Disorders in chronic kidney disease. Causes of chronic renal failure: symptoms, treatment methods and consequences. Treatment of chronic renal failure

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 the pathogenetic mechanisms of progression of chronic kidney diseases. In this case, special attention is paid 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, cardiac rhythm and conduction disorders, 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 : The most accurate methods for determining GFR are 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. In a 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 the 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, smell of urine, hypertension, and also for patients with diabetes, a mandatory check-up with a specialist is necessary.

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 methods are also used to diagnose chronic renal failure: these include ultrasound, 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 степенях прибегают к заместительной почечной терапии (хронический гемодиализ , перитонеальный диализ, гемосорбция, трансплантация почки).

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 with 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:

• sharp decrease in 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 fluid should correspond to daily diuresis at a level of 2-3 liters, which helps 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.

Renal failure is a serious complication of various renal pathologies, and a very common one. The disease can be treated, but the organ cannot be restored. Chronic renal failure is not a disease, but a syndrome, that is, a set of signs indicating impaired renal function. The causes of chronic failure can be various diseases or injuries, as a result of which the organ is damaged.

Stages of kidney failure

Water, nitrogen, electrolyte and other types of metabolism in the human body depend on the functioning of the kidney. Kidney failure is evidence of failure to perform all functions, leading to disruption of all types of balance at once.

Most often, the cause is chronic diseases, in which the kidney parenchyma is slowly destroyed and replaced by connective tissue. Kidney failure becomes the last stage of such ailments - urolithiasis and the like.

The most indicative sign of pathologies is the daily volume of urine - diuresis, or minute. The latter is used when examining the kidneys using the clearance method. With normal kidney function, daily urine output is about 67–75% of the volume of fluid drunk. In this case, the minimum volume required for the organ to function is 500 ml. Therefore, the minimum volume of water that a person should consume per day is 800 ml. With standard water consumption of 1–2 liters per day, daily diuresis is 800–1500 ml.

In renal failure, urine volume changes significantly. In this case, there is both an increase in volume - up to 3000 ml, and a decrease - up to 500 ml. The appearance of daily diuresis of 50 ml is an indicator of kidney failure.

There are acute and chronic renal failure. The first is characterized by the rapid development of the syndrome, pronounced symptoms, and severe pain. However, most of the changes that occur with acute renal failure are reversible, allowing renal function to be restored within a few weeks with appropriate treatment.

The chronic form is caused by the slow irreversible replacement of the kidney parenchyma with connective tissue. In this case, it is impossible to restore the functions of the organ, and in later stages surgical intervention is required.

Acute renal failure

Acute renal failure is a sudden, severe disruption of the functionality of an organ associated with suppression of excretory function and the accumulation of nitrogen metabolism products in the blood. In this case, a disorder of water, electrolyte, acid-base, and osmotic balance is observed. Changes of this kind are considered potentially reversible.

ARF develops within a few hours, less often within 1–7 days, and becomes so if the syndrome is observed for more than a day. Acute renal failure is not an independent disease, but a secondary one, developing against the background of other diseases or injuries.

The causes of acute renal failure are:

• low blood flow rate;
• tubular damage;
• obstruction of urine flow due to obstruction;
• destruction of the glomerulus with loss of capillaries and arteries.

The cause of acute renal failure serves as the basis for appropriate qualifications: according to this criterion, prerenal acute failure is distinguished - 70% of all cases, parenchymal - 25% and obstructive - 5%.

According to medical statistics, the causes of such phenomena are:

• surgery or trauma – 60%. The number of cases of this kind is constantly growing, as it is associated with an increase in the number of operations under artificial circulation;
• 40% are treatment related. The use of nephrotoxic drugs, necessary in some cases, leads to the development of acute renal failure. This category also includes acute poisoning with arsenic, mercury, and mushroom poison;
• 1–2% appear during pregnancy.

Another classification of the stages of the disease is used, related to the patient’s condition; 4 stages are distinguished:

• elementary;
• oligoanuric;
• polyuric;
• recovalescence.

Causes of acute renal failure

initial stage

Signs of the disease depend on the cause and nature of the underlying disease. Caused by stress factors - poisoning, blood loss, injury.

• Thus, with an infectious lesion of an organ, the symptoms coincide with the symptoms of general intoxication - headache, lethargy, muscle weakness, and possible fever. If an intestinal infection becomes complicated, vomiting and diarrhea may occur.
• If acute renal failure is a consequence of poisoning, then anemia, signs of jaundice, and possible seizures are observed.
• If the cause is acute kidney disease - for example, there may be blood in the urine and severe pain in the lower back.

Changes in diuresis at the initial stage are unusual. Pallor, a slight decrease in blood pressure, and a rapid pulse may be observed, but there are no characteristic signs.

Diagnosis at the initial stage is extremely difficult. If acute renal failure is observed against the background of an infectious disease or acute poisoning, the disease is taken into account during treatment, since kidney damage due to poisoning is a completely natural phenomenon. The same can be said for those cases when the patient is prescribed nephrotoxic drugs.

A urine test at the initial stage indicates not so much acute renal failure as it does the factors that provoke the deficiency:

• the relative density for prerenal OPN is higher than 1.018, and for renal OPN is lower than 1.012;
• slight proteinuria and the presence of granular or cellular casts are possible in renal acute renal failure of nephrotoxic origin. However, in 20–30% of cases this sign is absent;
• in case of injury, tumor, infection, urolithiasis, a greater number of red blood cells is detected in the urine;
• a large number of leukocytes indicates an infection or allergic inflammation of the urinary tract;
• if uric acid crystals are found, urate nephropathy can be suspected.

At any stage of acute renal failure, a bacteriological urine test is prescribed.

A general blood test corresponds to the primary disease; a biochemical test at the initial stage can provide evidence of hyperkalemia or hypokalemia. However, mild hyperkalemia – less than 6 mmol/l, does not cause changes.

Clinical picture of the initial stage of acute renal failure

Oligoanuric

This stage in acute renal failure is the most severe and can pose a threat to both life and health. Its symptoms are much better expressed and characteristic, which makes it possible to quickly establish a diagnosis. At this stage, nitrogen metabolism products quickly accumulate in the blood - creatinine, urea, which in a healthy body are excreted in the urine. Potassium absorption decreases, which destroys the water-salt balance. The kidney does not perform the function of maintaining the acid-base balance, resulting in metabolic acidosis.

The main signs of the oligoanuric stage are:

• decreased diuresis: if the daily urine volume drops to 500 ml, this indicates oliguria, if it drops to 50 ml, anuria;
• intoxication with metabolic products - skin itching, nausea, vomiting, tachycardia, rapid breathing;
• a noticeable increase in blood pressure, conventional antihypertensive drugs do not work;
• confusion, loss of consciousness, possible coma;
• swelling of organs, cavities, subcutaneous tissue. Body weight increases due to fluid accumulation.

The stage lasts from several days - an average of 10-14 - to several weeks. The duration of the period and methods of treatment are determined by the severity of the lesion and the nature of the primary disease.

Symptoms of the oligoanuric stage of acute renal failure

Diagnostics

At this stage, the primary task is to separate anuria from acute urinary retention. To do this, catheterization of the bladder is performed. If no more than 30 ml/hour is still excreted through the catheter, it means that the patient has acute renal failure. To clarify the diagnosis, an analysis of creatinine, urea and potassium in the blood is prescribed.

• With the prerenal form, there is a decrease in sodium and chlorine in the urine, the rate of fractional excretion of sodium is less than 1%. With calcium necrosis in oliguric acute renal failure, the rate increases from 3.5%, in non-oliguric acute renal failure - to 2.3%.
• For differentiation, the ratio of urea in blood and urine, or creatinine in blood and urine is specified. In the prerenal form, the ratio of urea to plasma concentration is 20:1, in the renal form it is 3:1. For creatinine, the ratio will be similar: 40 in urine and 1 in plasma with prerenal acute renal failure and 15:1 with renal acute renal failure.
• In case of renal failure, a characteristic diagnostic sign is a low chlorine content in the blood - less than 95 mmol/l.
• Microscopy data of urinary sediment allows us to judge the nature of the damage. Thus, the presence of non-protein and erythrocyte casts indicates damage to the glomeruli. Brown epithelial casts and loose epithelium indicate. Hemoglobin casts are detected with intratubular blockade.

Since the second stage of acute renal failure provokes severe complications, in addition to urine and blood tests, it is necessary to resort to instrumental methods of analysis:

• , Ultrasound is performed to detect urinary tract obstruction, analyze the size, condition of the kidney, and assess the blood supply. Excretory urography is not performed: radiopaque angiography is prescribed for suspected arterial stenosis;
• chromocystoscopy is prescribed for suspected obstruction of the ureteral orifice;
• Chest radiography is performed to determine pulmonary edema;
• to assess renal perfusion, isotope dynamic scanning of the kidney is prescribed;
• a biopsy is performed in cases where prerenal acute renal failure is excluded and the origin of the disease has not been identified;
• An ECG is prescribed to all patients, without exception, to detect arrhythmia and signs of hyperkalemia.

Treatment of acute renal failure

Treatment is determined by the type of acute renal failure - prerenal, renal, postrenal, and the degree of damage.

The primary task in the prerenal form is to restore blood supply to the kidney, correct dehydration and vascular insufficiency.

• In the renal form, depending on the etiology, it is necessary to stop taking nephrotoxic drugs and take measures to remove toxins. In case of systemic diseases, the administration of glucocorticoids or cytostatics will be required as the cause of acute renal failure. For pyelonephritis and infectious diseases, therapy includes antiviral drugs and antibiotics. In conditions of a hypercalcemic crisis, large volumes of sodium chloride solution, furosemide, and drugs that slow down the absorption of calcium are administered intravenously.
• The condition for the treatment of postrenal acute insufficiency is the elimination of obstruction.

The water-salt balance must be corrected. Methods depend on the diagnosis:

• for hyperkalemia above 6.5 mmol/l, a solution of calcium gluconate is administered, and then glucose. If hyperkalemia is refractory, hemodialysis is prescribed;
• To correct hypervolemia, furasemide is administered. The dose is selected individually;
• It is important to observe the total intake of potassium and sodium ions - the value should not exceed daily losses. Therefore, in case of hyponatremia, the volume of fluid is limited, and in case of hypernatremia, sodium chloride solution is administered intravenously;
• the volume of fluid, both consumed and administered intravenously, should generally exceed losses by 400–500 ml.

When the concentration of bicarbonates decreases to 15 meq/l and the blood pH reaches 7.2, acidosis is corrected. Sodium bicarbonate is administered intravenously over 35–40 minutes and then monitored during treatment.

With the non-oliguric form, they try to do without dialysis therapy. But there are a number of indicators for which it is prescribed in any case: symptomatic uremia, hyperkalemia, severe stage of acidemia, pericarditis, accumulation of a large volume of fluid that cannot be removed by medication.

Basic principles of treatment of acute renal failure

Restorative, polyuric

The stage of polyuria appears only with sufficient treatment and is characterized by a gradual restoration of diuresis. At the first stage, the daily volume of urine is fixed at 400 ml, at the stage of polyuria - more than 800 ml.

At the same time, the relative density of urine is still low, the sediment contains a lot of proteins and red blood cells, which indicates restoration of glomerular functions, but indicates damage to the tubular epithelium. The blood remains high in creatinine and urea.

During the treatment process, potassium levels are gradually restored and accumulated fluid is removed from the body. This stage is dangerous because it can lead to hypokalemia, which is no less dangerous than hyperkalemia and can cause dehydration.

The polyuric stage lasts from 2–3 to 10–12 days, depending on the degree of organ damage and is determined by the rate of restoration of the tubular epithelium.

Activities carried out during the oliguric stage continue during recovery. In this case, the doses of drugs are selected and changed individually depending on the test results. Treatment is carried out against the background of a diet: the consumption of proteins, liquids, salt, and so on is limited.

Recovery stage of acute renal failure

Recovery

At this stage, normal diuresis is restored, and, most importantly, the products of nitrogen metabolism are removed. If the pathology is severe or the disease is detected too late, nitrogen compounds may not be eliminated completely, and in this case, acute renal failure may become chronic.

If treatment is ineffective or too late, the terminal stage may develop, which poses a serious threat to life.

The symptoms of the thermal stage are:

• spasms and muscle cramps;
• internal and subcutaneous hemorrhages;
• cardiac dysfunction;
• bloody sputum, shortness of breath and cough caused by the accumulation of fluid in the lung tissues;
• loss of consciousness, coma.

The prognosis depends on the severity of the underlying disease. According to statistics, with an oliguric course the mortality rate is 50%, with a non-oliguric course - 26%. If acute renal failure is not complicated by other diseases, then in 90% of cases complete restoration of kidney function is achieved over the next 6 weeks.

Symptoms of recovery from acute renal failure

Chronic renal failure

CRF develops gradually and represents a decrease in the number of active nephrons - the structural units of the kidney. The disease is classified as chronic if a decrease in functionality is observed for 3 or more months.

Unlike acute renal failure, chronic renal failure is difficult to diagnose even at later stages, since the disease is asymptomatic, and up to the death of 50% of nephrons, it can only be detected during functional load.

There are many causes of the disease. However, about 75% of them are , and .

Factors that significantly increase the likelihood of chronic renal failure include:

• diabetes;
• smoking;
• obesity;
• systemic infections, as well as acute renal failure;
• infectious diseases of the urinary tract;
• toxic lesions - poisons, drugs, alcohol;
• age-related changes.

However, for a variety of reasons, the mechanism of damage is almost the same: the number of active ones gradually decreases, which provokes the synthesis of angiotensin II. As a result, hyperfiltration and hypertension develop in intact nephrons. In the parenchyma, the renal functional tissue is being replaced by fibrous tissue. Due to the overload of the remaining nephrons, a violation of water-salt balance, acid-base, protein, carbohydrate metabolism, and so on gradually arises and develops. Unlike acute renal failure, the consequences of chronic renal failure are irreversible: it is impossible to replace a dead nephron.

The modern classification of the disease distinguishes 5 stages, which are determined by the glomerular filtration rate. Another classification is related to the level of creatinine in the blood and urine. This sign is the most characteristic, and from it you can quite accurately determine the stage of the disease.

The most commonly used classification is related to the severity of the patient's condition. It allows you to quickly determine what measures need to be taken first.

Stages of chronic renal failure

Polyuric

The polyuric or initial stage of compensation is asymptomatic. Signs of the primary disease prevail, while there is little evidence of kidney damage.

• Polyuria is the excretion of too much urine, sometimes exceeding the volume of fluid consumed.
• Nocturia is an excess of nocturnal diuresis. Normally, urine is released at night in smaller quantities and is more concentrated. Excretion of more urine at night indicates the need for renal-hepatic tests.
• Even at the initial stage, chronic renal failure is characterized by a decrease in the osmotic density of urine - isosthenuria. If the density is above 1.018, CRF is not confirmed.
• Arterial hypertension is observed in 40–50% of cases. Its difference is that in case of chronic renal failure and other kidney diseases, conventional antihypertensive drugs have little effect on blood pressure.
• Hypokalemia can occur at the stage of polyuria with an overdose of saluretics. It is characterized by severe muscle weakness and changes in the ECG.

Sodium wasting syndrome or sodium retention may develop, depending on tubular reabsorption. Anemia is often observed, and it progresses as other symptoms of chronic renal failure increase. This is due to the fact that when nephrons fail, a deficiency of endogenous epoetin is formed.

Diagnosis includes urine and blood tests. The most revealing of them include the assessment of creatinine content in the blood and urine.

Glomerular filtration rate is also a good determining sign. However, at the polyuric stage, this value is either normal - more than 90 ml/min or slightly reduced - to 69 ml/min.

At the initial stage, treatment is mainly aimed at suppressing the primary disease. It is very important to follow a diet with restrictions on the amount and origin of protein, and, of course, salt intake.

Symptoms of the polyuric stage of chronic renal failure

Stage of clinical manifestations

This stage, also called azotemic or oligoanuric, is distinguished by specific disturbances in the functioning of the body, indicating noticeable damage to the kidneys:

• The most characteristic symptom is a change in urine volume. If at the first stage more fluid was excreted than normal, then at the second stage of chronic renal failure the volume of urine becomes less and less. Oligouria develops - 500 ml of urine per day, or anuria - 50 ml of urine per day.
• Signs of intoxication increase - vomiting, diarrhea, nausea, the skin becomes pale, dry, and in later stages acquires a characteristic jaundiced tint. Due to the deposition of urea, patients are bothered by severe itching; scratched skin practically does not heal.
• There is severe weakness, weight loss, lack of appetite, even anorexia.
• Due to an imbalance in nitrogen balance, a specific “ammonia” odor appears from the mouth.
• At a later stage, it forms, first on the face, then on the limbs and torso.
• Intoxication and high blood pressure cause dizziness, headaches, and memory impairment.
• A feeling of chills appears in the arms and legs - first in the legs, then their sensitivity decreases. Movement disorders are possible.

These external signs indicate the addition of concomitant diseases and conditions caused by kidney dysfunction to chronic renal failure:

• Azotemia – occurs when there is an increase in nitrogen metabolic products in the blood. Determined by the amount of creatinine in plasma. The uric acid content is not so indicative, since its concentration increases for other reasons.
• Hyperchloremic acidosis is caused by a violation of the mechanism of calcium absorption and is very characteristic of the stage of clinical manifestations; it increases hyperkalemia and hypercatabolism. Its external manifestation is the appearance of shortness of breath and great weakness.
• Hyperkalemia is the most common and most dangerous symptom of chronic renal failure. The kidney is able to maintain the function of potassium absorption until the terminal stage. However, hyperkalemia depends not only on the functioning of the kidney and, if it is damaged, develops in the initial stages. When the potassium content in the plasma is excessively high - more than 7 meq/l, nerve and muscle cells lose their ability to excitability, which leads to paralysis, bradycardia, central nervous system damage, acute respiratory failure, and so on.
• With a decrease in appetite and against the background of intoxication, a spontaneous decrease in protein intake occurs. However, its too low content in food for patients with chronic renal failure is no less destructive, since it leads to hypercatabolism and hypoalbuminemia - a decrease in albumin in the blood serum.

Another characteristic symptom for patients with chronic renal failure is an overdose of drugs. With chronic renal failure, the side effects of any drug are much more pronounced, and overdose occurs in the most unexpected cases. This is due to kidney dysfunction, which is unable to remove waste products, which leads to their accumulation in the blood.

Diagnostics

The main goal of diagnosis is to distinguish chronic renal failure from other kidney diseases with similar symptoms, and especially from the acute form. To do this, they resort to various methods.

Of the blood and urine tests, the most informative are the following indicators:

• the amount of creatinine in the blood plasma is more than 0.132 mmol/l;
• – a pronounced decrease is 30–44 ml/min. At a value of 20 ml/min, urgent hospitalization is required;
• urea content in the blood is more than 8.3 mmol/l. If an increase in concentration is observed against the background of normal creatinine levels, the disease most likely has a different origin.

Among instrumental methods, ultrasound and x-ray methods are used. A characteristic sign of chronic renal failure is reduction and shrinkage of the kidney; if this symptom is not observed, a biopsy is indicated.

X-ray contrast research methods are not permitted

Treatment

Until the end stage, treatment of chronic renal failure does not include dialysis. Conservative treatment is prescribed depending on the degree of kidney damage and associated disorders.

It is very important to continue treatment of the underlying disease, while eliminating nephrotoxic drugs:

• A mandatory part of treatment is a low-protein diet - 0.8-0.5 g/(kg*day). When the albumin content in the serum is less than 30 g/l, the restrictions are weakened, since with such a low protein content the development of nitrogen imbalance is possible; the addition of keto acids and essential amino acids is indicated.
• When GFR is around 25–30 ml/min, thiazide diuretics are not used. For lower values, they are assigned individually.
• For chronic hyperkalemia, ion-exchange polystyrene resins are used, sometimes in combination with sorbents. In acute cases, calcium salts are administered and hemodialysis is prescribed.
• Correction of metabolic acidosis is achieved by administering 20–30 mmol of sodium bicarbonate intravenously.
• For hyperphosphatemia, substances are used that prevent the absorption of phosphates by the intestine: calcium carbonate, aluminum hydroxide, ketosteryl, phosphocitrile. For hypocalcemia, calcium preparations - carbonate or gluconate - are added to therapy.

Stage of decompensation

This stage is characterized by deterioration of the patient’s condition and the appearance of complications. The glomerular filtration rate is 15–22 ml/min.

• Headaches and lethargy are accompanied by insomnia or, conversely, severe drowsiness. The ability to concentrate is impaired and confusion is possible.
• Peripheral neuropathy progresses - loss of sensation in the arms and legs, up to immobilization. Without hemodialysis, this problem cannot be solved.
• Development of gastric ulcer, appearance of gastritis.
• Chronic renal failure is often accompanied by the development of stomatitis and gingivitis - inflammation of the gums.
• One of the most severe complications of chronic renal failure is inflammation of the serous membrane of the heart - pericarditis. It is worth noting that with adequate treatment this complication is rare. Myocardial damage due to hyperkalemia or hyperparathyroidism is observed much more often. The degree of damage to the cardiovascular system is determined by the degree of arterial hypertension.
• Another common complication is pleurisy, that is, inflammation of the pleural layers.
• With fluid retention, blood stagnation in the lungs and swelling are possible. But, as a rule, this complication appears already at the stage of uremia. The complication is detected by x-ray.

Treatment depends on the complications that arise. Possibly connection to conservative hemodialysis therapy.

The prognosis depends on the severity of the disease, age, and timeliness of treatment. At the same time, the prognosis for recovery is questionable, since it is impossible to restore the functions of dead nephrons. However, the prognosis for life is quite favorable. Since the relevant statistics are not kept in the Russian Federation, it is quite difficult to say exactly how many years patients with chronic renal failure live.

In the absence of treatment, the stage of decompensation passes into the terminal stage. And in this case, the patient’s life can only be saved by resorting to kidney transplantation or hemodialysis.

Terminal

The terminal (last) stage is uremic or anuric. Against the background of retention of nitrogen metabolism products and disruption of water-salt, osmotic homeostasis, etc., autointoxication develops. Dystrophy of body tissues and dysfunction of all organs and systems of the body are recorded.

• Symptoms of loss of sensation in the limbs are replaced by complete numbness and paresis.
• There is a high probability of uremic coma and cerebral edema. Against the background of diabetes mellitus, a hyperglycemic coma is formed.
• In the terminal stage, pericarditis is a more frequent complication and is the cause of death in 3–4% of cases.
• Gastrointestinal lesions - anorexia, glossitis, frequent diarrhea. Every 10 patients experience gastric bleeding, which is the cause of death in more than 50% of cases.

Conservative treatment at the terminal stage is powerless.

Depending on the general condition of the patient and the nature of the complications, more effective methods are used:

• – blood purification using an “artificial kidney” device. The procedure is carried out several times a week or every day, has different durations - the regimen is selected by the doctor in accordance with the patient’s condition and the dynamics of development. The device performs the function of a dead organ, so diagnosed patients cannot live without it.

Hemodialysis today is a more affordable and more effective procedure. According to data from Europe and the USA, the life expectancy of such a patient is 10–14 years. Cases have been recorded where the prognosis is most favorable, since hemodialysis prolongs life by more than 20 years.

• - in this case, the role of the kidney, or, more precisely, the filter, is performed by the peritoneum. The fluid introduced into the peritoneum absorbs the products of nitrogen metabolism and is then removed from the abdomen to the outside. This procedure is carried out several times a day, since its effectiveness is lower than that of hemodialysis.
• - the most effective method, which, however, has a lot of limitations: peptic ulcers, mental illness, endocrine disorders. It is possible to transplant a kidney from either a donor or a cadaveric one.

Recovery after surgery lasts at least 20–40 days and requires the most careful adherence to the prescribed regimen and treatment. A kidney transplant can prolong a patient's life by more than 20 years, unless complications arise.

Stages of creatinine and degree of glomerular filtration reduction

The concentration of creatinine in urine and blood is one of the most characteristic hallmarks of chronic renal failure. Another very telling characteristic of a damaged kidney is the glomerular filtration rate. These signs are so important and informative that the classification of chronic renal failure by creatinine or by GFR is used more often than the traditional one.

Classification by creatinine

Creatinine is a breakdown product of creatine phosphate, the main source of energy in muscles. When a muscle contracts, the substance breaks down into creatinine and phosphate, releasing energy. Creatinine then enters the blood and is excreted by the kidneys. The average norm for an adult is considered to be a blood level of 0.14 mmol/l.

An increase in creatinine in the blood causes azotemia - the accumulation of nitrogen breakdown products.

Based on the concentration of this substance, 3 stages of disease development are distinguished:

• Latent - or reversible. Creatinine levels range from 0.14 to 0.71 mmol/L. At this stage, the first uncharacteristic signs of chronic renal failure appear and develop: lethargy, polyuria, and a slight increase in blood pressure. There is a decrease in the size of the kidney. The picture is typical for a condition when up to 50% of nephrons die.
• Azotemic - or stable. The level of the substance varies from 0.72 to 1.24 mmol/l. Coincides with the stage of clinical manifestations. Oligouria develops, headaches, shortness of breath, swelling, muscle spasms, etc. appear. The number of working nephrons decreases from 50 to 20%.
• Uremic stage - or progressive. Characterized by an increase in creatinine concentration above 1.25 mmol/l. Clinical signs are pronounced, complications develop. The number of nephrons is reduced to 5%.

By glomerular filtration rate

Glomerular filtration rate is a parameter used to determine the excretory capacity of an organ. It is calculated in several ways, but the most common involves collecting urine in two hourly portions, determining minute urine output and creatinine concentration. The ratio of these indicators gives the value of glomerular filtration.

GFR classification includes 5 stages:

• Stage 1 – with a normal level of GFR, that is, more than 90 ml/min, signs of renal pathology are observed. At this stage, for cure, sometimes it is enough to eliminate the existing negative factors - smoking, for example;
• Stage 2 – slight decrease in GFR – from 89 to 60 ml/min. At both stages 1 and 2, it is necessary to adhere to a diet, accessible physical activity and periodic observation by a doctor;
• Stage 3A – moderate decrease in filtration rate – from 59 to 49 ml/min;
• Stage 3B – marked decrease to 30 ml/min. At this stage, drug treatment is carried out.
• Stage 4 – characterized by a severe decrease – from 29 to 15 ml/min. Complications appear.
• Stage 5 – GFR is less than 15 ml, the stage corresponds to uremia. The condition is critical.

Stages of chronic renal failure according to glomerular filtration rate


Kidney failure is a severe and very insidious syndrome. In a chronic course, the first signs of damage to which the patient pays attention appear only when 50% of the nephrons, that is, half of the kidneys, have died. Without treatment, the likelihood of a favorable outcome is extremely low.

Chronic renal failure (CRF) is a disorder of kidney function that occurs due to the death of nephrons and their replacement by connective tissue due to chronic kidney disease. The frequency of this condition ranges from 100–600 people per 1,000,000 adults.

What causes chronic renal failure

Chronic renal failure can be caused by:

• chronic;
• chronic glomerulonephritis;
• interstitial nephritis;
• radiation nephritis;
• hydronephrosis;
• urolithiasis disease;
• tumors of the genitourinary system;
• hypertonic disease;
• stenosis (narrowing) of the renal arteries;
• systemic connective tissue diseases (systemic scleroderma, systemic lupus erythematosus, hemorrhagic vasculitis, periarteritis nodosa);
• metabolic diseases (diabetes, amyloidosis);
• congenital kidney diseases (hypoplasia, polycystic disease, Fanconi and Alport syndromes).

What happens in the body during chronic renal failure

As a result of a chronic pathological process, irreversible changes occur in the renal parenchyma associated with a decrease in the number of functioning nephrons and the replacement of affected cells with connective tissue. At first, healthy nephrons take over the function of the affected ones, but over time, the compensatory capabilities of the kidneys are depleted, metabolic products are not excreted in the urine, but accumulate in the body, damaging other tissues and organs:

• due to impaired excretory function of the kidneys, nitrogen metabolism products accumulate in the body, which have a toxic effect on the central nervous system;
• as a result of water imbalance, the load on the nephrons increases, which leads to a decrease in the relative density of urine (hyposthenuria) and the absence of daily fluctuations in its density (isosthenuria); increased frequency of urination at night (nocturia); in the initial stages there is an increase in the amount of urine excreted (polyuria), and in the terminal period the volume of urine excreted gradually decreases (oliguria) until it stops completely (anuria);
• urea retention leads to disturbances in mineral metabolism (sodium, potassium and calcium are intensively excreted, phosphates are retained - arrhythmias, secondary hyperparathyroidism, osteomalacia, polyneuropathy occur);
• the kidneys lose the ability to synthesize erythropoietin (a substance that promotes the formation of red blood cells) - anemia develops; its development is also facilitated by the toxic effects of uremic toxins on the bone marrow and increased intravascular hemolysis (destruction) of red blood cells;
• the result of the accumulation of metabolic products is a violation of the acid-base balance - acidosis develops;
• carbohydrate metabolism is disrupted - the level of glucose in the blood increases, the body’s tolerance to it is disrupted;
• the ratio of factors regulating blood pressure is disrupted, resulting in persistent arterial hypertension.

Classification of chronic renal failure

Previously, the degree of chronic renal failure was determined by the level in the blood of a substance called creatinine, the end product of protein metabolism. It has now been proven that the level of creatinine directly depends on a person’s gender, age and body weight and can vary between 50–115 µmol/l. Currently, to assess the degree of chronic renal failure, an indicator such as glomerular filtration rate, or GFR, is used, which is calculated using a special formula.

So, depending on the GFR, there are 5 degrees of chronic renal failure:

• 0 – GFR ˃ 90 ml/min;
• I – GFR 60–89 ml/min;
• II – GFR 30–59 ml/min;
• III – GFR 15–30 ml/min;
• IV – GFR ˂ 15 ml/min.

Depending on the clinical manifestations, 4 stages of chronic renal failure are distinguished:

• latent (not clinically manifested, only mild fatigue and dry mouth are possible);
• compensated (clinical manifestations of the latent stage become more pronounced, appear more often, polyuria occurs up to 2–2.5 liters per day);
• intermittent (the electrolyte and acid-base balance is disturbed, there are complaints of general weakness, increased fatigue, decreased or lack of appetite, thirst; periodically, due to the exacerbation of the underlying disease, the patient’s condition worsens, and after treatment, positive dynamics are noted);
• terminal (characterized by pronounced dysfunctions of organs and systems, changes in them are irreversible).

Symptoms of chronic renal failure

Chronic renal failure can occur in different ways, but in most cases it is characterized by a slowly and steadily progressive course with alternating stages. Chronic renal failure worsens against the background of acute infectious diseases or exacerbation of its main cause - kidney disease. With adequate treatment of the process that caused the exacerbation, kidney function improves and the symptoms of chronic renal failure regress.

With this disease, complaints from any of the systems of our body are possible. Let's consider each of them separately.

Skin damage:

• pale, yellowish color of the skin, due to the accumulation of urochrome in it;
• “uremic frost” – deposition of white urea crystals on the skin;
• dry skin;
• puffiness of the face.

Respiratory system damage:

• cough;
• attacks of suffocation up to pulmonary edema (so-called uremic edema);
• prone to infections.

Damage to the cardiovascular system:

• increased blood pressure, often to extremely high levels (up to 280–300 mm Hg), which cannot be controlled with antihypertensive drugs;
• feeling of fading, interruptions in heart function;
• decrease in the number of heartbeats;
• tense pulse.

Damage to the urinary system:

• first polyuria, at the terminal stage oligo and anuria;
• decreased density of urine (externally, urine is almost transparent and colorless);
• Frequent urination at night (nocturia).

Damage to the nervous system:

• malaise;
• drowsiness or insomnia;
• tremor (shaking);
• memory impairment;
• irritability;
• slow, drawling speech;
• lethargy;
• disturbances of consciousness (stupor, coma);
• polyneuropathy;
• convulsions;
• nervous tics;
• “silent uremia” – a progressive increase in apathy;
• “noisy uremia” – eclampsia (convulsions + edema + increased blood pressure);

Damage to the gastrointestinal tract:

• nausea and vomiting;
• thirst;
• perversion of taste;
• decreased or complete lack of appetite;
• symptoms of stomatitis (ulceration of the oral mucosa), mumps (inflammation of the parotid salivary glands);
• symptoms of gastritis (pain in the stomach, discomfort, heaviness in the stomach);
• symptoms of intestinal ulcers (severe abdominal pain, gastrointestinal bleeding);
• weight loss;
• diarrhea.

Damage to the skeletal system:

• growth retardation;
• osteodystrophy and softening of bones (osteomalacia), manifested by pain along the bones and muscles, the occurrence of pathological fractures and bone deformations;
• signs of hyperparathyroidism (muscle weakness, fatigue, bone pain, long-healing fractures, skeletal deformities).

General symptoms:

• decrease in body temperature;
• smell of urine from the mouth;
• general weakness;
• frequent infectious diseases (indicate a decrease in immunity);
• decrease in human social activity.

In some cases, chronic renal failure progresses rapidly, reaching the terminal stage within 6–8 weeks after the onset of the disease.

Which doctor should I contact?

Kidney failure is treated by a nephrologist. If various organs and systems are affected, additional consultations may be prescribed: a dermatologist (for severe itching, scratching, infection of wounds), a pulmonologist (for pneumonia), a cardiologist (for treatment-resistant hypertension), a neurologist (for damage to the brain or peripheral nerves), a gastroenterologist (in case of bleeding), a dentist (in case of stomatitis), and finally, a traumatologist or surgeon in case of fractures.

What is it - kidney failure is a serious functional disorder of the kidneys that leads to water, electrolyte and acid-base imbalances 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, and medications. 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 is marked by the further development of oliguria up to anuria - the 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 fatigue of the patient progress. Constant dry mouth and thirst appear. 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 acquires a 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, his overall immunity decreases, which leads to the development of 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 through intensive therapy. 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 at balancing 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. At the last stage of chronic renal failure, regular dialysis or transplantation of a healthy kidney is necessary.

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 in the functional state of the 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 choose treatment tactics: in periods 1 and 2, there are still opportunities to use effective methods of 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 methods and surgical ones. The vast majority of patients will require all possible treatment options 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, purifying it through a machine filter and returning it back to the body’s vascular system. 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 of the endocrine system, mental illness, stomach ulcers and the presence of 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 the initial period of the 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 longest possible preservation of 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 of 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 to be 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 of boiled water, left for about 1 hour and taken 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. Severe decline in 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 a medical condition 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 with unsaturated fats and make a diet low in fat overall. 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 surgery or injury. 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 occur during severe 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. There may also be loose stools 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.

A particularly serious condition is caused by the terminal stage of 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 of 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. You should use very carefully those 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 medicines, despite its slow effects, compared with Western medicine, will be able to nourish the kidneys, refrain from inflammation, accelerate the addition of nutrients to repair damaged (not completely damaged) kidney cells, and accompanying the correction of the kidneys, clinical symptoms/complications will be better under control 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 dietician. 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 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.

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 waste, 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 the development of severe forms of renal failure even in 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 treatment, such an outcome of any kidney disease such 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, 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

In 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. Clinical signs of renal failure appear: 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 are reflected in chilliness of the limbs, tingling sensations, and crawling sensations. Later, movement disorders in the arms and legs develop.

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 as 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 levels of phosphorus and low levels of calcium appear in the blood. 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)
• Dull pain in the heart, heart rhythm disturbances, shortness of breath, swelling in the legs, and enlarged liver appear.
• 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 is uremic lung - interstitial edema and bacterial inflammation of the lung against the background of a decrease 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 of the stomach and intestines appear, 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 overstrain of the 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 a 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 exhaustion, infectious complications of chronic renal failure, 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, and 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 usually resolved by cesarean 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.