Symptoms of kidney failure. Symptoms of chronic renal failure What is the manifestation of renal failure

According to the clinical course, acute and chronic renal failure are distinguished.

Acute renal failure

Acute renal failure develops suddenly, as a consequence of acute (but most often reversible) damage to the kidney tissue, and is characterized by a sharp drop in the amount of urine excreted (oliguria) to its complete absence (anuria).

Causes of acute renal failure

Symptoms of acute renal failure

small amounts of urine (oliguria);
complete absence (anuria).

The patient's condition worsens, this is accompanied by nausea, vomiting, diarrhea, lack of appetite, swelling of the extremities occurs, and the liver increases in volume. The patient may be inhibited or, on the contrary, agitation may occur.

In the clinical course of acute renal failure, several stages are distinguished:

Stage I- initial (symptoms caused by the direct impact of the cause that caused acute renal failure), lasting from the moment of exposure to the main cause until the first symptoms of the kidneys have a different duration (from several hours to several days). Intoxication may appear (pallor, nausea,);

Stage II- oligoanuric (the main symptom is oliguria or complete anuria, also characterized by a severe general condition of the patient, the occurrence and rapid accumulation of urea and other end products of protein metabolism in the blood, causing self-poisoning of the body, manifested by lethargy, adynamia, drowsiness, diarrhea, arterial hypertension, tachycardia , body edema, anemia, and one of the characteristic signs is progressively increasing azotemia - an increased content of nitrogenous (protein) metabolic products in the blood and severe intoxication of the body);

Stage III- restorative:

early diuresis phase - the clinic is the same as in stage II;
the phase of polyuria (increased urine production) and restoration of the concentrating ability of the kidneys - renal functions are normalized, the functions of the respiratory and cardiovascular systems, the digestive canal, the support and movement apparatus, and the central nervous system are restored; the stage lasts about two weeks;

IV stage- recovery - anatomical and functional restoration of renal activity to initial parameters. It can take many months, sometimes it takes up to one year.

Chronic renal failure

Chronic renal failure is a gradual decline in kidney function until it disappears completely, caused by the gradual death of kidney tissue as a result of chronic kidney disease, the gradual replacement of kidney tissue with connective tissue and shrinkage of the kidney.

Chronic renal failure occurs in 200-500 out of every million people. Currently, the number of patients with chronic renal failure is increasing annually by 10-12%.

Causes of chronic renal failure

The causes of chronic renal failure can be various diseases that lead to damage to the renal glomeruli. This:

kidney diseases: chronic glomerulonephritis, chronic pyelonephritis;
metabolic diseases diabetes mellitus, gout, amyloidosis;
congenital kidney diseases, polycystic disease, underdevelopment of the kidneys, congenital narrowing of the renal arteries;
rheumatic diseases, scleroderma, hemorrhagic vasculitis;
vascular diseases arterial hypertension, diseases leading to impaired renal blood flow;
diseases leading to disruption of the outflow of urine from the kidneys: urolithiasis, hydronephrosis, tumors leading to gradual compression of the urinary tract.

The most common causes of chronic renal failure are chronic glomerulonephritis, chronic pyelonephritis, diabetes mellitus and congenital anomalies of kidney development.

Symptoms of chronic renal failure

There are four stages of chronic renal failure.

Latent stage. At this stage, the patient may not have any complaints, or fatigue during physical activity, weakness that appears in the evening, and dry mouth may occur. A biochemical blood test reveals slight disturbances in the electrolyte composition of the blood, sometimes protein in the urine.
Compensated stage. At this stage, the patients’ complaints are the same, but they occur more often. This is accompanied by an increase in urine output to 2.5 liters per day. Changes are detected in the biochemical parameters of blood and in.
Intermittent stage. Kidney function is further reduced. There is a persistent increase in the blood products of nitrogen metabolism (protein metabolism), an increase in the level of urea and creatinine. The patient experiences general weakness, fatigue, thirst, dry mouth, appetite decreases sharply, an unpleasant taste in the mouth is noted, nausea and vomiting appear. The skin acquires a yellowish tint, becomes dry and flabby. Muscles lose tone, small muscle twitching, tremors of fingers and hands are observed. Sometimes there is pain in the bones and joints. The patient may have a much more severe course of common respiratory diseases, sore throats, and pharyngitis.
During this stage, periods of improvement and deterioration in the patient's condition may be expressed. Conservative (without surgical intervention) therapy makes it possible to regulate homeostasis, and the general condition of the patient often allows him to still work, but increased physical activity, mental stress, errors in diet, restriction of drinking, infection, surgery can lead to deterioration of kidney function and aggravation of symptoms.
Terminal (final) stage. This stage is characterized by emotional lability (apathy is replaced by excitement), disturbance of night sleep, daytime drowsiness, lethargy and inappropriate behavior. The face is puffy, gray-yellow in color, the skin is itchy, there are scratches on the skin, the hair is dull and brittle. Dystrophy increases, and hypothermia (low body temperature) is characteristic. No appetite. The voice is hoarse. There is an ammonia smell from the mouth. Aphthous stomatitis occurs. The tongue is coated, the abdomen is swollen, vomiting and regurgitation are often repeated. Often - diarrhea, foul-smelling, dark-colored stools. The filtration capacity of the kidneys drops to a minimum.
The patient may feel satisfactory for several years, but at this stage the amount of urea, creatinine, and uric acid in the blood is constantly increased, and the electrolyte composition of the blood is disturbed. All this causes uremic intoxication or uremia (uremia urine in the blood). The amount of urine excreted per day decreases until it is completely absent. Other organs are affected. Cardiac muscle dystrophy, pericarditis, circulatory failure, and pulmonary edema occur. Disorders of the nervous system are manifested by symptoms of encephalopathy (sleep disturbances, memory, mood, and the occurrence of depressive states). The production of hormones is disrupted, changes occur in the blood coagulation system, and immunity is impaired. All these changes are irreversible. Nitrogenous waste products are excreted in sweat, and the patient constantly smells of urine.

Prevention of kidney failure

Prevention of acute renal failure comes down to preventing the causes that cause it.

Prevention of chronic renal failure comes down to the treatment of such chronic diseases as: pyelonephritis, glomerulonephritis, urolithiasis disease.

Forecast

With timely and correct application of adequate treatment methods, most patients with acute renal failure recover and return to normal life.

Acute renal failure is reversible: the kidneys, unlike most organs, are able to restore completely lost function. However, acute renal failure is an extremely serious complication of many diseases, often foreshadowing death.

However, in some patients, the decrease in glomerular filtration and the concentrating ability of the kidneys remains, and in some, renal failure takes a chronic course, with associated pyelonephritis playing an important role.

In advanced cases, death in acute renal failure most often occurs from uremic coma, hemodynamic disorders and sepsis.

Chronic kidney failure must be monitored and treated early in the disease, otherwise it can lead to complete loss of kidney function and require a kidney transplant.

What can you do?

The main task of the patient is to notice in time the changes that occur to him both in terms of his general well-being and in the amount of urine, and consult a doctor for help. Patients who have a confirmed diagnosis of pyelonephritis, glomerulonephritis, congenital kidney anomalies, or systemic disease should be regularly monitored by a nephrologist.

And, of course, you must strictly follow the doctor’s instructions.

What can a doctor do?

The doctor will first determine the cause of kidney failure and the stage of the disease. After which all necessary measures will be taken to treat and care for the patient.

Treatment of acute renal failure is aimed primarily at eliminating the cause that causes this condition. Measures are applicable to combat shock, dehydration, hemolysis, intoxication, etc. Patients with acute renal failure are transferred to the intensive care unit, where they receive the necessary assistance.

Treatment of chronic renal failure is inseparable from treatment of the kidney disease that led to kidney failure.

Content

This pathological condition can be characterized as a serious disease of the genitourinary system, which leads to disturbances in acid-base, osmotic and water-salt homeostasis. The disease affects all processes that occur in the body, which ultimately leads to secondary damage.

What is kidney failure

There are two main paths of the disease, the result of which will be either complete loss of kidney function or ESRD. Kidney failure is a syndrome that causes problems with the functioning of the kidneys. The disease is the main cause of disorders of most types of metabolism in the human body, including nitrogen, water or electrolyte. The disease has two forms of development - chronic and acute, as well as three stages of severity:

risk;
damage;
failure.

Causes of kidney failure

Based on reviews from doctors, the main causes of kidney failure in people affect only two areas - high blood pressure and diabetes. In some cases, the disease may occur due to heredity or be suddenly triggered by unknown factors. Such patients seek help from the clinic in very advanced cases, when it is extremely difficult to establish the source and cure the disease.

Stages of kidney failure

Chronic kidney disease occurs in five hundred out of a million patients undergoing treatment, however, this figure is steadily increasing every year. As a result of the disease, there is a gradual death of tissue and the loss of all its functions by the organ. Medicine knows four stages of chronic renal failure that accompany the course of the disease:

The first stage proceeds almost unnoticed; the patient may not even be aware of the development of the disease. The latent period is characterized by increased physical fatigue. The disease can only be detected through biochemical testing.
At the compensated stage, there is an increase in the number of urinations against the background of general weakness. The pathological process can be detected by the results of blood tests.
The intermittent stage is characterized by a sharp deterioration in kidney function, which is accompanied by an increase in the concentration of creatinine and other products of nitrogen metabolism in the blood.
According to etiology, end-stage renal failure causes irreversible changes in the functioning of all body systems. The patient feels constant emotional instability, lethargy or drowsiness, appearance deteriorates, and appetite disappears. The consequence of the last stage of chronic renal failure is uremia, aphthous stomatitis or dystrophy of the heart muscle.

Acute renal failure

The reversible process of kidney tissue damage is known as acute renal failure. AKI can be determined by referring to symptoms of kidney failure in a person, which are expressed by complete or partial cessation of urination. The constant deterioration of the patient's condition at the terminal stage is accompanied by poor appetite, nausea, vomiting and other painful manifestations. The causes of the syndrome are the following factors:

infectious diseases;
renal condition;
decompensated renal hemodynamic disorder;
urinary tract obstruction;
exogenous intoxications;
acute kidney diseases.

Chronic renal failure

Chronic renal failure gradually leads to a complete loss of the ability to function for this organ, causing shrinkage of the kidney, death of nephrons and complete replacement of its tissues. Being at the terminal stage of the disease, the patient’s body begins to refuse to excrete urine, which affects the electrolyte composition of the blood. Damage to the glomeruli can occur due to a number of reasons, the most common of which are:

systemic lupus erythematosus;
tumors;
chronic glomerulonephritis;
hydronephrosis;
gout;
urolithiasis disease;
amyloidochronic pyelonephritis;
diabetes;
arterial hypertension;
polycystic disease;
hemorrhagic vasculitis;
underdevelopment of the kidneys;
scleroderma;

Kidney failure - symptoms

In order to find out how to treat kidney failure, it is first worth studying the main symptoms of chronic renal failure. At first, it is problematic to independently identify the disease, although timely medical intervention can reverse the development of dangerous pathological processes, eliminating the need for surgery. Mostly, patients complain of symptoms of kidney failure such as severe swelling, high blood pressure or pain.

First signs of kidney failure

The syndrome of kidney dysfunction has a gradual stage of development, so each stage is characterized by more pronounced manifestations of the disease. The first signs of kidney failure are considered to be weakness or fatigue without good reason, refusal to eat, and problems sleeping. In addition, you can check for the presence of the disease based on the frequency of urination at night.

Kidney failure - symptoms in women

Disturbances in the functioning of the kidneys can cause a variety of manifestations depending on what stage of the pathological process the patient is at. Symptoms of kidney failure in women manifest themselves in a special, specific way. The first warning sign is emotional instability caused by a deficiency of the substance progesterone in the body. Against this background, a number of complications associated with the functioning of the genitourinary system are actively developing.

Kidney failure - symptoms in men

The syndrome affects the body in the early stages of its appearance, therefore, how to determine kidney failure and what to do can be found out by comparing some key facts. Symptoms of kidney failure in men are practically no different from the reactions of other groups of patients. The initial stages are characterized by: decreased urination, diarrhea, loss of appetite, itchy skin, and clearly visible signs of a nervous system disorder.

Kidney failure in children - symptoms

Kidney problems rarely affect young children, but if action is not taken in time, inaction can cause death. Symptoms of renal failure in children are no different from the course of the disease in adult patients. In addition to general malaise, the child feels nausea, his temperature rises, and in some cases swelling is detected. Such children often go to the toilet, but the amount of urine excreted is not normal. Analyzes allow us to diagnose the following picture:

stones in the kidneys;
cough;
increased amount of protein in the urine;
decreased muscle tone;
tremor;
the skin acquires a yellow tint.

Kidney failure - diagnosis

The main sign of the presence of severe pathology in a patient is not only a decrease in the frequency of urination, but also the presence of an increased amount of potassium or nitrogenous compounds in the blood. Diagnosis of renal failure is carried out in several stages, the condition of the kidneys is assessed according to the diagnosis based on the results of the Zimnitsky test. The main indicators of treatment effectiveness are:

biochemical blood monitoring;
Biopsy;
Doppler ultrasound of blood vessels.

Kidney failure - treatment

During therapy, the main cause of pathogenesis is eliminated with the help of modern medications. The recovery process includes replenishing the missing blood volume and normalizing blood pressure in case of a shock reaction in the patient. Treatment of renal failure during the period of nephrotoxin poisoning consists of washing the intestines and stomach from toxins; for these purposes the following is often used:

plasmapheresis;
nephroprotective treatment;
hemodialysis;
hemoperfusion;
peritoneal dialysis;
hemosorption.

Treatment of kidney failure - drugs

Treatment of such a serious disease must be supported by appropriate medical intervention, for example, insulin drugs. Most of the existing diuretics, when taken uncontrolled, can be harmful to human health, so the use of therapeutic substances is possible only under the strict supervision of a specialist. The most effective drugs for the treatment of kidney failure can be divided into a separate category of drugs:

Trimetazidine;
Lisinopril;
Desferal;
Sulodexide;
Eufillin;
Hypothiazide;
Digoxide;
Ramipril;
Chime;
Glurenorm;
Enalapril;
Metoprolol;
Deferoxamine;
Propranolol;
Dopamine.

Kidney failure - treatment with folk remedies

Some people adhere to natural methods of therapy, so treatment of kidney failure with folk remedies allows the use of only the gifts of nature. With the help of medicinal plants, fruits or vegetables, special decoctions are prepared to relieve a person of this ailment. The most effective folk therapy methods are the use of burdock, pomegranate juice and corn silk. There are other useful ingredients to treat:

seaweed;
echinacea tincture;
Dill seeds;
horsetail.

Kidney failure during pregnancy

While carrying a child, the pregnant mother's body is subjected to an additional degree of stress, which is why all its systems are forced to work in increased mode. Sometimes the main cause of kidney failure during pregnancy is a malfunction of certain organs. These diseases threaten the health of the woman and her unborn child, so childbirth in such circumstances is impossible. The only exceptions are those cases when the disease was promptly eliminated in the early stages of diagnosis.

Prevention of kidney failure

Timely treatment of diseases such as chronic pyelonephritis and glomerulonephritis will help prevent further complications, and regular adherence to the doctor’s recommendations will ensure the preservation of the functionality of the genitourinary system. Prevention of kidney failure is used for any category of patients, no matter what stage of the disease they are at. Simple rules, including following a diet, adjusting the water-salt balance and using medications will help prevent the development of the disease.

Video: kidney failure symptoms and treatment

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Renal failure is a syndrome that develops as a result of severe impairment of renal function and leads to disorders of homeostasis. When diagnosed with renal failure, symptoms arise as a result of disturbances in acid-base and water-electrolyte balance in the body.

Kinds

There are two forms of kidney failure: acute and chronic. (AKI) is characterized by a sudden deterioration in kidney function. This syndrome is caused by a sharp slowdown or cessation of excretion of nitrogen metabolism products from the body. Acute renal failure leads to disorders of electrolyte, water, acid-base, and osmotic balance, resulting in disruption of the normal composition of the blood.

(CRF) is a gradually progressive condition caused by a decrease in the number of functioning nephrons. Symptoms of chronic renal failure increase slowly. In the initial stages of the process, kidney function remains at the proper level due to the activation of nephrons that do not function normally. With further death of renal tissue, the deficiency of renal functions increases, which leads to gradual intoxication of the body with products of its own metabolism.

Causes

AKI is caused by diseases that lead to a sudden deterioration in renal blood flow. As a result, the glomerular filtration rate decreases and tubular reabsorption slows down. The causes of acute renal failure can be:

shock of various origins;
severe infectious diseases;
massive bleeding;
acute heart failure;
intoxication with nephrotoxic poisons;
kidney vascular damage;
acute kidney diseases;
obstruction of the urinary tract.

CRF develops as a result of chronic kidney diseases or other organs and systems:

diabetes,
hypertonic disease,
scleroderma,
systemic lupus erythematosus,
long-term use of certain medications,
chronic intoxication,
chronic glomerulonephritis, pyelonephritis,
urolithiasis, etc.

Symptoms

Symptoms of acute and chronic forms of renal failure differ in the time of onset. In acute renal failure, they develop rapidly, and with adequate treatment they can disappear quite quickly with almost complete restoration of kidney function. CRF develops gradually, sometimes over years or decades. At first, it may be asymptomatic, and then the symptoms steadily increase. Once chronic renal failure is diagnosed, treatment can improve the condition of patients, but it is almost impossible to completely restore renal function.

Symptoms of acute renal failure

In the first stage of acute renal failure, symptoms of a condition that causes acute renal dysfunction are observed. In case of infectious diseases, this may include fever, chills, headache, and muscle pain. Intestinal infections are accompanied by vomiting, diarrhea, and headache. In case of sepsis, intoxication - jaundice, signs of anemia, convulsions (depending on the type of poison). Shock states are characterized by confusion or loss of consciousness, pallor and sweating, thready pulse, and low blood pressure. Acute glomerulonephritis is manifested by the release of bloody urine and pain in the lumbar region.

The second (oligoanuric) stage of acute renal failure is characterized by:

a sharp decrease or complete cessation of urine output;
symptoms of azotemia (nausea, vomiting, itching of the skin, loss of appetite);
disturbances of consciousness (confusion, coma);
increase in body weight as a result of fluid accumulation;
swelling of the subcutaneous tissue (face, ankles, sometimes the entire subcutaneous tissue - anasarca);
swelling of vital organs (lungs, brain);
accumulation of fluid in the pleural, pericardial, abdominal cavity;
general serious condition.

If the outcome is favorable, after some time a period of diuresis recovery begins. At first, urine begins to be excreted in small quantities, and then its volume exceeds normal (polyuria). The accumulated liquid and nitrogenous wastes are removed. Then the amount of urine excreted is normalized and recovery occurs.

In case of improper treatment or its absence, after the second period the terminal stage occurs. During this period, signs of renal failure are as follows:

shortness of breath, cough, discharge of pink foamy sputum (due to pulmonary edema and the presence of fluid in the pleural cavity);
subcutaneous hemorrhages, hematomas, internal bleeding;
confusion, drowsiness, coma;
spasms or muscle cramps;
cardiac dysfunction (arrhythmia).

As a rule, such cases end in death.

Symptoms of chronic renal failure

Signs of chronic renal failure begin to appear with significant changes in the renal structure. These include:

decrease or increase in the volume of urine excreted;
excretion of more urine at night than during the day;
swelling in the morning (especially on the face);
malaise, weakness.

The final stage of chronic renal failure is manifested by symptoms of uremia (accumulation of uric acid salts in the blood) and disturbances of water and electrolyte metabolism:

massive swelling of the subcutaneous tissue;
accumulation of fluid in body cavities;
shortness of breath, cough (cardiac asthma or pulmonary edema);
persistent increase in blood pressure;
visual impairment;
signs of anemia (pallor, tachycardia, brittle hair and nails, weakness, fatigue);
nausea, vomiting, loss of appetite;
ammonia odor from the mouth;
stomach ache;
weight loss;
itchy skin, “powdery” skin;
yellowish skin tone;
fragility of blood vessels (bleeding gums, subcutaneous hemorrhages);
in women - cessation of menstruation;
disturbances of consciousness up to coma.

If in the terminal stage of chronic renal failure the patient is not transferred to, then death is inevitable.

Important! If any of the above symptoms appear, you should consult a doctor. Kidney failure, like many other diseases, is better treated in the early stages. Neglecting your health can cost your life!

Treatment

Treatment of acute renal failure includes eliminating the cause, restoring homeostasis and impaired renal function. Depending on the cause of acute renal failure, you may need:

antibacterial agents,
detoxification therapy (saline infusions, enterosorbents, hemodialysis),
fluid replenishment (infusion of saline and colloid solutions, transfusion of blood, its components and blood substitutes);
hormonal drugs, etc.

Hemodialysis is one of the methods of detoxification therapy

To detoxify the body and remove nitrogenous waste, they resort to hemodialysis, plasmapheresis, and hemosorption. To restore diuresis, diuretics are prescribed. In addition, solutions of potassium, sodium, calcium and other electrolytes are introduced depending on the type of acid-base and water-electrolyte imbalance. During the stage of restoration of diuresis, it is necessary to ensure that dehydration of the body does not occur. If cardiac function is disrupted during acute renal failure, cardiac medications are used.

Treatment of chronic renal failure involves addressing the cause of the disease, maintaining kidney function and detoxification therapy. In addition, diet is of great importance for kidney failure.

In the initial stages, treatment is aimed at the underlying disease. Its goal is to slow progression or stable remission. For arterial hypertension, antihypertensive drugs are prescribed. Constant correction of metabolism in diabetes mellitus is carried out. If the cause of chronic renal failure is autoimmune diseases, then glucocorticoid hormones and cytostatics are prescribed. For chronic heart failure, medications are used to correct the functioning of the heart. If chronic renal failure is caused by anatomical changes, then surgical intervention is performed. For example, the patency of the urinary tract is restored or a large stone or tumor is removed.

Subsequently, against the background of ongoing treatment of the underlying disease, symptomatic therapy is prescribed. Diuretics are used to reduce swelling. For symptoms of anemia, it is necessary to prescribe iron supplements, vitamins, etc.

In the last stages of chronic renal failure, the patient is transferred to chronic hemodialysis (the process of artificial blood filtration). The procedure is performed 2-3 times a week. An alternative to hemodialysis is kidney transplantation. In the terminal stage of renal failure, irreversible changes in internal organs develop, so it is better to decide on transplantation in advance. With good compatibility and a successful kidney transplant, the patient has a great chance of recovery and a full life.

Diet

A special diet for chronic renal failure will help reduce the load on the kidneys and slow down the progression of the process. In addition, proper nutrition during kidney failure will significantly improve your well-being.

Basic principles of the diet:

limiting protein intake,
high calorie content,
sufficient content of fruits and vegetables,
control of the intake of table salt and liquid,
fasting fruit and vegetable days 1-2 times a week.

In the initial stage of chronic renal failure, the amount of protein in food approaches normal (about 1 g/kg body weight), provided that there are 1-2 fasting days per week. In later stages, the daily protein intake should not exceed 20-30 g. At the same time, a sufficient supply of essential amino acids is necessary (the daily norm is contained in two chicken eggs). The high calorie content of food is achieved through fats (mainly vegetable) and carbohydrates. It is believed that under such conditions, nitrogenous waste can be used for the synthesis of non-essential amino acids.

The amount of fluid required is calculated by the formula: the volume of urine excreted per day plus 500-800 ml. In this case, all liquids (drinks, soups, fruits, vegetables) should be taken into account. In the absence of severe arterial hypertension and edema and the water balance is maintained, the patient can receive 4-6 g of table salt per day. If drug treatment includes sodium preparations, then the amount of salt in food is reduced accordingly. When hypertension and edema are severe, salt in the daily menu is limited to 3-4 g or less. Long-term significant restriction of salt is undesirable, therefore, with a decrease in edema and a decrease in blood pressure, its amount can again be slightly increased.

Treatment with traditional methods

If kidney failure is diagnosed, treatment with folk remedies can have a good effect, especially in the early stages. Many plants that have a diuretic effect are used for this purpose. The most commonly used are birch buds, lingonberry leaves, horsetail, string, black currant leaves, chamomile, and kidney tea. Sometimes mint, corn silk, St. John's wort and other plants, as well as preparations from them, are used. They are usually consumed in the form of infusions and decoctions.

Important: before starting treatment with one of the folk remedies, consult your doctor. There are contraindications for some plants. Traditional medicine methods are used only as an auxiliary treatment in combination with doctor’s prescriptions.

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

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

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

Today, CKD is also called chronic kidney disease (CKD). This term emphasizes the potential for 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 affect the limbs with chilliness, 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.

Epidemiology. Acute renal failure is a terminal pathological condition manifested by rapid deterioration of renal function, resulting from a disorder of renal blood flow, damage to the glomerular membrane of the nephron, or sudden obstruction of the ureters. Acute renal failure is a dangerous condition that requires emergency adequate treatment and, in the absence of qualified intervention, leads to death.

Every year, about 150 out of 1 million people need emergency care for acute kidney failure. As a rule, two thirds of them require hemodialysis and hemosorption due to prerenal and renal anuria, about a third have obstructive (postrenal) anuria, which is an indication for surgical treatment in a urological hospital. However, even with treatment, mortality in all forms of acute renal failure reaches 20%.

Etiology and pathogenesis. Acute renal failure can be arenal, prerenal, renal and postrenal.

Arenal acute renal failure may occur in newborns with renal aplasia and as a result of surgical removal of the only remaining or only functioning kidney. Kidney aplasia is incompatible with life, although there is a known case in which a girl who did not have kidneys and lived to be 8 years old secreted a cloudy liquid with the smell of urine from the navel area, which came through the urachus from the hepatic duct system, which took over the function of the kidneys.

Prerenal acute renal failure occurs due to insufficient blood supply to the kidneys. It may be the result of a disturbance in cardiac activity that causes a sharp decrease in blood pressure, the cause of which may be shock (hemorrhagic, painful, post-transfusion, septic, post-traumatic, allergic, etc.). Complete cessation of blood flow in the renal arteries as a result of thrombosis or embolism, as well as severe dehydration due to blood loss, profuse diarrhea, uncontrollable vomiting or dehydration leads to prerenal acute renal failure.

Insufficient blood flow to the kidneys causes ischemia, which leads to necrosis of the tubular epithelium, and subsequently to the development of dystrophic changes in the renal parenchyma. The triggering factor of hypoxia leading to tubular disorders is insufficiency of renal blood flow, a decrease in tubular fluid flow, which leads to acute renal failure. Impaired delivery of water and sodium to the distal tubules increases the secretion of renin, which increases renal ischemia. This is exacerbated by a decrease in the release of prostaglandins from the renal medulla, which have a vasodilating effect, which further impairs renal blood flow.

When the vessels of the renal cortex spasm, blood does not flow to it, entering only the juxtamedullary layer. Stasis in the renal vessels increases the pressure in the tubular system, as a result of which filtration in the glomeruli stops. Severe hypoxia of the distal tubules causes necrosis of the epithelium, basement membrane and tubular necrosis. The anuria observed in this case is a consequence not only of necrosis of the tubular epithelium, but also of impaired patency of the distal tubules due to edema, protein detritus and abundant desquamation of necrotic cells.

Renal acute renal failure develops as a result of two main reasons:

1) damage to the renal parenchyma by immunoallergic processes, which are based on both circulatory disorders (ischemia, hypoxia) and various types of damage to the glomerular endothelium associated with the deposition of immune complexes in them (glomerulonephritis, systemic collagenosis, acute interstitial nephritis, systemic vasculitis, etc. .);

2) direct exposure to toxic substances on the kidney tissue. This type of renal acute renal failure occurs with poisoning with mercury, phosphorus, lead, alcohol substitutes, poisonous mushrooms, with toxic-allergic effects of sulfonamide drugs, antibiotics, barbiturates or intoxication associated with infection during sepsis, septic abortion, ascending urinary tract infection.

Nephrotoxic substances act on the tubular epithelial cells that secrete them, causing necrotic changes and their detachment from the basement membrane. In the pathogenesis of renal and prerenal anuria, the leading factor is impaired blood circulation in the kidneys. The difference between these types of acute renal failure is that in the prerenal form the circulatory disorder is mainly global in nature, and in the renal form it is more often local, renal.

Postrenal acute renal failure in urological practice it occurs most often. Among its causes, it is necessary to highlight obstruction of the ureter of a single functioning kidney or both ureters by stones, blood clots, or compression of the ureters from the outside by a tumor infiltrate coming from the genitals or large intestine. One of the causes of postrenal acute renal failure is an iatrogenic factor: ligation or suturing of the ureters during operations in the pelvic area. Compared to prerenal and renal acute renal failure, postrenal acute renal failure is characterized by a slower decrease in glomerular filtration, and irreversible changes in the nephrons develop only after 3-4 days. Restoring the patency of the ureters by catheterization or drainage of the renal pelvis quite quickly leads to the restoration of diuresis and relief of anuria. In case of acute disturbance of the outflow of urine from the kidneys, overstretching of the pelvis, cups, collecting ducts, distal and proximal parts of the nephron occurs. Initially, filtration does not suffer, but pressure equalizes on both sides of the glomerular membrane and anuria develops.

Against the background of anuria, electrolyte retention, hyperhydration occurs with an increase in the concentration of potassium, sodium and chlorine in the extracellular environment, while the level of urea and creatinine in the blood plasma rapidly increases. Already on the first day, the concentration of creatinine doubles and increases by 0.1 mmol/l daily.

Anuria in acute renal failure is accompanied by metabolic acidosis, the content of bicarbonates decreases, which leads to dysfunction of cell membranes. The breakdown of tissue proteins, fats and carbohydrates occurs in the cells, and the content of ammonia and medium molecules increases. This releases a large amount of cellular potassium, which, against the background of acidosis, disrupts the heart rhythm and can cause cardiac arrest.

An increase in the content of nitrogenous components in the blood plasma disrupts the dynamic function of platelets, and primarily their adhesion and aggregation, and reduces the coagulation potential of the blood plasma due to the accumulation of the main antithrombin - heparin. Acute renal failure of any origin in the absence of adequate treatment leads to overhydration, electrolyte imbalance and severe azotemia, which together is the cause of death in these patients.

Symptoms and clinical course. The clinical picture and symptoms of acute renal failure are very diverse and depend both on the degree of functional impairment and on the characteristics of the initial pathological process that led to renal failure.

Often, the initial disease masks severe kidney damage for a long time and prevents early detection of impaired kidney function. During acute renal failure, four periods are distinguished: 1) initial, shock; 2) oligoanuric; 3) restoration of diuresis and polyuria; 4) recovery.

IN initial stage the symptoms of the disease that caused acute renal failure dominate: trauma, infection, poisoning in combination with symptoms of shock and collapse. Against the background of the clinical picture of the underlying disease, signs of severe kidney damage are revealed, including, first of all, a sharp decrease in diuresis to complete anuria.

IN oligoanuric stage urine is usually bloody, with a massive sediment, microscopy of which reveals red blood cells densely covering the entire field of view, and many pigmented cylinders. Despite oliguria, urine density is low. Along with oligoanuria, severe intoxication and uremia rapidly progress. The most severe disorders accompanying acute renal failure are fluid retention, hyponatremia and hypochloremia, hypermagnesemia, hypercalcemia, decreased alkaline reserve and accumulation of acid radicals (phosphate anions, sulfates, organic acids, all products of nitrogen metabolism). The oligoanuric stage is the most dangerous, characterized by the highest mortality, its duration can be up to three weeks. If oligoanuria continues, then the presence of cortical necrosis should be noted. Typically, patients experience lethargy, anxiety, and possible peripheral edema. As azotemia increases, nausea, vomiting, and decreased blood pressure appear. Due to the accumulation of interstitial fluid, shortness of breath is observed due to pulmonary edema. Substernal pain appears, cardiovascular failure develops, central venous pressure increases, and with hyperkalemia, bradycardia is noted.

Due to impaired excretion of heparin and thrombocytopathy, hemorrhagic complications occur, manifested by subcutaneous hematomas, gastric and uterine bleeding. The reason for the latter is not only a violation of hemocoagulation, since in acute renal failure due to uremic intoxication, acute ulcers of the mucous membranes of the stomach and intestines develop. Anemia is a constant companion of this disease.

One of the signs preceding anuria is dull pain in the lumbar region associated with renal hypoxia and swelling, accompanied by stretching of the renal capsule.

The pain becomes less pronounced after the capsule is stretched and swelling of the perinephric tissue occurs.

Third stage Acute renal failure occurs in two periods and sometimes lasts up to two weeks. The beginning of the “diuretic” period of the disease should be considered an increase in the daily amount of urine to 400-600 ml. Although an increase in diuresis is a favorable sign, this period can only conditionally be considered as a recovery period. An increase in diuresis is initially accompanied not by a decrease, but by an increase in azotemia, distinct hyperkalemia, and about 25% of patients die during this period of incipient recovery. The reason is an insufficient increase in diuresis, the separation of low-density urine with a low content of dissolved substances. Therefore, the previously occurring disturbance in the content and distribution of electrolytes in the extra- and intracellular sectors persists, and sometimes even intensifies at the beginning of the diuretic period. In the oligoanuric and at the beginning of the diuretic period, the most dramatic changes in water metabolism are observed, which consist in excessive accumulation of fluid in the extra- or intracellular sector or their dehydration. With overhydration of the extracellular sector, the patient’s body weight increases, edema, hypertension, hypoproteinemia appear, and the hematocrit decreases. Extracellular dehydration occurs after uncompensated sodium loss and is characterized by hypotension, asthenia, weight loss, hyperproteinemia and high hematocrit. Cellular dehydration joins the previously occurring extracellular dehydration and occurs with an exacerbation of all its symptoms. In this case, mental disorders, respiratory arrhythmia, and collapse develop. Clinically, this type of intoxication occurs with severe weakness, nausea, vomiting, aversion to water, convulsive seizures, blackouts and coma. A rapid increase in urine output and loss of electrolytes in the diuretic phase of acute renal failure contribute to the emergence and deepening of these disorders of water-salt metabolism. However, as kidney function and their ability to not only remove, but also regulate the content of water and electrolytes are restored, the danger of dehydration, hyponatremia, and hypokalemia quickly decreases.

The period of recovery of kidney function after acute renal failure (the recovery stage) lasts more than six months, its duration depends on the severity of clinical manifestations and their complications. The criterion for restoring renal function should be their normal concentration ability and adequacy of diuresis.

Diagnostics. Acute renal failure in urological practice is diagnosed by the absence of urine in the bladder. It is always necessary to differentiate the symptom of anuria from acute urinary retention, in which signs of renal failure may also be observed. When the bladder is full, anuria is excluded. In the differential diagnosis of types of acute renal failure, anamnesis is of great importance. Establishing the fact of poisoning, diseases that can cause anuria, and the presence of pain in the lumbar region make it possible to determine its form (renal, postrenal, etc.). If there is at least a small amount of urine (10-30 ml), its examination allows us to establish the cause of anuria: hemoglobin clumps in hemolytic shock, myoglobin crystals in crush syndrome, sulfonamide crystals in sulfonamide anuria, etc. To differentiate postrenal acute renal failure from others its forms require ultrasound, instrumental and x-ray examinations.

If the catheter can be inserted freely into the renal pelvis and urine is not excreted through it, then this indicates prerenal or renal forms of anuria. In some cases, radioisotope renography helps determine the degree of preservation of kidney function, and ultrasound and CT can determine the size of the kidneys, their position, expansion of the pelvis and cups, and the presence of tumors that can compress the ureters.

To diagnose acute renal failure, it is necessary to conduct biochemical studies of blood plasma for the content of urea, creatinine, electrolytes and acid-base balance. The data from these analyzes are decisive for deciding whether to prescribe plasmapheresis, hemosorption or hemodialysis.

Treatment, first of all, it should be aimed at eliminating the causes that caused acute renal failure. Antishock measures, restoration of cardiac activity, replenishment of blood loss, and infusion of blood substitutes are indicated to stabilize vascular tone and restore adequate renal blood flow.

In case of poisoning with salts of heavy metals, detoxification measures are carried out with gastric lavage, enterosorbents and unithiol are prescribed, and hemosorption is carried out.

In case of postrenal acute renal failure, the leading treatment measures are measures aimed at restoring the impaired passage of urine: catheterization of the ureters, early surgical intervention in the form of pyelo- or nephrostomy.

For arenal, prerenal and renal forms of acute renal failure, treatment should be carried out in a kidney center equipped with hemodialysis equipment. If, in postrenal acute renal failure, the patient’s condition is extremely severe due to uremic intoxication, then before the intervention it is necessary to perform hemodialysis and only after that carry out pyelo- or nephrostomy. Given the severity of the patient's condition, surgery should be performed on the most functionally capable side, as determined clinically. The most severe pain in the lumbar region is observed on the side of the most functionally capable kidney. Sometimes, with postrenal anuria, based on radioisotope renography data, it is possible to determine the most intact kidney.

In case of ureteral obstruction caused by a malignant neoplasm in the pelvis or retroperitoneum, an urgent puncture nephrostomy is performed. In the first hours of acute renal failure of any etiology, osmotic diuretics are administered (300 ml of a 20% mannitol solution, 500 ml of a 20% glucose solution with insulin). Together with mannitol, it is recommended to administer furosemide (200 mg) intravenously. The combination of furosemide (30-50 mg/kg per 1 hour) with dopamine (3-6 µg/kg per 1 minute, but not more) for 6-24 hours is especially effective, reducing renal vasoconstriction.

For prerenal and renal forms of anuria, treatment consists mainly of normalizing water and electrolyte disturbances and eliminating hyperazotemia. To do this, resort to detoxification therapy - intravenous administration of up to 500 ml of 10-20% glucose solution with an adequate amount of insulin, 200 ml of 2-3% sodium bicarbonate solution. In case of anuria, administering more than 700-800 ml of fluid per day is dangerous due to the possibility of developing severe extracellular hyperhydration, one of the manifestations of which is the so-called water lung. The administration of these solutions should be combined with gastric lavage and siphon enemas. In case of acute renal failure caused by poisoning with mercury preparations (sublimate), the use of unithiol (sodium 2,3-dimer-captopropanesulfonate) is indicated. It is prescribed subcutaneously and intramuscularly at 1 ml per 10 kg of body weight. Three or four injections are given on the first day, two or three injections on the subsequent days. All patients with the oligoanuric form of acute renal failure should be treated in a dialysis center, where, if necessary, extracorporeal dialysis machines (hemo-, peritoneal dialysis) can be used. Indications for the use of efferent detoxification methods are electrolyte disturbances, especially hyperkalemia, azotemia (urea content in the blood serum more than 40 mmol/l, creatinine more than 0.4 mmol/l), extracellular hyperhydration. The use of hemodialysis can dramatically reduce the number of deaths in acute renal failure, even in its arenal forms, in which kidney transplantation has become possible after the use of chronic hemodialysis.

In case of renal failure, hemosorption is used - a method of extrarenal blood purification based on the use of adsorbents, mainly carbon. The best clinical effect was obtained by combining hemosorption with hemodialysis, which is explained simultaneously by the correction of salt and water metabolism, as well as the removal of compounds with an average molecular weight.

After the elimination of prerenal, renal and postrenal anuria, the genesis of which is impaired blood circulation in the kidneys, it is necessary to use drugs that change the rheological properties of the blood and improve renal blood flow.

To improve microcirculation and activate metabolic processes, it is recommended to use trental, which increases the elasticity of erythrocytes and reduces platelet aggregation, enhances the natriuretic effect, delaying the formation of phosphodiesterase enzymes in the tubular epithelium. This plays a role in the process of tubular sodium reabsorption. By normalizing sodium reabsorption, trental enhances filtration processes, thereby exerting a diuretic effect.

Trental is prescribed 100 mg (5 ml) intravenously or 1-2 tablets 3 times a day, venoruton - 300 mg in capsules or 500 mg injections also 3 times a day.

Successful treatment of patients with acute renal failure due to various causes is possible only with close cooperation between urologists and nephrologists.

Forecast. In acute renal failure, the prognosis depends on the reasons that caused this serious condition, the timeliness and quality of treatment measures. Acute renal failure is a terminal condition, and untimely provision of assistance leads to an unfavorable prognosis. The treatment and restoration of renal function allow more than half of the patients to restore their ability to work within a period of 6 months to 2 years.