Progressive renal failure. Renal failure: symptoms, treatment and prevention. Types of chronic kidney failure and their classification

13.1. ACUTE RENAL FAILURE

Epidemiology. Acute renal failure is a terminal pathological condition that manifests itself as a rapid deterioration in kidney function, resulting from a disorder of renal blood flow, damage to the glomerular membrane of the nephron, or sudden obstruction of the ureters. Acute renal failure is a dangerous condition that requires an urgent, adequate therapeutic effect and, in the absence of qualified intervention, leads to death.

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

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

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

Prerenal acute renal failure occurs due to insufficient blood flow to the kidneys. It may be the result of a violation of cardiac activity that caused a sharp decrease in blood pressure, the cause of which may be shock (hemorrhagic, pain, post-transfusion, septic,

post-traumatic, allergic, etc.). Complete cessation of blood flow in the renal arteries as a result of their thrombosis or embolism, as well as severe dehydration due to blood loss, profuse diarrhea, uncontrollable vomiting, or dehydration of the body leads to prerenal acute renal failure.

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

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

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

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

2) direct impact on the renal tissue of toxic substances. This type of renal acute renal failure occurs in case of poisoning with mercury, phosphorus, lead, alcohol surrogates, poisonous mushrooms, with toxic-allergic effects of sulfanilamide drugs, antibiotics, barbiturates or intoxication associated with infection in sepsis, septic abortion, ascending urinary tract infection.

Nephrotoxic substances act on the tubular epithelial cells that secrete them, causing necrotic changes and exfoliation from the basement membrane. In the pathogenesis of renal and prerenal anuria, circulatory disorders in the kidneys are leading. The difference between these types of acute renal failure lies in the fact that in the prerenal form, the circulatory disturbance is mainly global in nature, and in the renal form it is more often local, renal.

Postrenal acute renal failure most common in urological practice. Among its causes, it is necessary to single out obstruction of the ureter of the only functioning kidney or both ureters with calculi, blood clots, or compression of the ureters from the outside by a tumor infiltrate emanating from the genital organs or the large intestine. One of the causes of postrenal acute renal failure is an iatrogenic factor: ligation or stitching of the ureters during operations in the pelvic area. Compared with prerenal and renal acute renal failure, postrenal one is characterized by a slower decrease in glomerular filtration, and irreversible changes in nephrons develop only after 3-4 days. Restoration of the patency of the ureters by catheterization or drainage of the renal pelvis rather quickly leads to the restoration of diuresis and relief of anuria. In acute violation of the outflow of urine from the kidneys, overstretching of the pelvis, cups, collecting ducts, distal and proximal nephron occurs. Initially, filtration is not affected, but pressure equalizes on both sides of the glomerular membrane and anuria develops.

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

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

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

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

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

V initial stage the symptoms of the disease that caused acute renal failure dominate: injuries, infections, poisoning, combined with shock and collapse. Against the background of the clinical picture of the underlying disease, signs of severe kidney damage are revealed, among which, first of all, a sharp decrease in diuresis to complete anuria.

V oligoanuric stage the urine is usually bloody, with a massive sediment, microscopy of which reveals erythrocytes densely covering the entire field of view, and many pigmented cylinders. Despite oliguria, urine density is low. Simultaneously with oligoanuria, severe intoxication and uremia rapidly progress. The most severe disorders accompanying acute renal failure are fluid retention, hyponatremia and hypochloremia, hypermagnesemia, hypercalcemia, a decrease in the alkaline reserve and the accumulation of acid radicals (phosphate anions, sulfates, organic acids, all products of nitrogen metabolism). The oligoanuric stage is the most dangerous, characterized by the highest mortality, its duration can be up to three weeks. If oligoanuria continues, then the presence of cortical necrosis should be noted. Usually, patients have lethargy, anxiety, and peripheral edema is possible. With an increase in azotemia, nausea, vomiting, a decrease in arte-

real pressure. Due to the accumulation of interstitial fluid, shortness of breath is noted due to pulmonary edema. Retrosternal pains appear, cardiovascular insufficiency develops, central venous pressure rises, and bradycardia is noted with hyperkalemia.

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

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

Pain becomes less pronounced after stretching the capsule and the occurrence of edema of the perirenal tissue.

Third stage acute renal failure occurs in two periods and sometimes lasts up to two weeks. The beginning of the "diuretic" period of the disease should be considered an increase in the daily amount of urine to 400-600 ml. Although an increase in diuresis is a favorable sign, however, this period can only be conditionally considered as a recovery period. An increase in diuresis is initially accompanied not by a decrease, but by an increase in azotemia, a distinct hyperkalemia, and about 25% of patients die during this period of incipient recovery. The reason is an insufficient increase in diuresis, low-density urine separation with a low content of dissolved substances. Therefore, the previously occurring violation of the content and distribution of electrolytes in the extra- and intracellular sectors persists, and sometimes even intensifies at the beginning of the diuretic period. In the oligoanuric and at the beginning of the diuretic period, the most dramatic shifts in water metabolism are noted, which consist in excessive accumulation of fluid in the extra or intracellular sector or their dehydration. With hyperhydration of the extracellular sector, the patient's body weight increases, edema, hypertension, hypoproteinemia appear, and the hematocrit decreases. Extracellular dehydration occurs after uncompensated sodium loss and is characterized by hypotension, asthenia, weight loss, hyperproteinemia, and high hematocrit. Cellular dehydration joins the previously occurring extracellular

dehydration and proceeds with an exacerbation of all its symptoms. At the same time, mental disorders, respiratory arrhythmia, and collapse develop. Clinically, this type of intoxication occurs with severe weakness, nausea, vomiting, aversion to water, convulsive seizures, blackout and coma. A rapid increase in urination and loss of electrolytes in the diuretic phase of acute renal failure contribute to the emergence and deepening of these disorders of water-salt metabolism. However, as the function of the kidneys is restored and their ability not only to excrete, but also to regulate the content of water and electrolytes, the risk of dehydration, hyponatremia, hypokalemia is rapidly waning.

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

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

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

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

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

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

In postrenal acute renal failure, the leading measures in the treatment are measures aimed at restoring the disturbed passage of urine: ureteral catheterization, early surgical aid in the form of pyelo or nephrostomy.

In arenal, prerenal and renal forms of acute renal failure, treatment should be carried out in a renal center equipped with hemodialysis equipment. If, with postrenal acute renal failure, the patient's condition is extremely severe due to uremic intoxication, then hemodialysis should be performed before the intervention and only after that, pyelo or nephrostomy should be performed. Given the severity of the patient's condition, the operation should be performed on the most functionally capable side, which is determined by the clinical sign. The most pronounced pains in the lumbar region are observed on the side of the most functionally capable kidney. Sometimes, with postrenal anuria, on the basis of radioisotope renography data, it is possible to determine the most intact kidney.

With obstruction of the ureters caused by a malignant neoplasm in the pelvis or retroperitoneal space, an urgent puncture nephrostomy is performed. In the first hours of acute renal failure of any etiology, osmotic diuretics are administered (300 ml of a 20% mannitol solution, 500 ml of a 20% glucose solution with insulin). Furosemide (200 mg) is recommended to be administered intravenously with mannitol. The combination of furosemide (30-50 mg/kg for 1 hour) with dopamine (3-6 µg/kg for 1 minute, but no more) for 6-24 hours is especially effective, reducing renal vasoconstriction.

With prerenal and renal forms of anuria, treatment consists mainly in the normalization of water and electrolyte disorders, the elimination of hyperazotemia. To do this, they resort to detoxification therapy - intravenous administration of up to 500 ml of 10-20% glucose solution with an adequate amount of insulin, 200 ml of 2-3% sodium bicarbonate solution. With anuria, it is dangerous to inject more than 700-800 ml of fluid per day because of the possibility of developing severe extracellular overhydration, one of the manifestations of which is the so-called water lung. The introduction of these solutions should be combined with gastric lavage and siphon enemas. In acute renal failure caused by poisoning with mercury preparations (mercuric chloride), the use of unitiol (sodium 2,3-dimer-captopropanesulfonate) is indicated. It is prescribed subcutaneously and intramuscularly, 1 ml per 10 kg of body weight. On the first day, three or four injections are carried out, in the next - two or three injections. All patients with oligoanuric form of acute renal failure should be treated in a dialysis center, where, if necessary, extracorporeal dialysis machines (hemo-, peritoneal dialysis) can be used. Indications for the use of efferent detoxification methods are electrolyte disorders, especially hyperkalemia, azotemia (serum urea more than 40 mmol/l, creatinine more than 0.4 mmol/l), extracellular overhydration. The use of hemodialysis can dramatically reduce the number of deaths in acute renal failure, even in its arenal forms, in which after the use of chronic hemodialysis, kidney transplantation became possible.

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

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

To improve microcirculation and activate metabolic processes, it is recommended to use trental, which increases the elasticity of erythrocytes and reduces platelet aggregation, enhances the natriuretic effect, delaying the formation of enzymes

tubular epithelium phosphodiesterase. It plays a role in the process of tubular sodium reabsorption. By normalizing sodium reabsorption, trental enhances filtration processes, thereby exerting a diuretic effect.

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

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

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

13.2. CHRONIC RENAL

FAILURE

Chronic renal failure is a syndrome caused by the gradual death of nephrons as a result of progressive kidney disease.

Etiology and pathogenesis. Most often, chronic and subacute glomerulonephritis leads to chronic renal failure, in which the renal glomeruli are predominantly affected; chronic pyelonephritis affecting the renal tubules; diabetes mellitus, malformations of the kidneys (polycystosis, hypoplasia of the kidneys, etc.), contributing to the violation of the outflow of urine from the kidneys, nephrolithiasis, hydronephrosis, tumors of the genitourinary system. Vascular diseases (hypertension, renal stenosis), diffuse connective tissue diseases with kidney damage (hemorrhagic vasculitis, systemic lupus erythematosus, etc.) can lead to chronic renal failure.

Chronic renal failure occurs as a result of structural changes in the kidney parenchyma, leading to a decrease in the number of functioning nephrons, their atrophy and cicatricial replacement. The structure of the functioning nephrons is also disturbed, some glomeruli hypertrophy, while others show atrophy of the tubules during

preservation of the glomeruli and hypertrophy of individual sections of the tubules. In accordance with the modern hypothesis of "intact nephrons", a steady decrease in the number of functioning nephrons and an increase in the load on existing nephrons is considered as the main cause of impaired water and electrolyte metabolism in chronic renal failure. Given the anatomical changes in the preserved nephrons, it should be assumed that their functional activity is also impaired. In addition, damage to the vascular system, squeezing and desolation of blood vessels, inflammatory edema and sclerosis of the connective tissue structures of the kidney, impaired blood and lymph circulation in it undoubtedly affect all aspects of the organ's activity. The kidneys have a high reserve capacity, both kidneys contain about 1 million nephrons. At the same time, it is known that the loss of function of even 90% of nephrons is compatible with life.

In chronic renal failure, the catabolism of many proteins and carbohydrates is disturbed in the body, which leads to a delay in metabolic products: urea, creatinine, uric acid, indole, guanidine, organic acids and other products of intermediate metabolism.

Classification. Numerous classifications of chronic renal failure have been proposed, reflecting the etiology and pathogenesis, the degree of decline in kidney function, clinical manifestations and other signs of a violation of the functional state of the kidneys. Since 1972, urologists in our country have adopted the classification of chronic renal failure proposed by Academician N. A. Lopatkin and Professor I. N. Kuchinsky. According to this classification, CRF is divided into four stages: latent, compensated, intermittent and terminal.

Latent stage of chronic renal failure usually clinically silent, characterized by normal plasma levels of creatinine and urea, sufficient diuresis and high relative density of urine. However, the earliest symptom of chronic renal failure is a violation of the daily rhythm of urine production, a change in the ratio of daytime and night diuresis: alignment, and then a persistent predominance of the night. There is a decrease in the glomerular filtration rate to 60-50 ml / min, the percentage of water reabsorption in the tubules decreases to 99%, and the secretory activity of the tubules decreases.

Compensated stage of chronic renal failure. This stage is called compensated because, despite

an increase in renal destruction and a decrease in the number of fully functioning nephrons, the main indicators of protein metabolism - the content of creatinine and urea - do not increase in the blood plasma. This occurs due to the inclusion of compensatory protective mechanisms, consisting in polyuria against the background of a decrease in the concentration ability of the distal tubules with a simultaneous decrease in the glomerular filtration rate to 30-50 ml/min. The compensated stage of chronic renal failure is characterized by polyuria, the daily amount of urine increases to 2-2.5 liters, the osmolarity of urine decreases, and nocturnal diuresis predominates. The presence of a compensated stage of chronic renal failure in urological patients is a direct indication for radical therapeutic measures and operations to restore the outflow of urine from the kidneys, and with proper treatment, there is a possibility of regression of chronic renal failure and its transition to a latent stage. If a patient with a compensated stage of chronic renal failure is not given adequate assistance, then the compensatory mechanisms in the body are exhausted, and it passes into the third stage - intermittent.

intermittent stage. In the intermittent stage of chronic renal failure, there is a persistent increase in the level of creatinine to 0.3-0.4 mmol / l, and urea above 10.0 mmol / l. It is this condition that is often considered as "renal failure", in which clinical manifestations are pronounced in the form of thirst, dryness and itching of the skin, weakness, nausea, and lack of appetite. The underlying disease, which led to severe destruction of nephrons, is accompanied by periodic exacerbations, in which the already elevated creatinine level reaches 0.8 mmol/l, and urea - above 25.0 mmol/l. Polyuria, which compensated for the excretion of metabolic products, is replaced by a decrease in daily diuresis to a normal level, but the urine density does not exceed 1003-1005. The glomerular filtration rate is reduced to 29-15 ml / min, and water reabsorption in the tubules is less than 80%.

During periods of remission, the level of creatinine and urea decreases, but does not normalize and remains elevated - 3-4 times higher than normal. In the intermittent stage of chronic renal failure, even during remission, radical surgical interventions pose a great risk. Typically, in these cases,

implementation of palliative interventions (nephrostomy) and the use of efferent methods of detoxification.

Restoration of kidney function after a while allows you to perform radical operations that save the patient from a cysto- or nephrostomy.

Terminal stage. Untimely seeking medical help or an increase in chronic renal failure due to other circumstances inevitably leads to the final stage, manifested by severe, irreversible changes in the body. The level of creatinine exceeds 1.0 mmol / l, urea - 30.0 mmol / l, and glomerular filtration decreases to 10-14 ml / min.

According to the classification of N. A. Lopatkin and I. N. Kuchinsky, the terminal stage of chronic renal failure is divided into four periods of the clinical course.

The first form of the clinical course of the end stage of chronic renal failure is characterized by a decrease in glomerular filtration to 10-14 ml / min, and the level of urea to 20-30 mmol / l, but the preservation of the water excretory function of the kidneys (more than 1 l).

The second-A-form of the clinical course of the end-stage chronic renal failure is characterized by a decrease in diuresis, a decrease in urine osmolarity to 350-300 mosm / l, decompensated acidosis is observed, azotemia increases, however, changes in the cardiovascular system, lungs and other organs are reversible.

The second-B-form of the clinical course of the terminal stage of chronic renal failure is characterized by the same manifestations as the second-A-form, but more pronounced intraorganic disorders.

The third form of the clinical course of the end stage of chronic renal failure is characterized by severe uremic intoxication (creatinine - 1.5-2.0 mmol / l, urea - 66 mmol / l and above), hyperkalemia (more than 6-7 mmol / l). Cardiac decompensation, liver dystrophy are observed. Modern methods of detoxification (peritoneal dialysis or hemodialysis) are minimally effective or ineffective.

End-stage chronic renal failure has a typical clinical picture, which is manifested by thirst, lack of appetite, persistent nausea, vomiting, confusion, euphoria, pruritus and a decrease in the amount of urine. At

in the terminal stage there is a sharp decrease in all functional renal parameters, a tendency to hypoproteinemia and hypoalbuminemia. The clinical syndrome of chronic uremia develops, which is characterized not only by a sharp decrease in kidney function, but also by a violation of the activity of all organs and systems. Such patients are usually emaciated, lethargic, drowsy, noisy breathing, pronounced smell of urea; the skin is pale, with a yellowish tint; the skin is dry, flaky, with traces of scratching, its turgor is lowered; hemorrhagic complications are not uncommon, manifested by subcutaneous hematomas, gingival, gastric and uterine bleeding. A petechial rash appears on the skin, the mucous membranes are anemic, often covered with petechial hemorrhages. The mucous membrane of the tongue, gums, pharynx is dryish, sometimes has a brownish coating and superficial ulcerations.

Hoarseness of voice is usually noted, shortness of breath, dry cough appear, in the terminal period suffocation and respiratory arrhythmias develop. Characterized by the appearance of tracheitis and bronchopneumonia, dry pleurisy. Pulmonary complications are manifested by subfebrile body temperature, hemoptysis, hard or mixed breathing, dry and small bubbling rales, pleural friction noise are determined when listening.

Symptoms and clinical course. Chronic renal failure is detected in more than a third of patients in urological hospitals. Features of chronic renal failure in urological diseases - early damage to the predominantly tubular system, persistent infection in the urinary tract, frequent violation of the outflow of urine from the upper and lower urinary tract, undulating course of renal failure with possible reversibility and slow progression. However, it should be noted that with timely surgical intervention and adequate therapy of urological patients, periods of long-term remission occur, which sometimes last for decades.

Clinical symptoms in the early stages of chronic renal failure are very mild. These are, as a rule, stressful conditions associated with the use of salty foods, large doses of low-alcohol drinks (beer), a violation of the regimen, which are manifested by pastosity of the subcutaneous fatty tissue, swelling of the face in the morning, weakness and decreased performance.

As chronic renal failure increases, nocturia is noted with a decrease in urine output during the daytime.

current, sleep disorder, polyuria, dry mouth. With the progression of the disease, which led to impaired renal function, the clinical picture becomes more pronounced. Manifestations of the disease develop in all systems and organs.

Kidney failure is manifested by a decrease in the production of erythropoietin, therefore, patients have anemia, a violation of the excretion of uroheparin by the tubules, which contributes to increased bleeding, and the nitrogenous components of the plasma, being antiaggregants, disrupt the dynamic function of platelets. With oliguria, which is noted in the intermittent and terminal stages of chronic renal failure, hypernatremia is determined, which leads to extra- and intracellular overhydration and arterial hypertension. The most dangerous electrolyte disorder in oliguria is hyperkalemia, in which damage to the central nervous system occurs, accompanied by muscle paralysis, blockade of the conduction system of the heart, up to its stop.

Arterial hypertension in chronic renal failure in combination with hyperhydration, anemia, electrolyte disturbances, acidosis leads to uremic myocarditis, leading to cardiac muscle dystrophy and chronic heart failure. In uremia, dry pericarditis is often associated, the symptom of which is a pericardial friction rub, as well as recurrent pain and elevation of the interval S-T above the isoelectric line.

Uremic tracheitis and tracheobronchitis in combination with hyperhydration and heart failure against the background of impaired cellular and humoral immunity lead to the development of uremic pneumonia and pulmonary edema.

The gastrointestinal tract is one of the first to respond to impaired renal function. In the early stages of chronic renal failure, many patients experience chronic colitis, manifested by stool disorders, periodic diarrhea, which sometimes explains oliguria. In the later stages of chronic renal failure, an increase in the content of nitrogenous components in the blood plasma is accompanied by their release through the mucous membrane of the gastrointestinal tract and salivary glands. Perhaps the development of uremic parotitis, stomatitis, stomach ulcers, leading against the background of impaired hemostasis to profuse bleeding.

Diagnosis of chronic renal failure should be carried out in all patients with complaints typical of urological diseases. The anamnesis should contain data on the transferred angina, urological diseases, changes in urine tests, and in women - on the features of the course of pregnancy and childbirth, the presence of leukocyturia and cystitis.

Of particular importance in the diagnosis of subclinical stages of chronic renal failure are laboratory, radionuclide, ultrasound research methods, which have become routine in outpatient practice.

Having established the presence of a urological disease, its activity and stage, it is necessary to carefully study the functional ability of the kidneys, using the methods of their total and separate assessment. The simplest test that evaluates the total kidney function is the Zimnitsky test. The interpretation of its indicators allows us to note an early violation of the functional ability - a violation of the rhythm of the kidneys, the ratio of daytime and nighttime diuresis. This indicator has been used for several decades and is still used in clinical practice due to its high information content. The study of creatinine clearance, the calculation of glomerular filtration and tubular reabsorption according to the Rehberg test allow the most accurate assessment of nephron function.

In the modern diagnosis of chronic renal failure, the most accurate are radionuclide methods that determine the effective renal blood flow, Doppler ultrasound methods and excretory urography. Diagnosis of subclinical forms of chronic renal failure, which allows early detection of impaired renal function, is the most demanded in clinical practice and should use the full range of modern possibilities.

Treatment. The initial, latent phase of chronic renal failure may not significantly affect the general condition of the patient for many years and does not require special therapeutic measures. In severe or advanced renal failure, characterized by azotemia, metabolic acidosis, massive loss or significant retention of sodium, potassium and water in the body, only correctly chosen, rationally planned, carefully carried out corrective measures can, to a greater or lesser extent, restore the lost balance and prolong life. sick.

Treatment of chronic kidney failure in the early stages is associated with the elimination of the causes that caused a decrease in their function. Only the timely elimination of these causes makes it possible to successfully deal with its clinical manifestations.

In cases where the number of functioning nephrons progressively decreases, there is a persistent trend towards an increase in the level of nitrogenous metabolites and fluid and electrolyte disturbances. Treatment of patients is as follows:

Reducing the load on the remaining functioning nephrons;

Creation of conditions for the inclusion of internal protective mechanisms capable of removing products of nitrogen metabolism;

Carrying out drug correction of electrolyte, mineral, vitamin imbalance;

The use of efferent methods of blood purification (peritoneal dialysis and hemodialysis);

Carrying out substitution treatment - kidney transplantation.

To reduce the load on the functioning nephrons of chronic renal failure, it is necessary: ​​a) to exclude drugs with a nephrotoxic effect; b) limit physical activity; c) sanitize sources of infection in the body; d) use agents that bind protein metabolites in the intestine; e) strictly limit the diet - reduce the daily intake of protein and salt. Daily protein intake should be limited to 40-60 g (0.8-1.0 g/day per 1 kg of body weight); if azotemia does not decrease, then the amount of protein in the diet can be reduced to 20 g / day, but subject to the obligatory content in it or the addition of essential amino acids.

A persistent increase in blood pressure, sodium retention, and the presence of edema dictate the need to limit salt in the daily diet to no more than 2-4 g. Further restriction should be carried out only under strict indications, since vomiting and diarrhea can easily cause severe hyponatremia. A salt-free diet, even in the absence of dyspepsia, can slowly and gradually lead to hypovolemia, a further reduction in filtration volume.

Among the protective mechanisms capable of excreting the products of nitrogen metabolism, one should indicate the sweat glands of the skin, hepatocytes, the epithelium of the small and large intestines, and the peritoneum. Up to 600 ml of fluid is released through the skin per day, while increased sweating has a beneficial effect on reducing the load on nephrons. Sick

Means that bind protein metabolites include the drug lespenephril, which is taken orally 1 teaspoon 3 times a day.

Enterosorption is considered to be a very effective method of correction in renal failure. Enterosorbent (polyphepan) is recommended to be taken orally at a dose of 30 to 60 g / day with a small amount of water before meals for 3-4 weeks.

To eliminate hyperkalemia, patients with chronic renal failure should be prescribed laxatives: sorbitol, vaseline oil, buckthorn, rhubarb, which prevent the absorption of potassium in the intestine and ensure its speedy excretion; cleansing enemas with 2% sodium bicarbonate solution.

Drug correction of homeostasis is indicated for all patients with chronic renal failure in a day hospital 3-4 times a year. Patients undergo infusion therapy with the introduction of rheopolyglucin, 20% glucose solution, 4% sodium bicarbonate solution, diuretics (lasix, ethacrynic acid), anabolic steroids, vitamins B, C. Protamine sulfate is prescribed to correct the level of heparin, and to restore dynamic function platelets - magnesium oxide (burnt magnesia) 1.0 g orally and adenosine triphosphoric acid 1.0 ml intramuscularly for a month. The ongoing treatment helps to reduce the severity of symptoms of uremia.

The most effective method of treating patients with end-stage chronic renal failure is hemodialysis and its varieties: hemofiltration, hemodiafiltration, continuous arteriovenous hemofiltration. These methods of blood purification from protein metabolites are based on the ability of their diffusion through a semi-permeable membrane into a dialysis saline solution.

Dialysis is carried out in the following way: arterial blood (from the radial artery) enters the dialyzer, where it contacts with a semi-permeable membrane, on the other side of which the dialysis solution circulates. The products of nitrogen metabolism contained in the blood of patients with uremic intoxication in high concentrations diffuse into the dialysis solution, which leads to a gradual purification of the blood from metabolites. Together with the products of nitrogen metabolism, excess water is removed from the body, which becomes

bilizes the internal environment of the body. The blood purified in this way returns to the lateral saphenous vein of the arm.

Chronic hemodialysis is carried out every other day for 4-5 hours under the control of the level of electrolytes, urea and creatinine. Currently, there are dialysis machines that allow you to conduct blood purification sessions at home, which, of course, has a positive effect on the quality of life of patients with severe forms of chronic renal failure.

Some categories of patients (especially the elderly) with chronic renal failure, with severe comorbidities (diabetes mellitus) and intolerance to heparin, are shown peritoneal dialysis, which is widely used in clinical practice after the introduction of a special intraperitoneal catheter and the release of dialysis solution in special sterile packages. Dialysate introduced into the abdominal cavity through a catheter is saturated with uremic metabolites, especially of medium molecular weight, and is removed through the same catheter. The method of peritoneal dialysis is physiological, does not require expensive dialyzers and allows the patient to perform the treatment procedure at home.

A radical method of treating patients with terminal renal failure is kidney transplantation, which is performed in almost all nephrological centers; patients on chronic hemodialysis are potential recipients preparing for transplantation. The technical issues of kidney transplantation have been successfully resolved today, B.V. Petrovsky and N.A. Lopatkin made a great contribution to the development of this direction in Russia, who successfully performed kidney transplantation from a living donor (1965) and from a corpse (1966). The kidney is transplanted into the iliac region, a vascular anastomosis is formed with the external iliac artery and vein, the ureter is implanted into the side wall of the bladder. The main problem of transplantology remains tissue compatibility, which is of decisive importance in kidney transplantation. Tissue compatibility is determined by the AB0 system, Rh factor, typing is also carried out by the HLA system, a cross-test.

After kidney transplantation, the most severe and dangerous is the rejection crisis, for the prevention of which immunosuppressive drugs are prescribed: corticosteroids (prednisolone, methylprednisolone), cytostatics (azathioprine, imuran), antilymphocyte globulin. To improve blood circulation in the graft

use anticoagulants, vasodilators and antiplatelet agents that prevent thrombosis of vascular anastomoses. To prevent inflammatory complications, a short course of antibiotic therapy is carried out.

Control questions

1. What are the causes of acute renal failure?

2. What stages of acute renal failure do you know?

3. What principles of diagnosis and treatment of acute renal failure can you name?

4. How is chronic renal failure classified?

Renal failure by itself means such a syndrome in which all functions relevant to the kidneys are violated, as a result of which a disorder of various types of exchanges in them (nitrogen, electrolyte, water, etc.) is provoked. Kidney failure, the symptoms of which depend on the variant of 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 a balance in the acid-base state and water-electrolyte composition, are directly involved in renal blood flow, as well as glomerular filtration in combination with tubules. In the latter version, the processes are concentration, secretion and re-absorption.

Remarkably, not all changes that may affect the listed variants of the processes are an obligatory cause of the subsequent pronounced impairment in the functions of the kidneys, respectively, as the renal failure that interests us, it is impossible to determine any violation in the processes. Thus, it is important to determine what kidney failure really is and on the basis of which processes it is advisable to single it out as this type of pathology.

So, renal insufficiency means such a syndrome that develops against the background of severe disorders in the renal processes, in which we are talking about a disorder of homeostasis. Homeostasis is generally understood as maintaining the internal environment inherent in the body at a level of relative constancy, which, in the variant we are considering, is attached to its specific area - that is, to the kidneys. At the same time, azotemia becomes relevant in these processes (in which there is an excess of protein metabolism products in the blood, which include nitrogen), disturbances in the body's general acid-base balance, as well as disturbances in the balance of water and electrolytes.

As we have already noted, the condition of interest to us today may arise against the background of various causes, these causes, in particular, are determined by the type of renal failure (acute or chronic) in question.

Renal failure, the symptoms in children in which are manifested similarly to the symptoms in adults, will be considered by us below in terms of the course of interest (acute, chronic) in combination with the causes that provoke their development. The only point that I would like to note against the background of the generality of symptoms is in children with chronic renal failure, growth retardation, and this connection has been known for a long time, noted by a number of authors as "renal infantilism".

Actually, the reasons provoking such a delay have not been finally elucidated, however, the loss of potassium and calcium against the background of exposure provoked by acidosis can be considered as the most likely factor leading to it. It is possible that this is also due to renal rickets, which develops as a result of the relevance of osteoporosis and hypocalcemia in the state 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 kidney. This state is achieved due to traumatic shock, which manifests itself in combination with a massive tissue lesion, 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 muscle crushing with their crushing; blood transfusion (in case of incompatibility); wasting vomiting or toxicosis during pregnancy; myocardial infarction.
  • Toxic kidney. In this case, we are talking about poisoning that arose against the background of 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 variant. The possibility of acute renal failure in this variant of the provoking factor is not excluded with 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 exerted on the body by infectious diseases. So, for example, an acute infectious kidney is an actual condition in sepsis, which, in turn, can have a different type of origin (first of all, 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 infectious diseases such as cholera or dysentery, etc.
  • Embolism and thrombosis relevant to the renal arteries.
  • Acute pyelonephritis or glomerulonephritis.
  • obstruction of the ureters, due to compression, the presence of a tumor formation or stones in them.

It should be noted that acute renal failure occurs in about 60% of cases as a result of trauma or surgery, about 40% is observed during treatment in medical facilities, up to 2% during pregnancy.

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

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

Acute renal failure: symptoms

Acute renal failure, which we will abbreviate further in the text as ARF, is a syndrome in which there is a rapid decrease or complete cessation of the functions inherent in the kidneys, and these functions can decrease / stop both in one kidney and in both at the same time. As a result of this syndrome, metabolic processes are drastically disrupted, an increase in the products formed during nitrogen metabolism is noted. Actual in this situation violations of the nephron, which is defined as a structural renal unit, occur 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 both within just a few hours, and in 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 the 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 onset of this syndrome, that is, from the disease that directly provoked it.

Thus, 4 main periods can be distinguished 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 above-mentioned symptoms of the disease that provoked the OPS syndrome - it is at this moment of 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, it soon stabilizes to normal levels). There is a chill, pallor and yellowness of the skin is noted, the body temperature rises.

Next, second period (oligoanuria, the duration is mainly about 1-2 weeks), is characterized by a decrease or an absolute cessation of the process of urination, 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. Remarkably, in many cases it is during this period that the condition of most patients improves significantly, although, as already noted, there is no urine during it. Already later, complaints of severe weakness and headache appear, patients have worsening appetite and sleep. There is also nausea with accompanying vomiting. The progression of the condition is evidenced by the smell of ammonia that appears during breathing.

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

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

Almost every patient has nausea and vomiting, somewhat less often - diarrhea. Especially often certain phenomena from the side of digestion 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 character is defined as erosive. Meanwhile, some of the actual symptoms are caused by disorders arising from the electrolyte balance.

In addition to these processes, there is a development in the lungs of edema resulting from increased permeability, which is present in the alveolar capillaries during this period. Clinically, it is difficult to recognize it, because the 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, after, with anuria, the volume of urine excreted is about 50 ml. The duration of the course 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 a prolonged form of manifestation of these processes, active therapy is required to maintain human life.

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

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

The period at 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 daily diuresis) often occurs several days after the completion 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 after that, again, gradually, this figure increases to a mark of about 2000 ml or more per day, and it is from this moment that we can talk about the beginning of the third period of OPN.

WITH third period improvements are noted in the patient's condition not immediately, moreover, in some cases, the condition may even worsen. The phase of polyuria 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 appetite in patients, in addition to this, previously relevant changes in the circulatory system and the work of the central nervous system disappear.

Conditionally the beginning of the recovery period, that is, the next, fourth period disease, there is a day of normalization of indicators of the level of urea or residual nitrogen (which is determined on the basis of relevant analyzes), the duration of this period is about 3-6 months to 22 months. During this period of time, homeostasis is restored, the concentration function of the kidneys and filtration improves along with an improvement in tubular secretion.

It should be borne in mind that over the next year or two, it is possible to preserve signs that indicate functional insufficiency on the part of certain systems and organs (liver, heart, etc.).

Acute renal failure: prognosis

OPN, in the event that it does not become the cause of 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 development against the background of this condition to chronic kidney disease.

After about 6 months, more than half of the patients reach a state of full recovery, but the option of its limitation for a certain part of patients is not excluded, on the basis of which they are assigned disability (group III). In general, the 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 periodically determine the considered variant of the course of the syndrome of chronic renal failure, is a process indicating an irreversible violation that kidney function has undergone with 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). CRF is characterized by a number of disorders, and in particular, these include violations of the 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 their toxic effects.

At the initial stage, chronic renal failure has insignificant, one might say, symptoms, therefore it can be determined only on the basis of an appropriate laboratory test. Already obvious symptoms of chronic renal failure appear by 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 exclusion of the subsequent regeneration of the renal parenchyma (that is, the outer layer from the cortical substance of the organ in question and the inner layer, presented as a brain substance). In addition to structural damage to the kidneys against the background of chronic renal failure, other types of immunological changes are also not excluded. The development of an irreversible process, as we have already noted, can be quite short (up to six months).

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

In addition to disorders associated with the excretory function of the kidneys, the violation of their homeostatic, blood-purifying and hematopoietic functions also becomes relevant. There is a forced polyuria (increased urine production), on the basis of which one can judge a small number of still preserved nephrons that perform their functions, which occurs in combination with isostenuria (in which the kidneys are unable to produce urine with a greater or lesser specific gravity). Isosthenuria in this case is a direct indicator that renal failure is at the final stage of its own development. Along with other processes relevant to this state, CRF, as can be understood, also affects other organs, in which, as a result of the processes inherent in the syndrome under consideration, changes develop similar to dystrophy with simultaneous disruption of enzymatic reactions and a decrease in reactions of an already immunological nature.

Meanwhile, it should be noted that the kidneys in most cases still do not lose the ability to completely excrete the water that enters the body (in combination with calcium, iron, magnesium, etc.), due to the appropriate effect of which, in the future, adequate water is provided. activities of other organs.

So, now let's go directly to the symptoms that accompany CRF.

First of all, patients have a pronounced state of weakness, drowsiness predominates and, in general, apathy. There is also polyuria, in which about 2 to 4 liters of urine are excreted per day, and nocturia, characterized by frequent urination at night. As a result of such a course of the disease, patients are faced with dehydration, and against the background of its progression, with the involvement of other systems and organs of the body in the process. Subsequently, weakness becomes even more pronounced, nausea and vomiting join it.

Among other manifestations of symptoms, one can single out the 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 condition of the skin of patients is dry, itching appears, excessive excitement is accompanied by increased sweating. Muscle twitches also appear (in some cases reaching convulsions) - this is already caused by calcium losses 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 terms of calcium and reduced glomerular filtration function in the kidneys. Moreover, such changes are often accompanied by changes in the skeleton, and already at the level of such a disease as osteoporosis, and this happens due to demineralization (that is, a decrease in the content of mineral components in bone tissue). The previously noted soreness 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 soreness, in combination with an inflammatory reaction, occurs (this is defined as secondary gout).

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

Anorexia, which develops with CRF, can reach the appearance of aversion to any products in patients, also combined with nausea and vomiting, the appearance of an unpleasant aftertaste in the mouth and dryness. After eating, fullness and heaviness in the area "under the pit of the stomach" can be felt - along with thirst, these symptoms are also characteristic of CRF. In addition, patients develop shortness of breath, often high blood pressure, pain in the heart area is not uncommon. Blood clotting decreases, which causes not only nosebleeds, but also gastrointestinal bleeding, with possible skin hemorrhages. Anemia also develops against the background of 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 disturbed. As a result of a number of these processes, the possibility of a coma is not 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, against the background of which the general condition and kidney failure in particular are only aggravated.

In the preterminal period of the disease, patients have polyuria, while in the terminal period - predominantly oliguria (some patients experience anuria). The functions of the kidneys, as can be understood, decrease with the progression of the disease, and this happens up to their complete disappearance.

Chronic renal failure: prognosis

The prognosis for this variant of the course of the pathological process is determined to a greater extent on the basis of the course of the disease, which gave the main impetus to its development, as well as on the basis of the complications that arose during the process in a complex form. Meanwhile, an important role for the prognosis is also given to the phase (period) of CRF, which is relevant for the patient, with the rate of development characterizing it.

Let us single out that the course of chronic renal failure is not only an irreversible process, but also steadily progressing, 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 clinic of uremia are not excluded, but these are rather exceptions - in the vast majority of cases (especially with high arterial hypertension, that is, high pressure), the clinic of this disease is characterized by the previously noted rapid progression.

Diagnosis

As the main marker taken into account in the diagnosis acute renal failure , emit an increase in the blood level of nitrogenous compounds and potassium, which occurs at the same time as a significant decrease in excreted urine (up to the complete cessation of this process). The assessment of the concentration ability of the kidneys and the volume of urine excreted during the day is made on the basis of the results obtained from the Zimnitsky test.

An important role is also given to the biochemical analysis of blood for electrolytes, creatinine and urea, because it is on the basis of indicators for these components that specific conclusions can be drawn 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 is to determine this form itself (that is, to specify it), for which an ultrasound of the bladder and kidneys is done. Based on the results of this study measure, the relevance/absence of ureteral obstruction is determined.

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

As for diagnostics chronic renal failure, then it uses, again, a urine and blood test, as well as a Reberg test. Data indicating a reduced level of filtration, as well as an increase in the level of urea and creatinine, are used as the basis for confirming CRF. In this case, the Zimnitsky test determines isohyposthenuria. In the ultrasound of the kidneys in this situation, the thinning of the parenchyma of the kidneys is determined with their simultaneous decrease in size.

Treatment

• Treatment of acute renal failure

Initial phase

First of all, the goals of therapy are reduced to the elimination of those causes that led to violations in the functioning of the kidneys, that is, to the treatment of the underlying disease that provoked acute renal failure. If shock occurs, it is urgent to ensure the replenishment of blood volumes with the simultaneous normalization of blood pressure. Poisoning with nephrotoxins implies the need to wash the stomach and intestines of the patient.

Modern methods of cleaning the body of toxins have various options, and in particular - the method of extracorporeal hemocorrection. Plasmapheresis and hemosorption are also used for this purpose. If the obstruction is urgent, the normal state of the passage of urine is restored, which is ensured by the removal of stones from the ureters and kidneys, the elimination of tumors and strictures in the ureters by the surgical method.

Oliguria phase

As a method that provides stimulation of diuresis, osmotic diuretics, furosemide, are prescribed. Vasoconstriction (that is, narrowing of the arteries and blood vessels) against the background of the condition under consideration is produced by the administration of dopamine, in determining the appropriate volume of which, not only the loss of urination, bowel movements and vomiting, but also losses during breathing and sweating are taken into account. Additionally, the patient is provided with a protein-free diet with restriction of potassium intake with food. For wounds, drainage is carried out, areas with necrosis are eliminated. Selection of antibiotics involves taking into account the overall severity of renal damage.

Hemodialysis: indications

The use of hemodialysis is relevant in case of an increase in urea to 24 mol / l, as well as potassium to 7 or more mol / l. As an indication for hemodialysis, symptoms of uremia, as well as hyperhydration and acidosis, are used. Today, in order to avoid complications that occur 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.

By itself, this method consists in extrarenal blood purification, due to which the removal of toxic substances from the body is ensured 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 a characteristic pronounced form.

Early-stage therapy is focused more on those activities, due to which the progression of the underlying disease can be prevented / slowed down. Of course, the underlying disease requires treatment for disorders in the renal processes, however, it is the early stage that determines the great role for therapy directed at it.

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

Chronic hemodialysis is focused specifically on patients with the considered form of renal failure, we noted its general specificity a little higher. Hospitalization is not required for the procedure, but visits to the dialysis unit in a hospital setting or outpatient centers in this case cannot be avoided. The so-called dialysis time is defined within the framework of the standard (about 12-15 hours / week, that is, 2-3 visits per week). After the procedure is completed, you can go home, this procedure practically does not affect the quality of life.

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

Kidney transplantation is the process of replacing an affected kidney with a healthy kidney from a donor. Remarkably, one healthy kidney can cope with all those functions that could not be provided by two diseased kidneys. The issue of acceptance / rejection is solved 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 rejection by the body of the kidney remains even if the necessary indicators in the previously noted study are met. The probability of accepting an organ 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 takes root within a year from the moment of the operation, 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 needs to take constantly, throughout his subsequent life, although in some cases they cannot affect the rejection of the organ. In addition, there are a number of side effects from taking them, one of which is the weakening of the immune system, on the basis of 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, a consultation with a urologist, nephrologist and treating therapist is necessary.

Kidney failure is not a separate disease. This is a syndrome that develops with a number of severe conditions. The kidneys are an extremely important paired organ, which is involved not only in purifying the blood and removing decay products and excess water in the form of urine, but also being a link in the metabolism that occurs in the human body. Violation of their function causes rapid intoxication. Many conditions can cause a malfunction of this paired organ. For example, liver damage with cirrhosis often causes the appearance of such a complication as hepatorenal syndrome (HRS), in which the work of the kidneys is rapidly deteriorating, and its recovery is not always possible.

Sometimes the existing disorders can be reversible, and after targeted treatment, the function is restored. Under certain circumstances, the growing damage to this paired organ leads to the fact that the patient has to periodically undergo a procedure. This is vital when the kidneys completely lose their ability to function normally.

The only way to restore the patient's health in this case is an organ transplant.

According to statistics, about 600 cases of total renal failure are diagnosed annually per 1 million people, requiring radical treatment.

The main types of kidney failure

There are 2 main forms of this pathological condition: acute and chronic. Each of them has its own reasons for the appearance, as well as separate approaches to treatment and rehabilitation. Acute renal failure that confirms? A rather sharp violation or a strong decrease in the functionality of the kidneys, as a result of which the patient needs emergency medical assistance.

Often this form is reversible. Now there are 3 main types of acute renal failure (ARF):

• hemodynamic (prerenal);
• parenchymal (renal);
• obstructive (postrenal).

This is a condition in which there is a slowdown or complete cessation of the output of nitrogen metabolism. In addition, with the development of acute renal failure, the water-acid-base and electrolyte balance may be disturbed. The influence of this pathology also on the composition of the blood is significant. A certain level of certain substances affects the patient's condition.

The presence of (CRF), as a rule, indicates a gradually progressive condition that develops as a result of the death of nephrons. The remaining normal cells gradually cease to cope with the function assigned to them. appears very slowly.

If, at the beginning of the pathological process, the remaining healthy cells are still capable of maintaining a normal level of blood purification and urine excretion, subsequently overloading the nephrons becomes the reason for their more rapid death.

The deficiency of renal functionality begins to increase, and, as a result, intoxication of the body with the products of its own metabolic processes is observed.

Causes of acute renal failure

Various factors have already been well studied, which, under certain circumstances, can cause not only an acute lesion of this organ, but also lead to a chronic violation of its function. The causes of this condition in acute form are extremely diverse. People who have health problems should carefully monitor the manifestations of this organ.

For example, the prerenal form of acute renal failure usually occurs in conditions that provoke a decrease in cardiac output and intracellular fluid volume, in addition, in vasodilation and bacteriological and anaphylactic forms of shock. A similar disorder of the kidneys can be caused by:

• heart failure;
• thromboembolism;
• tamponade;
• arrhythmia;
• cardiogenic, anaphylactic and bacteriotoxic shock;
• ascites;
• burns;
• acute blood loss;
• prolonged diarrhea;
• severe dehydration.

Under the condition of complex treatment of the primary pathological condition, a rapid recovery of lost or reduced kidney functionality is usually observed. In severe diseases (cirrhosis of the liver), hepatorenal syndrome often develops. Since it is not possible to improve the situation with hepatocyte damage, the patient's condition, as a rule, is rapidly deteriorating. Hepatorenal syndrome, accompanied by severe renal failure, can be caused not only by cirrhosis, but also by erosion of the biliary tract and viral hepatitis.

However, it is most often found in people who have abused alcohol or drugs.

In this case, hepatorenal syndrome, accompanied by a pronounced impairment of kidney function, is extremely difficult to treat, since against the background of harmful addictions, all organs are affected. If the patient has hepatorenal syndrome, that is, the kidneys are damaged due to severe destruction of the liver, transplantation is necessary. In some cases, not only kidney but also liver transplantation is required, and double transplants are extremely rare. Hemodialysis in this case is dangerous because it threatens to lead to severe bleeding.

The development of the renal form of acute renal failure may have completely different causes. Usually the problem lies in the toxic effect on the parenchyma tissue of various potent substances. You can poison this paired organ:

• copper salts;
• uranium;
• mercury;
• mushroom poisons;
• fertilizers;
• substances from anticancer drugs;
• antibiotics;
• sulfonamides, etc.

Among other things, the development of this form of acute renal failure is observed if the level of hemoglobin and myoglobin circulating in the blood is increased or tissues are compressed as a result of injury. Much less often, this condition is associated with an alcohol or drug coma and transfusion of incompatible blood.

Postrenal form of acute renal failure may occur due to blockage of the urinary tract by stones.

Sometimes it is caused by tuberculosis, tumors of the prostate gland and urea, with urethritis and dystrophic variants of the defeat of the abdominal tissue.

Etiology of CRF

This condition is usually caused by various diseases that affect the nephrons. Most often, in chronic renal failure, signs of the disease are detected in people who have suffered from the following diseases for a long time:

• systemic autoimmune;
• glomerulosclerosis of the diabetic form;
• pyelonephritis;
• glomerulonephritis;
• hereditary nephritis;
• amyloidosis;
• nephrangiosclerosis.

The inflammatory process that is observed in these diseases leads to the gradual death of nephrons. Thus, at first, the processes in the kidneys become less efficient. Damaged areas are quickly replaced by connective tissue, which cannot perform the functions necessary for the body.

When the parenchyma dies, with the development of renal failure, immediate treatment is required.

Usually, before the formation of this pathological condition, a person suffers from one or another inflammatory disease for 2 to 10 years.

Symptomatic manifestations of renal failure

As a rule, the manifestations of this state, regardless of its form, increase sequentially. Signs of insufficiency, proceeding according to an acute scenario, are fully detected within a few days. Usually the clinical picture is caused by the primary disease that provoked the shutdown of the kidneys. The first non-specific signs include manifestations of drowsiness, weakness, lack of appetite and nausea. Usually, these symptoms of kidney failure are easily confused with signs characteristic of the underlying disease. After that, characteristic signs of intoxication may appear. In addition, a violation of urine production is immediately noted. Renal failure is characterized by:

• azotemia;
• metabolic acidosis;
• proteuria;
• hyperphosphatemia;
• an increase in potassium levels.

Patients complain of signs of general intoxication, including abdominal pain, decreased appetite, nausea, vomiting, and diarrhea.

Among other things, pulmonary edema may develop, which is characterized by the presence of shortness of breath and moist rales.

In severe cases and the absence of targeted treatment, the patient is threatened with coma. The condition is often complicated by bleeding, pericarditis, uremic gastroenterocolitis.

In patients with acute renal failure, immunity is often greatly reduced, which predisposes to the appearance of stomatitis, pneumonia, parotitis, sepsis, and pancreatitis. With proper treatment, there is a gradual increase in daily urine output. This continues for 2 weeks. At this time, the normal water-electrolyte balance is restored, and all other indicators return to normal. Complete recovery of the kidneys after experiencing the acute phase of the course of the disease is observed after about 6-12 months.

In chronic renal failure, the manifestations of damage to the paired organ increase over a long period of time. People suffering from the latent form of this disorder often do not observe intense signs of the disease, but at the same time they note a decrease in working capacity and the appearance of weakness.

After the transition of this state to the stage of compensation, the signs of renal failure become more pronounced. Usually weakness becomes a frequent occurrence. Mild dry mouth may be present all the time. Further, there is a release of more urine than is required, which can cause dehydration. In the later stages of chronic renal failure, a sharp decrease in the amount of urine produced can be observed. If one kidney is affected, the prognosis is more favorable. Among other things, progressive CRF is characterized by manifestations:

• vomiting;
• nausea;
• muscle twitching;
• bitterness in the mouth;
• skin itching;
• pain in the abdomen;
• stomach and nosebleeds;
• hematomas.

Despite the fact that in chronic renal failure, the signs of the development of pathology are very similar to the acute form, these conditions cannot be confused, since the symptoms appear at different speeds. Slowly increasing manifestations of damage to this paired organ require the adoption of certain measures.

In the case of such a condition, as with interrelated, the doctor must constantly adjust therapy in order to stop or at least slow down the process and delay the need for the patient to switch to dialysis.

Complications of pathology

The extreme danger of both acute and chronic forms of damage to this paired organ is not an exaggeration at all. In addition to the characteristic signs, which in themselves have an extremely unfavorable effect on the state of the entire human body, additional severe complications can be observed.

The most typical consequences of this condition include:

• stomatitis,
• dystrophy;
• anemia;
• dropsy;
• uremic coma;
• bleeding in the gastrointestinal tract;
• osteodystrophy;
• myocarditis;
• encephalopathy;
• pericarditis;
• pulmonary edema;
• decreased immunity;
• arterial hypertension;
• disorders of the gastrointestinal tract.

Neurological disorders may develop. In patients with renal insufficiency, lethargy, loss of orientation in space, and confusion are often observed. In older people, against the background of this pathological condition, peripheral neuropathy may develop.

Methods for diagnosing kidney failure

When signs of the development of this syndrome appear, it is imperative to contact a nephrologist. Timely identified symptoms and treatment of existing pathologies allows you to restore the functionality of the kidneys and prevent the progression of failure.

Diagnosis requires taking an anamnesis and conducting a general and bacteriological analysis of urine. In addition, blood is taken from the patient for research. Modern diagnostic tools make it much easier to identify problems associated with kidney function. Frequently ordered studies include:

• ultrasonic dopplerography;
• chest x-ray;
• chromocystoscopy;
• biopsy;
• electrocardiography;
• urography;
• Zimnitsky test.

What is kidney failure and what danger it carries, doctors are already well aware. After determining the nature and severity of the pathological process as a result of a comprehensive examination, the optimal course of therapy can be selected.

Without research, it will not be possible to find out the causes of kidney failure and prescribe therapy.

Treatment of the disease

After a comprehensive diagnosis, doctors can determine the optimal therapy strategy. If acute renal failure is detected, hospitalization is required. If the condition is severe, the patient can be immediately redirected to the intensive care unit. Treatment of kidney failure should be aimed at addressing the root cause of the problem.

Usually, hemodialysis is performed to remove toxins. If the problem was caused by the ingestion of poisonous substances, detoxification therapy can be carried out. In the presence of various diseases of the cardiovascular system, an adequate treatment regimen for these abnormalities is prescribed. In addition, removal of stones from the kidneys and bladder, gastric lavage, antibiotic therapy, removal of necrosis areas and washing of existing wounds, normalization of blood pressure, etc. can be carried out.

Plasmapheresis may be indicated to improve the patient's condition. Furosemide and osmotic diuretics can be used to stimulate diuresis in the presence of acute renal failure. Dopamine administration may be required to improve the condition.

With proper targeted treatment, as a rule, the patient's condition stabilizes within 2 weeks.

During this time, the patient must follow a protein-free diet and a special drinking regimen. After the acute period, the patient should continue to follow the recommendations given by the attending physician, since full recovery may take about a year.

In chronic renal failure, treatment presents a certain difficulty. There are many treatment regimens that can significantly slow down the process of dying off normal kidney tissues. Since this condition usually develops against the background of various conditions, efforts are directed towards eliminating the primary problem. Due to the constant deterioration of renal processes, symptomatic therapy methods, special diets and drug treatment regimens are selected. Staying in sanatoriums and resorts can bring significant benefits.

The patient needs to understand the severity of his health problems. Existing treatment tactics can only slow down the pathological process, but not completely eliminate it. Such patients need to take tests at regular intervals to correct therapy.

If homeostasis is detected, the water-salt balance, azotemia and acid-base composition of the blood are corrected.

When the question arises of how to treat kidney failure, it is often prescribed:

• calcium gluconate;
• Almagel;
• sodium bicarbonate solution;
• antihypertensive drugs;
• Lasix;
• iron preparations;
• folic acid.

The treatment regimen aimed at correcting the condition, as a rule, often changes. However, therapy does not allow 100% cure of the kidneys. Thus, increasing damage eventually leads to a complete violation of their function. In the presence of kidney failure, how to treat it should be determined by a qualified doctor.

With the development of the terminal stage of chronic renal failure, the patient requires regular hemodialysis.

It is believed that these procedures can extend the life of the patient by about 23 years. So that the patient no longer needs them, an organ transplant is required.

Prevention of kidney failure

Many people do not even think about the importance of certain organs until severe violations begin to appear on their part. The kidneys have a high regeneration resource, so they can be restored even after serious damage. However, it is advisable to take care of your health from a young age. Eliminating the negative effects of alcohol, drugs and tobacco smoke can significantly reduce the risk of developing pathology.

It is necessary to pay attention to the existing symptoms of the kidneys in a timely manner. Timely treatment of stones, as well as infectious diseases, is the most important moment in the prevention of insufficiency. People who are at risk of kidney damage need to monitor the quality of the water they drink and follow a special diet.

Kidney failure is a progressive disease that gradually leads to tissue death. When the process is chronic, the functionality of all organs and systems is disrupted.

What are the symptoms of kidney failure?

Clinical picture

Kidney failure affects both men and women, proceeding in their bodies in approximately the same way.

Starting with an exacerbation phase, the process quickly becomes chronic, which is characterized by a high concentration of urea and creatinine in the blood. They are nitrogenous breakdown products of proteins. Gradually, the kidneys fail, and the body tries to remove these substances through the delicate mucous membranes of the gastrointestinal tract and lungs, which are simply not adapted to such loads. As a result, uremia appears, poisoning all cells.

In renal insufficiency, an aversion to meat develops, the patient constantly suffers from thirst, nausea and vomiting. There are muscle cramps, aches and pain in the bones. The skin on the face becomes icteric, the breath is accompanied by an ammonia smell.

The amount of urine excreted is significantly reduced or urination stops completely. The patient drinks diuretics, but they do not help much, his swelling does not go away. A decrease in renal function is accompanied by a violation of the production of biologically active substances in the filtering organ. At the same time, the metabolism of glucose, calcium and phosphorus is hampered, the performance of the sex glands is deteriorating.

acute form

Acute renal failure (ARF) in men and women is usually asymptomatic and manifests itself suddenly. When a person learns about the disease, kidney damage is often irreversible. This creates urinary retention. In men, this condition in most cases becomes one of the manifestations of prostate adenoma. However, this symptom can also signal the presence of kidney stones or bladder tumors. In this case, men experience arching pains in the lower abdomen, and the urge to go to the toilet becomes strong and frequent. If back pain and fever are added, pyelonephritis most likely developed.

Acute renal failure is an indication for urgent hospitalization. The patient needs serious treatment. In this case, the methods of therapy are determined by the causes of impaired renal function. The modern approach involves conservative treatment, which uses drugs to eliminate symptoms.

Causes

The following causes of acute renal failure are distinguished:

1. Violation of the hemodynamics of the kidneys.
2. Infectious diseases.
3. Pathologies of the urinary system.
4. Trauma and surgery on the kidneys.

The prerenal form of acute renal failure causes difficulty in blood circulation as a result of blood loss and congestion. Treatment involves drugs to normalize the heart rhythm, droppers with saline solutions to restore plasma levels, medicines to improve blood microcirculation.

The renal form of acute renal failure appears due to pathologies of small blood vessels or medication. Acute renal failure syndrome develops as a result of poisoning with household toxins and bites from poisonous snakes. Treatment is also conservative. For glomerulonephritis and immune disorders, cytostatic drugs and glucocorticosteroids are prescribed, and for infections, antibiotics. Signs of intoxication are removed by plasmapheresis.

The postrenal form of the disease occurs due to difficulty in the outflow of urine. This is common in older men with an enlarged prostate. Surgery is often required to remove an obstruction that interferes with the normal flow of urine. Otherwise, even diuretics will not be effective.

Characteristic features

When acute renal failure is formed, symptoms may not appear for a long time. The main symptom of acute renal failure syndrome is a decrease in urine output (oliguria), up to a complete cessation of urination (anuria). The patient's health is rapidly deteriorating, the following symptoms are observed:

• nausea with vomiting;
• diarrhea;
• loss of appetite;
• swelling of the hands and feet;
• lethargy;
• excited state;
• enlarged liver.

Symptoms may vary depending on the stage of the disease. In total, 4 stages of the disease are distinguished.

With acute renal failure of the first degree, poisoning occurs with nausea, which is accompanied by intestinal pain. The patient becomes pale, feels weak and unwell.

Acute renal failure of the II degree is characterized by oliguria or anuria. The patient's condition worsens significantly, urea and other products of protein metabolism begin to accumulate rapidly in his blood. Self-intoxication starts in the body, a person suffers from edema, diarrhea, hypertension, tachycardia. He quickly loses strength, constantly wants to sleep, becomes inhibited.

Acute kidney failure III degree is marked by the beginning of recovery. The formation of urine increases and the concentration function of the kidneys is restored. The performance of the paired organ is restored.

Stage IV of the acute renal failure syndrome is the recovery phase. All indicators of renal activity are normalized. However, full recovery can take up to a year.

Chronic form

Chronic renal failure (CRF) is a steady deterioration in the functioning of the kidneys, due to the death of tissue, which is replaced by connective tissue. The body shrinks and completely loses its performance. CKD affects up to 500 people out of every million men and women, and the number of cases is growing every year.

Reasons for the appearance

Chronic renal failure develops due to various pathologies with concomitant damage to the glomeruli, among them:

• chronic kidney disease;
• metabolic disorders;
• congenital anomalies of the kidneys;
• rheumatic diseases;
• vascular diseases;
• pathology leading to difficulty in the outflow of urine.

Often, CRF syndrome appears against the background of chronic pyelonephritis and glomerulonephritis, diabetes mellitus and gout. The hereditary factor has a significant influence on the development of the disease.

Among rheumatic diseases that provoke chronic renal failure syndrome, lupus erythematosus, scleroderma are distinguished, among vascular diseases - arterial hypertension. Often, chronic renal failure is formed as a result of nephrolithiasis, hydronephrosis and tumors, due to which the urinary tract is compressed.

Symptoms

Signs of renal failure during the transition to a chronic form become pronounced, so it is not difficult to determine the disease.

Chronic renal failure occurs in 4 stages:

1. Latent.
2. Compensated.
3. Intermittent.
4. Terminal.

Depending on the degree of the disease, the symptoms are stronger or weaker, which affects the treatment. Initially, a person has weakness, dry mouth.

In stage II, these signs are intensified. CRF syndrome with compensation is accompanied by an increase in urine output up to 2.5 liters per day, while analyzes show deviations in the chemical composition of biological fluids.

In the intermittent stage, chronic renal failure is characterized by even greater inhibition of organ function. In the blood, a consistently elevated level of nitrogenous products of protein metabolism, urea and creatinine is detected. CKD syndrome leads to severe fatigue and nausea with vomiting. The patient experiences constant thirst and dry mouth, his appetite disappears. The skin becomes flabby and dry, acquires an icteric color. At the same time, muscle tone is lost, tremor develops (involuntary vibrations of any part of the body), joints and bones begin to hurt less often.

When chronic renal failure reaches such a degree of development, there is a sharp decrease in the body's defenses. A person's condition may improve periodically, but then it gets worse again. The patient is treated with conservative methods, at this time he is still able-bodied. But with non-compliance with the diet, physical and emotional stress, the symptoms worsen. Surgical treatment may be required.

With the onset of the final stage, the general condition of people worsens. Apathy is replaced by excitation, problems with night sleep arise, inhibition of movements appears, and inadequacy of behavior. A person's appearance changes: the face becomes puffy and gray-yellow in color, the hair becomes thinner, loses its shine, scratches remain on the skin, because it constantly itches, dystrophy develops. The voice becomes hoarse, and from the mouth begins to smell like ammonia.

From the gastrointestinal tract there is bloating, diarrhea, vomiting. At the same time, the tongue is constantly lined, aphthous stomatitis is observed.

In the patient's blood during the tests, a persistently elevated concentration of urea and creatinine is found, which provokes uremia. The presence of hematuria in men may be a sign of hemophilia.

CRF syndrome at the final stage is also accompanied by encephalopathy with depression, memory failures, mood swings. The normal synthesis of hormones is disturbed, as a result of which blood clotting worsens and immunity decreases. The patient requires long-term treatment, and the sooner it is started, the more likely it is to avoid surgery.

Survey methodology

Diagnosis of acute and chronic renal failure is necessary for the doctor to clarify the diagnosis and prescribe proper treatment. The following analyzes are expected:

1. General and bacteriological analysis of urine.
2. Biochemical and general blood test.

Urinalysis can confirm the reason for the decrease in renal function. Erythrocytes indicate urolithiasis, tumors, injuries, and leukocytes indicate the presence of infection and impaired immunity.

If a decrease in renal function occurred due to infection, then during the bacteriological analysis of urine, the pathogen will be detected.

Both chronic and acute renal failure are characterized by a high level of leukocytes in the blood and a slight decrease in the content of platelets in it. A decrease in hemoglobin indicates anemia, and an acceleration of their settling indicates the presence of inflammation.

A biochemical blood test allows you to track changes in the body that caused a decrease in kidney function. In acute renal failure, high levels of magnesium and creatine, low pH are detected. With a chronic process in the blood, an increased content of cholesterol, urea, potassium and phosphorus is found. At the same time, a decrease in the concentrations of calcium and protein is recorded.

Analyzes are carried out first of all, then hardware research methods are applied:

1. Computed and magnetic resonance imaging.
2. X-ray.
3. Kidney biopsy.

Ultrasound, CT, and MRI are used in acute renal failure to determine the cause of narrowing of the urinary tract, which has led to deterioration in renal function.

X-rays are used to detect pathologies of the respiratory system. A biopsy is used when other methods fail to identify the cause of the deterioration in kidney function. With the help of an ECG, arrhythmias are detected.

Symptoms of kidney failure do not appear immediately, so the disease is not always diagnosed at an early stage. . However, conservative treatment is usually applied, and surgery is required only in advanced cases.

Renal failure is a serious pathology, which is characterized by a persistent violation of all kidney functions. The kidneys lose the ability to form urine and excrete it. As a result the body is poisoned harmful decay products and toxins.

The symptoms of kidney failure are quite typical, and if left untreated, the disease can lead to serious consequences.

What is kidney failure?

The kidneys are the main organ in the urinary system, which has the ability to remove metabolic products from the body, regulate the optimal balance of ions in the blood, produce hormones and biologically active substances involved in hematopoiesis. With renal failure, these opportunities are lost.

Renal failure is a syndrome of disorder of all vital functions of the kidneys.

The disease can affect anyone, regardless of gender and age. There are frequent cases of pathology in children.

In the ICD-10, renal failure covers codes N17-N19 and is subdivided into:

• acute renal failure - code N17;
• renal failure - code N18;
• unspecified renal failure - code N19.

With renal failure, a violation of nitrogen, water, salt, acid-base metabolism occurs, as a result, all organs cannot function adequately, the human condition noticeably worsens.

Features of the classification

There are several approaches to the classification of the disease. The classical approach involves the division of renal failure into acute and chronic.

A different approach to classification in terms of reasons that caused the disease, subdivide renal failure into:

1. prerenal - caused by a violation of normal blood flow in the kidneys, due to which pathological changes occur in the tissues of the kidneys, and the process of urine formation is disturbed; prerenal renal failure is diagnosed in 50% of patients;
2. renal - caused by pathologies of the renal tissue, due to which the kidney is not able to accumulate and excrete urine; diagnosed in 40% of patients;
3. postrenal - caused by the formation of obstructions in the urethra and the impossibility of urine outflow; the condition is rarely diagnosed, in 5% of cases.

Classification of the disease by stages(degrees):

• Stage 1 - the kidneys are affected, but GFR (glomerular filtration rate) is preserved or increased, there is no chronic renal failure;
• stage 2 - the kidneys are affected with a moderate decrease in GFR; chronic insufficiency begins to develop;
• stage 3 - the kidneys are affected with an average decrease in GFR; compensated renal failure develops;
• stage 4 - kidney damage is combined with a pronounced decrease in GFR; decompensated insufficiency develops;
• Stage 5 - severe kidney damage, terminal renal failure.

How long they live with 5 degrees of renal failure depends on the treatment and organization of replacement therapy - without it, the kidneys cannot work on their own.

In the presence of replacement therapy, a person can live for a long time, subject to concomitant nutrition, lifestyle.

Classification of renal failure by creatinine in the blood is widely used in nephrological practice. In a healthy person, the norm of creatinine concentration is 0.13 mmol / l. The concentration of creatinine in patients with renal insufficiency makes it possible to distinguish the stages of the development of the disease:

• latent (creatinine values ​​0.14-0.71);
• Azotemic (creatinine from 0.72 to 1.24);
• progressive (creatinine above 1.25).

Reasons for the development of the disease

The main causes of kidney failure include:

• diabetes mellitus type 1 and 2;
• hypertension;
• inflammatory diseases of the kidneys (, pyelonephritis);
• kidneys;
• the formation of obstacles along the outflow of urine (tumors, kidney stones, inflammation of the prostate gland in men);
• intoxication (poisoning with poisons, pesticides);
• infectious lesions of the urinary system.

There are cases of kidney failure without specific causes. The so-called unknown causes provoke the development of the disease in 20% of cases.

How the disease is expressed - characteristic signs

Symptoms of renal failure in adults (men and women) are almost identical. There is only one difference - in children with the development of renal failure almost always appears nephrotic syndrome. This is not seen in adults.

Otherwise, the symptoms are similar and depend on the phase of insufficiency (acute or chronic). V acute phase kidney failure manifests itself:

For chronic form other signs of insufficiency are:

• deterioration of the general condition (lethargy, drowsiness, lethargy, dry mouth);
• increase in the daily volume of urine excreted (up to 3 liters);
• development of hypothermia;
• dryness of the skin, the appearance of yellowness;
• development of emotional lability (sharp change from apathy to excitement);
• development of uremic intoxication.

In the chronic form, the patient may feel normal for several years, but urine and blood tests will show persistent disturbances in the main indicators (protein, leukocytes, ESR, creatinine).

How to diagnose?

To make a diagnosis of "renal failure" a number of laboratory and instrumental studies are required:

• - a reliable way to establish how fully the kidneys function. With the development of renal failure, the analysis reveals a change in the density of urine, the appearance of leukocytes and bacteria.
• Urine culture will be useful if a violation of the kidneys is provoked by pathogenic microflora.
• A general blood test in patients with renal insufficiency will show upward shifts in ESR and the number of leukocytes; hemoglobin and platelets - in the direction of decreasing.
• A biochemical blood test is required if kidney failure is suspected. In the presence of pathology, according to the analysis, an increase in the content of urea, creatinine, cholesterol, and nitrogen is noted. The level of phosphorus, calcium, total protein decreases.

Instrumental studies allow you to accurately establish degree of pathological changes in the kidneys. The most reliable diagnostic methods:

Sometimes to clarify the diagnosis additional diagnostic procedures are required:

• chest x-ray;
• electrocardiography;
• kidney tissue biopsy.

How to treat, what to do?

Treatment of renal failure should be comprehensive, the acute form is treated exclusively in a hospital setting. In a serious condition, the patient is placed in intensive care.

The tactics of treating the disease depends on how severe the violations of the kidneys are.

When organizing the treatment of renal failure, the main thing is elimination of the root cause that provoked the disease:

• the use of glucocorticosteroids in the presence of glomerulonephritis and autoimmune diseases;
• organization of plasmapheresis - blood purification, if renal failure has developed due to intoxication;
• antibiotics in the presence of infectious lesions of the kidneys;
• therapeutic measures to normalize the outflow of urine and eliminate obstacles in the urethra;
• prescribing drugs to normalize blood pressure in hypertension.

Therapy for renal failure includes mandatory therapeutic measures that help improve the patient's condition:

• normalization of the water-salt balance is carried out by intravenous infusion of plasma-substituting solutions;
• elimination of blood acidification using droppers with the introduction of sodium bicarbonate;
• fighting anemia through blood transfusion;
• organization of hemodialysis to cleanse the blood of decay products and toxins;
• Kidney transplantation is performed in advanced cases, when other methods of treatment have been powerless.

Treatment of kidney failure in pregnant women

Renal failure can affect pregnant women, more often in the later stages. Basically, acute insufficiency develops against the background of infectious lesions of the kidneys (pyelonephritis, neglected), which can become chronic.

Treatment is required immediately, the ideal option is considered placement in a hospital.

Therapy of the disease during pregnancy is complex, but when prescribing medications, their possible negative effect on the fetus should be taken into account.

Tactics for the treatment of renal failure in pregnant women:

• prescription of antibiotics and antiviral tablets;
• transfer to a sparing protein-free diet;
• elimination of cardiovascular insufficiency;
• organization of infusion therapy to eliminate dehydration;
• elimination of obstructions in the urinary tract;
• in severe condition - the organization of hemodialysis.

Delivery is carried out by caesarean section according to the life indications of a woman. Subsequent pregnancies can be planned after partial restoration of kidney function.

After suffering severe forms of the disease with non-recovered renal function, pregnancy is strictly prohibited.

What is the danger of the disease - the consequences

In the absence of treatment or its ineffectiveness, the course of the disease leads to a number of negative complications:

Preventive measures

plays an important role in the prevention of kidney failure following simple rules:

1. preventing the occurrence of diseases affecting the kidneys and other organs of the urinary system (cystitis, pyelonephritis, urolithiasis, glomerulonephritis);
2. timely treatment of any infectious and non-infectious kidney diseases;
3. quitting smoking and drinking alcohol;
4. proper, rationally organized nutrition;
5. prevention of uncontrolled intake of drugs;
6. regular delivery of a general urine test, optimally - once every six months;
7. observation by a nephrologist in the presence of pathologies in the kidneys.

Kidney failure is a disease that should not be ignored. The disease is dangerous in terms of a hidden beginning, when, with external well-being and well-being, the kidneys gradually lose their vital functions, and the body is slowly poisoned.

Therefore, it is so important to consult a doctor at the slightest malfunction in the urinary system. If detected early, kidney failure is treated and kidney function is restored.

Learn more about the symptoms and causes of the disease from the video clip: