To identify kidney problems and choice of treatment tactics for chronic renal failure the doctor will conduct a whole range of diagnostic studies. Among all examination methods, one of the most important is the determination of the level of nitrogen compounds in the blood. By the amount of nitrogen-containing waste that must be eliminated from the body through the urinary tract, one can determine with high certainty the degree of violation renal functions. Determining the stages of chronic renal failure by creatinine concentration is very indicative and highly informative, therefore it is widely used in complex diagnostics renal failure.
Variants of nitrogenous slags
The urinary function of the kidneys ensures the constant removal from the human body of harmful substances and toxic compounds that are formed in the process of life. If this does not happen, then gradual poisoning occurs with disruption of the functioning of all organs and systems. Some unnecessary substances are very difficult to identify, while others are quite simple. One of the main diagnostic criteria for identifying chronic renal failure are nitrogen-containing wastes, which include:
- residual nitrogen;
- urea;
- uric acid;
- creatinine
Of these biochemical compounds, the last one is most indicative for the diagnosis of chronic renal failure: based on the concentration of creatinine, one can confidently determine the stage of the disease. The levels of other nitrogenous wastes are ineffective and do not affect the determination of the stage of chronic renal failure. However, urea and residual nitrogen concentrations can help diagnose renal failure.
Azotemia
When treating chronic renal failure, the doctor will dynamically determine the level of azotemia, a significant increase in which occurs when the condition worsens or when there is no effect from therapeutic measures. Blood creatinine concentration is the most specific finding, but it is advisable to consider urea and uric acid levels. Sometimes determining the cause of the disease depends on this.
With high blood urea levels and normal values creatinine level, the doctor will look for conditions that are not associated with renal pathology:
- excessive consumption of protein foods;
- severe malnutrition and hunger;
- severe loss of fluid from the body;
- excess metabolic processes.
If all nitrogen-containing compounds increase simultaneously, then we can confidently speak of chronic renal failure.
Classifications of chronic renal failure
Quite a few types of classification of chronic renal failure have been proposed, in which different indicators are taken into account. Among laboratory classifications, doctors widely and actively use the following 2 options:
- By degree of reduction glomerular filtration.
- Initial. The reduction in the cleansing capacity of the kidneys reaches almost 50% of normal values.
- Conservative. Renal cleansing deteriorates significantly and is only 20-50% of what is required.
- Terminal. The filtration capacity of the kidney parenchyma drops to less than 20%, reaching extremely low levels in the worst case.
- Based on the concentration of blood creatinine (at a norm of 0.13 mmol/l).
- latent or reversible stage (nitrogen compound level ranges from 0.14 to 0.71);
- azotemic or stable (creatinine level from 0.72 to 1.24);
- uremic or progressive stage (if the value exceeds 1.25 mmol/l).
In each classification, all stages are divided into phases, which are used to select the most effective methods therapy. Both for diagnosis and for monitoring the treatment of chronic renal failure, it is best to use biochemical studies to identify the characteristics of nitrogen metabolism.
Treatment of chronic renal failure based on creatinine levels
One of the most important areas of treatment for chronic renal failure is the correction of azotemia: it is necessary to improve filtration capacity renal parenchyma to waste and harmful substances were removed from the body. In addition, a decrease in the level of nitrogen compounds in the blood can be achieved using following methods treatment:
- Diet therapy.
At minimum concentrations creatinine in the latent stage of chronic renal failure, it is necessary to use a diet with a moderate protein content. It is advisable to consume vegetable protein, giving preference to soy and avoiding meat and fish. It is necessary to maintain normal calorie content of food to maintain energy expenditure.
In the azotemic and uremic stages of chronic renal failure, a significant reduction in protein foods and dietary restrictions on phosphorus and potassium are shown. To maintain the level of vital amino acids, the doctor will prescribe special medications. Be sure to exclude the following products:
- mushrooms;
- legumes and nuts;
- White bread;
- milk;
- chocolate and cocoa.
- Detoxification.
Purification of blood from nitrogenous compounds is achieved with the help of intravenous administration solutions that help bind and remove harmful substances that accumulate in vascular bed. Typically, sorbent solutions and preparations of calcium salts (carbonate) are used. However, if therapy for chronic renal failure does not bring the desired effect (which will be evident from the level of azotemia), then replacement methods of treatment must be used.
- Hemodialysis.
An important criterion for starting blood purification by dialysis is the concentration of nitrogen compounds. Against the background of concomitant serious illnesses ( diabetes, arterial hypertension), hemodialysis can be started at stage 2, when the creatinine level exceeds 0.71 mmol/l. However, the typical indication for dialysis is stage 3 with severe azotemia.
After each session, blood purification must be carried out diagnostic studies, which determines indicators such as:
- general clinical urine and blood tests;
- assessment of the level of azotemia by creatinine and urea 1 hour after the end of the hemodialysis session;
- determination of minerals (calcium, sodium, phosphorus) in the blood after hardware purification.
- Treatment of concomitant diseases.
Improving the general condition of the body with correction pathological changes will help restore the processes of removing nitrogenous compounds. Sometimes it is the harmful substances that accumulate in the blood during chronic renal failure that contribute to the following problems:
- anemia;
- erosive gastritis;
- diseases of joints and bones;
- accumulation of phosphate compounds with an increased risk of urolithiasis.
All variants of pathologies detected in chronic renal failure require a course of therapy taking into account the capabilities of the kidneys. Do not use drugs that have even minimal nephrotoxic effects. Treatment should be carried out in a hospital setting under the constant supervision of a physician with regular monitoring of laboratory parameters. An important factor therapy will be sugar correction and blood pressure in people with diabetes, obesity and hypertension.
Among all the classifications used for the diagnosis and treatment of chronic renal failure, one of the optimal, quite simple and informative ones is determining the stage of the disease by the level of azotemia. IN biochemical analysis blood concentrations of creatinine and urea are most indicative for assessing the urinary function of the kidneys and for monitoring during course treatment of chronic renal failure. Assessment of azotemia is almost always used with any method replacement therapy carried out in the hemodialysis department. The best option for predicting future complications is dynamic monitoring of the concentration of nitrogen-containing compounds in the blood. That is why the doctor will use lab tests with mandatory determination of creatinine concentration.
According to the clinical course, acute and chronic renal failure are distinguished.
Acute renal failure
Acute renal failure develops suddenly, as a consequence of acute (but most often reversible) damage to the kidney tissue, and is characterized by a sharp drop in the amount of urine excreted (oliguria) to its complete absence (anuria).
Causes of acute renal failure
Symptoms of acute renal failure
- small amounts of urine (oliguria);
- complete absence(anuria).
The patient's condition worsens, this is accompanied by nausea, vomiting, diarrhea, lack of appetite, swelling of the extremities occurs, and the liver increases in volume. The patient may be inhibited or, on the contrary, agitation may occur.
IN clinical course There are several stages of acute renal failure:
Stage I- initial (symptoms caused by the direct impact of the cause that caused acute renal failure), lasting from the moment of exposure to the main cause until the first symptoms of the kidneys have a different duration (from several hours to several days). Intoxication may appear (pallor, nausea,);
Stage II- oligoanuric (the main symptom is oliguria or complete anuria, severe general state patient, the emergence and rapid accumulation of urea and other end products of protein metabolism in the blood, causing self-poisoning of the body, manifested by lethargy, adynamia, drowsiness, diarrhea, arterial hypertension, tachycardia, body edema, anemia, and one of characteristic features are progressively increasing azotemia - increased levels of nitrogenous (protein) metabolic products in the blood and severe intoxication of the body);
Stage III- restorative:
- early diuresis phase - the clinic is the same as in stage II;
- phase of polyuria (increased urine production) and restoration of the concentrating ability of the kidneys - renal functions are normalized, respiratory and cardiovascular systems, digestive canal, support and movement apparatus, central nervous system; the stage lasts about two weeks;
IV stage- recovery - anatomical and functional restoration of renal activity to initial parameters. It can take many months, sometimes it takes up to one year.
Chronic renal failure
Chronic renal failure is a gradual decline in kidney function until it disappears completely, caused by the gradual death of kidney tissue as a result of chronic kidney disease, the gradual replacement of kidney tissue connective tissue and kidney shrinkage.
Chronic renal failure occurs in 200-500 out of every million people. Currently, the number of patients with chronic renal failure is increasing annually by 10-12%.
Causes of chronic renal failure
Chronic renal failure can be caused by various diseases, which lead to damage to the renal glomeruli. This:
- kidney diseases chronic glomerulonephritis, chronic pyelonephritis;
- metabolic diseases diabetes mellitus, gout, amyloidosis;
- congenital diseases polycystic kidney disease, underdevelopment of the kidneys, congenital narrowing renal arteries;
- rheumatic diseases, scleroderma, hemorrhagic vasculitis;
- vascular diseases arterial hypertension, diseases leading to impaired renal blood flow;
- diseases leading to disruption of the outflow of urine from the kidneys urolithiasis disease, hydronephrosis, tumors leading to gradual compression of the urinary tract.
The most common causes of chronic renal failure are chronic glomerulonephritis, chronic pyelonephritis, diabetes mellitus and congenital anomalies of kidney development.
Symptoms of chronic renal failure
There are four stages of chronic renal failure.
- Latent stage. At this stage, the patient may not have any complaints, or fatigue during physical activity, weakness that appears in the evening, and dry mouth may occur. A biochemical blood test reveals slight disturbances in the electrolyte composition of the blood, sometimes protein in the urine.
- Compensated stage. At this stage, the patients’ complaints are the same, but they occur more often. This is accompanied by an increase in urine output to 2.5 liters per day. Changes are detected in the biochemical parameters of blood and in.
- Intermittent stage. Kidney function is further reduced. There is a persistent increase in the blood products of nitrogen metabolism (protein metabolism), an increase in the level of urea and creatinine. The patient experiences general weakness, fast fatiguability, thirst, dry mouth, appetite decreases sharply, note bad taste in the mouth, nausea and vomiting appear. The skin acquires a yellowish tint, becomes dry and flabby. Muscles lose tone, small muscle twitching, tremors of fingers and hands are observed. Sometimes there is pain in the bones and joints. The patient may have a much more severe course of common respiratory diseases, sore throats, and pharyngitis.
During this stage, periods of improvement and deterioration in the patient's condition may be expressed. Conservative (without surgical intervention) therapy makes it possible to regulate homeostasis, and the general condition of the patient often allows him to still work, but an increase physical activity, mental stress, errors in diet, restriction of drinking, infection, surgery can lead to deterioration of kidney function and aggravation of symptoms.
- Terminal (final) stage. This stage is characterized by emotional lability(apathy gives way to excitement), night sleep disturbance, daytime sleepiness, lethargy and inappropriate behavior. The face is puffy, gray-yellow, itchy skin, there are scratches on the skin, the hair is dull and brittle. Dystrophy increases, hypothermia is characteristic ( low temperature body). No appetite. The voice is hoarse. There is an ammonia smell from the mouth. Arises aphthous stomatitis. The tongue is coated, the abdomen is swollen, vomiting and regurgitation are often repeated. Often - diarrhea, foul-smelling, dark-colored stools. The filtration capacity of the kidneys drops to a minimum.
The patient may feel satisfactory for several years, but at this stage the amount of urea, creatinine, and uric acid in the blood is constantly increased, and the electrolyte composition of the blood is disturbed. All this causes uremic intoxication or uremia (uremia urine in the blood). The amount of urine excreted per day decreases until it is completely absent. Other organs are affected. Cardiac muscle dystrophy, pericarditis, circulatory failure, and pulmonary edema occur. Violations by nervous system manifested by symptoms of encephalopathy (sleep disturbance, memory, mood, the occurrence of depressive states). The production of hormones is disrupted, changes occur in the blood coagulation system, and immunity is impaired. All these changes are irreversible. Nitrogenous waste products are excreted in sweat, and the patient constantly smells of urine.
Prevention of kidney failure
Prevention of acute renal failure comes down to preventing the causes that cause it.
Prevention of chronic renal failure comes down to treatment of such chronic diseases as: pyelonephritis, glomerulonephritis, urolithiasis disease.
Forecast
With timely and correct use With adequate treatment methods, most patients with acute renal failure recover and return to normal life.
Acute renal failure is reversible: the kidneys, unlike most organs, are able to restore completely lost function. However, acute renal failure is an extremely severe complication many diseases, often foreshadowing death.
However, in some patients, the decrease in glomerular filtration and concentrating ability of the kidneys remains, and in some, renal failure occurs chronic course, important role At the same time, associated pyelonephritis plays a role.
In advanced cases, death in acute renal failure most often occurs from uremic coma, hemodynamic disorders and sepsis.
Chronic renal failure should be monitored and treatment initiated at early stages disease, otherwise it may lead to complete loss of renal function and require a kidney transplant.
What can you do?
The main task of the patient is to notice in time the changes that occur to him both in terms of his general well-being and in the amount of urine, and consult a doctor for help. Patients with a confirmed diagnosis of pyelonephritis, glomerulonephritis, congenital anomalies kidneys, systemic disease, should be regularly monitored by a nephrologist.
And, of course, you must strictly follow the doctor’s instructions.
What can a doctor do?
The doctor will first determine the cause of kidney failure and the stage of the disease. After which all necessary measures will be taken to treat and care for the patient.
Treatment of acute renal failure is aimed primarily at eliminating the cause that causes this state. Measures to combat shock, dehydration, hemolysis, intoxication, etc. are applicable. Patients with acute renal failure are transferred to intensive care unit where they get the help they need.
Treatment of chronic renal failure is inseparable from treatment of the kidney disease that led to kidney failure.
Kidneys - organ human body, one of the components of the urinary system. The process of filtration and secretion takes place here.
In addition to the formation of primary and secondary urine, the kidneys are involved in hematopoiesis. Malfunction of at least one of them leads to serious problems homeostasis, significantly affects a person’s quality of life, causing severe pain.
Chronic renal failure (CRF) is a condition of extreme severity in which kidney function partially stops. In rare cases, the paired organ fails completely.
Negligence in treatment leads to the appearance of the disease renal pathologies. CRF develops as a consequence of a poorly treated disease genitourinary system. This pathology of the urinary system develops slowly and goes through several stages:
- hidden;
- early;
- average;
- heavy;
- terminal.
Reveal this complication possible by carrying out appropriate laboratory or instrumental studies. In all cases, tests are prescribed to make a specific diagnosis and diagnostic accuracy.
The first, the most important analysis– determination of the amount of nitrogenous compounds in the body. Their content clearly shows the presence of a lesion and its degree. The stages of chronic renal failure are usually determined by the element creatinine.
Creatinine is a component found in plasma. He takes part in metabolic processes, then excreted in the urine as a toxin. An increased level in the blood is a sign of chronic renal failure, and the stage is determined by the quantitative indicator. This effective way, widely used in practice.
Classification can occur not only by stages, but also by the degree of damage to the nephrons:
- partial;
- total;
- terminal.
The types of injuries can be different, the doctor’s task is to correctly diagnose and prescribe productive treatment. Having characterized the patient’s condition as fully as possible, the attending physician draws up a further plan of action.
Detection of the disease in the early stages is the key to high-quality and productive treatment. If you do not pay proper attention to the symptoms of kidney disease, over time the situation becomes critical. The most common complications: anemia, metabolic and excretory disorders, uncontrolled urination, arterial hypertension, heart failure.
In addition to creatinine, uric acid is a waste product, which is normally excreted in the urine. In addition to chronic renal failure, increased level its content indicates diseases such as diabetes, gout, and problems of the cardiovascular system.
Classification of chronic renal failure according to Ryabov
For better treatment of chronic renal failure, it is customary to distinguish its types and degrees and classify it. The classification according to S.I. Ryabov is most widespread in the post-Soviet space. The system he developed is based on GFR (glomerular filtration rate) and creatinine levels.
For comparison, the classification of A. Yu. Nikolaev and Yu. S. Milovanov takes into account only the creatinine content and identifies the initial, conservative, terminal stage of chronic renal failure.
Determination of the stage of renal failure by creatinine has been possible for several decades in medical practice This is the method that was used.
The Ryabov classification is more accurate, because it includes several indicators and gives a more complete picture of the course of the disease.
|
Phase |
Creatinine | SCF |
|
First stage - Latent |
||
| Phase A | norm |
norm |
| Phase B | Increase to 0.13 mmol/l | Reduction by no less than 50% |
|
Second stage - Azothermic |
||
| Phase A | 0.14-0.44 mmol/l |
20-50% |
|
Phase B |
0.45-0.71 mmol/l |
10-20% |
|
Third stage - Uremic |
||
| Phase A | 0.72-1.24 mmol/l |
5-10% |
| Phase B | 1.25 and> mmol/l |
< 5% |
The modern method for determining chronic renal failure is based on the detection of several substances in the blood, the determination of the level of which excludes medical error. Nitrogen compounds must be eliminated during kidney function.
Their presence, combination and high concentration are a 100% sign of damage to the organs of the urinary system and the development of necrosis of kidney tissue. All these problems lead to the development of chronic renal failure.
Stages depending on the degree of GFR
CRF is a long process that develops slowly, passing through stages, each of which has its own characteristics and specific characteristics. Based on the level of GFR, four stages of the disease are distinguished.
The first is the latent stage. This is a reversible process when tissue damage has just begun to develop. Detection of the disease at this stage would have a beneficial effect on the course of treatment. However, due to vaguely expressed symptoms, patients often do not pay attention to them and do not go to the doctor for help.
Kidney function is not impaired, the person is not bothered by pain or discomfort, and there are no specific signs. Considering that chronic renal failure develops against the background of existing pathology, all symptoms can be attributed to an already identified disease.
The test results do not show significant deviations from the norm, but even exceeding the norm by 0.1% can alert the doctor, and he will prescribe additional examinations.
The second is the compensated stage. This stage of the disease has clearly defined symptoms. Tests show a specific excess of the norm, the doctor is able to accurately determine the diagnosis and tell the stage.
The lack of kidney function is partially compensated by the work of other organs and systems. Basic functions are performed, so the patient may not experience specific disruptions.
The doctor will notice a characteristic decrease in the filtration rate, which clearly indicates the presence of pathology.
Diagnosis at this stage will help stop the development and prevent the worsening of the pathology. Obvious symptoms are a violation of homeostasis (changes in body temperature and blood pressure), constant thirst And frequent urge to urination.
The third is the intermittent stage. It is characterized by a more pronounced deviation of test results from the norm. There is increased urine production and a constant urge to go to the toilet. Nocturnal diuresis predominates, the patient has to constantly interrupt sleep to urinate. Cases of incontinence may occur.
In addition to the kidneys, other organs of the genitourinary system also suffer, for example, damage to the tubules appears. Due to weakened immunity, the patient becomes more susceptible to viruses and infections.
The general condition worsens, weakness and fatigue appear. Impaired kidney function has external manifestations: the skin becomes pale and acquires a yellowish tint.
The fourth is end-stage renal failure. The most complex and difficult stage, which is practically impossible to treat.
There is no need to talk about assessing the condition of the kidneys, because at the terminal stage in most cases they fail completely. There are significant deviations in GFR indicators,<15 мл/мин. Этот критический показатель сопровождается четкими симптомами, постоянно беспокоящими пациента.
The functioning of most organs is disrupted. Changes in metabolism reach a critical level. The risk of death is enormous; urgent medical intervention is required. An increased level of creatinine and a decrease in GFR lead to severe intoxication of the body.
Treatment of chronic renal failure
Determining the course of treatment is always based on the results of tests and studies. In each individual case, the attending doctor prescribes specific treatment to stop the development of the disease, completely restore the functionality of vital organs, and normalize metabolism.
The primary task is to restore normal blood supply to the affected kidney (or two) and correct azotemia. The increased content of nitrogenous compounds and waste in the blood must be quickly eliminated, then the natural filtration rate in the kidneys must be restored so that harmful substances are quickly eliminated from the body.
Treatment methods primarily depend on the stages of the disease. Different levels of creatinine require appropriate therapy. All symptoms must be carefully checked, and taking them into account, treatment for chronic renal failure is prescribed. All efforts are directed towards eliminating the cause of chronic insufficiency.
Traditionally, several methods have been used to treat chronic renal failure.
Diet
Diet for illness is mandatory. Correction of nutrition is the most important point on the path to recovery. A balanced diet will promote the correct action of medications.
Reduce your consumption of protein-containing foods to a minimum. The more serious the degree of pathology, the less animal proteins should enter the body. Preference is given to vegetable proteins.
If you have chronic renal failure, you are not allowed to eat foods that contain phosphorus. Beans, mushrooms, milk, nuts, rice, cocoa should be completely excluded. It is necessary to completely exclude bread from the diet. You will have to give up both white and black bread.
Due to problems with urination, a personal water consumption regimen is introduced. It is recommended to keep a diary in which you note your diet. This is necessary for the correct accounting of all elements entering the body. The egg-potato diet is often used. But its use is possible only with the permission of the doctor.
Keep in mind that all methods are purely individual, prescribed by a doctor for each patient, and diet is no exception.
Detoxification
The patient is injected intravenously with a special solution that promotes detoxification. Harmful substances are bound and excreted from the body along with urine, as this should happen normally.
In this way, the blood is cleansed, the content of nitrogenous compounds and wastes is reduced, which is reflected in the test results. The solution is selected individually, most often it is preparations of calcium salts.
The introduction of the solution is not used as an independent method, only in combination with others. Depending on the degree of damage, the method that will be effective at this stage of the disease is selected. If there is no desired effect, replacement therapy and other methods are used.
Hemodialysis
Hemodialysis is the purification of blood without the participation of the kidneys. This extrarenal cleansing is carried out with a special device to eliminate excess toxic elements that poison the body. It is necessarily prescribed at stages 3 and 4 of chronic renal failure, at stages 2 and 1 - if necessary, at the discretion of the doctor. If the situation is not critical, then hemodialysis is not used.
Since the kidneys do not perform their direct function of filtering and purifying the blood, and a person does not have another organ that could perform this task, one has to turn to devices.
The principle of operation is that blood is passed through the artificial kidney apparatus. Passing through a special membrane, the blood gives excess water and waste products to the dialyzer.
After each procedure, tests are taken to confirm a positive result: the level of electrolytes, urea, and creatinine decreases. Dialysis is carried out periodically, so the results can only be considered intermediate.
However, the patient feels better after getting rid of the toxic elements in his blood. The doctor will prescribe a further course based on the patient’s general condition and recovery progress.
Treatment of existing concomitant diseases
Considering that chronic renal failure does not exist on its own, but is a consequence of other kidney diseases, the doctor’s actions should not be aimed solely at eliminating chronic renal failure.
An important stage of treatment is the fight against the underlying disease. In addition, chronic renal failure affects not only the urinary system, but also the entire body as a whole. Other organs also suffer during the development of the disease, so it is necessary to increase immunity and restore the balance of substances in the blood.
Kidney transplant
An extreme measure and extremely expensive, which only a few resort to. This is a radical solution that turns out to be truly effective. There is a risk that the new organ will not take root and will be rejected, so it is rarely transplanted.
Don't forget about preventative measures as well. Give up bad habits that adversely affect the condition of the body in general and the kidneys in particular, adjust your diet once and for all so that there is no relapse and no complications arise. Be regularly examined by a urologist so that in case of an exacerbation, you can react in time and take appropriate measures.
Forecast
When such a serious illness is discovered, the question naturally arises of how long people live with it. The answer is simple: it all depends on at what stage of development of the disease it is detected. If it was possible to stop the disorders in the early stages, then the patient will live happily ever after.
But in cases where the patient ignores obvious symptoms and seeks help only in the later stages, there is less chance of further life. The fourth stage in most cases ends with immediate death.
The transition from stage to stage is quite slow, but the specific period depends on the characteristics of the human body. It takes approximately 3 months from the onset of the first chronic renal failure to death.
All cases are considered individually, and forecasts are made individually for each. Every little detail plays a role: age, health status, the presence of other pathologies. The worst-case scenario is a person’s gradual decline, disability, and then death.
For a faster recovery and a longer life, it is important to follow all the doctor’s recommendations.
Self-discipline and following the established course are 90% of success in treatment. From time to time, the doctor checks the dynamics of recovery, and if the patient fulfills all the instructions, then he manages to win the battle with the disease.
Kidney failure- a pathological condition that occurs in various diseases and is characterized by a violation of all kidney functions.
The kidney is an organ of the urinary system. Its main function is the formation of urine. 
It goes like this:
- Blood entering the kidney vessels from the aorta reaches the glomerulus from the capillaries, surrounded by a special capsule (Shumlyansky-Bowman capsule). Under high pressure, the liquid part of the blood (plasma) with substances dissolved in it seeps into the capsule. This is how primary urine is formed.
- Primary urine then moves through the convoluted tubule system. Here, water and substances necessary for the body are absorbed back into the blood. Secondary urine is formed. Compared to the primary one, it loses in volume and becomes more concentrated, only harmful metabolic products remain in it: creatine, urea, uric acid.
- From the tubular system, secondary urine enters the renal calyces, then into the pelvis and into the ureter.
- Excretion of harmful metabolic products from the body.
- Regulation of blood osmotic pressure.
- Hormone production. For example, renin, which is involved in the regulation of blood pressure.
- Regulation of the content of various ions in the blood.
- Participation in hematopoiesis. The kidneys secrete the biologically active substance erythropoietin, which activates the formation of erythrocytes (red blood cells).
Causes of kidney failure
Causes of acute renal failure
Classification of acute renal failure, depending on the causes:- Prerenal. Caused by impaired renal blood flow. The kidney does not receive enough blood. As a result, the process of urine formation is disrupted, and pathological changes occur in the kidney tissue. Occurs in approximately half (55%) of patients.
- Renal. Associated with pathology of renal tissue. The kidney receives enough blood, but cannot produce urine. Occurs in 40% of patients.
- Postrenal. Urine is produced in the kidneys, but cannot flow out due to an obstruction in the urethra. If an obstruction occurs in one ureter, the function of the affected kidney will be taken over by the healthy one - renal failure will not occur. This condition occurs in 5% of patients.
In the picture: A - prerenal renal failure; B - postrenal renal failure; C - renal renal failure.Causes of acute renal failure:
| Prerenal |
|
| Renal |
|
| Postrenal |
|
Causes of chronic renal failure
Symptoms of kidney failure
Symptoms of acute renal failure
Symptoms of acute renal failure depend on the stage:- initial stage;
- stage of decrease in daily urine volume to less than 400 ml (oliguric stage);
- stage of restoration of urine volume (polyuric stage);
- full recovery stage.
| Stage | Symptoms |
| Initial | At this stage, there is no renal failure as such yet. The person is concerned about the symptoms of the underlying disease. But disturbances in the kidney tissue are already occurring. |
| Oliguric | Renal dysfunction increases and the amount of urine decreases. Due to this, harmful metabolic products are retained in the body, and disturbances in the water-salt balance occur. Symptoms:
|
| Polyuric | The patient's condition returns to normal, the amount of urine increases, usually even more than normal. At this stage, dehydration and infections may develop. |
| Full recovery | Final restoration of kidney function. Usually lasts from 6 to 12 months. If during acute renal failure a large part of the kidney tissue was turned off, then complete recovery is impossible. |
Symptoms of chronic renal failure
- At the initial stage, chronic renal failure has no manifestations. The patient feels relatively normal. Typically, the first symptoms appear when 80%-90% of the kidney tissue ceases to perform its functions. But before this time, a diagnosis can be made if an examination is carried out.
- Usually the first to appear are general symptoms: lethargy, weakness, increased fatigue, frequent malaise.
- Urine excretion is impaired. More of it is produced per day than it should be (2-4 liters). Because of this, dehydration may develop. There is frequent urination at night. In the later stages of chronic renal failure, the amount of urine decreases sharply - this is a bad sign.
- Nausea and vomiting.
- Muscle twitching.
- Skin itching.
- Dryness and bitter feeling in the mouth.
- Stomach ache.
- Diarrhea.
- Nose and stomach bleeding due to decreased blood clotting.
- Hemorrhages on the skin.
- Increased susceptibility to infections. Such patients often suffer from respiratory infections, pneumonia.
- At a late stage: the condition worsens. Attacks of shortness of breath and bronchial asthma occur. The patient may lose consciousness or fall into a coma.
Diagnosis of kidney failure
| Diagnostic method | Acute renal failure | Chronic renal failure |
| General urine analysis | A general urine test for acute and chronic renal failure can reveal:
 |
|
| Bacteriological examination of urine | If the renal dysfunction was caused by an infection, the pathogen will be detected during the study. This analysis also makes it possible to identify an infection that has occurred against the background of renal failure and determine the sensitivity of the pathogen to antibacterial drugs.  |
|
| General blood analysis | In acute and chronic renal failure, changes in the general blood test are revealed:
 |
|
| Blood chemistry | Helps evaluate pathological changes in the body caused by impaired renal function. In a biochemical blood test in acute renal failure, changes can be detected:
| In chronic renal failure, biochemical blood tests usually reveal changes:
|
| These methods allow you to examine the kidneys, their internal structure, renal calyces, pelvis, ureters, and bladder. In acute renal failure, CT, MRI and ultrasound are most often used to find the cause of narrowing of the urinary tract.  |
|
| Doppler ultrasound | Ultrasound examination, during which you can evaluate the blood flow in the vessels of the kidneys. | |
| Chest X-ray | It is used to identify disorders of the respiratory system and some diseases that may cause renal failure.
|
|
| Chromocystoscopy |
| |
| Kidney biopsy | The doctor obtains a piece of kidney tissue and sends it to the laboratory for examination under a microscope. Most often this is done using a special thick needle, which the doctor inserts into the kidney through the skin. Biopsy is resorted to in doubtful cases when it is not possible to establish a diagnosis.
|
|
| Electrocardiography (ECG) | This study is mandatory for all patients with acute renal failure. It helps to identify heart problems and arrhythmias.  |
|
| Zimnitsky test | The patient collects all urine during the day into 8 containers (each for 3 hours). Determine its density and volume. The doctor can evaluate the state of kidney function and the ratio of daytime and nighttime urine volumes. | |
Treatment of kidney failure
Acute renal failure requires immediate hospitalization of the patient in a nephrology hospital. If the patient is in serious condition, he is placed in the intensive care unit. Therapy depends on the causes of renal dysfunction. For chronic renal failure, therapy depends on the stage. At the initial stage, treatment of the underlying disease is carried out - this will help prevent severe renal dysfunction and make it easier to cope with them later. When the amount of urine decreases and signs of renal failure appear, it is necessary to combat pathological changes in the body. And during the recovery period, you need to eliminate the consequences.
Directions for treatment for renal failure:
| Direction of treatment | Events |
| Eliminating the causes of prerenal acute renal failure. |
|
| Eliminating the causes of renal acute renal failure |
|
| Eliminating the causes of postrenal acute renal failure | It is necessary to remove the obstacle that interferes with the outflow of urine (tumor, stone, etc.). Most often, this requires surgical intervention. |
| Eliminating the causes of chronic renal failure | Depends on the underlying disease. |
| Measures to combat disorders that occur in the body during acute renal failure |
|
| Elimination of water-salt imbalances |
|
| Fighting blood acidification | The doctor prescribes treatment when the acidity (pH) of the blood drops below the critical value of 7.2. A sodium bicarbonate solution is injected intravenously until its concentration in the blood rises to certain values and the pH rises to 7.35. |
| Fighting Anemia | If the level of red blood cells and hemoglobin in the blood decreases, the doctor prescribes blood transfusions and epoetin (a drug that is an analogue of the kidney hormone erythropoietin and activates hematopoiesis). |
| Hemodialysis, peritoneal dialysis | Hemodialysis and peritoneal dialysis are methods of purifying the blood of various toxins and unwanted substances. Indications for acute renal failure:
In peritoneal dialysis, a blood purification solution is injected into the abdominal cavity. As a result of the difference in osmotic pressure, it absorbs harmful substances. It is then removed from the abdomen or replaced with a new one.
|
| Kidney transplant | Kidney transplantation is carried out in case of chronic renal failure, when severe disorders occur in the patient’s body, and it becomes clear that it will not be possible to help the patient in other ways. The kidney is taken from a living donor or a cadaver. After the transplant, a course of therapy with drugs that suppress the immune system is administered to prevent rejection of the donor tissue.
|
Diet for acute renal failure
Prognosis for renal failure
Prognosis for acute renal failure
Depending on the severity of acute renal failure and the presence of complications, from 25% to 50% of patients die.The most common causes of death:
- Damage to the nervous system - uremic coma.
- Severe circulatory disorders.
- Sepsis is a generalized infection, “blood poisoning”, in which all organs and systems are affected.
Prognosis for chronic renal failure
Depends on the disease against which the kidney function was impaired, the age, and the condition of the patient’s body. Since hemodialysis and kidney transplantation began to be used, patient deaths have become less frequent.Factors that worsen the course of chronic renal failure:
- arterial hypertension;
- incorrect diet when food contains a lot of phosphorus and protein;
- high protein content in the blood;
- increased function of the parathyroid glands.
- kidney injury;
- urinary tract infection;
- dehydration.
Prevention of chronic renal failure
If proper treatment of a disease that can lead to chronic renal failure is started in a timely manner, then kidney function may not be affected or, at least, its impairment will not be as severe.Some drugs are toxic to kidney tissue and can lead to chronic renal failure. You should not take any medications without a doctor's prescription.
Most often, kidney failure develops in people suffering from diabetes, glomerulonephritis, and arterial hypertension. Such patients need to be constantly monitored by a doctor and undergo timely examinations.
Chronic renal failure (CRF) is a condition in which gradual decline occurs due to the death of nephrons.
The causes of this pathological process are directly related to chronic kidney disease. CRF is characterized by a gradual and irreversible impairment of the main functions of the kidneys - excretory and filtration.
Its result is the complete cessation of kidney function due to the death of healthy kidney tissue. The last stage of the disease is fraught with the development of the following complications:
- heart failure;
- pulmonary edema;
- encephalopathy.
Features of the course of the disease
The course of chronic renal failure occurs gradually and the disease goes through several stages in its development.
CRF is characterized by the replacement of pathologically altered glomeruli of the kidney with connective tissue and dysfunction. In addition, the blood filtration rate (GFR) in the glomerulus decreases.
Normally, this figure should be in the range of 100–120 ml per minute. In accordance with this indicator, several stages of chronic renal failure are distinguished:
- Initial – the filtration rate is reduced to 90 ml, which is considered one of the normal options. There is diagnosed kidney damage. This stage is called latent because it does not have any obvious symptoms. There is no chronic kidney failure as such.
- The second stage is characterized by a moderate decrease in filtration rate to 60–80 ml. Identification of these indicators means that a disease such as chronic renal failure begins to manifest itself.
- The third stage (compensated) is characterized by a moderate drop in filtration rate to 30–60 ml. There are no clear clinical symptoms yet, but the person experiences slight morning swelling and an increase in the amount of urine excreted. In addition, lethargy and weakness may appear, accompanied by a decrease in performance. You should be wary of symptoms such as brittle nails and hair loss, pale skin and decreased appetite. This occurs due to a moderate decrease in hemoglobin levels in the blood. Most patients suffer from high blood pressure.
- The fourth or intermittent stage - the filtration rate drops to 15-30 ml per minute. The severity of clinical symptoms increases. Acidosis develops and there is a significant and persistent increase in the level of creatinine in the blood. A person is worried about increased fatigue and a constant feeling of dry mouth. At this stage, it is still possible to delay the development of the disease with medications and there is no need for hemodialysis yet.
- The fifth or terminal stage is characterized by a decrease in GFR to 15 ml. This final stage of chronic renal failure is characterized by a significant decrease in the volume of urine excreted or its complete absence. Against the background of water-electrolyte imbalance, the body is poisoned by toxins. As a consequence, there is a disruption in the functioning of vital organs and systems of the body. To save the patient's life, hemodialysis or a kidney transplant is required.
What causes the disease?
In most cases, chronic renal failure is a consequence of various diseases associated with the functioning of the kidneys, in particular pyelonephritis, polycystic kidney disease.
In addition, such kidney pathology is often provoked by the following conditions:
- chronic glomerulonephritis;
- atherosclerosis and;
- diabetes;
- presence of excess weight;
- developmental anomalies of the urinary system;
- gout;
- cirrhosis;
- systemic lupus erythematosus;
- various disorders of the urinary system;
- acute cancers;
- chemical poisoning;
- intoxication of the body;
- stones in the kidneys.
The causes of chronic renal failure are often due to the presence of diseases that affect one or both kidneys. Among them, experts distinguish chronic and diabetic glomerulosclerosis and.
The basis for the development of renal failure is the progressive death of nephrons. Kidney function is impaired to a degree until it stops completely.
Replaced by connective tissue. CRF does not occur immediately; it is preceded by long-term chronic kidney disease from 2 to 10 years.
Stages of development of chronic renal failure
Chronic renal failure affects the functioning of other organs and systems of the body. Thus, chronic renal failure causes the following changes:
- anemia, which is caused by disturbances in the functioning of red blood cells and the process of hematopoiesis. Blood clotting is also impaired, which manifests itself in a decrease in the level of prothrombin, prolongation of bleeding time and disruption of the platelet component of hemostasis;
- disturbances in the functioning of the heart. Many patients with chronic renal failure suffer from congestive heart failure and arterial hypertension. Cases of myocarditis and pericarditis are common;
- pulmonary disorders manifested by uremic pneumonitis. It develops in the later stages of chronic renal failure;
- dysfunction of the gastrointestinal tract. Impaired renal excretory function, which is characterized by chronic renal failure, causes atrophic gastritis and enterocolitis. In addition, patients may develop superficial ulcers in the stomach and intestines, causing bleeding;
- neurological pathologies - at the initial stage, chronic renal failure causes sleep disturbances and absent-mindedness, and at later stages, lethargy is added.
- Musculoskeletal disorders. Chronic kidney failure as a result of water and electrolyte imbalance can cause pathologies such as osteosclerosis, osteoporosis, osteomalacia. They manifest themselves in deformation of skeletal bones and accidental fractures, arthritis and compression of the vertebrae.
Symptoms
In case of chronic renal failure, the symptoms of the initial stage do not appear, so the patient has no specific complaints.
The first symptoms and signs appear at stage 2 of the disease, when GFR reaches 90 ml per minute. If at this stage of the disease the patient undergoes an examination, then doctors can reliably make a diagnosis.
The first symptoms appear:
- weakness;
- lethargy;
- malaise;
- increased fatigue for no apparent reason.
As the disease progresses, urine output becomes impaired and its volume increases significantly. This causes dehydration to develop. In addition, frequent urination at night is observed.
Late stages of chronic renal failure are characterized by a decrease in the amount of urine. Such signs in the patient are very unfavorable.
Diagnostic methods
Detection of chronic renal failure is carried out by various methods. First of all, the doctor examines the medical history of the disease. To do this, it is necessary to find out when the first signs of the disease began to appear and how pronounced they were.
The patient talks about the diseases that he had and, based on these indicators, the doctor preliminarily determines the reasons for the development of chronic renal failure. External signs of the disease include swelling and discoloration of the skin, impaired sensitivity of the limbs and bad breath.
In modern medicine, there are many laboratory methods for diagnosing renal failure. These include:
- general urine analysis - the content of protein and red blood cells, as well as leukocytes, indicates the kidney pathology in question;
- general blood test - signs of chronic renal failure identified by this study: an increase in leukocytes and ESR against the background of a decrease in hemoglobin and red blood cells. In addition, there will be a slight decrease in platelets;
- bacteriological analysis of urine - this study will identify the infectious agents that led to chronic renal failure;
- biochemical blood test - chronic renal failure is characterized by increased levels of potassium, phosphorus, urea and creatinine, cholesterol. In this case, the analysis will show a decrease in protein and calcium levels.
Diagnosis of chronic renal failure is also carried out using hardware examination methods, which include ultrasound, computed tomography and magnetic resonance imaging.
As additional clarifying methods of examination, Doppler ultrasound and chest x-ray are often performed. A kidney biopsy is also performed strictly according to indications; most often this method is used when doubts arise about the diagnosis.
Main directions of treatment
To be effective, accurate diagnosis is necessary to determine the stage of the disease. Up to a certain point, pathology is sold to canned drug treatment. Usually these are the initial stages of the development of the disease.
In this case, treatment is intended to:
- eliminate symptoms of high blood pressure;
- promote urine production;
- prevent the development of an autoimmune process in the body;
- eliminate anemia;
- normalize the level of acidity in the stomach;
- strengthen bones to prevent fractures.
With this pathology, symptoms and treatment are directly related. When the disease reaches its final stage and a significant failure of the kidneys occurs in the body, drug therapy methods are no longer able to provide the necessary therapeutic effect.
In this case, there is a need for hemodialysis. During this procedure, the patient's blood is cleaned and filtered using a special device. This manipulation replaces kidney function. It is as follows:
- venous blood from one arm enters the device;
- undergoes purification there;
- returns to the human body through the other arm, to which the tube from the device is attached.
Hemodialysis is carried out in case of severe nitrogen intoxication, which is accompanied by nausea and vomiting, enterocolitis and instability of blood pressure. A similar procedure is also indicated for patients with persistent edema as a result of electrolyte disturbances.
In the last stages of chronic renal failure, significant acidification of the blood occurs and this is also the basis for performing hardware blood purification.
Blood purification occurs due to the fact that toxin molecules settle on the filter
Contraindications to hemodialysis
Hemodialysis for chronic renal failure is not prescribed if the patient has the following pathologies:
- bleeding disorders;
- persistently low blood pressure;
- cancer with metastases has been diagnosed;
- the presence of infectious processes in the body.
Hemodialysis is carried out throughout life, several times a week. A kidney transplant will free the patient from this procedure. For treatment, and is used. This procedure is similar to hemodialysis with the only difference that in addition to blood purification, the water-salt balance is corrected.
The importance of diet in the treatment of pathology
Along with conservative drug treatment, patients with chronic renal failure should be supported by a therapeutic diet.
The diet is based on limiting the consumption of animal protein, as well as sodium and phosphorus. This approach to nutrition will help slow down the progression of chronic renal failure.
Minimizing the dose of protein depends on the stage of the disease; the more severe it is, the less protein is allowed to be consumed. It is recommended to replace animal protein with plant protein. Vegetable protein contains less phosphorus.
The basis of the diet of a patient with chronic renal failure must be carbohydrates and fats. The latter must be of plant origin and with a sufficient degree of calorie content.
As carbohydrates, the diet must contain products of plant origin, with the exception of mushrooms, legumes and nuts.
