Symptoms and treatment of chronic renal failure. Appearance of patients. Complications of chronic renal failure

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 development severe forms renal failure even with initial stages 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, systemic diseases may lead to renal failure.

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

How does chronic renal failure develop?

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

• First stage of chronic renal failure– initial

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

• Second stage

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

• Third stage

On the third moderate stage GFR drops to 60-30 ml per minute. At the same time, the process occurring in the kidneys is often hidden from view. There is no bright clinic. There may be an increase in the volume of urine excreted, a moderate decrease in the number of red blood cells and hemoglobin (anemia) and associated weakness, lethargy, decreased performance, pale skin and mucous membranes, brittle nails, hair loss, dry skin, decreased appetite. About half of the patients experience an increase in blood pressure (mainly diastolic, i.e. lower).

• Fourth stage

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

• Fifth stage

The fifth stage of renal failure is called terminal, i.e. final. When glomerular filtration decreases below 15 ml per minute, the amount of urine excreted drops (oliguria) until it is completely absent in the outcome of the condition (anuria). All signs of poisoning of the body with nitrogenous wastes (uremia) appear against the background of disturbances in water-electrolyte balance, damage to all organs and systems (primarily nervous system, cardiac 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

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

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

Nervous system lesions

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

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

Urinary function

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

Water-salt balance

• salt imbalance manifests itself as increased thirst, dry mouth
• weakness, darkening of the eyes when standing up abruptly(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, a high level of phosphorus appears and low level calcium 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)
• appear dull pain in the heart, disorders heart rate, shortness of breath, swelling in the legs, enlarged liver.
• If myocarditis progresses unfavorably, the patient may die due to acute heart failure.
• pericarditis can occur with the accumulation of fluid in the pericardial sac or the loss of uric acid crystals in it, which in addition to pain and expansion of the boundaries of the heart, when listening chest gives a characteristic (“funeral”) friction noise of the pericardium.

Hematopoiesis

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

Pulmonary complications

characteristic of late stages of chronic renal failure. This uremic lung - interstitial edema and bacterial inflammation 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 conditions for pregnancy and its gestation. A pregnant woman with chronic renal failure and her fetus face a number of pregnancy complications:

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

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

Treatment methods

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

• Patients are recommended to eat a diet with limited protein intake to within 60 grams per day, with primary consumption vegetable proteins. As chronic renal failure progresses to stage 3-5, protein is limited to 40-30 g per day. At the same time, the share 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).
• Excess potassium requires reducing the consumption of black bread, potatoes, bananas, dates, raisins, parsley, figs).
• Patients have to make do with a drinking regimen of 2-2.5 liters per day (including soup and taking pills) if there is pronounced 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 included in the diet specialized mixtures, enriched with fats and containing a fixed amount of soy proteins and balanced in microelements.
• 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 oral medications iron (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 drugs vitamin D.

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 the “artificial kidney”, less often peritoneal dialysis is performed, when the solution is poured into abdominal cavity, and the role of the membrane is played by the peritoneum. Hemodialysis for chronic renal failure is carried out in a chronic mode. For this, patients travel several hours a day to 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. Once the GFR drops below 15 ml, dialysis begins in children and patients with diabetes mellitus, with GFR less than 10 ml per minute, dialysis is performed in other patients. In addition, indications for hemodialysis will be:

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

Contraindications to hemodialysis:

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

Kidney transplant

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

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

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

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

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

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

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

Diagnostic methods

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

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

Symptoms of the disease

The main ones include:

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

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

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

Stages of the chronic form

Classification of chronic renal failure:

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

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

Each classification has its own clinical picture.

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

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

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

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

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

Therapeutic measures

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

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

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

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

Carrying out a hemodialysis procedure

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

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

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

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

Doctors' opinions on the issue are always different, however, average duration life - 20 years. It is not uncommon in medical practice for patients to live for more than 35 years.

Kidney transplant

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

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

Definition

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

Causes

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

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

Significant progress has now been made in uncovering pathogenetic mechanisms progression of chronic kidney disease. 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. Defeat of cardio-vascular system: hypertension, pericarditis, uremic cardiopathy, cardiac rhythm and conduction disturbances, 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 yellowish tint, its dryness, traces of scratching, hemorrhagic rash (petechiae, ecchymoses, 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 skeletal muscles, convulsions, proximal myopathy, ossalgias, fractures, aseptic bone necrosis, gout, arthritis, intradermal and dimensional 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 higher level urea, creatinine oblige the doctor to further examine the patient in order to establish the cause that caused azotemia and prescribe rational treatment.

Signs of chronic renal failure

1.Early signs:

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

2.Late signs:

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

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

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

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

A decrease in the RF reserve (functional renal reserve - FR) due to nephropathy is considered as an early sign of impaired renal filtration function. In a healthy person after an acute load of protein or CP increases by 10-39%. Decrease or complete absence 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, urine odor, hypertension, and also for patients with diabetes mellitus. mandatory check from a specialist.

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

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

Prevention

Conservative treatment of chronic renal failure

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

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 due to carbohydrates, and instead 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 for every 6 g of urine protein egg. Patients with chronic renal failure are recommended to replace half of the required daily protein soy supplements and add fish oil.

The effectiveness of MBD is assessed by reducing uremic intoxication, dyspeptic phenomena, decreased levels of phosphates, urea, creatinine, absence of hypoalbuminemia, hypotransferinemia, lymphopemia, hyperkalemia, stability of pH and blood bicarbonate levels.

Contraindications to MBD:

• sharp decrease in residual function (RF< 5мл/мин.);
• spicy infectious complications 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.

Urologist

Natalia: 03/08/2014
hello! at my husband's strong smell from the penis. It even seems like leucorrhoea remains on the underwear. The pain doesn’t bother me either during PA or when urinating. (I went to a gynecologist; I have cervicitis, an inflammation of the cervix). And I assume that the infection was transmitted to him through sexual intercourse. They didn’t contact a urologist because the work schedule does not coincide with the doctor’s work schedule... and there are no paid private clinics! Please help. Can you advise what medications my husband should take. I’m already undergoing treatment. Thank you in advance)

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

What is chronic renal failure

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

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

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

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

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

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

Classification and stages

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

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

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

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

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

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

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

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

Causes of chronic kidney disease

Diseases and conditions that cause chronic kidney disease include:

Additional factors that increase the risk of the disease include:

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

Symptoms of the disease

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

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

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

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

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

Video: signs of kidney dysfunction

Diagnostic methods

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

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

Laboratory methods

The following laboratory tests are used to make a diagnosis:

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

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

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

Imaging studies

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

Patients with CKD should avoid x-ray studies that require intravenous contrast material, such as an angiogram, intravenous pyelogram, and some CT scans, as these may cause more damage to the kidneys.

Treatment options for chronic kidney disease

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

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

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

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

Drug therapy for early stage disease

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

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

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

Photo gallery: drugs prescribed for renal failure

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

Treatment of late stage chronic kidney disease

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

Dialysis

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

Video: hemodialysis and peritoneal dialysis

Kidney transplant

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

Developed different approaches for kidney transplantation:

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

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

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

Traditional methods

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

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

Preparation of the decoction:

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

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

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

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

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

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

Photo gallery: traditional methods of treating kidney failure

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

Diet food

Principles of dietary nutrition for chronic kidney disease:

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

Features of treatment in pregnant women

Chronic kidney disease It is rare during pregnancy. This is explained by the fact that many women with renal failure are either beyond childbearing age or are secondary infertile, which is associated with uremia. Most women who become pregnant and have mild renal dysfunction do not feel the negative impact of pregnancy on their own health.

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

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

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

Prognosis and complications

The life prognosis of patients with chronic renal failure depends on many individual factors. The cause of kidney failure is big influence on the outcome of the disease. The rate at which kidney function declines depends directly on the underlying disorder causing CKD and how well it is controlled. In people with chronic renal failure there is more high risk death from stroke or heart attack.

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

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

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

But only a successful organ transplant makes it possible to more full life and lack of dependence on dialysis. A transplanted kidney functions on average for 15–20 years, then it requires reoperation. In practice, one person can undergo 4 kidney transplants.

Prospects for the treatment of chronic kidney disease

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

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

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

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

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

Prevention

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

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

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

Chronic renal failure (CRF) refers to severe pathologies of the urinary system, in which there is a complete or partial decrease in kidney function. The disease develops quite slowly, goes through several stages of its development, each of which is accompanied by certain pathological changes in the functioning of the kidneys and the whole organism. Chronic renal failure can occur in different ways, but in the vast majority of cases the disease has a progressive course, which is accompanied by periods of remission and exacerbation. At timely diagnosis disease, carrying out the necessary medical therapy, its development can be slowed down, thereby stopping the manifestation of more severe stages.

It is possible to determine at what stage chronic renal failure is located using laboratory and instrumental studies. A biochemical blood test is very informative, the results of which help determine the type of disease, concomitant diseases, stages of chronic renal failure, as well as the level of creatine in the blood.

Creatinine is an important component of blood plasma, which is involved in the energy metabolism of tissues. Excreted from the body along with urine. When creatinine in the blood is elevated, this is a sure sign of kidney dysfunction, as well as a signal of possible development, the stages of which directly depend on its level.

In addition to the increased level of creatinine in the blood plasma, doctors also pay attention to other indicators: urea, ammonia, urate and other components. Creatinine is a waste product that must be removed from the body, so if its amount exceeds the permissible limit, it is important to immediately take measures to remove it.

The normal level of creatinine in the blood for men is 70-110 µmol/l, for women 35-90 µmol/l, and for children - 18-35 µmol/l. With age, its amount increases, which increases the risk of developing kidney disease.

In nephrology, the disease is divided into stages of chronic renal failure, each of which requires an individual approach to treatment. Chronic form most often develops against the background of long-term pathologies in the urinary system or after acute form, in the absence of proper treatment. Very often, early degrees of renal failure do not cause a person any discomfort, but when there is a history of other chronic diseases, then the clinical picture will be more pronounced, and the disease itself will progress rapidly.

Chronic renal failure in medicine is considered as a symptom complex that manifests itself with the death of kidney nephrons caused by progressive pathologies. Given the complexity of the disease, it is divided into several stages, forms and classifications.

Determination of the stage of chronic kidney disease using blood creatinine

Classification according to Ryabov

Ryabov’s classification of chronic renal failure consists of indicators of the three main stages of the disease and the amount of creatinine in the blood plasma.

Latent (stage 1) – refers to the initial and reversible forms of the disease. They classify it:

1. Phase A - creatinine and GFR are normal.
2. Phase B - creatinine is increased to 0.13 mmol/l, and GFR is reduced, but not less than 50%.

Azotemic (stage 2) is a stable progressive form.

1. Phase A - creatinine 0.14-0.44, GFR 20-50%.
2. Phase B - creatinine 0.45-0.71, GFR 10-20%.

Uremic (stage 3) – progressive.

1. Phase A – creatinine level 0.72-1.24, GFR 5-10%.
2. Phase B - creatinine 1.25 or higher, GFR< 5%.

Classification by GFR

In addition to the classification of chronic renal failure by creatinine, doctors pay attention to the glomerular filtration rate (GFR), which is calculated using a special formula. Kidney damage according to GFR is divided into 5 stages:

• 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.

Regardless of the classification of chronic renal failure, the creatinine stage and the level of glomerular filtration rate are the most important indicators biochemical analysis blood. During its development, the disease goes through 4 stages. Clinical signs can be recognized by stages, each of which has a characteristic clinic.

Latent stage of chronic renal failure

Latent – ​​the initial stage of renal failure, in which the level of GFR, as well as creatinine, are within normal limits or slightly increased. The functionality of the kidneys is not impaired at stage 1, so the symptoms practically do not bother the person. At this stage of the disease, ammonia synthesis and urine osmolarity decrease, and there are no significant deviations in test results. During development latent form CRF symptoms are absent or may appear in the form of other deviations.

Patients during this period may complain of:

• blood pressure surges;
• increased fatigue;
• dry mouth;
• intense thirst.

If the disease is diagnosed at this stage and adequate treatment is carried out, the prognosis for recovery is quite favorable.

Compensated stage

Stage 2 chronic renal failure, which is also called polyuric or compensated. At this stage, the level of all indicators is above acceptable standards. The work of the kidneys at this stage is compensated by other organs. The clinical picture is more pronounced, the patient has the following symptoms:

• chronic fatigue in the first half of the day;
• strong and constant thirst;
• decrease in body temperature;
• anemia;
• pale, yellowish color skin;
• high blood pressure;
• decreased urine density;
• frequent urination.

At this stage of the disease, glomerular filtration and urine osmolarity are markedly reduced. The patient develops acidosis, protein metabolism is disrupted, and the urge to urinate becomes more frequent. Correct and timely treatment will keep the disease under control and reduce the risk of the disease progressing to more serious stages.

Intermittent stage

Stage 2-B is intermittent, in which the level of creatinine in the blood significantly exceeds the norm - 4.5 mg/dl. During this period, the amount of urine doubles, calcium and potassium decreases. The patient is concerned about the following symptoms:

• muscle twitching;
• constant fatigue;
• convulsions;
• signs of anemia;
• hypertension;
• nausea;
• urge to vomit;
• anorexia;
• bloating.

The third stage is accompanied by the appearance of polyuria and nocturia, there are also changes in the skin, which becomes flabby and loses natural color, weakness may also be present and periodic pain in the joints.

During the intermittent stage, kidney function deteriorates significantly, the person becomes susceptible to various viral infections, appetite disappears. Treatment is carried out comprehensively, consisting of symptomatic and systemic medications.

Terminal stage

The last and most severe form of chronic renal failure, in which the kidneys refuse to perform their functions. The terminal stage of chronic renal failure is accompanied by severe symptoms that disrupt the functioning of the whole organism. Accompanied by the following symptoms:

• mental state disorder;
• itching, dryness and sagging skin;
• convulsions;
• memory loss;
• smell of ammonia from the mouth;
• swelling of the body and face;
• nausea, vomiting;
• bloating, problems with stool;
• fast weight loss.

Due to severe impairment of kidney function, all organs and systems suffer. The patient's condition is serious, there are great risks fatal outcome. End-stage chronic renal failure is accompanied by high level creatinine in the blood, which causes general intoxication body.

At this stage of the disease, the kidneys practically do not work, urine is not excreted, but enters the blood. The only way saving a person's life is considered to be a kidney transplant or constant hemodialysis, which helps cleanse the blood of toxins. Thanks to hemodialysis, a person can live for many years, but the procedure must be performed regularly in a hospital setting.

Conclusion

Life expectancy with CKD directly depends on the stage at which the disease is detected, treatment methods and the person’s lifestyle. If the disease is diagnosed in the early stages, and the patient follows all the doctor’s recommendations, follows a diet and takes the necessary medications, the prognosis is very favorable. Late stages of the disease give less chance of survival, especially when the disease has become terminal stage. If at this stage a person does not undergo hemodialysis or there is no possibility of a kidney transplant, the consequences are quite severe, and the patient himself dies within a few days or weeks.

With the development of chronic renal failure, the classification has vital importance, since at each stage of the disease a person requires a special and individual approach to treatment.

Chronic kidney disease is a serious condition that can manifest itself due to a long-term pathological process in renal tissues, which lasts about 3 months. At the initial stages of the disease, symptoms may go unnoticed, but as the nephrons are damaged, the clinical picture will become more pronounced, and ultimately can lead to complete disability and death of the person.