, potassium and urea in the blood, as well as constant monitoring of the amount of urine excreted. Ultrasound, radiography and radionuclide methods can be used.

To diagnose chronic renal failure, a complex of advanced biochemical studies of blood and urine, filtration rate analysis, and urography are used.

Treatment with medications

Treatment of renal failure is carried out in the intensive care unit or intensive care wards of a hospital. In case of the slightest complications, you should immediately seek medical help. Today it is possible to treat patients with acute renal failure using an artificial kidney device, while renal function is restored.

If treatment is started promptly and carried out in full, the prognosis is usually favorable.

During therapy, impaired metabolic processes are treated, diseases that aggravate chronic renal failure are identified and treated. At a later stage, continuous hemodialysis and kidney transplantation are required.

Medicines for renal failure are used to reduce metabolic processes: anabolic hormones - testosterone propionate solution, methylandrostenediol. To improve renal microcirculation, you need to use trental, chimes, troxevasin and complamin for a long time. To stimulate urine output, a glucose solution with insulin or diuretics from the furosemide group is prescribed. If there is a high concentration of nitrogen in the blood, then the gastrointestinal tract is washed with a solution of sodium bicarbonate, due to which nitrogenous wastes are removed. This procedure is carried out on an empty stomach, before meals, once a day.

Antibiotics for renal failure are used in reduced doses, since their rate of elimination is significantly reduced. The degree of chronic renal failure is taken into account and the dose of antibiotics is reduced to 2 or 4 times.

Treatment of the disease with traditional methods

How to treat kidney failure without the use of antibiotics and other medications is described in the recipes below.

11. Take lingonberry leaves, chamomile, motherwort herb, string flowers, dandelion and violet, half a teaspoon each. This collection is poured into a glass boiled water, leave for about 1 hour and take a third of a glass 5 times a day.
12. Second recipe: mix mint, St. John's wort, lemon balm, calendula 1 tbsp. l. In a saucepan, add 2 cups of boiled water to the herbal mixture and bring to a boil. Pour the prepared infusion into a thermos and leave overnight. Take 100 ml per day.
13. Treatment with folk remedies for kidney failure includes the use of watermelon rinds, which have a diuretic effect. Take 5 tbsp. l. chopped watermelon rinds per liter of water. You need to fill the crusts with water, leave for an hour and take several times throughout the day.
14. Pomegranate peel and rose hips also have a mild diuretic effect. Take them in equal parts and pour two glasses of boiled water. Leave in a warm place for half an hour and take up to 2 glasses per day.

Principles of diet therapy for renal failure

Diet for kidney failure plays an important role - it is necessary to adhere to a diet low in protein and sodium chloride, and to exclude drugs that have a toxic and damaging effect on the kidneys. Nutrition for kidney failure depends on several general principles:

15. It is necessary to limit protein intake to 65 g per day, depending on the phase of kidney disease.
16. The energy value of food increases due to increased consumption of fats and carbohydrates.
17. The diet for kidney failure boils down to eating a variety of fruits and vegetables. In this case, it is necessary to take into account the content of proteins, vitamins and salts in them.
18. Proper culinary processing of products is carried out to improve appetite.
19. The amount of sodium chloride and water entering the body is regulated, the amount of which affects the presence of swelling and blood pressure indicators.

Sample diet menu for kidney failure:

First breakfast: boiled potatoes – 220g, one egg, sweet tea, honey (jam) – 45g.

Lunch: sweet tea, sour cream – 200g.

Dinner: rice soup - 300g (butter - 5-10g, sour cream - 10g, potatoes - 90g, carrots - 20g, rice - 20g, onions - 5g and tomato juice– 10g). For the second course, serve vegetable stew - 200g (from carrots, beets and rutabaga) and a glass of apple jelly.

Dinner: milk porridge from rice - 200g, sweet tea, jam (honey) - 40g.

Prognosis for the disease

With timely and adequate treatment The prognosis for acute renal failure is quite favorable.

In the chronic version of the disease, the prognosis depends on the stage of the process and the degree of renal dysfunction. If renal function is compensated, the prognosis for the patient’s life is favorable. But in the terminal stage, the only options to maintain life are continuous hemodialysis or transplantation of a donor kidney.

Stage 4 Chronic Kidney Failure (CKF)

Stage 4 chronic renal failure is a serious stage of kidney disease with a glomerular filtration rate of 15-30 ml/min. Strong decline kidney function will cause systemic symptoms. Patients at this stage, on the one hand, should pay special attention to diet and lifestyle changes in order to manage the disease situation and not burden the kidneys, and on the other hand, receive treatment to improve the kidney situation and avoid threatening complications.

As kidney function deteriorates, metabolites will be able to accumulate in the bloodstream and cause medical situation, which is called Anemia. Because the kidneys cannot produce erythropoietin effectively and the hormone stimulates the production of blood cells, patients with stage 4 kidney failure will become anemic. The kidneys regulate electrolyte balance, and in stage 4 kidney failure it was common for patients to suffer from high sodium, high phosphorus, low calcium, high sodium, etc. High potassium will cause arrhythmia, high sodium threatens fluid retention and will increase blood pressure, and elevated phosphorus will cause sore bones.

Symptoms of stage 4 chronic kidney failure mainly include:

* Weakness. Feeling tired is a result of stage 4 anemia symptom.

* Change in urination. Urine may be foamy and the foam persists for a long time. This is a sign of increased protein in the urine. Blood in the urine will cause the urine color to be dark orange, brown, tea-colored, or red. The person may pass more or less urine, or go to the toilet frequently at night.

* Difficulty falling asleep. Itchy skin, restless legs or muscle cramps may keep the sufferer awake and have difficulty falling asleep.

* Nausea. Chronic kidney failure may cause vomiting or nausea.

* Lack of appetite. The patient has no desire to eat and often complains of a metallic or ammonia taste in the mouth.

* Cardiovascular diseases. In stage 4 chronic renal failure, various factors, including high blood pressure, water and salt retention, anemia and toxic substances, will increase the patient's risk of heart failure, arrhythmia, myocardial damage, etc.

* Symptoms in the nervous system. Early symptoms mainly include insomnia, poor concentration, and memory loss. In some cases, patients suffer from tingling, numbness, coma, insanity and others.

Patients with stage 4 usually require blood testing creatinine. hemoglobin, calcium, potassium and calcium in order to find out how the kidneys work and how to reduce the risk of complications. After determining the test result, the doctor will advise the patient on the best treatment option. Because diet is a necessary part of treatment, so a dietician will also be necessary for treatment. And the dietitian will examine the test result and give the patient his own dietary plan. A proper nutrition plan helps maintain kidney function and overall health.

Some of the basic dietary tips for stage 4 kidney failure mainly include the following:

Calculate protein intake. Proteins are sources of nutrition for the human body. However, too much protein is harmful because it will produce more nitrogenous waste. Taking 0.6 grams of protein per kilogram per day is beneficial when your glomerular filtration rate falls below 25, or approximately 25% of your kidney function remains. You should ask your doctor how much protein is available per day and remember that at least half of the protein comes from high-quality sources like egg whites, lean meats, fish, etc.

Limiting sodium intake. Too much sodium can cause retention of large liquids. And this will lead to swelling and shortness of breath in the person. A person in stage 4 kidney failure should avoid eating processed foods and prepare a lunch with low sodium or sodium ingredients. Most diets start with a goal of 1500-2000 mg per day or as recommended by your doctor.

Maintain a healthy body weight. If you want to maintain a healthy weight by burning calories, now you need to exercise regularly.

Cholesterol intake. Replace saturated fats unsaturated fats and make a diet generally low in fat. This may help reduce the risk of heart disease.

Other tips. You should limit potassium intake if laboratory results are above the normal range. If the palm has too much fluid content, it will limit fluid intake. Symptoms of fluid retention mainly include swelling in the legs, arms, face, high blood pressure and shortness of breath.

In order to prolong kidney health, patients in stage 4 kidney failure should take medications recommended by their doctor to control blood pressure, anemia and other situations. People in stage 4 are likely to further lose kidney function and end up on dialysis. Apart from a basic management plan to control the progress of the disease, proper treatment will help improve renal function from a poor position to a better position and therefore dialysis will not be necessary. And this will be accomplished by combining Western medicine and traditional Chinese medicine.

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Renal failure and anuria

Acute renal failure is a condition in which there is a sudden cessation or a very sharp decrease in the function of both kidneys or a single kidney. As a result of the development of this condition, it appears azotemia . which increases rapidly, and severe water and electrolyte disturbances are also noted.

In the same time anuria is a serious condition of the body in which the flow of urine into the bladder completely stops, or no more than 50 ml of urine enters during the day. A person suffering from anuria has no urination and no urge to urinate.

What's happening?

In the pathogenesis of the disease, the leading factor is impaired blood circulation in the kidneys and a decrease in the level of oxygen delivered to them. As a result, all important kidney functions are disrupted - filtration . excretory . secretory . As a result, the content of nitrogen metabolism products in the body sharply increases, and metabolism is seriously disturbed.

In approximately 60% of cases, signs of acute renal failure are observed after surgical operations or injuries. About 40% of cases of the disease occur during the treatment of patients in a hospital. In rare cases (approximately 1-2%) this syndrome develops in women during pregnancy .

Distinguish acute And chronic stage of renal failure. The clinical picture of acute renal failure can develop within several hours. If the diagnosis is made in a timely manner and all measures have been taken to prevent this condition, then kidney function is fully restored. Presentation of treatment methods is carried out only by a specialist.

There are several types of acute renal failure. Prerenal renal failure develops due to acute disruption of blood flow in the kidneys. Renal renal failure is the result of damage to the renal parenchyma. Postrenal renal failure is a consequence of a sudden disruption of the outflow of urine.

Causes

The development of acute renal failure occurs during traumatic shock, which damages tissue. Also, this condition develops under the influence of reflex shock, a decrease in the amount of circulating blood due to burns, and large blood loss. In this case, the state is defined as shock bud . This occurs in serious accidents, severe surgical interventions, injuries, myocardial infarction . when transfusion of incompatible blood.

A condition called toxic kidney . manifests itself as a result of poisoning with poisons, intoxication of the body with medications, alcohol abuse, substance abuse, and radiation.

Acute infectious kidney - consequences of serious infectious diseases - hemorrhagic fever . leptospirosis . This can also happen during severe course infectious diseases in which dehydration quickly develops.

Acute renal failure also develops as a result of urinary tract obstruction. This happens if the patient’s tumor grows, there are stones, thrombosis, embolism of the renal arteries is observed, or an injury to the ureter occurs. In addition, anuria sometimes becomes a complication of acute pyelonephritis and acute glomerulonephritis .

During pregnancy, acute renal failure is most often observed in the first and third trimesters. In the first trimester, this condition may develop after abortion . especially if carried out under non-sterile conditions.

Kidney failure also develops as a result of postpartum hemorrhage, as well as preeclampsia in the last weeks of pregnancy.

There are also a number of cases where it is not possible to clearly determine the reasons why the patient develops acute renal failure. Sometimes this situation occurs when several different factors influence the development of the disease.

Symptoms

Initially, the patient does not show direct symptoms of renal failure, but signs of the disease that leads to the development of anuria. These could be signs of shock, poisoning, or direct symptoms of the disease. Further symptoms in children and adults manifest themselves as a decrease in the amount of urine excreted. Initially, its amount decreases to 400 ml daily (this condition is called oliguria ), later the patient excretes no more than 50 ml of urine per day (determined anuria ). The patient complains of nausea, he also vomits, and his appetite disappears.

The person becomes lethargic, drowsy, has a mental retardation, and sometimes has convulsions and hallucinations.

The condition of the skin also changes. It becomes very dry, pale, swelling and hemorrhages may appear. The person breathes frequently and deeply, and has tachycardia . the heart rhythm is disrupted and blood pressure rises. May also be noted loose stool And bloating .

Anuria is cured if treatment for anuria was started in a timely manner and carried out correctly. To do this, the doctor must clearly determine the causes of anuria. If therapy is carried out correctly, the symptoms of anuria gradually disappear and a period begins when diuresis is restored. During the period of improvement of the patient's condition, anuria is characterized by a daily diuresis of 3-5 liters. However, in order for health to be fully restored, it takes from 6 to 18 months.

Thus, the course of the disease is divided into four stages. At the initial stage, a person’s condition directly depends on the cause that provoked renal failure. In the second, oligoanuric stage, the amount of urine decreases sharply, or it may be completely absent. This stage is the most dangerous, and if it continues for too long, coma and even death are possible. In the third, diuretic stage, the patient gradually increases the amount of urine that is released. Next comes the fourth stage - recovery.

Diagnostics

A patient with suspected renal failure or with signs of anuria is prescribed a series of examinations. First of all, this is a consultation with a urologist, biochemical and clinical blood tests, ultrasound, intravenous urography. Anuria is easy to diagnose, since by interviewing the patient it can be understood that he has not had urination or the urge to urinate for a long time. To differentiate this condition from acute urinary retention, catheterization of the bladder is performed to confirm the absence of urine in it.

Treatment

All patients who present with symptoms of acute renal failure should be urgently transported to hospital, where diagnosis and subsequent treatment are carried out in the intensive care unit or in the nephrology department. The leading importance in this case is to begin treatment of the underlying disease as early as possible in order to eliminate all the causes that led to kidney damage. Considering the fact that the pathogenesis of the disease is most often determined by the effect of shock on the body, it is necessary to promptly carry out anti-shock measures . The classification of disease types is of decisive importance in the choice of treatment methods. Thus, in case of renal failure caused by blood loss, it is compensated by administering blood substitutes. If poisoning initially occurs, gastric lavage is required to remove toxic substances. In case of severe renal failure, hemodialysis or peritoneal dialysis is necessary.

Especially serious condition causes end-stage chronic renal failure. In this case, kidney function is completely lost, and toxins accumulate in the body. As a result, this condition leads to serious complications. Therefore, chronic renal failure in children and adults must be properly treated.

Treatment of renal failure is carried out gradually, taking into account certain stages. Initially, the doctor determines the reasons that led to the patient developing signs of renal failure. Next, it is necessary to take measures in order to achieve a relatively normal volume of urine that is excreted in a person.

Depending on the stage of renal failure, conservative treatment is carried out. Its goal is to reduce the amount of nitrogen, water and electrolytes that enter the body so that this amount matches that which is excreted from the body. In addition, an important point in the recovery of the body is diet in case of renal failure, constant monitoring of its condition, as well as monitoring of biochemical parameters. Particular care should be taken in treatment if there is renal failure in children.

The next important step in the treatment of anuria is to carry out dialysis therapy . In some cases, dialysis therapy is used to prevent complications in the early stages of the disease.

The absolute indication for a patient to undergo dialysis is symptomatic uremia, the accumulation of fluid in the patient’s body that cannot be eliminated using conservative methods.

Particular importance is given to the nutrition of patients. The fact is that both hunger and thirst can dramatically worsen a person’s condition. In this case it is shown low protein diet . that is, fats and carbohydrates should dominate the diet. If a person cannot feed himself, glucose and nutritional mixtures must be administered intravenously.

Complications

The course of acute renal failure is often complicated by infectious diseases. It is with this course that the disease can be fatal.

Complications from the cardiovascular system include: circulatory failure . arrhythmias . hypertension . pericarditis . Often in acute renal failure there is a manifestation neurological disorders. Those patients who are not on dialysis may note severe drowsiness . disturbances of consciousness, tremors and other disorders of the nervous system. More often, such disorders develop in older people.

From the outside Gastrointestinal tract Complications also develop frequently. This may be nausea, anorexia, or intestinal obstruction.

Prevention

In order to prevent the development of such a dangerous condition of the body, first of all, it is necessary to provide timely qualified assistance to those patients who have a high risk of developing acute renal failure. These are people with severe injuries, burns; those who have just undergone a major operation, patients with sepsis, eclampsia, etc. These should be used very carefully medications, that are nephrotoxic .

In order to prevent the development of chronic renal failure, which develops as a consequence of a number of kidney diseases, it is necessary to prevent exacerbation of pyelonephritis and glomerulonephritis. It is important for chronic forms of these diseases to follow a strict diet prescribed by a doctor. Patients with chronic kidney disease should see their doctor regularly.

Stage 5 Chronic Kidney Failure (CRF)

* Belching

* Shortness of breath caused by fluid accumulation

* Muscle cramp

* Tingling hands and feet

*Difficulty concentrating

*Decreased urine output

* Feeling tired and getting weaker and weaker

* Change in urine color

* Increased skin pigmentation

Kidneys are very important for our health. In the stage of kidney failure, the kidneys are unable to effectively excrete toxins and additional water from the body, and they cannot yet do things like regulate blood pressure, maintain the balance of electrolytes like potassium, phosphorus, etc. and produce erythropoietin to stimulate blood cell production.

Patients with stage 5 renal failure require a nephrologist. Patients will suffer from urine test and blood test for creatinine and electrolyte, and the doctor will advise treatment recommendations to reduce the complexion and make patients feel healthier. The doctor will probably recommend dialysis or some of their doctors will prepare a kidney transplant. There are two types of dialysis: peritoneal dialysis and hemodialysis. Before dialysis, patients will have questions. The essence of dialysis is only a method that helps patients live a long time, but it cannot improve the kidneys and cause side effects. When dialysis is necessary for patients, the doctor will simply advise taking this treatment and choosing which type to treat. As for kidney transplantation, patients will evaluate whether transplantation is possible, the risk of recurrence, and which kidney would be suitable.

If a person finds natural treatments, then Chinese medicine treatment will be your choice. Treatment with Chinese medicine, despite its slow effects, compared with Western medicine, will be able to nourish the kidneys, refrain from inflammation, speed up the supplement nutrient to restore damaged (not completely damaged) kidney cells, and accompanying kidney correction, clinical symptoms/complications will be better controlled and patients can feel much relieved.

Diet is so important in reducing the risk of complications and improving overall health that patients should visit a dietitian. And the dietician will provide a dietary plan that is based on the personal laboratory result and the underlying disease situation. Dietary tips for stage 5 kidney failure include:

More vegetables, grains and fruits may be included, but be careful to limit or avoid foods high in potassium and phosphorus. Limit your total fat intake, and replace saturated fats with unsaturated fats. And this helps prevent cardiovascular diseases.

Limit your intake of refined and processed foods. food products high in sodium, and prepare a low-sodium lunch.

Sufficient protein supplementation to supplement protein loss due to dialysis.

Goal for a healthy body weight by calorie intake based on body size and individual needs.

If the urine output is less than 1 liter per day (almost 32 ounces) and? Serum potassium above 5.0, low potassium diet is recommended.

Avoid foods high in potassium and monitor your potassium levels by getting regular blood tests.

Limit 2000 mg calcium and 1000 mg phosphorus based on individual requirements.

Remember that there really is no diet that fits every kidney disease condition. Patients need to make a diet plan based on individual condition after talking with a doctor. Please note that this may be a kidney complication that can be dangerous. Check your illness as often as possible and communicate with your doctor regularly to know if treatment or dietary changes are needed.

If you have any questions, please contact us via phone +86-311-89261580 or email [email protected] or skype:hospital.kidney. We will answer your questions as soon as possible.