Acute and chronic kidney disease. Kidney failure

Kidney failure is a pathological condition in which the ability of the kidneys to form and/or excrete urine is partially or completely lost, and, as a result, serious disturbances of the water-salt, acid-base and osmotic homeostasis of the body develop, which lead to secondary damage to all body systems. According to the clinical course, acute and chronic renal failure are distinguished. Acute renal failure is a sudden, potentially reversible disruption of the homeostatic function of the kidneys. Currently, the incidence of acute renal failure reaches 200 per 1 million population, with 50% of patients requiring hemodialysis. Since the 1990s, there has been a steady trend, according to which acute renal failure is increasingly becoming not a single-organ pathology, but a component of the multiple organ failure syndrome. This trend continues into the 21st century.

Causes of kidney failure

Acute renal failure is divided into prerenal, renal and postrenal. Prerenal acute renal failure is caused by impaired hemodynamics and a decrease in the total volume of circulating blood, which is accompanied by renal vasoconstriction and decreased renal circulation. As a result, renal hypoperfusion occurs, the blood is not sufficiently cleared of nitrogenous metabolites, and azotemia occurs. Prerenal anuria accounts for 40 to 60% of all cases of acute renal failure.

Renal acute renal failure is often caused by ischemic and toxic damage to the renal parenchyma, less often by acute inflammation of the kidneys and vascular pathology. In 75% of patients with renal acute renal failure, the disease occurs against the background of acute tubular necrosis. Postrenal acute renal failure is more often than other types accompanied by anuria and occurs as a result of obstruction at any level of the extrarenal urinary tract. The main causes of prerenal acute renal failure are cardiogenic shock, cardiac tamponade, arrhythmia, heart failure, pulmonary embolism, i.e. conditions accompanied by a decrease in cardiac output.

Another cause may be severe vasodilation caused by anaphylactic or bacteriotoxic shock. Prerenal acute renal failure is often caused by a decrease in the volume of extracellular fluid, which can be caused by conditions such as burns, blood loss, dehydration, diarrhea, liver cirrhosis (www.diagnos-online.ru/zabol/zabol-185.html) and resulting ascites . Renal acute renal failure is caused by exposure to toxic substances on the kidney: mercury salts, uranium, cadmium, copper. Poisonous mushrooms and some medicinal substances, primarily aminoglycosides, have a pronounced nephrotoxic effect, the use of which in 5-20% of cases is complicated by moderate acute renal failure and in 1-2% - severe. In 6-8% of all cases of acute renal failure, it develops due to the use of non-steroidal anti-inflammatory drugs.

Radiocontrast agents have nephrotoxic properties, which requires careful use in patients with impaired renal function. Hemoglobin and myoglobin, circulating in the blood in large quantities, can also cause the development of renal acute renal failure. The reason for this is massive hemolysis caused by transfusion of incompatible blood and hemoglobinuria. The causes of rhabdomyolysis and myoglobinuria can be traumatic, such as crash syndrome, or non-traumatic, associated with muscle damage during prolonged alcohol or drug coma. Somewhat less frequently, the development of renal acute renal failure is caused by inflammation of the renal parenchyma: acute glomerulonephritis, lupus nephritis, Goodpasture's syndrome.

Postrenal acute renal failure accounts for approximately 5% of all cases of renal dysfunction. Its cause is a mechanical disruption of the outflow of urine from the kidneys, most often due to obstruction of the upper urinary tract by stones on both sides. Other causes of impaired urine outflow are ureteritis and periureteritis, tumors of the ureters, Bladder, prostate, genitals, constrictions and tuberculous lesions urinary tract, metastases of breast or uterine cancer in the retroperitoneal tissue, bilateral sclerotic periureteritis of unknown origin, degenerative processes of the retroperitoneal tissue. In acute renal failure caused by prerenal factors, the cause that triggers the pathological mechanism is ischemia of the renal parenchyma.

Even a short-term decrease in blood pressure below 80 mm Hg. Art. leads to a sharp decrease in blood flow in the kidney parenchyma due to the activation of shunts in the juxtamedullary zone. A similar condition can occur with shock of any etiology, as well as as a result of bleeding, including surgical intervention. In response to ischemia, necrosis and rejection of the epithelium of the proximal tubules begins, and the process often reaches acute tubular necrosis. The reabsorption of sodium is sharply disrupted, which leads to its increased entry into the macula densa area and stimulates the production of renin, which maintains spasm of the afferent arterioles and ischemia of the parenchyma. In case of toxic damage, the epithelium of the proximal tubules also most often suffers, and in the case of toxic effects of myoglobin and hemoglobin pigments, the situation is aggravated by obstruction of the tubules by these proteins.

In acute glomerulonephritis, acute renal failure can be caused by both swelling of the interstitial tissue, an increase in hydrostatic pressure in the proximal tubules, which leads to a sharp decrease in glomerular filtration, and rapidly developing processes of proliferation in the glomeruli with compression of the tubular loops and the release of vasoactive substances causing ischemia. In postrenal acute renal failure, a violation of the outflow of urine from the kidneys causes overstretching of the ureters, pelvis, collecting ducts and distal and proximal parts of the nephron. The consequence of this is massive interstitial edema. If the outflow of urine is restored quickly enough, the changes in the kidneys are reversible, but with long-term obstruction, severe circulatory disorders of the kidneys occur, which can result in tubular necrosis.

Diagnosis by symptoms

Select the symptoms that concern you and get a list of possible diseases

Symptoms of kidney failure

The course of acute renal failure can be divided into initial, oligoanuric, diuretic and the phase of complete recovery. The initial phase can last from several hours to several days. During this period, the severity of the patient’s condition is determined by the cause that caused the development pathological mechanism acute renal failure. It is at this time that all the previously described pathological changes develop, and the entire subsequent course of the disease is their consequence. A common clinical symptom of this phase is circulatory collapse, which is often so short-lived that it goes unnoticed. The oligoanuric phase develops in the first 3 days after an episode of blood loss or exposure to a toxic agent.

It is believed that the later acute renal failure develops, the worse its prognosis. The duration of oligoanuria ranges from 5 to 10 days. If this phase lasts more than 4 weeks. we can conclude that there is bilateral cortical necrosis, although there are known cases of recovery of renal function after 11 months. oliguria. During this period, daily diuresis is no more than 500 ml. Urine is dark in color and contains a large amount of protein. Its osmolarity does not exceed plasma osmolarity, and the sodium content is reduced to 50 mmol/l. The content of urea nitrogen and serum creatinine increases sharply. Electrolyte imbalances begin to appear: hypernatremia, hyperkalemia, phosphatemia. Metabolic acidosis occurs.

During this period, the patient notes anorexia, nausea and vomiting, accompanied by diarrhea, which after some time gives way to constipation. Patients are drowsy, lethargic, and often fall into a coma. Overhydration causes pulmonary edema, which is manifested by shortness of breath, moist rales, and Kussmaul breathing often occurs. Hyperkalemia causes severe heart rhythm disturbances. Pericarditis often occurs against the background of uremia. Another manifestation of an increase in serum urea is uremic gastroenterocolitis, which results in gastrointestinal bleeding that occurs in 10% of patients with acute renal failure. During this period, there is a pronounced inhibition of phagocytic activity, as a result of which patients become susceptible to infection.

Pneumonia, mumps, stomatitis, pancreatitis occur, the urinary tract becomes infected and postoperative wounds. Sepsis may develop. The diuretic phase lasts 9-11 days. The amount of urine excreted gradually begins to increase and after 4-5 days reaches 2-4 liters per day or more. Many patients experience a loss of large amounts of potassium in the urine - hyperkalemia is replaced by hypokalemia, which can lead to hypotension and even paresis skeletal muscles, heart rhythm disturbances. Urine has low density, it has low creatinine and urea content, but after 1 week. During the diuretic phase, with a favorable course of the disease, hyperazotemia disappears and the electrolyte balance is restored. During the full recovery phase, kidney function is further restored. The duration of this period reaches 6-12 months, after which kidney function is fully restored.

Diagnosis of kidney failure

Diagnosis of acute renal failure is usually not difficult. Its main marker is a continuous increase in the level of nitrogen metabolites and potassium in the blood along with a decrease in the amount of urine excreted. In a patient with clinical manifestations of acute renal failure, it is imperative to determine its cause. Carrying out a differential diagnosis of prerenal acute renal failure from renal one is extremely important, since the first form can quickly turn into the second, which will aggravate the course of the disease and worsen the prognosis. First of all, it is necessary to carry out a differential diagnosis of postrenal acute renal failure from its other types, for which an ultrasound of the kidneys is performed, which makes it possible to determine or exclude the fact of bilateral obstruction of the upper urinary tract by the presence or absence of dilatation of the pyelocaliceal system.

If necessary, bilateral catheterization of the renal pelvis can be performed. If ureteral catheters are freely passed to the pelvis and in the absence of urine discharge through them, postrenal anuria can be confidently rejected. Laboratory diagnostics is based on measuring urine volume, creatinine, urea and serum electrolytes. Sometimes it is necessary to resort to renal angiography to characterize renal blood flow. Kidney biopsy should be performed according to strict indications: if acute glomerulonephritis, tubular necrosis or systemic disease is suspected.

Treatment of kidney failure

In the initial phase of acute renal failure, treatment should primarily be aimed at eliminating the cause that caused the development of the pathological mechanism. In case of shock, which is the cause of 90% of acute renal failure, the main thing is therapy aimed at normalizing blood pressure and replenishing the volume of circulating blood. The introduction of protein solutions and large-molecular dextrans is effective, which should be administered under the control of central venous pressure so as not to cause overhydration. In case of poisoning with nephrotoxic poisons, it is necessary to remove them by washing the stomach and intestines. Unithiol is a universal antidote for salt poisoning heavy metals. Hemosorption, undertaken even before the development of acute renal failure, can be especially effective.

In the case of postrenal acute renal failure, therapy should be aimed at early restoration of urine outflow. In the oliguric phase in acute renal failure of any etiology, it is necessary to administer osmotic diuretics in combination with furosemide, doses of which can reach 200 mg. Administration of dopamine in “renal” doses is indicated, which will reduce renal vasoconstriction. The volume of fluid administered should replenish its loss through stool, vomiting, urine, and an additional 400 ml consumed during Breathing and sweating. The diet of patients should be protein-free and provide up to 2000 kcal/day.

To reduce hyperkalemia, it is necessary to limit its intake from food, as well as perform surgical treatment of wounds with removal of necrotic areas and drainage of cavities. In this case, antibiotic therapy should be carried out taking into account the severity of kidney damage. Indications for hemodialysis are an increase in potassium content more than 7 mmol/l, urea up to 24 mmol/l, the appearance of symptoms of uremia: nausea, vomiting, lethargy, as well as overhydration and acidosis. Currently, they are increasingly resorting to early or even preventive hemodialysis, which prevents the development of severe metabolic complications. This procedure is carried out every day or every other day, gradually increasing the protein quota to 40 g/day.

Complications of kidney failure

Mortality in acute renal failure depends on the severity of the course, the age of the patient, and most importantly, the severity of the underlying disease that caused the development of acute renal failure. In patients who survived acute renal failure, complete recovery of renal function is observed in 35-40% of cases, partial recovery in 10-15%, and from 1 to 3% of patients require constant hemodialysis. Moreover, the latter indicator depends on the genesis of acute renal failure: in renal forms, the need for constant dialysis reaches 41%, while in traumatic acute renal failure this figure does not exceed 3%. The most common complication of acute renal failure is urinary tract infection with further development chronic pyelonephritis and outcome in chronic renal failure.

Questions and answers on the topic “Kidney failure”

Question: The girl is weak, has no fever, lower abdomen hurts, drinks often, but pees once a day. What are these symptoms of? Doctors cannot diagnose.

Answer: In such a case, you should determine how much the child drinks (let's drink from a measuring cup) and how much liquid he excretes (weigh the diaper) during the day. If the amount of urine excreted is significantly less than the amount of fluid consumed (the difference is more than 300-500 ml), renal failure can be assumed.

Chronic renal failure symptoms and signs | Diagnosis of kidney failure

Chronic renal failure (CRF) is a symptom complex that develops as a result of the gradual death of nephrons with any signs of progressive kidney disease. The term “uremia”, used for a detailed picture of the symptoms of chronic renal failure, should be understood not only in the sense of a pronounced decrease in the excretion of nitrogenous derivatives, but also a violation of all kidney symptoms, including metabolic and endocrine ones. In this article, we will look at the symptoms of chronic kidney failure and the main signs of chronic kidney failure in humans. Diagnosis of kidney disease is not quite complicated, due to the fact that the symptoms coincide with other signs of kidney damage.

Chronic renal failure - symptoms

Polyuria and nocturia are typical signs of the conservative stage of chronic renal failure before the development of the terminal stage of the disease. In the terminal stage of chronic renal failure, symptoms of oliguria followed by anuria are noted.

Changes in the lungs and cardiovascular system with symptoms of chronic renal failure

Signs of blood stagnation in the lungs and pulmonary edema with uremia can be observed with fluid retention. X-rays reveal signs stagnation in the roots of the lungs, shaped like “butterfly wings”. These changes disappear during hemodialysis. Symptoms of pleurisy in chronic renal failure can be dry and exudative (polyserositis with uremia). The exudate is usually hemorrhagic in nature and contains a small number of mononuclear phagocytes in chronic renal failure. The concentration of creatinine in pleural fluid is increased, but lower than in serum in chronic renal failure.

Signs of arterial hypertension often accompany chronic renal failure. Symptoms of malignant arterial hypertension with encephalopathy, seizures, and retinopathy may develop. The persistence of symptoms of arterial hypertension during dialysis is observed due to hyperrenin mechanisms. The absence of signs of arterial hypertension in conditions of end-stage chronic renal failure is due to the loss of salts (in chronic pyelonephritis, polycystic kidney disease) or excessive fluid excretion (abuse of diuretics, vomiting, diarrhea).

Signs of pericarditis are rarely observed with adequate management of patients with chronic renal failure. Clinical symptoms pericarditis are nonspecific. Signs of both fibrinous and effusion pericarditis are noted. To prevent the development of symptoms of hemorrhagic pericarditis, anticoagulants should be avoided. Myocardial damage occurs against the background of signs of hyperkalemia, vitamin deficiency, and hyperparathyroidism. An objective study can detect symptoms of chronic renal failure: muffled tones, “gallop rhythm”, systolic murmur, expansion of the boundaries of the heart, various rhythm disturbances.

Signs of atherosclerosis of the coronary and cerebral arteries with symptoms of chronic renal failure may have a progressive course. Symptoms of myocardial infarction, acute left ventricular failure, and arrhythmias are especially often observed in insulin-dependent diabetes mellitus in the stage of renal failure.

Signs of hematological disorders in chronic renal failure

Signs of anemia in chronic renal failure are normochromic and normocytic in nature. Causes of symptoms of anemia in chronic renal failure:

• decreased production of erythropoietin in the kidneys;
• effects of uremic toxins on Bone marrow, i.e., the aplastic nature of the symptoms of anemia is possible;
• decreased life expectancy of red blood cells in conditions of uremia.

Patients with symptoms of chronic renal failure on hemodialysis are at increased risk of developing bleeding symptoms during routine heparin administration. In addition, routine hemodialysis promotes the “washing out” of folic, ascorbic acids and B vitamins. Also, with chronic renal failure, increased bleeding is noted. With uremia, platelet aggregation function is impaired. In addition, with an increase in the concentration of guanidinosuccinic acid in the blood serum, the activity of platelet factor 3 decreases.

Symptoms of chronic renal failure from the nervous system

CNS dysfunction is manifested by signs of drowsiness or, conversely, insomnia. Loss of ability to concentrate is noted. In the terminal stage, symptoms are possible: “fluttering” tremor, convulsions, chorea, stupor and coma. Typically noisy acidotic breathing (Kussmaul type). Some symptoms of chronic renal failure can be corrected with hemodialysis, but changes in the electroencephalogram (EEG) are often persistent. Peripheral neuropathy is characterized by signs of a predominance of sensory lesions over motor ones; The lower extremities are affected more often than the upper extremities, and the distal extremities are more often affected than the proximal extremities. Without hemodialysis, peripheral neuropathy steadily progresses with the development of flaccid tetraplegia in chronic renal failure.

Some neurological disorders may be symptoms of complications of hemodialysis in chronic renal failure. Thus, aluminum intoxication presumably explains dementia and convulsive syndromes in patients undergoing planned hemodialysis. After the first dialysis sessions, due to a sharp decrease in urea content and osmolarity of liquid media, cerebral edema may develop.

Symptoms of gastrointestinal disorders in chronic renal failure

Lack of appetite, nausea, vomiting (as well as itching) are common symptoms of uremic intoxication in chronic renal failure. An unpleasant taste in the mouth and an ammonia-like odor from the mouth are caused by the breakdown of urea by saliva into ammonia. Every fourth patient with signs of chronic renal failure shows signs of gastric ulcer. Possible causes include Helicobacter pylori colonization, gastrin hypersecretion, and hyperparathyroidism. Symptoms of mumps and stomatitis associated with secondary infection are often observed. Patients on hemodialysis are at increased risk for viral hepatitis B and C.

Symptoms of endocrine disorder in chronic renal failure

When describing the pathogenesis, the reasons for the development of symptoms of uremic pseudodiabetes and signs of secondary hyperparathyroidism have already been indicated. Signs of amenorrhea are often noted; ovarian function can be restored during hemodialysis. In men, impotence and oligospermia, a decrease in the concentration of testosterone in the blood, are observed. In adolescents, growth and puberty are often disrupted.

Signs of skin changes in chronic renal failure

The skin is typically dry; pale, with a yellow tint due to the retention of urochromes. Hemorrhagic changes (petechiae, ecchymoses), scratching with itching are found on the skin. With the progression of symptoms of chronic renal failure in the terminal stage, the concentration of urea in sweat can reach such high values ​​that the so-called “uremic frost” remains on the surface of the skin.

Signs of the skeletal system in chronic renal failure

They are caused by secondary hyperparathyroidism in chronic renal failure. These signs are more clearly expressed in children. Three types of damage are possible: renal rickets (changes similar to those in ordinary rickets), cystic fibrous osteitis (characterized by symptoms of osteoclastic bone resorption and subperiosteal erosions in the phalanges, long bones and distal sections collarbones), osteosclerosis (increased bone density, mainly of the vertebrae). Against the background of renal osteodystrophy in chronic renal failure, bone fractures are observed, the most common location being the ribs and femoral neck.

Chronic renal failure - signs

A decrease in the mass of functioning nephrons leads to signs of changes in hormonal autoregulation of glomerular blood flow (angiotensin II-prostaglandin system) with the development of hyperfiltration and hypertension in the remaining nephrons. It has been shown that angiotensin II is able to enhance the synthesis of transforming growth factor beta, and the latter, in turn, stimulates the production of extracellular matrix in chronic renal failure. Thus, increased intraglomerular pressure and increased blood flow associated with hyperfiltration lead to glomerular sclerosis. A vicious circle closes; To eliminate it, it is necessary to eliminate hyperfiltration.

Since it became known that the symptoms of the toxic effect of uremia are reproduced by experimentally introducing serum from a patient with chronic renal failure, the search for these toxins continues. The most likely candidates for the role of toxins are metabolic products of proteins and amino acids, for example, urea and guanidine compounds (guanidines, methyl and dimethyl guanidine, creatinine, creatine and guanidinosuccinic acid, urates, aliphatic amines, some peptides and derivatives of aromatic acids - tryptophan, tyrosine and phenylalanine ). Thus, with symptoms of chronic renal failure, metabolism is significantly impaired. Its consequences are varied.

Symptoms of basal metabolism in chronic renal failure

When signs of chronic renal failure are present, signs of hypothermia are often noted. The reduced activity of energy processes in tissues is possibly due to the inhibition of the K. Na pump by uremic toxins. With hemodialysis, body temperature returns to normal.

Symptoms of impaired water-electrolyte metabolism in chronic renal failure

Changes in the operation of the K+, Na+ pump lead to intracellular accumulation of sodium ions and a deficiency of potassium ions. Excess intracellular sodium is accompanied by osmotically induced accumulation of water in the cell. The concentration of sodium ions in the blood remains constant regardless of the degree of decrease in the glomerular filtration rate: the lower it is, the more intensely each of the remaining functioning nephrons excretes sodium ions. There are practically no signs of hypernatremia in chronic renal failure. The multidirectional effects of aldosterone (retention of sodium ions) and atrial natriuretic factor (excretion of sodium ions) play a role in the regulation of sodium ion excretion.

As signs of chronic renal failure develop, there is also an increase in water excretion by each of the remaining functioning nephrons. Therefore, even with a glomerular filtration rate of 5 ml/min, the kidneys are usually able to maintain diuresis, but at the expense of reduced concentrating symptoms. When the glomerular filtration rate is below 25 ml/min, isosthenuria is almost always observed. This leads to an important practical conclusion: fluid intake must be adequate to ensure excretion of the total daily salt load in chronic renal failure. Both excessive restriction and excessive introduction of fluid into the body are dangerous.

The content of extracellular potassium ions in chronic renal failure depends on the ratio of potassium-sparing and potassium-lowering mechanisms. The first include conditions accompanied by insulin resistance (insulin normally increases the absorption of potassium by muscle cells), as well as metabolic acidosis (inducing the release of potassium ions from cells). A decrease in potassium levels is facilitated by an excessively strict hypokalemic diet, the use of diuretics (except potassium-sparing ones), and secondary hyperaldosteronism. The sum of these opposing factors results in normal or slightly elevated blood potassium levels in patients with symptoms of chronic renal failure (with the exception of end-phase symptoms, which are characterized by hyperkalemia). Signs of hyperkalemia are one of the most dangerous manifestations of chronic renal failure. With high hyperkalemia (more than 7 mmol/l), muscle and nerve cells lose their ability to excitability, which leads to paralysis, damage to the central nervous system, AV block, and even cardiac arrest.

Symptoms of change carbohydrate metabolism for chronic renal failure

The content of circulating insulin in the blood with signs of chronic renal failure is increased. Nevertheless, in conditions of renal failure, glucose tolerance is often impaired, although significant hyperglycemia, much less ketoacidosis, is not observed. Several reasons for this in chronic renal failure have been identified: signs of peripheral receptor resistance to the action of insulin, symptoms of intracellular potassium deficiency, metabolic acidosis, increased levels of contrainsular hormones (glucagon, growth hormone, glucocorticoids, catecholamines). Impaired glucose tolerance in chronic renal failure is called azotemic pseudodiabetes; this phenomenon does not require independent treatment.

Symptoms of changes in fat metabolism in chronic renal failure

Hypertriglyceridemia, elevated levels of lipoprotein A and decreased HDL levels are characteristic of chronic renal failure. At the same time, the cholesterol level in the blood with symptoms of chronic renal failure remains within normal limits. An undoubted contribution to increased triglyceride synthesis is made by hyperinsulinism.

Changes in symptoms of calcium and phosphorus metabolism in chronic renal failure

The concentration of phosphorus in the blood serum begins to increase when the glomerular filtration rate decreases below 25% of the normal level. Phosphorus promotes signs of calcium deposition in bones, which contributes to the development of hypocalcemia in chronic renal failure. In addition, an important prerequisite for hypocalcemia is a decrease in the synthesis of 1,25-dihydroxycholecalciferol in the kidneys. This is an active metabolite of vitamin D, responsible for the absorption of calcium ions in the intestine. Hypocalcemia stimulates the production of parathyroid hormone, i.e., secondary hyperparathyroidism develops, as well as renal osteodystrophy (more often in children than in adults).

Diagnosis of kidney failure by symptoms

The most informative in the diagnosis of symptoms of chronic renal failure is the determination of the maximum (in the Zimnitsky test) relative density of urine, the glomerular filtration rate and the level of creatinine in the blood serum. Diagnosis of the nosological form that led to signs of renal failure is more difficult, the later the stage of chronic renal failure. At the stage of end-stage renal failure, symptoms disappear. Distinguishing between signs of chronic and symptoms of acute renal failure is often difficult, especially in the absence of medical history and medical documentation over the past years. The presence of persistent normochromic anemia in combination with polyuria, arterial hypertension, and symptoms of gastroenteritis indicates chronic renal failure.

Determination of the relative density of urine in the diagnosis of chronic renal failure

For chronic renal failure characteristic feature: isosthenuria. A relative density greater than 1.018 is indicative of renal failure. A decrease in the relative density of urine, in addition to chronic renal failure, can be observed with excessive fluid intake, use of diuretics, and aging.

With symptoms of chronic renal failure, hyperkalemia usually develops in the terminal stage. The content of sodium ions changes insignificantly, and hypernatremia is noted significantly less frequently than hyponatremia. The content of calcium ions is usually reduced, phosphorus is increased.

Diagnosis of kidney size in chronic renal failure

To diagnose the symptoms of chronic renal failure, X-ray and ultrasound methods are used. Distinctive feature renal failure - reduction in kidney size. If no reduction in size is observed, in some cases a kidney biopsy is indicated.

Symptoms of metabolic changes in chronic renal failure

The most important mechanisms:

• Retention of sodium and water ions with an increase in bcc, accumulation of sodium ions in the vessel wall with subsequent edema and increased sensitivity to pressor agents.
• Activation of pressor systems: reninangiotensinaldosterone, vasopressin, catecholamine systems.
• Insufficiency of renal depressor systems (Pg, kinins) with symptoms of chronic renal failure.
• Accumulation of nitric oxide synthetase inhibitors and digoxin-like metabolites, insulin resistance.
• Increased risk of developing atherosclerosis

Risk factors for signs of atherosclerosis in conditions of chronic renal failure: hyperlipidemia, impaired glucose tolerance, prolonged arterial hypertension, hyperhomocysteinemia.

Weakening of signs of anti-infective immunity in chronic renal failure

The reasons for it are the following:

• Decreased effector functions of phagocytes in chronic renal failure.
• Arteriovenous shunts: during hemodialysis, if the rules of care for them are violated, they become the “entry gate” of infection.
• Pathogenetic immunosuppressive therapy for underlying kidney diseases increases the risk of intercurrent infections.

Pathomorphology of signs of chronic renal failure

Symptoms morphological changes in the kidneys in chronic renal failure are of the same type, despite the variety of causes of CGTN. Fibroplastic processes predominate in the parenchyma: some nephrons die and are replaced by connective tissue. The remaining nephrons experience functional overload. A morphofunctional correlation is observed between the number of “working” nephrons and renal dysfunction.

Classifications of chronic renal failure

There is no generally accepted classification of chronic renal failure. The most significant signs in all classifications are the level of creatinine in the blood and the glomerular filtration rate.

From a clinical perspective to assess prognosis and choice therapeutic tactics It is advisable to distinguish three stages of chronic renal failure:

Initial or latent. symptoms - a decrease in glomerular filtration rate to 60-40 ml/min and an increase in blood creatinine to 180 µmol/l.

Conservative. signs - glomerular filtration rate 40-20 ml/min, blood creatinine up to 280 µmol/l.

Terminal. symptoms - glomerular filtration rate less than 20 ml/min, blood creatinine above 280 µmol/l.

If in the first two stages of chronic renal failure it is possible to use medicinal methods treatments that support residual renal function, then in the terminal stage only replacement therapy is effective - chronic dialysis or kidney transplantation.

Causes of symptoms of chronic renal failure

Glomerulonephritis (primary and secondary) is the most common cause of chronic renal failure. Failure may also be due to symptoms of tubular damage and renal interstitium(pyelonephritis, tubulointerstitial nephritis), signs of metabolic diseases ( diabetes), amyloidosis, congenital pathology (polycystic kidney disease, renal hypoplasia, Fanconi syndrome, Allport disease, etc.), obstructive nephropathies (urolithiasis, hydronephrosis, tumors) and vascular lesions (hypertension, renal artery stenosis).

Kidney failure

What it is?

Eliminating metabolic products from the body and maintaining acid-base and water-electrolyte balance - these two important functions are performed by the kidneys. The renal blood flow ensures these processes. The renal tubules are responsible for concentration, secretion and reabsorption, and the glomeruli carry out filtration.

Renal failure refers to severe impairment of kidney function. As a result, the water-electrolyte and acid-base balance of the body is disrupted, and homeostasis is disrupted.

There are two stages of kidney failure: chronic and acute. Following acute kidney disease, an acute form of failure develops. In most episodes this is a reversible process. The loss of functioning parenchyma leads to the gradual development and progression of a chronic form of renal failure.

Causes of kidney failure

This disease can appear as a result of many reasons. Exogenous intoxications, for example, snake bites or poisonous insect bites, poisoning medicines or poison, lead to the development of acute renal failure. Infectious diseases can also be the cause; inflammation processes in the kidneys (glomerulonephritis, pyelonephritis); obstruction of the urinary tract; injury or hemodynamic disorder of the kidneys (collapse, shock).

Chronic inflammatory diseases usually lead to the development of a chronic form of deficiency. This may be pyelonephritis or glomerulonephritis, also of a chronic form. Urological pathologies, polycystic kidney disease, diabetic glomerulonephritis, renal amyloidosis - all these diseases lead to the development of a chronic form of kidney failure.

Symptoms of kidney failure

Painful, bacterial or anaphylactic shock manifests itself as symptoms at an early stage of the disease. Homeostasis is then disrupted. Symptoms of acute uremia gradually increase. The patient loses his appetite, he becomes lethargic, drowsy and weak. Vomiting, nausea, muscle cramps and spasms, anemia, and tachycardia appear. shortness of breath (due to pulmonary edema). The patient's consciousness is inhibited.

Signs increase and develop along with the disease itself. Performance decreases sharply, the patient quickly gets tired. He suffers from headaches. Appetite decreases, and an unpleasant taste is felt in the mouth, vomiting and nausea occur. The skin dries, turns pale and flabby, muscle tone decreases, trembling of the limbs (tremor), aches and pain in the bones and joints appear. Leukocytosis, bleeding occurs, and anemia is pronounced. A decrease in glomerular filtration leads to the patient experiencing a change in excitability and apathy, that is, he becomes emotionally labile. The patient behaves inappropriately, his mental reactions are inhibited, and night sleep is disturbed. The condition of the skin worsens, its shade becomes yellow-gray, puffiness of the face, itching and scratching appear. Nails and hair become brittle and become dull. Due to lack of appetite, dystrophy progresses. The voice is hoarse. Aphthous stomatitis and an ammonia smell appear in the mouth. Digestive disorders such as vomiting, nausea, bloating, belching and diarrhea are frequent accompaniments of renal failure. Muscle cramps increase and cause excruciating pain. Diseases such as pleurisy, ascites, and pericarditis may appear. Possible development of uremic coma.

Treatment of kidney failure

When treating profound impairment of kidney function, the causes leading to its development should be identified and eliminated. If it is impossible to carry out this stage of treatment, hemodialysis is required, that is, using an artificial kidney to clean the blood. In cases where blockage of the renal arteries has occurred, it is necessary to perform bypass surgery, prosthetics and balloon angioplasty. In addition, it is necessary to restore impaired blood circulation, acid-base and water-electrolyte balance. The blood is cleansed and therapy with antibacterial drugs is carried out. A qualified specialist in this field must monitor the entire process of treating this disease, since this is a complex, complex therapeutic measure.

Nutrition correction is one of the main preventive measures. The prescribed diet should contain a large volume of liquid and a limited amount of protein foods. It is necessary to completely remove meat and fish, dairy products, dried fruits, potatoes and bananas, as well as other foods rich in potassium, from the menu. Cottage cheese, grains and legumes, bran containing large amounts of magnesium and phosphorus should be limited when consumed. When treating a disease, it is very important to follow a work schedule; you should not overwork and overexert yourself, and devote more time to rest.

If adequate treatment of acute form of insufficiency is started in time, it will help the patient get rid of the disease and live full life. Transplantation of a diseased kidney or hemodialysis - only these two methods will help a person live with a chronic form of the disease.

VIDEO

Treatment of kidney failure with alternative medicine recipes

• Burdock. Brewed burdock root will help improve the condition of a patient with kidney failure. The root is ground into flour in any available way, one large spoon of powder is brewed in a glass of very hot water. Leave to infuse overnight so that the infusion is ready by morning. During the day you need to drink the prepared infusion in small portions. Since it is forbidden to drink more liquid than will be excreted in the urine, the dosage is selected in accordance with the patient’s drinking regime. If this condition is not met, swelling may develop. It is necessary to prepare water for infusion in advance. It needs to be boiled, allowed to settle and filtered if a precipitate forms. The jar for settling should contain a magnet or a silver spoon for disinfection.
• Echinacea tincture. This drug will bring considerable benefits in the treatment of the disease. Making this product at home is not difficult. The roots, leaves and inflorescences have equal healing properties, so the whole plant is suitable for preparing the tincture. Approximately 150 grams of fresh raw materials or 50 grams of dry grass must be poured with one liter of vodka. Place the container in a dark and cool place to infuse for 14 days. The tincture needs to be shaken periodically. After the required time has passed, the tincture should be filtered through gauze. The dosage is 10 drops of the drug, which must be diluted in clean water and taken three times a day for six months. Along with the tincture, you can also use the following folk remedy: an infusion of insufficiently ripe walnuts and honey. It is prepared as follows: grind the nut using a meat grinder and mix with fresh honey in equal parts. Mix the mixture thoroughly, close the lid tightly and place in a dark place for 30 days. You need to eat three small spoons of the mixture per day, dividing them into three doses. This product will support the immune system and cleanse the blood.
• Collection of herbs. To prepare a healing herbal infusion that will help in treatment, you should mix crushed herbs in the following proportions: 6 shares of horsetail and strawberry leaves, 4 shares of rose hips, 3 shares of nettle leaves and stems, 2 shares of plantain and drop cap, 1 share of leaves lingonberries, Crimean rose petals, budra grass, juniper fruits, lavender, birch and currant leaves, bearberry. Mix all ingredients thoroughly until smooth. Two large spoons of the mixture are filled with 500 milliliters of hot water. Leave in a thermos for about one hour, then consume by mixing with honey three times a day. The warm infusion should be taken 20 minutes before meals every day for six months. When treating with herbs, it is necessary to avoid hypothermia and exposure to drafts.
• Flax and horsetail. An excellent remedy alternative medicine Flax seeds are used for treatment. One small spoon of seeds should be brewed in a glass of boiling water. Then cook over low heat for about 2 minutes. Leave the broth to infuse for 2 hours. After this, the cooled product must be filtered and taken 100 milliliters up to 4 times a day.

Horsetail is a classic remedy for the treatment of kidney failure. It restores water and electrolyte balance, and also has an anti-inflammatory, bactericidal, diuretic and astringent effect on the body. Horsetail grass is dried and crushed before use. To prepare the decoction, you will need 3 large spoons of raw materials, pour 500 milliliters of boiling water. Cook over low heat for 30 minutes. The broth is then cooled, filtered, and taken in three or four doses per day.

• Sea kale and dill. Dill is an excellent helper in treatment. Grind the grass seeds in a mortar and pour one part of them with 20 parts of water. The product should be taken 4 times a day, drinking half a glass at a time. Dill has anti-inflammatory, analgesic and diuretic effects.

Sea kale, or kelp, rich in iodine, provitamins and vitamins, also helps greatly in treatment. It can be added to various salads and thus eaten. The required dosage is approximately 100 grams per day. Laminaria will help the kidneys function when removing metabolic products from the body.

Chronic renal failure

Irreversible death of nephrons leads to kidney damage, that is, to a chronic form of renal failure. It appears as a result of chronic kidney disease and leads to the fact that the kidneys gradually begin to do their job worse and worse. All human life suffers from this. This disease poses considerable danger and often ends in the death of the patient.

Chronic kidney failure occurs in four stages.

Latent stage - practically no signs of the disease appear at this stage; they can only be detected with a thorough examination of the body.

Compensated stage – characterized by a decrease in glomerular filtration. This causes dryness in oral cavity and rapid fatigue and weakness of the body. The intermittent stage is characterized by the development of acidosis. In this case, the patient experiences sudden changes in condition from improvement to deterioration, which manifest themselves depending on the course of the disease, which caused the failure of the chronic form.

Terminal is the last fourth stage of the disease, it leads to uremic intoxication.

Causes of chronic renal failure

The causes of chronic deficiency are:

• hereditary lesions of the ureters, such as hypoplasia, polycystic disease and dysplasia, as well as hereditary kidney diseases;
• vascular diseases that lead to damage to the kidney parenchyma. These may be vascular diseases such as hypertension and renal artery stenosis;
• urological diseases, Albright's tubular acidosis, renal diabetes, that is, abnormal processes in the tubular apparatus;
• glomerulonephritis, amyloidosis, gout, nephrosclerosis, malaria and other diseases caused by damage to the glomeruli.

Symptoms of chronic kidney failure

The course of the underlying disease determines the presence of certain symptoms chronic failure. The most common and common manifestations are dry skin and its yellow tint, as well as itching, and decreased sweat production. The general condition of the nail plates and hair deteriorates, they lose their shine and strength. The body begins to retain fluid, which leads to the development of heart failure. Tachycardia and arterial hypertension appear. Nervous disorders manifest themselves in the fact that patients become apathetic, lethargic and drowsy, they experience a decrease in appetite, which leads to the development of dystrophy. Symptoms of the disease can also include pain in the joints and skeletal system, the presence of tremors in the limbs and muscle cramps. The mucous membrane also suffers, this manifests itself in the development of aphthous stomatitis, gastroenterocolitis with ulcers and erosions.

Treatment of chronic renal failure

The choice of methods and drugs for the treatment of chronic kidney failure depends on what stage it is at and how the underlying disease progresses. Correction of nutrition, normalization of cardiac function, and restoration of acid-base balance will help the patient recover. The diet should be designed in such a way that the consumption of protein foods and salt is limited. Physical activity should be regulated so as not to pose any danger to the patient.

As a replacement treatment, blood purification can be used using an artificial kidney. A kidney transplant can be used.

At a late stage of the disease, dangerous complications can develop: arrhythmia, myocardial infarction. viral hepatitis, pericarditis.

If treatment is started on time, the patient will be able to live a full life for many more years.

The most interesting news

Renal failure is a serious complication of damage to the urinary organs, vascular pathology, in which the formation and filtration of urine decreases or completely stops. It is important that the process is not limited to changes in the kidneys themselves, but disrupts the balance of a person’s water-salt metabolism, changes the acid-base properties of the blood and the concentration of biochemical compounds dissolved in it.

Consequences can be found in all organs and systems of the body in the form of secondary damage. As kidney failure progresses, it takes on an acute or chronic form. They have differences. Therefore, pathogenesis is best considered separately.

What is acute kidney failure and how common is it?

The term “acute” refers to the rapid, even rapid development of renal dysfunction. IN medical practice it is included in the list of emergency conditions that require intensive treatment and threaten the patient’s life. The incidence of acute renal failure is 15 cases per 100,000 population.

Renal dysfunction occurs due to:

• a sharp decrease in total blood flow - prerenal damage;
• pronounced massive destruction of the nephron membrane - renal;
• sudden obstruction to the outflow of urine (obstruction) - postrenal disorders.

As a result, the patient experiences a significant decrease in urine output (oligoanuria), then complete anuria. 75% of people with such changes require urgent hemodialysis (a method of purifying the blood using an artificial kidney).

According to the scheme, there is a possibility of transition of extrarenal failure to renal failure

Determining the type of anuria is important for timely treatment emergency care. If there is obstruction of the urinary tract (postrenal level of damage), the patient needs emergency surgical intervention. A feature of kidney tissue is the possibility of complete recovery, therefore, with timely and complete treatment, most patients recover.

What are the causes of acute kidney failure?

The causes of acute renal failure are most often caused by:

• intoxication with poisons due to accidental poisoning or for the purpose of suicide, these include liquids from household chemicals, food industry, lead compounds, medications, bites of poisonous snakes and insects;
• sudden decrease in blood circulation in renal vessels at states of shock, collapse, acute heart failure, thrombosis and embolism of the renal artery;
• acute forms of kidney inflammation (glomerulonephritis and pyelonephritis);
• infectious diseases occurring with severe renal syndrome (hemorrhagic fever, leptospirosis);
• sudden blockage of the urinary tract with a stone, tumor - obstruction of the urinary tract;
• kidney injuries, including removal of a single kidney.

Clinical course and stages of pathology

Symptoms of kidney failure are determined by therapeutic measures. Main manifestations:

• nausea with vomiting;
• diarrhea;
• complete lack of appetite;
• swelling of the arms and legs;
• excitement or lethargy.

Must appear:

• reduced amount or absence of urine output;
• liver enlargement.

According to the clinical course, renal failure develops in several stages.

I (initial) - characterized by the immediate cause that caused the pathology, can last several hours or days, the time of onset of the damaging factor (for example, ingestion of poison) and the appearance of the first symptoms are taken into account, signs of intoxication are possible (pallor of the skin, nausea, vague pain in the abdominal area ).

II (oligoanuric) - the patient’s condition is assessed as severe, a characteristic decrease in the excreted volume of urine is manifested, an increase in intoxication is caused by the accumulation of end products of protein breakdown (urea, creatinine) in the blood; weakness, drowsiness, and lethargy appear due to the effect on brain cells.

Other symptoms:

• diarrhea;
• hypertension;
• increased number of heartbeats (tachycardia).

Signs of severity of renal function damage are:

• azotemia (increased amount of nitrogenous substances accumulated in the blood);
• anemia (anemia);
• addition of liver damage in the form of hepatic-renal failure.

Read more about the symptoms of kidney failure.

III (restorative) - characterized by a return to the original phenomena. First, a phase of early diuresis appears, which corresponds to the clinical stage of stage II, then polyuria returns (there is a lot of urine) with the restoration of the kidneys’ ability to excrete sufficiently concentrated urine.

Against the background of normalization of biochemical blood parameters, there is an improvement in the functioning of the nervous system and heart, a decrease in high blood pressure, and a cessation of diarrhea and vomiting. Recovery lasts about 14 days.

IV (convalescent stage) - all kidney functions return to normal; it will take several months, for some people up to a year.

Chronic form

Chronic renal failure differs from acute renal failure by a gradual decrease in kidney function, death of structures, and replacement of tissue with scars with shrinkage of the organ. Its prevalence reaches from 20 to 50 cases per 100,000 population. Most often associated with a long course of inflammatory kidney diseases. Statistics show an annual increase in the number of patients by 10–12%.

Kidney shrinkage occurs gradually in chronic pathology

What leads to the development of chronic renal failure?

The mechanism of formation of the pathology is associated with a violation of the structure of the main structural units of the kidney - nephrons. Their number decreases significantly, atrophy and replacement with scar tissue occurs. Some glomeruli, on the contrary, hypertrophy, and similar changes in the tubules are possible.

Modern research shows that the development of renal failure in such conditions is caused by an overload of “healthy” nephrons and a reduction in “sick” ones. Due to insufficient organ function provided by the residual number of glomeruli, water and electrolyte metabolism is disrupted.

There are up to a million nephrons in both kidneys. Taking into account good reserves, it has been proven that one can hope for the life support of the body even with the loss of 90% of their quantity.

The death of the glomerular apparatus is aggravated by:

• vascular damage;
• compression of the afferent arterioles by edematous tissue;
• impaired lymph circulation.

Why does chronic deficiency occur?

The most common causes of chronic kidney failure include:

• long-term inflammatory kidney diseases that destroy glomeruli and tubules (glomerulonephritis, pyelonephritis);
• congenital anomalies (polycystic disease, narrowing of the renal arteries, underdevelopment) contributing to the functional inferiority of the renal structures;
• diseases of impaired general metabolism (amyloidosis, diabetes mellitus, gout);
• systemic vascular diseases (rheumatism, lupus erythematosus, a group of hemorrhagic vasculitis, scleroderma) with simultaneous changes in renal blood flow;
• hypertension and symptomatic hypertension, which impairs blood supply to the kidneys;
• diseases accompanied by impaired outflow of urine (hydronephrosis, tumors of the underlying tract and pelvis, urolithiasis).

Among fat people There is a widespread belief that it is possible to lose weight with the help of the hypoglycemic drug Metformin (synonyms Glucophage, Siofor, Formetin). The drug is prescribed very carefully by an endocrinologist. TO negative properties refers to impaired renal and liver function. Self-administration is not recommended.

Scientists from Sweden came to an interesting conclusion. They studied the gene composition of Shar Pei dogs, as they are most susceptible to the autoimmune mechanism of kidney damage in hereditary fever. It turned out that the skin folds of Shar Peis are associated with excess production hyaluronic acid. It signals the immune system to build antibodies to its own tissues. A certain gene, which is also present in humans, is responsible for the hyperreaction. Studying our pets will reveal more about the role autoimmune diseases in the pathogenesis of chronic renal failure.

It is in the folds of the skin that excess hyaluronic acid is “hidden”

Types of chronic kidney failure and their classification

Different classifications of chronic kidney failure are based on:

• etiological factors;
• pathogenesis;
• degree of functional impairment;
• clinical signs.

In the Russian Federation, urologists use the Lopatkin-Kuchinsky classification. It divides pathological manifestations into 4 stages.

Latent stage of renal failure - occurs without any clinical manifestations. Noted normal discharge urine with sufficient specific gravity. In biochemical blood tests, the concentration of nitrogenous substances remains unchanged.

The earliest manifestations are detected by monitoring the ratio of kidney function during the day and at night. The disrupted circadian rhythm of urine excretion consists of an initial equalization of daytime and nighttime volumes, and then a persistent excess of the nighttime volume. When examining the patient, decreased indicators are detected:

• glomerular filtration (60–50 ml/min. with a normal level of 80–120);
• percentage of water reabsorption;
• tubular activity.

Compensated stage - the number of fully functioning nephrons decreases, but the concentration of urea and creatinine in the blood remains normal. This means that it is supported by overload of the remaining glomeruli, the development of polyuria.

Protective mechanisms ensure the removal of harmful toxins from the body due to:

• reduced concentration function of the tubules;
• decrease in glomerular filtration rate (30–50 ml/min);
• increasing urine production to 2.5 liters per day.

In this case, nocturnal diuresis predominates.

Before the hemodialysis procedure, the patient must undergo control tests

If a patient has preserved compensatory capabilities, it is necessary to take urgent measures for treatment and surgical restoration of the urine outflow tract. There is still hope for reverse development. It is impossible to completely cure the patient, but there is still a chance to transfer the disease to a more favorable latent stage. In the absence of adequate treatment, compensatory mechanisms are quickly exhausted, and a decompensated intermittent stage occurs.

The intermittent stage differs from the previous ones:

• steadfastly increased level creatinine and urine;
• the most pronounced clinical manifestations;
• exacerbations during the course of the underlying disease.

Compensatory polyuria, which contributed to the elimination of waste, is replaced by oliguria. The daily volume of urine may be normal, but the specific gravity decreases and does not change during the day. Glomerular filtration occurs at a rate of 29 to 15 ml/min.

The stage allows for periodic remissions. Although creatinine and urea levels do not normalize at this time, they remain 3-4 times higher than normal. Surgical interventions are assessed as very risky. The patient and relatives are notified. It is possible to install a nephrostomy to ensure the outflow of urine.

Terminal stage – is a consequence of untimely consultation with a doctor, the malignant course of the underlying disease. Irreversible changes occur in the body. Intoxication is caused by a high level of nitrogenous waste in the blood, a drop in glomerular filtration to 10–14 ml/min.

Course of the terminal stage

The clinical course in the terminal stage has four forms. Otherwise, they are considered periods of pathological changes.

I - renal failure is characterized by reduced glomerular filtration to 10–14 ml/min, high urea levels while maintaining urine output in a volume of one liter or more.

II - stage is divided into forms “a” and “b”:

• With IIa, diuresis decreases, the content of dissolved substances in the urine decreases, acidosis develops (deviation of general metabolism in the acidic direction), and the amount of nitrogenous waste in the blood test continues to increase. The important thing is that changes in internal organs are still reversible. In other words, bringing the indicators closer to normal contributes to the complete restoration of damage to the heart, lungs, and liver.
• In stage IIb - in comparison with IIa, disorders of internal organs are more pronounced.

III - violations reach a critical level. Against the background of severe uremic intoxication, the brain reacts comatose state, renal-liver failure develops with degeneration of liver cells (hepatocytes), decompensation of cardiac activity and arrhythmias occur due to severe hyperkalemia.

The death of liver cells occurs after the nephrons, leaving areas of scar tissue in their place

Modern methods of treatment, including peritoneal dialysis and hemodialysis to relieve intoxication, are weakly effective or ineffective.

How to detect kidney failure?

In the diagnosis of acute renal failure, urologists attach primary importance to the absence of detected urine in the bladder. This sign does not necessarily confirm anuria. It is necessary to differentiate it from acute urinary retention due to a stone, spasm, in men with prostate adenoma.

The patient's bladder is examined using a cystoscope. If overfilling is detected, acute kidney failure is ruled out. Knowledge of the previous connection with poisoning and previous diseases helps to establish the cause and determine the form.

A urine test indicates:

• hemolytic shock in case of detection of hemoglobin clumps;
• tissue crush syndrome in the presence of myoglobin crystals;
• poisoning with sulfonamides when salts of sulfonamide substances are detected.

To establish the level of kidney damage, it is necessary to conduct ultrasound, x-ray and instrumental studies. If a catheter is successfully inserted into the renal pelvis and a lack of urine output is detected, one must think about renal or prerenal forms of failure.

Ultrasound, CT scan make it possible to determine:

• kidney size;
• disturbed structure of the pelvis and calyces;
• development of a tumor compressing the kidney tissue and ureters.

In specialized clinics, radioisotope scanning is performed, which makes it possible to judge the degree of destruction of the kidney parenchyma.

Biochemical blood tests play an important role. A mandatory comprehensive examination before prescribing hemodialysis, plasmapheresis, hemosorption in each individual case is to study the level of:

• nitrogen-containing components;
• composition of electrolytes;
• acid-base reaction;
• liver enzymes.

Chronic kidney failure must be excluded in the diagnosis of long-term ill patients with pyelonephritis, glomerulonephritis, diabetes mellitus and other concomitant pathologies.

Pregnancy is a serious provoking factor for the activation of inflammation in the kidneys

When questioning women, attention is always paid to complicated pregnancies and the occurrence of renal pathology during childbirth. First of all, it is necessary to fully examine to exclude the latent stage of chronic failure if the patient has:

• long-term dysuric symptoms;
• lower back pain;
• unclear temperature fluctuations;
• repeated attacks of renal colic;
• urinalysis reveals bacteriuria and leukocyturia.

When identifying any renal pathology, it is necessary to study the functional capabilities of the organs, make sure that both kidneys are functioning stable and that they have a reserve supply. Urine examination using the Zimnitsky method makes it possible to identify initial signs functional weakness due to daily urinary arrhythmia.

Add information about the work of nephrons calculations:

• glomerular filtration rate;
• creatinine clearance;
• Rehberg test results.

In case of chronic pathology, there is more time to carry out:

• radioisotope diagnostics;
• excretory urography;
• dopplerography.

How is the prognosis for the patient’s health and life assessed?

If medical care is provided to a patient with acute renal failure in a timely manner, the prognosis can be considered favorable for most patients. They recover and return to their work and normal lives. Diet restrictions will apply for about a year. However, one should take into account the impossibility of counteracting some toxic substances, lack of access to hemodialysis, and late admission of the patient.

Some poisonings occur against the background of deep alcohol intoxication, therefore, until close people and the patient himself come to their senses and begin to think about health, the possibility of recovery renal filtration no longer remains

Full recovery of kidney function after acute failure can be achieved in 35-40% of cases, in 10-15% of patients kidney function is partially normalized, from 1 to 3% the disease becomes chronic. The lethal outcome in acute poisoning reaches up to 20%; patients die from general sepsis, uremic coma, and impaired cardiac activity.

The course of chronic renal failure in inflammatory diseases is associated with advances in the treatment of glomerulo- and pyelonephritis. Therefore doctors give great importance timely detection and treatment of exacerbations. The development of kidney transplantation does not yet compensate for the needs of patients.

Prevention of renal failure is carried out by people who fulfill all the requirements of the attending physician regarding diet, control examinations, regular preventive courses of treatment during periods of no exacerbation and do not shy away from hospitalization in case of active process. Pathology is prevented by timely surgery for urolithiasis, tumors of the urinary organs, and prostate adenoma.

Any means of treating diseases that spread to the renal structures must be treated with due attention. Problems of diabetes mellitus and hypertensive crises do not bypass the sensitive vascular network of the kidneys. Recommended measures regarding regimen and diet are the least that a person can do for his health and preservation of his kidneys.

Renal failure means a syndrome in which all functions relevant to the kidneys are disrupted, resulting in a disorder various types exchanges in them (nitrogen, electrolyte, water, etc.). Renal failure, the symptoms of which depend on the course of this disorder, can be acute or chronic, each of the pathologies develops due to the influence of different circumstances.

general description

The main functions of the kidneys, which in particular include the functions of removing metabolic products from the body, as well as maintaining the balance in the acid-base state and water-electrolyte composition, directly involve renal blood flow, as well as glomerular filtration in combination with the tubules. In the latter version, the processes consist of concentration ability, secretion and re-absorption.

What is noteworthy is that not all changes that may affect the listed variants of the processes are the obligatory cause of subsequent pronounced disturbances in kidney function; accordingly, any disturbance in the processes cannot be defined as renal failure, which interests us. Thus, it is important to determine what renal failure actually is and on the basis of what specific processes it is advisable to distinguish it as this type of pathology.

So, by renal failure we mean a syndrome that develops against the background of severe disturbances in renal processes, in which we are talking about a disorder of homeostasis. Homeostasis generally refers to the maintenance at a level of relative constancy of the internal environment characteristic of the body, which in the variant we are considering is attached to its specific area - that is, to the kidneys. At the same time, azotemia (in which there is an excess of protein metabolic products in the blood, which includes nitrogen), disturbances in the body’s general acid-base balance, as well as disturbances in the water-electrolyte balance, become relevant in these processes.

As we have already noted, the condition we are interested in today can arise against the background of the influence of various causes; these causes, in particular, are determined by what type of renal failure (acute or chronic) we are talking about.

Renal failure, the symptoms of which in children manifest themselves similarly to those in adults, will be discussed below in terms of the course of interest (acute, chronic) in combination with the reasons that provoke their development. The only point that I would like to note against the background of the commonality of symptoms is that in children with a chronic form of renal failure, growth retardation, and this connection has been known for quite a long time, noted by a number of authors as “renal infantilism.”

The actual reasons that provoke such a delay have not been fully elucidated, however, the loss of potassium and calcium against the background of effects provoked by acidosis can be considered as the most likely factor leading to it. It is possible that this also occurs due to renal rickets, which develops as a result of the relevance of osteoporosis and hypocalcemia in the condition under consideration in combination with the lack of conversion to the required form of vitamin D, which becomes impossible due to the death of renal tissue.

• Acute renal failure :
  • Shock bud. This state is achieved due to traumatic shock, which manifests itself in combination with massive tissue damage, which occurs as a result of a decrease in the total volume of circulating blood. This condition is provoked by: massive blood loss; abortions; burns; a syndrome that occurs against the background of crushing muscles with their crushing; blood transfusion (in case of incompatibility); debilitating vomiting or toxicosis during pregnancy; myocardial infarction.
  • Toxic kidney. In this case, we are talking about poisoning that occurred due to exposure to neurotropic poisons (mushrooms, insects, snake bites, arsenic, mercury, etc.). Among other things, intoxication with radiopaque substances, medications (analgesics, antibiotics), alcohol, and narcotic substances is also relevant for this option. The possibility of acute renal failure in this variant of the provoking factor cannot be ruled out, given the relevance of professional activities directly related to ionizing radiation, as well as heavy metal salts (organic poisons, mercury salts).
  • Acute infectious kidney. This condition is accompanied by the impact of infectious diseases on the body. So, for example, an acute infectious kidney is an actual condition in sepsis, which, in turn, can have a different type of origin (primarily anaerobic origin is relevant here, as well as an origin against the background of septic abortions). In addition, the condition in question develops against the background of hemorrhagic fever and leptospirosis; with dehydration due to bacterial shock and such infectious diseases like cholera or dysentery, etc.
  • Embolism and thrombosis, relevant for the renal arteries.
  • Acute pyelonephritis or glomerulonephritis.
  • Ureteral obstruction, caused by compression, the presence of tumor formation or stones in them.

It should be noted that acute renal failure occurs in about 60% of cases as a result of injury or surgical intervention, about 40% are observed during treatment in medical institutions, up to 2% during pregnancy.

• Chronic renal failure:
  • Chronic form of glomerulonephritis.
  • Secondary kidney damage caused by the following factors:
    • arterial hypertension;
    • diabetes;
    • viral hepatitis;
    • malaria;
    • systemic vasculitis;
    • systemic diseases affecting connective tissues;
    • gout.
  • Urolithiasis, ureteral obstruction.
  • Renal polycystic disease.
  • Chronic form of pyelonephritis.
  • Current anomalies associated with the activity of the urinary system.
  • Exposure due to a number of medications and toxic substances.

Leadership in the positions of the causes provoking the development of chronic renal failure syndrome is assigned to chronic glomerulonephritis and the chronic form of pyelonephritis.

Acute renal failure: symptoms

Acute renal failure, which we will further abbreviate to the abbreviation ARF, is a syndrome in which there is a rapid decrease or complete cessation of kidney functions, and these functions can decrease/stop in one kidney or in both at the same time. As a result of this syndrome, the metabolic processes, there is an increase in products formed during nitrogen metabolism. Relevant disorders of the nephron, which is defined as a structural renal unit, in this situation arise due to a decrease in blood flow in the kidneys and, at the same time, due to a decrease in the volume of oxygen delivered to them.

The development of acute renal failure can occur either within literally a few hours or within a period of 1 to 7 days. The duration of the condition that patients experience with this syndrome can be 24 hours or more. Timely seeking medical help with subsequent adequate treatment can ensure complete restoration of all functions in which the kidneys are directly involved.

Turning, in fact, to the symptoms of acute renal failure, it should initially be noted that in the overall picture in the foreground there is precisely the symptomatology that served as a kind of basis for the occurrence of this syndrome, that is, from the disease that directly provoked it.

Thus, we can distinguish 4 main periods that characterize the course of acute renal failure: the shock period, the period of oligoanuria, the recovery period of diuresis in combination with the initial phase of diuresis (plus the polyuria phase), as well as the recovery period.

Symptoms first period (mostly its duration is 1-2 days) is characterized by the already noted above symptoms of the disease that provoked the OPS syndrome - it is at this moment in its course that it manifests itself most clearly. Along with it, tachycardia and a decrease in blood pressure are also noted (which in most cases is transient, that is, soon stabilizing to normal levels). Chills occur, pale and yellow skin is noted, and body temperature rises.

Next, second period (oligoanuria, the duration is usually about 1-2 weeks), is characterized by a decrease or absolute cessation of the process of urine formation, which is accompanied by a parallel increase in residual nitrogen in the blood, as well as phenol in combination with other types of metabolic products. What is noteworthy is that in many cases it is during this period that the condition of most patients improves significantly, although, as already noted, there is no urine. Later, complaints of severe weakness and headache appear; patients’ appetite and sleep worsen. Nausea with accompanying vomiting also appears. The progression of the condition is indicated by the smell of ammonia that appears during breathing.

Also, in acute renal failure, patients experience disorders associated with the activity of the central nervous system, and these disorders are quite diverse. The most common manifestations of this type are apathy, although the opposite option is not excluded, in which, accordingly, patients are in an excited state, having difficulty navigating the environment that surrounds them; a general confusion of consciousness can also be a companion to this state. In frequent cases, convulsive seizures and hyperreflexia are also observed (that is, revival or strengthening of reflexes, in which, again, patients are in an overly excitable state due to an actual “shock” to the central nervous system).

In situations where acute renal failure occurs against the background of sepsis, patients may develop a herpetic-type rash concentrated in the area around the nose and mouth. Skin changes in general can be very diverse, manifesting both in the form of urticarial rash or fixed erythema, and in the form of toxicoderma or other manifestations.

Almost every patient experiences nausea and vomiting, and somewhat less frequently, diarrhea. Especially often, certain digestive phenomena occur in combination with hemorrhagic fever along with renal syndrome. Lesions of the gastrointestinal tract are caused, first of all, by the development of excretory gastritis with enterocolitis, whose nature is defined as erosive. Meanwhile, some of the current symptoms are caused by disturbances arising from the electrolyte balance.

In addition to the listed processes, there is the development of edema in the lungs, resulting from increased permeability, which the alveolar capillaries have during this period. It is difficult to recognize it clinically, so diagnosis is made using an x-ray of the chest area.

During the period of oligoanuria, the total volume of urine excreted decreases. So, initially its volume is about 400 ml, and this, in turn, characterizes oliguria; then, with anuria, the volume of urine excreted is about 50 ml. The duration of oliguria or anuria can be up to 10 days, but some cases indicate the possibility of increasing this period to 30 days or more. Naturally, with protracted manifestations of these processes, active therapy is required to maintain human life.

During the same period, acute renal failure becomes a constant manifestation, in which, as the reader probably knows, hemoglobin drops. Anemia, in turn, is characterized by pale skin, general weakness, dizziness and shortness of breath, and possible fainting.

Acute renal failure is also accompanied by liver damage, and this occurs in almost all cases. As for the clinical manifestations of this lesion, they consist of yellowness of the skin and mucous membranes.

The period during which there is an increase in diuresis (that is, the volume of urine formed within a certain time period; as a rule, this indicator is considered within 24 hours, that is, within the framework of daily diuresis) often occurs several days after the end of oliguria/anuria. It is characterized by a gradual onset, in which urine is initially excreted in a volume of about 500 ml with a gradual increase, and only after, again, gradually, this figure increases to about 2000 ml or more per day, and from this moment we can talk about the beginning of the third period of OPN.

WITH third period improvements in the patient’s condition are not immediately observed; moreover, in some cases the condition may even worsen. The polyuria phase in this case is accompanied by weight loss of the patient; the duration of the phase is on average about 4-6 days. There is an improvement in the appetite of patients; in addition, previously relevant changes in the circulatory system and the functioning of the central nervous system disappear.

Conventionally, the beginning of the recovery period, that is, the next fourth period disease, the day of normalization of urea or residual nitrogen levels is noted (as determined based on appropriate tests), the duration of this period ranges from 3-6 months to 22 months. During this period of time, homeostasis is restored, renal concentration function and filtration improve, along with an improvement in tubular secretion.

It should be taken into account that over the next year or two it is possible that signs indicating functional failure in certain systems and organs (liver, heart, etc.) will persist.

Acute renal failure: prognosis

Acute renal failure, if it does not cause death for the patient, ends with a slow but, one might say, confident recovery, and this does not indicate the relevance for him of a tendency to transition to the development of chronic kidney disease against the background of this condition.

After about 6 months, more than half of the patients reach a state of full restoration of working capacity, however, the option of limiting it for a certain part of the patients is not excluded, on the basis of which they are assigned disability (group III). In general, ability to work in this situation is determined based on the characteristics of the course of the disease that provoked acute renal failure.

Chronic renal failure: symptoms

CRF, as we will further periodically define the considered variant of the course of chronic renal failure syndrome, is a process indicating an irreversible impairment to which kidney function has been subjected for a duration of 3 months or longer. This condition develops as a result of the gradual progression of the death of nephrons (structural and functional units of the kidneys). Chronic renal failure is characterized by a number of disorders, and in particular these include disturbances in excretory function (directly related to the kidneys) and the appearance of uremia, which occurs as a result of the accumulation of nitrogenous metabolic products in the body and the toxic effects they have.

At the initial stage, chronic renal failure has insignificant, one might say, symptoms, therefore it can only be determined on the basis of appropriate laboratory tests. Already obvious symptoms of chronic renal failure appear at the time of death of about 90% of the total number of nephrons. The peculiarity of this course of renal failure, as we have already noted, is the irreversibility of the process with the exception of subsequent regeneration of the renal parenchyma (that is, the outer layer from the cortex of the organ in question and the inner layer, presented in the form of the medulla). In addition to structural kidney damage against the background of chronic renal failure, other types of immunological changes cannot be excluded. The development of an irreversible process, as we have already noted, can be quite short (up to six months).

With chronic renal failure, the kidneys lose the ability to concentrate urine and dilute it, which is determined by a number of actual lesions of this period. In addition, the secretory function characteristic of the tubules is significantly reduced, and when the terminal stage of the syndrome we are considering is reached, it is completely reduced to zero. Chronic renal failure contains two main stages, this is the conservative stage (at which, accordingly, conservative treatment remains possible) and the terminal stage (in this case, the question arises regarding the choice replacement therapy, which consists of either extrarenal cleansing or a kidney transplant procedure).

In addition to disorders associated with the excretory function of the kidneys, disruption of their homeostatic, blood purification and hematopoietic functions also becomes relevant. Forced polyuria (increased urine production) is noted, on the basis of which one can judge a small number of still surviving nephrons performing their functions, which occurs in combination with isosthenuria (in which the kidneys are unable to produce urine with a higher or lower specific gravity). Isosthenuria in this case is a direct indicator that renal failure is at the final stage of its development. Along with other processes relevant to this condition, chronic renal failure, as can be understood, also affects other organs in which, as a result of processes characteristic of the syndrome in question, changes similar to dystrophy develop with simultaneous disruption of enzymatic reactions and a decrease in reactions of an immunological nature.

Meanwhile, it should be noted that the kidneys in most cases do not lose the ability to completely excrete water entering the body (in combination with calcium, iron, magnesium, etc.), due to the corresponding influence of which adequate activities of other bodies.

So, now let's move directly to the symptoms that accompany chronic renal failure.

First of all, patients experience a pronounced state of weakness, drowsiness and general apathy predominate. Polyuria also appears, in which about 2 to 4 liters of urine are excreted per day, and nocturia, characterized by frequent urination at night time. As a result of this course of the disease, patients are faced with dehydration, and as it progresses, with the involvement of other systems and organs of the body in the process. Subsequently, weakness becomes even more pronounced, accompanied by nausea and vomiting.

Other manifestations of symptoms include puffiness of the patient’s face and severe muscle weakness, which in this condition occurs as a result of hypokalemia (that is, a lack of potassium in the body, which, in fact, is lost due to processes relevant to the kidneys). The skin of patients is dry, itchy, excessive agitation is accompanied by increased sweating. Muscle twitching also appears (in some cases reaching cramps) - this is already caused by loss of calcium in the blood.

Bones are also affected, which is accompanied by pain, disturbances in movement and gait. The development of this type of symptomatology is caused by a gradual increase in renal failure, balance in calcium and reduced function glomerular filtration in the kidneys. Moreover, such changes are often accompanied by changes in the skeleton, even at the level of a disease such as osteoporosis, and this occurs due to demineralization (that is, a decrease in the content of mineral components in bone tissue). The previously noted pain in movements occurs against the background of the accumulation of urates in the synovial fluid, which, in turn, leads to the deposition of salts, as a result of which this pain, in combination with the inflammatory reaction, occurs (this is defined as secondary gout).

Many patients experience chest pain, which can also appear as a result of fibrous uremic pleurisy. In this case, when listening to the lungs, wheezing may be noted, although more often this indicates the pathology of pulmonary heart failure. Against the background of such processes in the lungs, the possibility of secondary pneumonia cannot be ruled out.

Anorexia developing with chronic renal failure can cause patients to develop an aversion to any food, also combined with nausea and vomiting, the appearance of an unpleasant taste in the mouth and dryness. After eating, you may feel fullness and heaviness in the pit of the stomach - along with thirst, these symptoms are also characteristic of chronic renal failure. In addition, patients experience shortness of breath, often high blood pressure, and frequent pain in the heart area. Blood clotting decreases, which causes not only nosebleeds, but also gastrointestinal bleeding, with possible skin hemorrhages. Anemia also develops against the background general processes, affecting the composition of the blood, and in particular, leading to a decrease in the level of red blood cells in it, which is relevant for this symptom.

Late stages of chronic renal failure are accompanied by attacks of cardiac asthma. Edema forms in the lungs, consciousness is impaired. As a result of a number of these processes, the possibility of coma cannot be excluded. An important point is also the susceptibility of patients to infectious effects, because they easily fall ill with both common colds and more serious diseases, the impact of which only worsens the general condition and kidney failure, in particular.

In the preterminal period of the disease, patients experience polyuria, while in the terminal period there is predominantly oliguria (some patients experience anuria). Kidney functions, as you can understand, decrease with the progression of the disease, and this happens until they disappear completely.

Chronic renal failure: prognosis

The prognosis for a given variant of the course of the pathological process is determined largely on the basis of the course of the disease, which gave the main impetus for its development, as well as on the basis of complications that arose during the process in a complex form. Meanwhile, an important role for the prognosis is assigned to the phase (period) of chronic renal failure that is relevant for the patient, with the rate of development that characterizes it.

Let us highlight separately that the course of chronic renal failure is not only an irreversible process, but also a steadily progressive one, and therefore a significant prolongation of the patient’s life can only be said if he is provided with chronic hemodialysis or a kidney transplant is performed (we will dwell on these treatment options below).

Of course, cases in which chronic renal failure develops slowly with a corresponding clinical picture of uremia cannot be excluded, but these are rather exceptions - in the vast majority of cases (especially with high arterial hypertension, that is, high blood pressure), the clinical picture of this disease is characterized by the previously noted rapid progression.

Diagnosis

As the main marker taken into account in diagnosis acute renal failure , emit an increase in the level of nitrogenous compounds and potassium in the blood, which occurs with a simultaneous significant decrease in urine output (up to the complete cessation of this process). An assessment of the concentrating ability of the kidneys and the volume of urine excreted during the day is based on the results obtained from the Zimnitsky test.

An important role is also played by a biochemical blood test for electrolytes, creatinine and urea, because it is on the basis of indicators for these components that one can draw specific conclusions regarding the severity of acute renal failure, as well as how effective the methods used in treatment are.

The main task of diagnosing acute renal failure comes down to determining this form itself (that is, its specification), for which an ultrasound scan of the bladder and kidney area is performed. Based on the results of this research measure, the relevance/absence of ureteral obstruction is determined.

If necessary, to assess the state of renal blood flow, an ultrasound ultrasound procedure is performed, aimed at an appropriate study of the renal vessels. A kidney biopsy may be performed if acute glomerulonephritis, tubular necrosis, or systemic disease is suspected.

Regarding diagnostics chronic renal failure, then it uses, again, urine and blood analysis, as well as the Rehberg test. As a basis for confirming chronic renal failure, data indicating a reduced level of filtration, as well as an increase in the level of urea and creatinine, are used. In this case, performing the Zimnitsky test determines isohyposthenuria. Ultrasound of the kidney area in this situation reveals thinning of the kidney parenchyma while simultaneously decreasing in size.

Treatment

• Treatment of acute renal failure

Initial phase

First of all, the goals of therapy come down to eliminating the causes that led to disturbances in the functioning of the kidneys, that is, to treating the underlying disease that provoked acute renal failure. If shock occurs, it is urgent to ensure replenishment of blood volumes while simultaneously normalizing blood pressure. Poisoning with nephrotoxins implies the need to lavage the patient’s stomach and intestines.

Modern methods of cleansing the body of toxins have various options, and in particular - by the method of extracorporeal hemocorrection. Plasmapheresis and hemosorption are also used for this purpose. In the case of actual obstruction, the normal state of urine passage is restored, which is ensured by removing stones from the ureters and kidneys, and surgically eliminating tumors and strictures in the ureters.

Oliguric phase

Osmotic diuretics, furosemide, are prescribed as a method to stimulate diuresis. Vasoconstriction (that is, narrowing of the arteries and blood vessels) against the background of the condition in question is carried out through the administration of dopamine, in determining the appropriate volume of which not only losses from urination, bowel movements and vomiting are taken into account, but also losses from breathing and sweating. Additionally, the patient is provided with a protein-free diet with limited intake of potassium from food. Wounds are drained and areas with necrosis are eliminated. The selection of antibiotics involves taking into account the overall severity of renal damage.

Hemodialysis: indications

The use of hemodialysis is relevant if urea levels increase to 24 mol/l, as well as potassium to 7 or more mol/l. Symptoms of uremia, as well as overhydration and acidosis are used as indications for hemodialysis. Today, in order to avoid complications that arise against the background of actual disturbances in metabolic processes, hemodialysis is increasingly prescribed by specialists in the early stages, as well as for the purpose of prevention.

This method itself consists of extrarenal blood purification, which ensures the removal of toxic substances from the body while normalizing disturbances in electrolyte and water balance. To do this, the plasma is filtered using a semi-permeable membrane for this purpose, which is equipped with an “artificial kidney” apparatus.

• Treatment of chronic renal failure

With timely treatment of chronic renal failure, focused on the result in the form of stable remission, there is often the possibility of a significant slowdown in the development of processes relevant to this condition with a delay in the appearance of symptoms in its characteristic pronounced form.

Early-stage therapy is focused more on those measures that can prevent/slow down the progression of the underlying disease. Of course, the underlying disease requires treatment for disorders in the renal processes, but it is the early stage that determines the greater role for therapy aimed at it.

As active measures in the treatment of chronic renal failure, hemodialysis (chronic) and peritoneal dialysis (chronic) are used.

Chronic hemodialysis is aimed specifically at patients with this form of renal failure; we noted its general specifics somewhat above. Hospitalization is not required, but a visit to a dialysis unit in a hospital or outpatient center cannot be avoided in this case. The so-called dialysis time is defined within the standard framework (about 12-15 hours/week, that is, for 2-3 visits per week). After completing the procedure, you can go home; this procedure has virtually no effect on the quality of life.

As for peritoneal chronic dialysis, it consists of introducing a dialysate solution into the abdominal cavity through the use of a chronic peritoneal catheter. This procedure does not require any special installations; moreover, the patient can carry it out independently in any conditions. Control over general condition is performed every month upon direct visit to the dialysis center. The use of dialysis is relevant as a treatment for the period during which a kidney transplant procedure is expected.

Kidney transplantation is the procedure of replacing a diseased kidney with a healthy kidney from a donor. What is remarkable is that one healthy kidney can cope with all those functions that could not be provided by two diseased kidneys. The issue of acceptance/rejection is resolved by conducting a series of laboratory tests.

Any member of the family or environment, as well as a recently deceased person, can become a donor. In any case, the chance of the body rejecting the kidney remains even if the necessary indicators in the previously noted study are met. The likelihood of an organ being accepted for transplantation is determined by various factors (race, age, health status of the donor).

In about 80% of cases, a kidney from a deceased donor survives within a year from the date of surgery, although if we are talking about relatives, the chances of a successful outcome of the operation increase significantly.

Additionally, after kidney transplantation, immunosuppressants are prescribed, which the patient must take constantly throughout his subsequent life, although in some cases they cannot affect organ rejection. In addition, there are a number side effects from taking them, one of which is a weakening of the immune system, due to which the patient becomes especially susceptible to infectious effects.

If symptoms appear that indicate the possible relevance of renal failure in one form or another of its course, consultation with a urologist, nephrologist and attending physician is necessary.

Pay attention to changes in urinary output. Both acute and chronic forms of renal failure are often accompanied by an increase or decrease in diuresis. In particular, chronic renal failure is accompanied by urinary incontinence and/or recurrent urinary tract infections. Damage to the renal tubules leads to polyuria. Polyuria is excessive urine production that usually occurs in the early stages of kidney failure. Chronic renal failure can also cause a decrease in daily urine output, which usually occurs in more advanced forms of the disease. Other changes include the following:

• Proteinuria: In kidney failure, protein leaks into the urine. The presence of protein causes the urine to foam.
• Hematuria: Dark orange urine results from the presence of red blood cells in the urine.

Watch out for sudden feelings of tiredness. One of the first signs of chronic kidney failure is fatigue. This occurs due to anemia, when the body does not have enough oxygen-carrying red blood cells. The decrease in oxygen will make you feel tired and cold. Anemia is attributed to the fact that the kidneys produce a hormone called erythropoietin, which causes your bone marrow to produce red blood cells. But because the kidneys are damaged, they produce less of this hormone, therefore, less red blood cells are also produced.

Note swelling of body parts. Edema is an accumulation of fluid in the body, which can occur in both acute and chronic renal failure. When the kidneys stop working properly, fluid begins to accumulate in the cells, which leads to swelling. Swelling most often occurs in the hands, feet, legs and face.

Call your doctor if you experience dizziness or slow thinking. Dizziness, poor concentration, or lethargy may be caused by anemia. This is because there aren't enough blood cells getting to your brain.

Pay attention to pain in the upper back, legs, or side. Polycystic kidney disease causes fluid-filled cysts to form in the kidneys. Sometimes cysts can form in the liver. They cause severe pain. The fluid in cysts contains toxins that can damage the nerve endings in lower limbs and lead to neuropathy, dysfunction of one or more peripheral nerves. In turn, neuropathy causes pain in the lower back and legs.

Monitor for shortness of breath, bad breath, and/or a metallic taste in the mouth. As your kidneys begin to fail, metabolic waste products, most of which are acidic, will begin to accumulate in the body. The lungs will begin to compensate for this increased acidity by expelling carbon dioxide through increased breathing. This will make you feel like you can't catch your breath.

Please note if you suddenly start itching or experience dry skin. Chronic kidney failure causes pruritis (the medical term for itchy skin). This itching is caused by the accumulation of phosphorus in the blood. All foods contain some phosphorus, but some foods, such as dairy, contain more phosphorus than others. Healthy kidneys are able to filter and remove phosphorus from the body. However, with chronic renal failure, phosphorus is retained in the body and phosphorus crystals begin to form on the surface of the skin, which cause itching.

Kidney failure refers to a number of pathologies that pose a significant threat to human life. The disease leads to disruption of the water-salt and acid-base balance, which entails deviations from the norm in the functioning of all organs and tissues. As a result pathological processes in the renal tissue, the kidneys lose the ability to fully remove the products of protein metabolism, which leads to the accumulation of toxic substances in the blood and intoxication of the body.

Depending on the nature of the disease, it can be acute or chronic. The causes, treatment methods and symptoms of kidney failure for each of them have certain differences.

Causes of the disease

The causes of kidney failure are very different. For acute and chronic forms of the disease they differ significantly. Symptoms of acute renal failure (ARF) occur due to injury or significant blood loss, complications after surgical operations, acute kidney pathologies, poisoning with heavy metals, poisons or drugs and other factors. In women, the development of the disease can be triggered by childbirth or infection entering and spreading beyond the pelvic organs as a result of abortion. With acute renal failure, the functional activity of the kidneys is disrupted very quickly, there is a decrease in the glomerular filtration rate and a slowdown in the reabsorption process in the tubules.

Chronic renal failure (CRF) develops over a long period of time with a gradual increase in the severity of symptoms. Its main causes are chronic kidney, vascular or metabolic diseases, congenital abnormalities of the development or structure of the kidneys. In this case, there is a dysfunction of the organ for removing water and toxic compounds, which leads to intoxication and generally causes disruption of the body.

Tip: Subject to availability chronic diseases kidneys or other factors that can provoke kidney failure, you should be especially careful about your health. Regular visits to a nephrologist, timely diagnosis and compliance with all doctor’s recommendations are of great importance to prevent the development of this serious disease.

Characteristic symptoms of the disease

Signs of renal failure in the case of acute form appear sharply and have a pronounced character. At chronic version In the first stages of the disease, symptoms may be unnoticeable, but with the gradual progression of pathological changes in the kidney tissue, their manifestations become more intense.

Symptoms of acute renal failure

Clinical signs of acute renal failure develop over a period of a couple of hours to several days, sometimes weeks. These include:

• a sharp decrease or absence of diuresis;
• increased body weight due to excess fluid in the body;
• the presence of swelling, mainly in the ankles and face;
• loss of appetite, vomiting, nausea;
• pallor and itching of the skin;
• feeling tired, headaches;
• excretion of bloody urine.

In the absence of timely or inadequate treatment, shortness of breath, cough, confusion and even loss of consciousness, muscle spasms, arrhythmia, bruising and subcutaneous hemorrhages appear. This condition can be fatal.

Symptoms of chronic renal failure

The period of development of chronic renal failure until the moment of manifestation characteristic symptoms, when significant irreversible changes have already occurred in the kidneys, can range from several to tens of years. Patients with this diagnosis experience:

• impaired diuresis in the form of oliguria or polyuria;
• violation of the ratio of night and daytime diuresis;
• the presence of swelling, mainly on the face, after a night's sleep;
• increased fatigue, weakness.

The last stages of chronic renal failure are characterized by the appearance of massive edema, shortness of breath, cough, high blood pressure, blurred vision, anemia, nausea, vomiting and other severe symptoms.

Important: If you notice symptoms indicating kidney problems, you should consult a specialist as soon as possible. The course of the disease has a more favorable prognosis if therapy is started in a timely manner.

Fatigue and headache may be due to renal failure

Treatment of the disease

In case of renal failure, treatment should be comprehensive and aimed primarily at eliminating or controlling the cause that provoked its development. The acute form of renal failure, unlike the chronic form, responds well to treatment. Properly selected and timely therapy makes it possible to almost completely restore kidney function. To eliminate the cause and treat acute renal failure, the following methods are used:

• taking antibacterial drugs;
• detoxification of the body using hemodialysis, plasmaphoresis, enterosorbents, etc.;
• fluid replenishment in case of dehydration;
• restoration of normal diuresis;
• symptomatic treatment.

Treatment for chronic renal failure includes:

• control of the underlying disease (hypertension, diabetes, etc.);
• maintaining kidney function;
• elimination of symptoms;
• detoxification of the body;
• following a special diet.

On last stage Chronic renal failure patients are advised to undergo regular hemodialysis or a donor kidney transplant. Such treatment methods are the only way to prevent or significantly delay death.

Hemodialysis is a method of purifying blood from electrolytes and toxic metabolic products

Nutritional considerations in the presence of renal failure

A special diet for kidney failure helps reduce the load on the kidneys and stop the progression of the disease. Its main principle is to limit the amount of protein, salt and liquid consumed, which leads to a decrease in the concentration of toxic substances in the blood and prevents the accumulation of water and salts in the body. The severity of the diet is determined by the attending physician, taking into account the patient’s condition. The basic rules of nutrition for kidney failure are as follows:

• limiting the amount of protein (from 20 g to 70 g per day, depending on the severity of the disease);
• high energy value of food (vegetable fats, carbohydrates);
• high content of vegetables and fruits in the diet;
• control of the amount of total fluid consumed, calculated from the volume of urine excreted per day;
• limiting salt intake (from 1 g to 6 g, depending on the severity of the disease);
• fasting days at least once a week, consisting of eating only vegetables and fruits;
• steam cooking method (or cooking);
• fractional diet.

In addition, foods that cause kidney irritation are completely excluded from the diet. These include coffee, chocolate, strong black tea, cocoa, mushrooms, spicy and salty foods, fatty meat or fish and broths based on them, smoked meats, and alcohol.

Diet is a very important element in the treatment of kidney failure

Traditional methods of treatment

Treatment for kidney failure folk remedies on early stages gives a good effect. The use of infusions and decoctions of medicinal plants that have a diuretic effect helps reduce swelling and remove toxins from the body. For this purpose, birch buds, rose hips, chamomile and calendula flowers, burdock root, dill and flax seeds, lingonberry leaves, horsetail grass, etc. are used. From the listed plants, you can make various infusions and use them to prepare kidney teas.

In case of kidney failure, drinking pomegranate juice and decoction of pomegranate peel, which has a general strengthening effect and improves immunity, also gives a good effect. The presence of seaweed in the diet helps improve kidney function and promote the elimination of metabolic products.

Advice: The use of traditional methods of treatment for renal failure must be agreed with the attending physician.