Classification and risk factors for chronic kidney disease. Acute renal failure is a pathology in which kidney function is lost. Chronic kidney disease, ICD code 10

A heavy load on the kidneys can often lead to various problems and malfunctions in their work, when they are no longer able to fully perform their function. And if you do not pay attention to this situation and do not start treatment, the patient develops chronic kidney disease.

The classification of this pathological condition is carried out depending on its stage and characteristic signs. The disease is considered very dangerous, and can lead not only to a decrease in quality of life and other health problems, but also to death.

Characteristics of the pathology

CKD (chronic kidney disease) includes a set of diseases and disorders in which the patient experiences impaired functionality of this organ, in particular, the filtration process is disrupted.

Over time (nephrons) die, or are replaced by connective tissue cells that do not have any specific functional load.

This leads to the fact that the organ cannot fully perform its function of purifying the blood, as a result of which the patient develops persistent intoxication of the body. This negatively affects the functioning of other organs and systems, and can ultimately lead to the death of the patient.

ICD 10 code – N18.

Stages of development

When making a diagnosis and prescribing treatment, it is necessary to find out the stage of development of the disease. For this purpose, a special indicator is used - Glomerular filtration rate (GFR), which allows you to determine the number of dead nephrons and determine the extent of organ damage.

Total allocated 5 stages development of pathology:

1. At the initial stage, the patient experiences a slight increase in GFR (about 90 ml/min). Kidney function is defined as normal;
2. The second stage is characterized by a slight decrease in GFR (80-60 ml per minute). There is a slight loss of organ functionality;
3. At the third stage, GFR indicators decrease more intensively (60-30 ml per minute). There are moderate disturbances in the functioning of the organ;
4. The fourth stage is characterized by a significant decrease in GFR (30-15 ml per minute). The functionality of the affected organ is significantly reduced;
5. The terminal stage of development of the disease is characterized by a critical decrease in GFR (less than 15). The patient develops severe renal failure.

Causes of development and risk factors for chronic kidney disease

The occurrence and development of the disease can lead to such negative factors How:

• organ (for example, during falls, blows, especially if they occur in the lumbar region);
• Persistent intoxication of the body. The main function of the kidneys is to remove toxic substances from the body. In a normal state, the organ copes with this task, however, if too many harmful elements accumulate in the body, the kidneys begin to work in an increased mode, which inevitably leads to disruption of their functions;
• Elderly age. Over the years, human organs wear out and lose some of their functions. This also applies to the kidneys, which can no longer function as they did at a younger age;
• Diseases of infectious and non-infectious nature. The functioning of the kidneys is negatively affected by pathologies such as diabetes mellitus, various types of inflammation that affect the tissues of the organ;
• Bad habits. Smoking and drinking alcohol negatively affect the functioning of all body systems. The kidneys are also exposed to the harmful effects of toxic substances;
• Compounded heredity leading to congenital malformations of the kidneys (for example, hypoplasia - insufficient development of tissues and organ structures).

Based on these reasons, we can conclude that the risk group includes elderly people, as well as those who lead an unhealthy lifestyle, suffer from various diseases due to reduced immunity, and have a history of relatives who have encountered a similar problem.

Clinical symptoms by stage

Each stage of development of chronic kidney disease is characterized by its own set of clinical manifestations.

First

Disease may be asymptomatic, without showing oneself in any way. In some cases, minor manifestations are observed (in particular, decreased functionality of the renal tubules), individual disturbances in the urination process, for example, frequent urge to visit the toilet), increased pressure in the kidneys.

With timely detection and proper treatment, the disease is easily treated, and the patient’s condition returns to normal in a short time. If there is no treatment, the pathology moves to the next stage of its development.

Second

At this stage, the patient experiences symptoms such as:

Third

The pathology is accompanied significant damage to the mucous membranes of the organ, disruption of its operation. The daily volume of urine excreted increases (up to 2.5 liters per day, with the norm being 1-2 liters for an adult), and the blood supply to the kidneys is disrupted. Characteristic symptoms develop:

• Significant heart rhythm disturbance;
• Constant dry mouth;
• Weakness, loss of appetite;
• Sleep disturbances.

Fourth

This stage of development of the disease is characterized significant urinary dysfunction(the patient often experiences oliguria), the composition of the blood changes (it contains an increased amount of harmful substances, such as urea, which are normally excreted by the kidneys). Symptoms such as:

• Nausea and persistent lack of appetite;
• Swelling;
• Thirst and a feeling of constant dry mouth;
• Significant reduction in the daily volume of urine excreted (in severe cases, complete absence of urination);
• Impaired functioning of the heart muscle;
• The appearance of skin rashes.

Terminal

This stage of the disease is the most severe and life-threatening. The symptoms mentioned above appear with a greater degree of intensity, in addition, the clinical picture is supplemented by the following signs:

• Convulsions that can lead to paralysis;
• Ammonia odor from the mouth;
• Anemia;
• Difficulty breathing.

Complications and consequences

If left untreated, CKD can lead to the development of such dangerous conditions as:

1. Significant fluid retention in the body, contributing to the development of severe swelling;
2. Disturbances in the functioning of other internal organs, in particular the organs of the cardiovascular system;
3. Damage to the bone tissue of the body;
4. Severe poisoning with a large amount of toxins accumulated in the body;
5. Death of a patient.

Diagnosis, treatment and prognosis

Before starting treatment, it is necessary to establish an accurate diagnosis, i.e. not only identify the presence of pathology, but also determine the stage of its development.

To do this, use the following research methods:

• Blood and urine tests, as well as analysis to determine GFR;
• CT scan and other organs located in the peritoneum;
• using a contrast agent.

Treatment of the disease has complex nature, is aimed at eliminating the cause of the development of pathology, normalizing kidney function, eliminating concomitant diseases and symptoms of CKD. The treatment regimen depends on the stage of the disease.

So, at the initial stage, the patient is prescribed medications (enzyme inhibitors, blockers, statins, anabolic steroids, vitamin complexes, symptomatic medications aimed at eliminating pathologies of other organs and systems).

In severe cases use more radical methods, such as kidney transplant.

A kidney transplant operation is not available to everyone, since the procedure has a fairly high cost and certain difficulties associated with finding a donor. Therefore, for many patients, hemodialysis remains the main life-sustaining procedure.

Regardless of the stage of the disease, the patient should adhere to the diet prescribed by the doctor. Thus, during drug treatment it is necessary to exclude (or significantly limit) fatty meat, cottage cheese, legumes, butter, and alcohol. It is required to significantly reduce the daily amount of salt consumed.

If a patient undergoes hemodialysis, nutritional principles change dramatically.

The prognosis for survival directly depends on at what stage of the disease course was the correct treatment prescribed?.

Thus, therapy carried out at an early stage of the disease gives quick positive results, while at stages 4 or 5 of the disease, the expected therapeutic effect can only be achieved using radical methods of treatment.

Prevention of CKD

Everyone can prevent the risk of developing CKD. To do this you must adhere to basic rules of a healthy lifestyle, such as:

• Complete and proper nutrition;
• Rejection of bad habits;
• Regular activities to strengthen the immune system;
• Body weight control;
• Complete rest and protection from stress and anxiety.

Kidneys are a vital organ that performs certain functions in the human body. Numerous unfavorable factors negatively affect the condition and functioning of the kidneys, leading to the development of such a dangerous disease as CKD.

The disease requires timely treatment, and the sooner it is prescribed, the higher the chance of a favorable outcome.

A nephrologist will tell you all about chronic kidney disease in a video clip:

Markers of kidney damage are any changes revealed during clinical and laboratory examination that are associated with the presence of a pathological process in the renal tissue (Table 1).

Table 1. Main markers of kidney damage that suggest the presence of CKD

CKD is a supranosological concept, and at the same time is not a formal association of chronic kidney damage of various natures.

The reasons for identifying this concept are based on the unity of the main pathogenetic mechanisms of progression of the pathological process in the kidneys, the commonality of many risk factors for the development and progression of the disease in case of organ damage of various etiologies and the ensuing methods of primary and secondary prevention.

The diagnosis of CKD should be based on the following criteria:

1. The presence of any clinical markers of kidney damage, confirmed at intervals of at least 3 months;
2. Any markers of irreversible structural changes in the organ, identified once during a lifetime morphological study of the organ or during its visualization;
3. Decreased glomerular filtration rate (GFR)< 60 мл/мин/1,73 кв.м в течение трех и более месяцев, вне зависимости от наличия других признаков повреждения почек.

In 2007, the World Health Organization (WHO) significantly clarified the N18 category (previously this code meant “Chronic renal failure”) of the International Classification of Diseases (ICD-10). In order to preserve the generally accepted structure of the diagnosis, it is recommended that the diagnosis “Chronic kidney disease” be indicated after the main disease, and then the coding of the disease is established in accordance with the ICD for the main disease.

If the etiology of renal dysfunction is unknown, then the main diagnosis can be “Chronic kidney disease”, which is coded under N18 (where N18.1 - Chronic kidney disease, stage 1; N18.2 - Chronic kidney disease, stage 2, etc. ).

* - appropriate disease codes should be used to indicate the etiology of CKD

** - code N18.9 indicates cases of CKD with an unspecified stage

The need to identify CKD at an early stage in children

Children have their own list of diseases that lead to the development of CKD:

1. Family history of polycystic kidney disease or other genetic kidney diseases.
2. Low birth weight.
3. Acute renal failure as a result of perinatal hypoxemia or other acute kidney injury.
4. Renal dysplasia or hypoplasia.
5. Urological abnormalities, especially obstructive uropathy.
6. Vesicoureteral reflux associated with recurrent urinary tract infections and kidney scarring.
7. History of acute nephritis or nephrotic syndrome.
8. History of hemolytic-uremic syndrome.
9. History of Schonlein-Henoch disease.
10. Diabetes mellitus.
11. Systemic lupus erythematosus.
12. History of hypertension, in particular as a result of thrombosis of the renal artery or renal vein in the perinatal period.

Children with retarded physical development (growth retardation, low body weight), rickets-like skeletal deformities, metabolic acidosis, early-onset anemia, polyuria, polydipsia, proteinuria, hypertension, impaired renal concentration function represent a risk group for the development of CKD, which requires a thorough examination of these patients, prescribing corrective and replacement therapy to prevent or slow down the progression of CKD.

Congenital, hereditary and acquired kidney diseases in children potentially carry the risk of developing unfavorable outcomes - the formation of chronic kidney disease (CKD) and chronic renal failure.

The need to identify CKD in children at an early stage is a socially significant task - the sooner we begin to prevent the identification of risk factors for the development of CKD in children, the more people will remain healthy and able to work, while the risk of developing concomitant diseases in them will be significantly reduced.

Acute renal failure (ARF) is a rapid, but reversible, depression of renal function, sometimes to the point of complete failure of one or both organs. The pathology is deservedly characterized as a critical condition that requires immediate medical intervention. Otherwise, the risk of an unfavorable outcome in the form of loss of organ function increases greatly.

Acute renal failure

The kidneys are the main “filters” of the human body, the nephrons of which continuously pass blood through their membranes, removing excess fluid and toxins with urine, sending the necessary substances back into the bloodstream.

Kidneys are organs without which human life is impossible. Therefore, in a situation where, under the influence of provoking factors, they cease to fulfill their functional task, doctors provide emergency medical care to the person, diagnosing him with acute renal failure. The somatic pathology code according to ICD-10 is N17.

Today, statistical information makes it clear that the number of people facing this pathology is growing every year.

Etiology

The causes of acute renal failure are as follows:

1. Pathologies of the cardiovascular system that disrupt the blood supply to all organs, including the kidneys:
   • arrhythmia;
   • atherosclerosis;
   • heart failure.
2. Dehydration against the background of the following ailments, which causes changes in blood parameters, or more precisely, an increase in its prothrombin index, and, as a consequence, difficulty in the functioning of the glomeruli:
   • dyspeptic syndrome;
   • extensive burns;
   • blood loss.
3. Anaphylactic shock, which is accompanied by a sharp decrease in blood pressure, which negatively affects kidney function.
4. Acute inflammatory phenomena in the kidneys, which lead to damage to organ tissue:
   • pyelonephritis.
5. A physical obstruction to the outflow of urine during urolithiasis, which first leads to hydronephrosis, and then, due to pressure on the kidney tissue, to damage to the kidney tissue.
6. Taking nephrotoxic drugs, which include a contrast composition for X-rays, causes poisoning of the body, which the kidneys cannot cope with.

Classification of surge arresters

The process of acute kidney failure is divided into three types:

1. Prerenal acute renal failure - the cause of the disease is not directly related to the kidneys. The most popular example of a prerenal type of acute renal failure can be called disturbances in the functioning of the heart, which is why the pathology is often called hemodynamic. Less commonly, it occurs due to dehydration.
2. Renal acute renal failure - the root cause of the pathology can be found precisely in the kidneys themselves, and therefore the second name of the category is parenchymal. Renal functional failure in most cases results from acute glomerulonephritis.
3. Postrenal acute renal failure (obstructive) is a form that occurs when the urine excretion pathways are blocked by stones and subsequent disruption of urine outflow.

Classification of acute renal failure

Pathogenesis

ARF develops over four periods, which always follow in the specified order:

• initial stage;
• oliguric stage;
• polyuric stage;
• recovery.

The duration of the first stage can last from several hours to several days, depending on what is the root cause of the disease.

Oliguria is a term that briefly refers to a decrease in urine volume. Normally, a person should excrete approximately the amount of fluid that he consumed, minus the portion “spent” by the body on sweating and breathing. With oliguria, the volume of urine becomes less than half a liter, without a direct connection with the amount of fluid drunk, which entails an increase in fluid and breakdown products in the body tissues.

Complete disappearance of diuresis occurs only in extremely severe cases. And statistically it rarely happens.

The duration of the first stage depends on how quickly adequate treatment was started.

Polyuria, on the contrary, means an increase in diuresis, in other words, the amount of urine can reach five liters, although 2 liters of urine per day is already a reason to diagnose polyuric syndrome. This stage lasts about 10 days, and its main danger is the body’s loss of the substances it needs along with urine, as well as dehydration.

After completion of the polyuric stage, the person, if the situation develops favorably, recovers. However, it is important to know that this period may last for one year, during which deviations in the interpretation of analyzes will be identified.

Stages of acute renal failure

Clinical picture

The initial stage of acute renal failure does not have specific symptoms by which the disease can be unmistakably recognized; the main complaints during this period are:

• loss of strength;
• headache.

The symptomatic picture is complemented by signs of the pathology that caused acute renal failure:

1. With oliguric syndrome against the background of acute renal failure, the symptoms become specific, easily recognizable and fit into the overall picture of the pathology:
   • decreased diuresis;
   • dark, foamy urine;
   • dyspepsia;
   • lethargy;
   • wheezing in the chest due to fluid in the lungs;
   • susceptibility to infections due to reduced immunity.
2. The polyuric (diuretic) stage is characterized by an increase in the amount of urine excreted, so all the patient’s complaints stem from this fact, and the fact that the body loses a large amount of potassium and sodium with urine:
   • disturbances in the functioning of the heart are recorded;
   • hypotension.
3. The recovery period, which takes from 6 months to one year, is characterized by fatigue, changes in the results of laboratory tests of urine (specific gravity, red blood cells, protein), blood (total protein, hemoglobin, ESR, urea).

Diagnostics

Diagnosis of acute renal failure is carried out using:

• questioning and examining the patient, compiling his anamnesis;
• clinical blood test showing low hemoglobin;
• biochemical blood test, which detects increased creatinine, potassium, urea;
• diuresis monitoring, that is, control over how much liquid (including soups, fruits) a person consumes in 24 hours and how much is excreted;
• ultrasound method, in acute renal failure more often shows the physiological size of the kidneys; a decrease in size indicators is a bad sign, indicating tissue damage, which may be irreversible;
• nephrobiopsy - taking a piece of an organ using a long needle for microscopic examination; It is performed infrequently due to the high degree of trauma.

Treatment

Treatment of acute renal failure occurs in the intensive care unit of the hospital, less often in the nephrology department of the hospital.

All medical procedures performed by doctors and medical staff can be divided into two stages:

1. Identification of the root cause of a pathological condition is carried out using diagnostic methods, studying symptoms, and specific complaints of the patient.
2. Eliminating the cause of acute renal failure is the most important stage of treatment, because without treating the root cause of the disease, any treatment measures will be ineffective:
   • when the negative effect of nephrotoxins on the kidneys is detected, extracorporeal hemocorrection is used;
   • If an autoimmune factor is detected, glucocorticosteroids (Prednisolone, Metipred, Prenizole) and plasmapheresis are prescribed.
   • in case of urolithiasis, drug litholysis or surgery is performed to remove stones;
   • For infection, antibiotics are prescribed.

At each stage, the doctor adjusts the prescription based on the symptomatic picture at the moment.

During oliguria, it is necessary to prescribe diuretics, a strict diet with a minimum amount of protein and potassium, and, if necessary, hemodialysis.

Hemodialysis, a procedure for cleansing the blood of waste products and removing excess fluid from the body, has an ambiguous attitude among nephrologists. Some doctors argue that prophylactic hemodialysis for acute renal failure is necessary in order to reduce the risk of complications. Other experts warn of a trend towards complete loss of kidney function since the start of artificial blood purification.

During the period of polyuria, it is important to replenish the patient’s missing blood volume, restore the electrolyte balance in the body, continue diet No. 4, and take care of any infection, especially when taking hormonal medications.

General principles of treatment of acute renal failure

Prognosis and complications

Acute renal failure with proper treatment has a favorable prognosis: after suffering the disease, only 2% of patients require lifelong hemodialysis.

Complications from acute kidney failure are associated with, that is, with the process of poisoning the body with its own decay products. As a result, the latter are not excreted by the kidneys during oliguria or when the rate of blood filtration by glomeruli is low.

Pathology leads to:

• disruption of cardiovascular activity;
• anemia;
• increased risk of infections;
• neurological disorders;
• dyspeptic disorders;
• uremic coma.

It is important to note that with acute nephrological failure, unlike chronic failure, complications rarely occur.

Prevention

Prevention of acute renal failure is as follows:

1. Avoid taking nephrotoxic medications.
2. Treat chronic diseases of the urinary and vascular system in a timely manner.
3. Monitor blood pressure readings, and if signs of chronic hypertension are detected, immediately consult a specialist.

In the video about the causes, symptoms and treatment of acute renal failure:

Despite the capabilities of modern medicine, about 40% of pathologies of the urinary system over time lead to impaired renal function and the development of chronic renal (renal) failure. This condition is characterized by the gradual death of nephrons, deterioration of the body’s vital functions and the appearance of various complications. How chronic renal failure develops, what symptoms it has, how it is diagnosed and treated: we will look at it in our review.

Acute and chronic progressive renal failure (code according to the international classification of diseases ICD10 – N17-N19) is a symptom complex in which the following occurs:

• disruption of the processes of blood purification from metabolic products, waste, nitrogenous bases, which are excreted by the kidneys;
• deterioration in the removal of excess water and salts;
• reduction or complete cessation of kidney production of erythropoietin, responsible for the activation of hematopoiesis;
• violation of homeostasis - the natural constancy of the internal environment.

Acute renal failure (ICD code N17), with timely treatment, can result in complete recovery of the patient. On average, it takes from 6 to 24 months to restore the functional activity of nephrons.

The diagnosis of chronic renal failure (ICD code N18) is made if laboratory criteria for the disease are maintained for 3 months or more. This pathology is characterized by an irreversible progressive course. However, regular courses of therapy will help maintain vital functions and avoid the development of life-threatening complications. Patients with chronic kidney failure who are treated live as long as people with healthy kidneys.

What diseases are complicated by kidney failure?

It is important to understand that chronic (as well as acute) kidney failure is not a separate disease, but only a syndrome that complicates the course of many pathologies. Among the main causes of chronic renal failure are:

• chronic pyelonephritis;
• chronic glomerulonephritis;
• amyloidosis;
• polycystic kidney disease;
• congenital anomalies of the structure/function of the kidneys;
• urolithiasis;
• hydronephrosis;
• diseases associated with impaired physiological outflow of urine;
• nephrotoxic effect of certain drugs;
• diabetes;
• obesity;
• cirrhosis of the liver;
• gout;
• systemic diseases (scleroderma, lupus erythematosus);
• oncological diseases;
• chronic intoxication.

Note! The incidence of chronic renal failure in developed countries averages 600 cases per 1 million population.

Classification

There are several types of chronic renal failure, and the disease is classified according to:

• features of the clinical picture;
• degree of severity.

Depending on the nature of the course, there are four stages of chronic renal failure:

1. latent (hidden) – has almost no clinical symptoms (except for fatigue, general deterioration of health) and is often diagnosed by chance during examination for another disease;
2. compensated stage of renal failure - characterized by a slight increase in urine output during the day (polyuria), swelling in the morning;
3. intermittent – ​​accompanied by symptoms of intoxication (weakness, fatigue) and disturbances in water-electrolyte balance (dry mouth, muscle weakness);
4. The terminal stage of chronic renal failure is accompanied by symptoms of uremia (poisoning by metabolic products) and pathology of the internal organs, mainly the heart and lungs.

Laboratory criteria for assessing the severity of chronic renal failure are presented in the table below.

Clinical manifestations: how to suspect the disease at an early stage

Chronic renal failure has a wide variety of symptoms. This pathology affects all major organs and systems.

Patient's appearance

For a long time, chronic renal failure, the symptoms and treatment of which largely depend on the stage of the disease, does not manifest itself in any way. External signs of the disease can be detected only with severe uremia. Among the most common symptoms:

• pallor and severe dryness of the skin;
• hemorrhages and bruises that occur even with minimal exposure to the skin;
• scratching the skin caused by severe itching;
• characteristic “renal” edema, manifested by puffiness of the face and eyelids, anasarca;
• decreased muscle tone.

Urinary organs

In the initial stages of the disease, polyuria is observed - the release of large amounts of low-density urine. Subsequently, as the deficiency progresses, a partial or complete cessation of urine production develops.

Nervous system

Intoxication with metabolic products and substances toxic to the body leads to the following symptoms:

• apathy;
• insomnia or, on the contrary, drowsiness during the day;
• memory impairment;
• decreased learning ability;
• chilliness of the limbs;
• tingling sensation, “goosebumps” in the arms and legs.

In the terminal stage of the disease, severe inhibition is observed, associated with inhibition of all functions of the central nervous system. If the patient is not provided with medical assistance, severe disorders of the nervous system, including coma, are possible.

Heart and blood vessels

An increase in circulating blood volume and electrolyte disturbances lead to the following symptoms:

• increase in blood pressure;
• infectious and inflammatory lesions of the pericardial sac (myocarditis, pericarditis), accompanied by dull pain in the heart, rhythm disturbances, shortness of breath, pathological friction noise of the pericardium during auscultation;
• sometimes - signs of acute cardiovascular failure.

Respiratory system

Damage to the respiratory system is typical for late stages of renal failure. Patients develop a syndrome called “uremic lung.” It is characterized by interstitial edema and bacterial pneumonia, which develops against a background of reduced immunity.

Digestive system

The gastrointestinal tract reacts with worsening appetite, nausea, and vomiting. Severe uremia is characterized by the development of erosive and ulcerative defects in the mucous membrane of the esophagus, stomach and intestines. Often, patients with chronic renal failure develop acute hepatitis.

Blood-forming organs

Against the background of kidney failure, the production of erythropoietin, one of the hematopoietic factors, decreases. Clinically, this is manifested by symptoms of anemia - weakness, lethargy and decreased performance.

Water and electrolyte balance

An imbalance of water-salt metabolism manifests itself:

• strong thirst;
• weakness (many patients complain that their vision becomes dark with sudden changes in body position);
• convulsive muscle contractions;
• shortness of breath, breathing problems;
• arrhythmias.

Metabolism

If the evacuation of protein metabolic products (creatinine, urea) is impaired, patients experience the following symptoms:

• toxic enterocolitis, accompanied by pain, bloating, loose stools;
• the appearance of a characteristic ammonia odor from the mouth;
• secondary joint lesions simulating gout.

Chronic renal failure is less common in children than in adults. A characteristic feature of the clinical course of the pathology in a child is the frequent development of nephrotic syndrome - massive urinary protein excretion (3 g/day or more), oncological edema and increased blood pressure.

A typical clinical picture with damage to the urinary system and other internal organs will allow one to suspect chronic renal failure, and further diagnostics will be aimed at confirming or refuting this diagnosis. The standard algorithm for examining a patient with suspected chronic renal failure includes:

Collection of complaints and medical history. Clinical examination. Auscultation of the heart and lungs. Blood pressure measurement. Laboratory tests.

• Clinical blood test;
• biochemical blood test with determination of creatinine, urea, total protein;
• general urine analysis;
• urine sample according to Nechiporenko;
• urine sample according to Zimnitsky;
• Reberg's test;
• determination of glomerular filtration rate.

Diagnostic measures should be aimed not only at determining the severity of renal failure, but also at identifying its main cause. It is important for the doctor to identify the background of what disease CRF developed in order to correctly draw up a treatment plan for it.

Current principles of treatment of chronic renal failure: is it possible to defeat the disease forever?

Treatment of chronic renal failure always requires an integrated approach. It is aimed at restoring impaired functions of the urinary system, correcting electrolyte imbalance, preventing complications and eliminating symptoms.

Nutritional correction plays an important role in therapy. Diet for chronic renal failure can achieve good results and improve the prognosis of the disease. The principles of the treatment table according to Pevzner (renal) include:

• limiting protein to 60-70 g per day (with severe uremia, this figure is reduced to 20-40 g);
• the predominance of easily digestible animal protein, dairy and plant foods in the diet;
• limiting salt to 2-3 g per day;
• To correct electrolyte disturbances during diet therapy, it is recommended to consume more processed vegetables and fruits.

The drinking regime for patients with chronic renal failure is determined individually. They are usually advised to consume no more than 1.5-2 liters of fluid per day (including soups and other liquid foods).

Drug correction of the patient’s condition consists of prescribing:

• enterosorbents;
• erythropoietin;
• iron supplements;
• antihypertensive drugs;
• infusions with bicarbonates, glucose solution.

If the patient's condition worsens, hospitalization in the nephrology department of hospitals is indicated. In addition to drug therapy, the patient needs special care. The nursing process for chronic renal failure includes providing:

• mental and physical peace;
• compliance with bed rest;
• taking into account water balance (the ratio of fluids drunk and excreted during the day);
• proper administration of medications by the patient.

In the terminal stage, the patient needs regular hemodialysis - blood purification using an artificial kidney machine.

Chronic renal failure remains one of the leading problems in nephrology. The long progressive course and serious health consequences that the pathology causes make it dangerous for the patient. You can avoid the development of kidney failure if you regularly undergo examinations of the urinary organs and follow medical recommendations.

The term “chronic kidney disease” (CKD) is a new concept, previously known as chronic kidney failure.

It is not a separate disease, but a syndrome, that is, a complex of disorders that are observed in the patient for three months.

According to statistics, the disease occurs in approximately 10% of people, and both women and men are susceptible to it.

There are many factors that cause kidney dysfunction; the most likely causes include:

• arterial hypertension. Persistently elevated blood pressure and the disorders that accompany hypertension cause chronic failure;
• diabetes. The development of diabetes mellitus provokes diabetic kidney damage, which leads to chronic disease;
• age-related changes in the body. Most people develop CKD after age 75, but if there are no associated diseases, the syndrome does not lead to serious consequences.

In addition, CKD can provoke conditions that are associated with kidney dysfunction (renal artery stenosis, urinary outflow disorders, polycystic disease, infectious diseases), poisoning accompanied by kidney damage, autoimmune diseases, obesity.