Renal failure in hypertension. Low blood pressure in renal failure. For renal pressure, the following are usually used

For citation: Kutyrina I.M. Treatment of renal hypertension // RMJ. 2000. No. 3. S. 124

Department of Nephrology and Hemodialysis MMA them. THEM. Sechenov

According to the modern classification of arterial hypertension, renal hypertension (PH) is usually understood as arterial hypertension (AH), pathogenetically associated with kidney diseases. This is the largest group among secondary hypertension in terms of the number of patients, which make up about 5% of all patients suffering from hypertension. Even with still intact kidney function, PG is observed 2-4 times more often than in the general population. In renal failure, its frequency increases, reaching 85-70% in the stage of terminal renal failure; only those patients who suffer from salt-losing kidney disease remain normotensive.

A complex system of relationships exists between systemic hypertension and the kidneys. This problem has been discussed by scientists for more than 150 years, and the works of leading nephrologists and cardiologists of the world are devoted to it. Among them are R.Bright, F.Volhard, E.M.Tareev, A.L.Myasnikov, H.Goldblatt, B.Brenner, G.London and many others. According to modern concepts, the relationship between the kidneys and hypertension is presented as a vicious circle, in which the kidneys are both the cause of the development of hypertension and the target organ of its effects. It has now been proven that hypertension not only damages the kidneys, but also dramatically accelerates the development of kidney failure. This provision determined the need for permanent treatment of hypertension at blood pressure levels exceeding 140/90 mm Hg, reducing these values ​​to 120/80 mm Hg. in order to slow down the progression of renal failure.

Of particular importance for nephrological patients is a strict restriction of sodium intake. Given the role of sodium in the pathogenesis of hypertension, as well as the violation of sodium transport in the nephron, which is characteristic of renal pathology, with a decrease in its excretion and an increase in the total sodium content in the body, daily salt intake in nephrogenic hypertension should be limited to 5 g/day. Since the sodium content in prepared foods (bread, sausages, canned food, etc.) is quite high, it is necessary to limit the additional use of salt in cooking (WHO, 1996; H.E. deWardener, 1985). Some expansion of the salt regime is allowed only with the constant intake of salturetics (thiazide and loop diuretics).

Salt restriction should be less severe in patients with polycystic kidney disease, salt-losing pyelonephritis, in some variants of the course of chronic renal failure, when, due to damage to the renal tubules, sodium reabsorption in them is impaired and sodium retention in the body is not observed. In these situations, the patient's salt regimen is determined on the basis of daily electrolyte excretion and the volume of circulating blood. In the presence of hypovolemia and / or with increased excretion of sodium in the urine, salt intake should not be limited.

Much attention is currently being paid to the tactics of antihypertensive therapy. Questions are discussed about the rate of BP reduction, the level to which initially elevated BP should be reduced, as well as the need for permanent antihypertensive treatment of “mild” AH (diastolic BP 95–105 mm Hg).

Based on the observations made, it is now considered proven that:

- the simultaneous maximum decrease in elevated blood pressure should not exceed 25% of the initial level, so as not to impair kidney function;

— in patients with kidney pathology and AH syndrome, antihypertensive therapy should be aimed at complete normalization of blood pressure, even despite a temporary decrease in the depuration function of the kidneys. This tactic is designed to eliminate systemic hypertension and thus intraglomerular hypertension as the main non-immune factors in the progression of renal failure and suggests a further improvement in renal function;

— “Mild” hypertension in nephrological patients requires permanent antihypertensive treatment in order to normalize intrarenal hemodynamics and slow down the progression of renal failure.

Basic principles of treatment of renal hypertension

A feature of the treatment of hypertension in chronic kidney disease is the need for a combination of antihypertensive therapy and pathogenetic therapy of the underlying disease. Means of pathogenetic therapy of kidney diseases (glucocorticosteroids, cyclosporine A, sodium heparin, dipyridamole, non-steroidal anti-inflammatory drugs - NSAIDs) themselves can have a different effect on blood pressure, and their combination with antihypertensive drugs can nullify or enhance the hypotensive effect of the latter.

Based on our own experience of long-term treatment of nephrogenic hypertension, we believe that hypertensive syndrome is a contraindication for the appointment of high doses of glucocorticosteroids, except in cases of rapidly progressive glomerulonephritis. In patients with “moderate” nephrogenic hypertension, glucocorticosteroids can increase it if, when administered, a pronounced diuretic and natriuretic effect does not develop, which is usually observed in patients with initial severe sodium retention and hypervolemia.

NSAIDs are inhibitors of prostaglandin synthesis. Our studies have shown that NSAIDs can have antidiuretic and antinatriuretic effects and increase blood pressure, which limits their use in the treatment of patients with nephrogenic hypertension. The appointment of NSAIDs simultaneously with antihypertensive drugs can either neutralize the effect of the latter, or significantly reduce their effectiveness (I.M. Kutyrina et al., 1987; I.E. Tareeva et al., 1988).

Unlike these drugs heparin sodium has a diuretic, natriuretic and hypotensive effect. The drug enhances the hypotensive effect of other drugs. Our experience shows that the simultaneous administration of sodium heparin and antihypertensive drugs requires caution, as it can lead to a sharp decrease in blood pressure. In these cases, it is advisable to start sodium heparin therapy with a small dose (15-17.5 thousand U / day) and increase it gradually under the control of blood pressure. In the presence of severe renal insufficiency (glomerular filtration rate less than 35 ml / min), sodium heparin in combination with antihypertensive drugs should be used with great caution.

For the treatment of nephrogenic hypertension, the most it is preferable to use antihypertensive drugs that:

. affect the pathogenetic mechanisms of the development of arterial hypertension;

Do not reduce blood supply to the kidneys and do not inhibit renal function;

Able to correct intraglomerular hypertension;

They do not cause metabolic disorders and give minimal side effects.

Currently, for the treatment of patients with nephrogenic arterial hypertension 5 classes of antihypertensive drugs are used:

. angiotensin-converting enzyme inhibitors;

calcium antagonists;

B-blockers;

diuretics;

A-blockers.

Drugs with a central mechanism of action (Rauwolfia drugs, clonidine) are of secondary importance and are currently used only under strict indications.

Among the above 5 classes of drugs proposed for the treatment of nephrogenic arterial hypertension, the drugs of first choice include angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (calcium antagonists). These two groups of drugs meet all the requirements for antihypertensive drugs intended for the treatment of nephrogenic arterial hypertension and, most importantly, simultaneously possess nephroprotective properties.

Angiotensin-converting enzyme inhibitors

ACE inhibitors are a class of antihypertensive drugs whose main pharmacological action is the inhibition of ACE (aka kininase II).

The physiological effects of ACE are twofold. On the one hand, it converts angiotensin I to angiotensin II, which is one of the most powerful vasoconstrictors. On the other hand, being kininase II, it destroys kinins, tissue vasodilating hormones. Accordingly, pharmacological inhibition of this enzyme blocks the systemic and organ synthesis of angiotensin II and accumulates kinins in the circulation and tissues.

Clinically, these effects are manifested:

. a pronounced hypotensive effect, which is based on a decrease in general and local renal peripheral resistance;

. correction of intraglomerular hemodynamics due to the expansion of the efferent renal arteriole, the main site of application of local renal angiotensin II.

In recent years, the renoprotective role of ACE inhibitors has been actively discussed, which is associated with the elimination of the effects of angiotensin, which determine the rapid sclerosis of the kidneys, i.e. with blockade of the growth of mesangial cells, their production of collagen and epidermal growth factor of the renal tubules (Opie L.H., 1992).

In table. 1 shows the most common ACE inhibitors with their dosages.

Depending on the time of excretion from the body, they secrete first generation ACE inhibitors (captopril with an elimination half-life of less than 2 hours and a haemodynamic effect of 4-5 hours) and second generation ACE inhibitors with a half-life of 11-14 hours and a hemodynamic effect duration of more than 24 hours. To maintain the optimal concentration of drugs in the blood during the day, a 4-fold dose of captopril and a single (sometimes double) dose of other ACE inhibitors are necessary.

Effects on the kidneys and complications

The effect of all ACE inhibitors on the kidneys is almost the same. Our experience of long-term use of ACE inhibitors (captopril, enalapril, ramipril) in nephrological patients with renal hypertension indicates that with initially intact renal function and long-term use (months, years), ACE inhibitors increase renal blood flow, do not change, or slightly reduce creatinine levels. blood by increasing the glomerular filtration rate (GFR). At the earliest stages of treatment with ACE inhibitors (1st week), a slight increase in the level of blood creatinine and potassium in the blood is possible, but over the next few days it normalizes on its own without discontinuation of the drug (I.M. Kutyrina et al., 1995). Risk factors for a stable decline in renal function are the elderly and senile age of patients. The dose of ACE inhibitors in this age group should be reduced.

Requires special attention therapy with ACE inhibitors in patients with renal insufficiency. In the vast majority of patients, long-term therapy with ACE inhibitors adjusted for the degree of renal failure has a beneficial effect on renal function - creatininemia decreases, GFR increases, and the onset of end-stage renal failure slows down.

ACE inhibitors have the ability to correct intrarenal hemodynamics, reducing intrarenal hypertension and hyperfiltration. In our observations, correction of intrarenal hemodynamics under the influence of enalapril was achieved in 77% of patients.

ACE inhibitors have a pronounced antiproteinuric property. The maximum antiproteinuric effect develops against the background of a low-salt diet. Increased salt intake leads to the loss of antiproteinuric properties of ACE inhibitors (de Jong RE et al., 1992).

ACE inhibitors are a relatively safe group of drugs, adverse reactions with their use occur infrequently.

The main complications are cough and hypotension. Cough can occur at various times of treatment with drugs - both at the earliest and after 20-24 months from the start of therapy. The mechanism of cough occurrence is associated with the activation of kinins and prostaglandins. The reason for the abolition of drugs in the event of a cough is a significant deterioration in the quality of life of the patient. After discontinuation of the drugs, the cough disappears within a few days.

A more severe complication of ACE inhibitor therapy is the development of hypotension. The risk of hypotension is high in patients with congestive heart failure, especially in the elderly, with malignant high-renin hypertension, renovascular hypertension. Important for the clinician is the ability to predict the development of hypotension during the use of ACE inhibitors. For this purpose, the hypotensive effect of the first low dose of the drug (captopril 12.5-25 mg; enalapril 2.5 mg; ramipril 1.25 mg) is evaluated. A pronounced hypotensive response to this dose may predict the development of hypotension during long-term drug treatment. In the absence of a pronounced hypotensive response, the risk of developing hypotension with further treatment is significantly reduced.

Quite frequent complications of treatment with ACE inhibitors are headache, dizziness. These complications usually do not require discontinuation of drugs.

In nephrological practice, the use of ACE inhibitors is contraindicated in:

. the presence of stenosis of the renal artery of both kidneys;

. the presence of stenosis of the renal artery of a single kidney (including a transplanted kidney);

. combination of renal pathology with severe heart failure;

. severe chronic renal failure, long-term treated with diuretics.

The appointment of ACE inhibitors in these cases may be complicated by an increase in blood creatinine, a decrease in glomerular filtration up to the development of acute renal failure.

ACE inhibitors are contraindicated during pregnancy, since their use in the II and III trimesters can lead to fetal hypotension, malformations and malnutrition.

calcium antagonists

The mechanism of the hypotensive action of calcium antagonists (AK) is associated with the expansion of arterioles and a decrease in increased total peripheral resistance (OPS) due to inhibition of the entry of Ca 2+ ions into the cell. The ability of drugs to block the vasoconstrictor effect of the endothelial hormone, endothelin, has also been proven.

According to antihypertensive activity, all groups of prototype drugs are equivalent, i.e. Effect nifedipine in dose of 30-60 mg/day is comparable to the effects verapamil in dose of 240-480 mg/day and diltiazema at a dose of 240-360 mg / day.

In the 1980s there were AK second generation. Their main advantages were a long duration of action, good tolerability and tissue specificity. In table. 2 shows the most common drugs in this group.

According to their antihypertensive activity, AKs represent a group of highly effective drugs. The advantages over other antihypertensive drugs are their pronounced anti-sclerotic (drugs do not affect the blood lipoprotein spectrum) and antiaggregation properties. These qualities make them the drugs of choice for the treatment of the elderly.

Effect on the kidneys

AA have a beneficial effect on renal function: they increase renal blood flow and cause natriuresis. Less clear is the effect of drugs on GFR and intrarenal hypertension. There is evidence that verapamil and diltiazem reduce intraglomerular hypertension, while nifedipine either does not affect it or increases intraglomerular pressure (P. Weidmann et al., 1995). In this connection for the treatment of nephrogenic hypertension from drugs of the AK group, preference is given to verapamil and diltiazem and their derivatives.

All AKs are characterized by a nephroprotective effect, which is determined by a decrease in kidney hypertrophy, inhibition of metabolism and mesangial proliferation and, consequently, a slowdown in the rate of progression of renal failure (P. Mene., 1997).

Side effects

Side effects are associated, as a rule, with the intake of short-acting AKs of the dihydropyridine group. In this group of drugs, the period of action is limited to 4-6 hours, the half-life ranges from 1.5 to 4-5 hours. Within a short time, the concentration of nifedipine in the blood varies over a wide range - from 65-100 to 5-10 ng / ml. A poor pharmacokinetic profile with a "peak" increase in the concentration of the drug in the blood, resulting in a decrease in blood pressure for a short time and a number of neurohumoral reactions, such as the release of catecholamines, determine the presence of the main adverse reactions when taking drugs - tachycardia, arrhythmias, "steal" syndrome with exacerbation of angina pectoris, redness of the face and other symptoms of hypercatecholaminemia, which are unfavorable for the function of both the heart and the kidneys.

Long-acting and continuous release nifedipine provides for a long time a constant concentration of the drug in the blood, due to which it is devoid of the above adverse reactions and can be recommended for the treatment of nephrogenic hypertension.

Due to the cardiodepressive action, verapamil can cause bradycardia, atrioventricular blockade and, in rare cases (when using large doses), atrioventricular dissociation. When taking verapamil, constipation is frequent.

Although AKs do not cause adverse metabolic effects, the safety of their use in early pregnancy has not yet been established.

Reception of AC is contraindicated in initial hypotension, sick sinus syndrome. Verapamil is contraindicated in atrioventricular conduction disorders, sick sinus syndrome, severe heart failure.

Blockers b-adrenergic receptors

β-adrenergic receptor blockers are included in the spectrum of drugs intended for the treatment of PH.

The mechanism of the antihypertensive action of b-blockers is associated with a decrease in cardiac output, inhibition of renin secretion by the kidneys, a decrease in OPS, a decrease in the release of noradrenaline from the endings of postganglionic sympathetic nerve fibers, a decrease in venous inflow to the heart and circulating blood volume.

In table. 3 shows the most common drugs in this group.

There are non-selective b-blockers, blocking both b 1 - and b 2 -adrenergic receptors, cardioselective, blocking predominantly b 1 -adrenergic receptors. Some of these drugs (oxprenolol, pindolol, talinolol) have sympathomimetic activity, which makes it possible to use them in heart failure, bradycardia, and bronchial asthma.

According to the duration of action are distinguished b-blockers short (propranolol, oxprenolol, metoprolol), middle (pindolol) and long (atenolol, betaxolol, nadolol) actions.

A significant advantage of this group of drugs is their antianginal properties, the possibility of preventing the development of myocardial infarction, reducing or slowing down the development of myocardial hypertrophy.

Effect on the kidneys of b-blockers

b-blockers do not cause oppression of the renal blood supply and reduce renal function. With long-term treatment with b-blockers of GFR, diuresis and sodium excretion remain within the initial values. When treated with high doses of drugs, the renin-angiotensin system is blocked and hyperkalemia may develop.

Side effects

In the treatment of b-blockers, there may be severe sinus bradycardia (heart rate less than 50 per 1 min); arterial hypotension; increased left ventricular failure; atrioventricular blockade of varying degrees; exacerbation of bronchial asthma or other chronic obstructive pulmonary disease; the development of hypoglycemia, especially in patients with labile diabetes mellitus; exacerbation of intermittent claudication and Raynaud's syndrome; hyperlipidemia; in rare cases - a violation of sexual function.

b-Adrenergic blockers are contraindicated in severe bradycardia, sick sinus syndrome, atrioventricular block II and III degree, bronchial asthma and severe broncho-obstructive diseases.

Diuretics

Diuretics are drugs specifically designed to remove sodium and water from the body. The essence of the action of all diuretic drugs is reduced to blockade of sodium reabsorption and a consistent decrease in water reabsorption during the passage of sodium through the nephron.

The hypotensive effect of natriuretics is based on a decrease in circulating blood volume and cardiac output due to the loss of part of the exchangeable sodium and a decrease in OPS due to a change in the ionic composition of the walls of arterioles (sodium output) and a decrease in their sensitivity to pressor vasoactive hormones. In addition, during combined therapy with antihypertensive drugs, diuretics can block the sodium-retaining effect of the main antihypertensive drug, potentiate the hypotensive effect and at the same time allow you to slightly expand the salt regimen, making the diet more acceptable to patients.

For the treatment of PH in patients with preserved kidney function, diuretic drugs acting in the area of ​​the distal tubules are most widely used - a group thiazide diuretics (hydrochlorothiazide) and thiazide-like diuretics (indapamide).

Small doses are used to treat hypertension hydrochlorothiazide — 12.5-25 mg 1 time per day. The drug is excreted unchanged through the kidneys. Hypothiazide has the ability to reduce GFR, and therefore its use is contraindicated in renal failure - with a blood creatinine level of more than 2.5 mg%.

Indapamide — a new antihypertensive agent of the diuretic series. Due to its lipophilic properties, indapamide is selectively concentrated in the vascular wall and has a long half-life of 18 hours.

The hypotensive dose of the drug is 2.5 mg of indapamide 1 time per day.

For the treatment of PH in patients with impaired renal function and diabetes mellitus, diuretics acting in the loop of Henle are used. - loop diuretics. Of the loop diuretics in clinical practice, the most common are furosemide, ethacrynic acid, and bumetanide.

Furosemide has a powerful natriuretic effect. In parallel with the loss of sodium, the use of furosemide increases the excretion of potassium, magnesium and calcium from the body. The period of action of the drug is short - 6 hours, the diuretic effect is dose-dependent. The drug has the ability to increase GFR, therefore it is indicated for the treatment of patients with renal insufficiency.

Furosemide is prescribed at 40-120 mg / day orally, intramuscularly or intravenously up to 250 mg / day.

Side effects of diuretics

Among the side effects of all diuretic drugs, hypokalemia is of the greatest importance (more pronounced when taking thiazide diuretics). Correction of hypokalemia is especially important in patients with hypertension, since potassium itself helps to reduce blood pressure. When the potassium content drops below 3.5 mmol / l, potassium-containing preparations should be added. Among other side effects, hyperglycemia (thiazides, furosemide), hyperuricemia (more pronounced with the use of thiazide diuretics), the development of dysfunction of the gastrointestinal tract, and impotence are of importance.

a-Adrenoblockers

Of this group of antihypertensive drugs, prazosin and, most recently, a new drug, doxazosin, are the most widely used.

Prazosin — selective postsynaptic receptor antagonist. The hypotensive effect of the drug is associated with a direct decrease in OPS. Prazosin expands the venous bed, reduces preload, which justifies its use in patients with heart failure.

The hypotensive effect of prazosin when taken orally occurs after 1/2-3 hours and lasts for 6-8 hours. The half-life of the drug is 3 hours. The drug is excreted through the gastrointestinal tract, so dose adjustment of the drug in case of renal failure is not required.

The initial therapeutic dose of prazosin 0.5-1 mg / day for 1-2 weeks is increased to 3-20 mg per day (in 2-3 doses). The maintenance dose of the drug is 5-7.5 mg / day.

Prazosin has a positive effect on kidney function - it increases renal blood flow, the amount of glomerular filtration. The drug has hypolipidemic properties, has little effect on electrolyte metabolism. The above properties make it appropriate to prescribe the drug in chronic renal failure.

Postural hypotension, dizziness, drowsiness, dry mouth, and impotence were noted as side effects.

Doxazosin structurally close to prazosin, but characterized by long-term action. The drug significantly reduces OPS. The great advantage of doxazosin is its beneficial effect on metabolism. Doxazosin has pronounced anti-atherogenic properties - it lowers cholesterol levels, low and very low density lipoprotein levels, and increases high density lipoprotein levels. At the same time, its negative effect on carbohydrate metabolism was not revealed. These properties make doxazosin drug of choice for the treatment of hypertension in diabetic patients.

Doxazosin, like prazosin, has a beneficial effect on renal function, which determines its use in patients with PH in the stage of renal failure.

When taking the drug, the peak concentration in the blood occurs after 2-4 hours; the half-life ranges from 16 to 22 hours.

Therapeutic doses of the drug are 1-16 mg 1 time per day.

Side effects include dizziness, nausea, and headache.

Conclusion

In conclusion, it should be emphasized that the presented range of drugs of choice for the treatment of PH, used as monotherapy and in combination, provides strict control of PH, inhibition of the development of renal failure and a decrease in the risk of cardiac and vascular complications. So, tight control of systemic blood pressure (mean dynamic blood pressure of 92 mm Hg, i.e. normal blood pressure values), according to a multicenter study MDRD, delayed the onset of renal failure by 1.2 years, and the control of systemic blood pressure with ACE inhibitors kept patients alive for almost 5 years without dialysis (Locatelli F., Del Vecchio L., 1999).
Literature

1. Ritz E. (Ritz E.) Arterial hypertension in kidney disease. Modern nephrology. M., 1997; 103-14.

1. Ritz E. (Ritz E.) Arterial hypertension in kidney disease. Modern nephrology. M., 1997; 103-14.

2. Brenner B, Mackenzie H. Nephron mass as a risk factor for progression of renal disease. Kidney Int. 1997; 52 (Suppl. 63): 124-7.

3. Locatelli F., Carbarns I., Maschio G. et al. Long-term progression of chronic renal insufficiency in the AIPRI Extension Study // Kidney Intern. 1997; 52 (Suppl. 63): S63-S66.

4. Kutyrina I.M., Nikishova T.A., Tareeva I.E. Hypotensive and diuretic effect of heparin in patients with glomerulonephritis. Ter. arch. 1985; 6:78-81.

5. Tareeva I.E., Kutyrina I.M. Treatment of nephrogenic hypertension. Wedge. honey. 1985; 6:20-7.

6. Mene P. Calcium channel blockers: what they can and what they can not do. Nephrol Dial Transplant. 1997; 12:25-8.

Chronic renal failure is a progressive disease that develops slowly, but leads to impaired kidney function. With the development of this disease, nephrons completely die off or are replaced by connective tissue, which prevents the kidneys from fully purifying the blood, removing excess fluid and salts from the body. As a result of renal failure, the electrolyte, acid-base, water, nitrogen balance is disturbed, which affects the performance of all organs, and in case of thermal renal failure leads to death. Diagnosis of this disease is carried out for more than one month, during which the identified violations are recorded.

Symptoms

Signs of chronic renal failure are reflected in the appearance of patients:

• pallor is observed;
• the skin dries and itches, its elasticity decreases;
• gradually the skin and mucous membranes turn yellow;
• bruises and hemorrhages appear for no apparent reason;
• edema appears;

In addition to external signs, other symptoms of chronic renal failure are also detected:

• decreased muscle tone, memory;
• insomnia and daytime sleepiness develop;
• limbs are cold, tingling is felt;
• motor abilities are gradually impaired;
• the volume of urine increases in the first stages of the disease and sharply decreases or disappears altogether with the development of the disease;
• constant feeling of thirst and dryness in the mouth;
• the heartbeat is knocked down;
• there are paralysis in the muscles;
• breathing is disturbed;
• bones soften, increasing the risk of fractures.

As a result of the development of this pathology, when the SFC is below 40 ml / min, there is a risk of destruction of the small and large intestines, bloating, pain and loose stools appear (enterocolitis develops). The smell from the mouth becomes ammoniacal.

The heart does not cope, blood pressure rises, the heart muscles are affected. Disorders in the work of the cardiovascular system are manifested in the form of dull pains in the region of the heart, cardiac arrhythmia, shortness of breath, swelling of the legs. If the appropriate drugs are not taken at the same time, the patient may die from acute heart failure.

Deficiency of erythropoietin leads to a slowdown in blood formation, so anemia develops and associated lethargy and fatigue.

The lungs suffer already in the later stages of chronic renal failure. Interstitial edema develops, and a decrease in immunity leads to bacterial inflammation.

In patients with this disease, appetite decreases, sensations of nausea, vomiting appear, the mucous membranes of the mouth and salivary glands become inflamed. Erosions and ulcers appear in the stomach and intestines, causing bleeding.

The reasons

Any kidney disease can cause CRF if left untreated. The disease causes nephrosclerosis and a decrease in the normal functioning of the kidneys. Patients with chronic diseases such as glomerulonephritis, pyelonephritis, tubulointerstitial nephritis, hydronephrosis, nephrolithiasis, tuberculosis, polycystic and kidney cancer should carefully monitor their health. However, we must not forget about other factors that also provoke CRF:

• cardiovascular pathologies;
• interruptions in the work of the endocrine system;
• systemic diseases;
• pathologies of the urinary tract.

The causes of chronic renal failure are different, so it is necessary to conduct a long and versatile examination, and evaluate kidney damage.

Stages of development of chronic renal failure

Simultaneously with the replacement of part of the renal glomeruli with scar tissue, chronic renal failure provokes functional changes in other organs. Since this process is gradual, there are several stages of chronic renal failure. When filtration in the glomerulus of the kidney decreases, pathological changes develop in the body. Normally, this figure is 100-120 ml / min. In laboratory studies, it is determined by the level of creatinine in the blood.

In the first stage of the disease, GFR drops to 90 ml/min, which is sometimes considered normal. This happens against the background of kidney damage.

At the second stage, kidney damage progresses, and the filtration rate decreases to the limits of 89-60 ml / min, which is the norm for the elderly.

The third stage is characterized by a drop in SFC to 60-30 ml / min, but kidney damage is still mild and does not have bright symptoms. You can observe a decrease in red blood cells and anemia, general weakness develops, efficiency decreases, the skin and mucous membranes become pale, nails are brittle, hair falls out, and appetite decreases. At this stage of the disease, diastolic (lower) pressure increases in almost 50% of patients.

The fourth or conservative stage of chronic renal failure can be controlled with medication. GFR level is kept within 29-15 ml/min. Nighttime urge to urinate becomes more frequent, as the volume of urine increases significantly, hypertension develops.

The final fifth stage of chronic renal failure is called terminal. Glomerular filtration drops below 15 ml/min, the volume of urine decreases, and in the initial state it completely disappears. Due to a violation of the water-electrolyte balance, intoxication of the body with nitrogenous slags occurs. The heart and nervous system are the first to suffer. Only blood dialysis can save the patient at the terminal stage. If a kidney is not transplanted or hemodialysis is not done on time, the patient will die.

Establishing diagnosis

Diagnosis of CKD is a lengthy process. It is necessary to observe the patient's condition for three months and record the identified violations in the functioning of the organs. Kidney failure is characterized by two types of changes:

1. Violation of the structure of the kidneys and their functions. Such changes are detected in the course of laboratory tests or by the method of instrumental diagnostics. The glomerular filtration rate does not always decrease, but may remain within the normal range.
2. Change in SFC level below 60 ml / min with or without kidney damage. This filtration rate indicates the death of almost half of the renal nephrons.

Treatment

It is necessary to start the treatment of chronic renal failure with a diet. You will need to reduce the amount of protein consumed to 60 g per day and give preference to vegetable proteins. Beef, eggs and lean fish are recommended at stages 3-5 of chronic renal failure, but the total amount of proteins is reduced to 30-40 g. Patients with this disease should give up white bread, rice, mushrooms and legumes, reduce black bread, potatoes, dates in the diet , raisins, bananas, parsley. The total amount of all fluid consumed should not exceed 2-2.5 liters per day.

Along with the diet, the doctor may prescribe drugs that replace amino acids. The amount of salt is reduced only when hypertension and edema appear.

In addition, drugs that reduce uremia are prescribed. The simplest enterosorbent is activated carbon. The production of red blood cells is stimulated by the administration of Erythropoietin, and various iron preparations complement the therapy.

If chronic renal failure is accompanied by the development of secondary infections, it is necessary to take antibiotics, antiviral or antifungal agents.

The drugs Ticlopedin, Clopidogrel and Aspirin improve blood clotting, and Enalapril and Lisinopril help with high blood pressure.

Patients with chronic renal failure are prescribed calcium carbonate to restore phosphorus, and vitamin D preparations for calcium deficiency.

To maintain water and electrolyte balance, it is necessary to reduce the amount of water and salt consumed. Also for these purposes, drugs with citrates and bicarbonates are used.

At the terminal stage of chronic renal failure, hemodialysis is necessary, connection to an "artificial kidney". For children, dialysis is initiated at SFC levels below 15 ml/min, and in diabetes mellitus below 10 ml/min.

But hemodialysis has contraindications: it cannot be carried out with blood clotting disorders, the presence of a tumor with metastases, an active infectious disease, and with mental disorders.

Chronic renal failure (CRF) is a chronic disease in which the normal functioning of the kidneys is disrupted.

The kidneys are two bean-shaped organs located on the sides of the spine below the ribs. The main function of the kidneys is to filter and cleanse the blood of waste products of metabolism that are converted into urine.

The kidneys also perform the following functions:

• help regulate blood pressure;
• participate in mineral metabolism, which in turn contributes to the normal functioning of the heart and muscles;
• convert vitamin D to its active form, which is needed for bone health;
• synthesize a substance called erythropoietin, which stimulates the production of red blood cells (erythrocytes).

In chronic renal failure, all these functions are impaired. Most often, the cause of chronic kidney failure is other diseases that increase the load on the kidneys.

Typically, CKD has no symptoms until an advanced stage. At an earlier stage, its existence can be guessed from blood and urine tests. The main symptoms of chronic renal failure in the late stage: fatigue, swelling of the hands, feet and face, shortness of breath.

Most often, chronic renal failure is diagnosed by blood and urine tests. In people at risk, such examinations should be carried out every year. About the predisposition to chronic renal failure says:

• high blood pressure (hypertension);
• family history of CKD.

CRF is a common disease, most often developing with age. The older you get, the more likely it is that your kidneys will fail. According to some estimates, about one in five men and one in four women between the ages of 65 and 74 have some degree of CRF.

People with chronic renal failure are at increased risk of stroke and heart attack as a result of impaired blood circulation. The outcome of the final (terminal) stage of CRF is kidney failure. In this case, to maintain vital functions, an artificial kidney machine is required, on which patients regularly undergo dialysis (blood purification).

Despite the fact that it is impossible to completely cure kidney failure and restore kidney function, with the help of drugs it is possible to slow down the development of the disease, for a long time or even permanently delay its terminal stage. Therefore, the diagnosis of chronic renal failure is not a sentence, but a reason to take health seriously and take the disease under control.

Symptoms of chronic renal failure

Most people with CKD do not have any symptoms, as the body compensates for even a significant decrease in kidney function for a long time. Severe clinical signs of renal failure develop only in the last stages of the disease.

In other words, the kidneys have a great compensatory potential and can work more than we need to provide vital processes. Often, even one working kidney copes with all the necessary work. Therefore, a gradual decrease in kidney function for a long time does not affect health.

Minor kidney problems are usually detected with a routine blood or urine test. In this case, you will be offered regular check-ups to closely monitor changes in the condition of the kidneys. Treatment will focus on managing symptoms and preventing further kidney damage. If, despite treatment, kidney function continues to decline, characteristic symptoms appear:

• weight loss and appetite;
• swelling of the ankles, feet, or hands (due to fluid retention);
• dyspnea;
• blood or protein in the urine (detected during tests);
• increased need to urinate, especially at night;
• skin itching;
• muscle cramps;
• high blood pressure (hypertension);
• nausea;

Similar symptoms can occur with other diseases. Many of them can be avoided if treatment is started early, before symptoms appear. If you have any of the symptoms listed above, make an appointment with your doctor.

Causes of chronic renal failure

Most often, kidney failure is associated with another disease or condition that puts more stress on the kidneys. High blood pressure (hypertension) and diabetes are the most common causes of kidney failure. According to some reports, just over a quarter of all cases of kidney failure are associated with high blood pressure. Diabetes is the cause of the disease in about a third of cases.

Blood pressure is the pressure that blood exerts on the vessels in the arteries with each heartbeat. Too much pressure can damage organs, leading to heart disease, stroke, and poor kidney function.

In about 90% of cases, the cause of high blood pressure remains unknown, but there is a connection between this disease and the general health, nutrition and lifestyle of a person. Known risk factors for high blood pressure include the following:

• Age (the older you get, the higher your risk of developing high blood pressure)
• cases of high blood pressure in the family (there is reason to believe that the disease is inherited);
• obesity;
• sedentary lifestyle;
• smoking;
• alcohol abuse;
• high salt intake;
• high fat intake;
• stress.

High blood pressure puts more pressure on the small blood vessels in the kidneys, which interferes with blood purification.

Diabetes mellitus is a disease in which the body does not produce enough insulin (type 1 diabetes) or uses it inefficiently (type 2 diabetes). Insulin is needed to regulate blood glucose (sugar) levels, preventing levels from rising too high after meals or falling too low between meals.

If diabetes is not monitored, too much glucose can accumulate in the blood. Glucose can damage the tiny filters in the kidneys, impairing the ability of the kidneys to filter out waste products and fluids. By some estimates, 20-40% of people with type 1 diabetes will develop kidney failure by the age of 50. About 30% of people with type 2 diabetes also have signs of kidney failure.

The first sign of kidney failure in diabetics is the appearance of a small amount of protein in the urine. Therefore, your GP will ask you to have your urine tested annually so that kidney failure can be diagnosed as early as possible.

Less often, other diseases become the cause of CKD:

• glomerulonephritis (inflammation of the kidney);
• pyelonephritis (kidney infection);
• polycystic kidney disease (a hereditary disease in which both kidneys are enlarged due to the gradual growth of a mass of cysts - vesicles with liquid);
• violation of the normal formation of the kidneys during fetal development;
• systemic lupus erythematosus (an immune system disease in which the body attacks the kidney as if it were foreign tissue);
• long-term regular use of drugs, for example, (non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen;
• obstruction of the urinary tract, for example, due to kidney stones or diseases of the prostate gland.

Diagnosis of chronic renal failure

If you are at risk for developing chronic renal failure, you should be regularly screened for this disease. Annual screening is recommended for the following groups:

• people with high blood pressure (hypertension);
• people with diabetes;
• people who regularly take drugs that can damage the kidneys (nephrotoxic drugs), such as: lithium, calcineurin inhibitors, painkillers, including ibuprofen, etc .;
• people with cardiovascular disease (such as coronary heart disease) or stroke;
• people with diseases of the urinary system, such as nephrolithiasis or an enlarged prostate;
• people whose close relatives had CRF at the fifth stage (for more details about the stages, see below) or hereditary renal failure;
• people with systemic connective tissue diseases (affecting many organs), such as systemic lupus erythematosus;
• People with blood in their urine (hematuria) or protein in their urine (proteinuria) for which no cause has been identified.

Talk to your GP about whether you need to be tested for CKD. Most often, kidney failure is diagnosed when a routine blood or urine test shows that the kidneys are not working properly. If this occurs, as a rule, the analysis is repeated to confirm the diagnosis.

Calculation of glomerular filtration rate (GFR)- an effective way to assess the work of the kidneys. GFR measures how many milliliters (mL) of metabolic waste products your kidneys can filter from your blood per minute (measured in ml/min). A healthy pair of kidneys should be able to filter more than 90 ml/min.

It is difficult to measure GFR directly, so the calculation is done using a formula. The result is called the estimated GFR or eGFR. Your eGFR is calculated by taking a blood test and measuring the level of a metabolic product called creatinine, and taking into account your age, gender, and ethnicity. The result is equal to the percentage of normal kidney function. For example, an eGFR of 50 ml/min means 50% of normal kidney function. shows how well the kidneys are doing their job.

Stages of chronic renal failure

During renal failure, it is customary to distinguish five stages. The classification is based on the glomerular filtration rate. The higher the stage, the more severe the CRF. These five stages are described below:

• first stage: normal glomerular filtration rate (above 90), but other tests indicate kidney damage;
• the second stage: a slight decrease in the glomerular filtration rate to 60-89, there are signs of kidney damage;

• third stage (divided into stages 3a and 3b). In stage 3a, the glomerular filtration rate decreases slightly (45–59) and moderately in stage 3b (30–44); in the future, tests must be taken every six months;
• fourth stage: a strong decrease in the glomerular filtration rate (15–29); by this time you may begin to experience symptoms of CKD, tests should be taken every three months;
• fifth stage: the kidneys have practically stopped working (glomerular filtration rate is below 15), kidney failure occurs; tests should be taken every six weeks.

However, GFR results can fluctuate, so a single change in glomerular filtration rate is not always indicative. The diagnosis of CKD is confirmed only if eGFR results are consistently below normal for three consecutive months.

Other methods for diagnosing chronic renal failure

A number of other methods are also used to assess the extent of kidney damage. They are described below:.

• Urinalysis - Shows if there is blood or protein in your urine. The results of some urine tests can be obtained immediately, while others have to wait several days.
• Kidney scans, such as ultrasonography (ultrasound), magnetic resonance imaging (MRI), or computed tomography (CT), show whether there is a urinary tract obstruction. In advanced renal failure, the kidneys shrink and become uneven.
• Kidney biopsy - taking a small sample of kidney tissue to assess damage to tissue cells under a microscope.

Treatment of chronic renal failure

Although there is no cure for chronic kidney disease, treatment can help relieve symptoms, slow or stop the progression of the disease, and reduce the risk of complications.

Health-care workers should provide the following services for the treatment and prevention of kidney failure:

• identify people at risk for kidney failure, especially those with high blood pressure or diabetes, and start treatment as early as possible to keep the kidneys working;
• conduct examinations and repeat them to reduce the risk of exacerbation of the disease;
• provide people with detailed information about self-help measures for this disease;
• provide information about the course of the disease and treatment options;
• provide specialist services for the treatment of kidney disease;
• if necessary, refer patients for dialysis or kidney transplantation.

You need to adjust the treatment regularly, under the supervision of a doctor. You may want to keep a diary in which you record test results, how you feel, and the treatment you are currently receiving.

Methods of treatment will depend on the stage of chronic renal failure (CRF) and the causes that caused it. The initial stages of the disease are treated on an outpatient basis (in the clinic). Planned hospitalization to the hospital is periodically recommended (1-2 times a year) for complex research methods and treatment correction. Treatment is usually supervised by a general practitioner who, if necessary, will refer you to a nephrologist, a specialist in kidney disease, for a consultation.

Treatment includes lifestyle changes and, in some cases, drugs to control blood pressure and lower blood cholesterol. This should help prevent further damage to the kidneys and circulation.

If you have stage 4 or 5 CKD, you will be treated in a hospital (hospital). In addition to the treatments mentioned above, you may also be prescribed drugs to manage or relieve symptoms of CKD. Kidney failure occurs when the kidneys have practically stopped working and the disease has become life threatening. Approximately 1% of people with stage 3 CKD develop kidney failure. At this stage, the disease is already a threat to life.

If the kidneys are no longer doing their job, there are several treatment options. The main ones are: dialysis - a method of blood purification using an artificial kidney machine and kidney transplantation from a donor. There are other methods of treatment that do not require surgical intervention - the so-called maintenance therapy.

To normalize blood pressure and keep kidney failure under control, it is important to make lifestyle changes:

• stop smoking;
• eat a healthy, balanced, low-fat diet;
• limit salt intake to 6 g per day;
• do not take medications without a doctor's recommendation, many of them become toxic against the background of reduced kidney function;
• do not exceed the permissible doses of alcohol consumption: men should not drink more than three to four drinks (75-100 grams in terms of vodka) of alcohol per day, and women, no more than two to three (50-75 grams in terms of vodka) servings per day)
• lose weight if you are obese or overweight;
• Exercise regularly, at least 30 minutes a day, five days a week.

High blood pressure drugs

One way to slow down kidney damage is to normalize blood pressure. If losing weight, reducing your salt intake, and making other lifestyle changes don't help lower your blood pressure, you may need to take medication.

There are many different types of medicines to lower blood pressure. Drugs called angiotensin converting enzyme inhibitors (ACE inhibitors) are used specifically to lower blood pressure in people with CKD. In addition to lowering blood pressure in the body and stress on the blood vessels, these drugs provide additional protection to the kidneys. These drugs include the following:

• ramipril;
• enalapril;
• lisinopril;
• perindopril.

Side effects of angiotensin converting enzyme (ACE) inhibitors include:

• persistent dry cough;
• dizziness;
• fatigue or weakness;
• headache.

Most side effects should go away within a few days, but some people continue to experience a dry cough. If you suffer from the side effects of angiotensin converting enzyme inhibitors, you may be prescribed drugs from a group called angiotensin-II receptor blockers instead. This group of drugs includes candesartan, eprosartan, irbesartan and losartan. These drugs usually have no side effects, but may cause dizziness.

Both angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers can cause a decrease in kidney function and an increase in the level of potassium in the blood, so after starting treatment and when changing the dosage, you will need to have blood tests.

Aspirin or statins for CKD

Studies have shown that people with CKD are more prone to cardiovascular disease, including heart attacks and strokes, as some risk factors for CKD overlap with risk factors for heart attack and stroke, including high blood pressure and high cholesterol levels. blood (atherosclerosis). You may be prescribed low-dose aspirin or statins to reduce your risk of heart attack or stroke.

Statins are a type of medicine for lowering blood cholesterol levels. Cholesterol causes narrowing of the arteries, which can prevent blood from reaching the heart (leading to a heart attack) or the brain (leading to a stroke). Statins block the action of an enzyme called HMG-CoA reductase, which is used to make cholesterol in the liver.

Sometimes statins can cause minor side effects, including the following:

• constipation;
• diarrhea;
• headache;
• abdominal pain.

Side effects of statins also include muscle pain and weakness. If you experience any of these symptoms, contact your physician. You may need to have a blood test or change your treatment.

How to reduce edema (fluid buildup)

If you have kidney failure, you may need to reduce your daily water and salt intake. Because your kidneys can't excrete excess fluid as quickly as they used to, excess fluid can accumulate in the form of edema. When counting the amount of water you drink in a day, don't forget the liquids in your food (soups, yogurt, fruits, etc.). You can consult your physician or nutritionist about this.

In renal failure, fluid accumulates not only under the skin on the legs, arms and face, but edema can also develop in internal organs, such as the lungs. You may be prescribed a diuretic, such as furosemide, to help remove excess fluid from your body. If edema does not occur, there is no need to restrict fluid, unless the doctor has advised otherwise. In some cases, fluid restriction can even hurt.

Treatment of anemia in renal failure

Many people with CKD in the third, fourth, and fifth stages develop anemia. Anemia is a disease in which there are not enough red blood cells (erythrocytes) in the blood. Anemia symptoms:

• fatigue;
• prostration;
• feeling short of breath (shortness of breath);
• cardiopalmus.

Anemia can be caused by a variety of conditions, and your doctor will test you to rule out other possible causes.

Most people with anemia are prescribed iron supplements because iron is essential for the production of red blood cells. To replenish your iron stores, you can take iron tablets, such as taking a ferrous sulfate tablet once a day, or giving it intravenously from time to time. If this is not enough to treat anemia, you may be given erythropoietin, a hormone that stimulates the body to make red blood cells. Erythropoietin is administered intravenously or subcutaneously.

Phosphorus balance correction

In stage 4 or 5 CKD, you may have a buildup of phosphorus in your body because your kidneys can't get rid of it on their own. Phosphorus is an element that, along with calcium, is essential for bones. We get phosphorus from food, mainly from dairy products. Excess phosphorus is usually filtered out by the kidneys. If there is too much phosphorus in the body, the calcium balance is disturbed, which can lead to weakened bones and clogged arteries.

In case of violation of phosphorus metabolism, it is necessary to reduce its intake with food. Phosphorus-rich foods include: red meat, dairy products, and fish. Talk to your doctor or dietitian about how much phosphorus you can consume. If the phosphorus content in your body is normal, you do not need to reduce its intake. Be sure to check with your doctor before changing your diet.

If restricting phosphorus in the diet does not sufficiently reduce the level of phosphorus in the body, you may be prescribed a special phosphate binder. This drug binds phosphorus in your stomach and prevents your body from absorbing it. For the drug to work, it must be taken right before meals. The most commonly used phosphate binder is calcium carbonate, but there are other drugs that may work better for you.

Side effects of phosphate binders are rare but may include:

• nausea;
• abdominal pain;
• constipation;
• diarrhea;
• flatulence;
• skin rash;
• skin itching.

Vitamin D

The kidneys convert vitamin D to its active form, which is involved in metabolism and essential for bone health. In people with kidney failure, vitamin D levels can drop significantly. You may be prescribed a vitamin D supplement called alfacalcidol or calcitriol to replenish your vitamin D stores and prevent bone damage.

Renal Failure Treatment - Dialysis or Transplant

Many people with kidney failure manage their kidneys with medication throughout their lives. However, in a small number of people, the disease progresses to the point where the kidneys stop working completely, which can be life-threatening. In this situation, a choice has to be made between dialysis (blood purification using an artificial kidney machine) or a donor kidney transplant. There is also drug maintenance (polliative) therapy.

Polliative therapy is prescribed in case of contraindications or impossibility of dialysis and transplantation, as well as in case of refusal of these methods by the patient.

The goal of polyactive treatment is to prolong life as much as possible and eliminate the symptoms of the disease. Supportive care consists of taking medication, psychological help, and caring for a sick person.

Many people choose maintenance therapy for the following reasons:

• they don't want to experience the inconvenience of dialysis and kidney transplants;
• dialysis is dangerous because there is another serious illness;
• they were on dialysis but decided to stop;
• they are on dialysis but have another incurable disease that will shorten their lives.

If you choose supportive care, your doctor will prescribe:

• drugs that will keep the kidneys working as long as possible;
• drugs that reduce the severity of symptoms: shortness of breath, anemia, loss of appetite or skin itching;
• psychologist consultation.

Prevention of chronic renal failure

In most cases, chronic kidney disease (CKD) cannot be completely prevented, but there are steps you can take to reduce your risk of developing the disease.

If you have a chronic condition, such as diabetes, that has the potential to lead to chronic kidney failure, you need to treat its symptoms and avoid flare-ups. For example, if you have diabetes, you need to carefully monitor your blood sugar levels and regularly examine your kidneys. Follow all the instructions of your therapist and do not miss the scheduled examinations regarding your disease.

Smoking increases the risk of developing cardiovascular diseases, including heart attacks and strokes, and can also exacerbate existing kidney problems. By quitting smoking, you will improve your overall health and reduce your risk of developing other serious diseases, such as lung cancer and heart disease.

To prevent CKD, you need to eat right. This will help lower blood cholesterol levels and maintain normal blood pressure. It is recommended to include in the diet a lot of fresh fruits and vegetables (at least five servings per day), as well as whole grains. Limit your salt intake to 6 grams per day. Excess salt increases blood pressure. One teaspoon of salt is approximately equal to 6 g.

Avoid foods rich in saturated fats as they raise cholesterol levels:

• meat pies;
• sausages and fatty meat;
• Indian cuisine;
• animal oils;
• pork fat;
• sour cream;
• hard cheeses;
• cakes and sweet pastries;
• products containing coconut or palm oil.

Eating foods rich in unsaturated fats can help lower your cholesterol:

• oily fish;
• avocado;
• nuts and grains;
• sunflower oil;
• rapeseed oil;
• olive oil.

Alcohol abuse raises blood pressure and blood cholesterol levels, and therefore increases the risk of CRF. Permissible doses of alcohol consumption:

• 3-4 drinks per day for men;
• 2-3 drinks per day for women.

A serving of alcohol is equal to approximately 250 ml of light medium-strength beer, a small glass of wine, or 25 ml of strong alcohol.

Regular physical activity should help reduce blood pressure and the risk of developing CKD. A minimum of 150 minutes (two and a half hours) of moderate-intensity aerobic exercise (such as cycling or brisk walking) is recommended each week.

If you need to take painkillers, follow the instructions for use.

Living with chronic kidney disease

The diagnosis of kidney failure can be a difficult test for you and your loved ones, but it is not a sentence, but only an excuse to take care of your health and get the disease under control.

Kidney damage cannot be repaired, but that doesn't mean you're bound to get worse. Kidney failure occurs in less than 1% of people with stage 3 kidney failure. By following a healthy lifestyle and following your doctor's advice on treating high blood pressure and other conditions, you can manage your symptoms and keep your kidneys functioning at a consistent level.

• stop smoking;
• maintain normal blood pressure;
• reduce the amount of cholesterol in the diet;
• people with diabetes should monitor their blood sugar levels.

Taking care of your own health is an integral part of your daily life. You are responsible for your health and wellness. It is very important that people close to you support you in this. It is also necessary to establish a trusting relationship with a doctor who will help you throughout the illness: regularly undergo scheduled examinations, take tests and follow medical recommendations.

The need for constant self-control forces people with chronic diseases to radically change their lifestyle and maintain strict discipline. Which, sometimes, gives a great advantage: it prolongs life, helps to cope with anxiety and pain, depression and fatigue, allows you to achieve a higher quality of life and maintain activity and independence for a long time.

Given that kidney failure is a chronic condition, you will meet regularly with the specialists involved in your treatment. A good relationship with these professionals gives you the freedom to discuss your symptoms and concerns with them. The more they know, the better they can help you.

Every person with a chronic condition, such as kidney failure, is recommended to get a flu shot every fall. It is also recommended to get vaccinated against pneumococcus. This vaccine is given once and protects against a serious lung infection called pneumococcal pneumonia.

Regular exercise and a healthy diet are recommended for everyone, not just people with kidney disease. This will help prevent many diseases, including heart disease and some forms of cancer. Regular exercise helps relieve stress and reduce fatigue. Try to eat a balanced diet with a variety of foods so that your body gets all the nutrients it needs. See a dietitian who will decide if you need to follow a special diet. His recommendations will depend on how well your kidneys are working.

A disease such as kidney failure can be hard on you, your family and friends. It may be difficult for you to discuss your diagnosis, even with loved ones. By learning more about your disease, you and your family will be able to better understand what to expect and feel that you are in control of the disease, that your life should not revolve around kidney failure and its treatment.

Be open in expressing your feelings, tell your loved ones how they can help you. And feel free to tell them that you need some time alone if you really need to.

The attending physician will tell you in detail about the features of the disease and how to deal with it. Perhaps you should visit a psychotherapist or psychologist who will help you adjust your attitude towards the disease. Sometimes it can be helpful to talk to people who have the same condition. Such an opportunity is available on forums on the Internet and local support groups.

Social rights of patients with renal failure

In the early stages of chronic renal failure, people usually remain able to work and do not need expensive treatments. At the time of the exacerbation of the disease, they are entitled to a paid disability certificate, which is issued on a general basis.

If you work in harmful conditions (heavy physical activity, work at the conveyor, in a standing position, with changes in air temperature, high humidity, smoke, etc.), as well as overtime, the doctor should refer you to a medical and social examination ( ITU). By decision of the examination, you can be transferred to an easier job.

With the development of complications of renal failure, as well as with the aggravation of the condition, the doctor also submits the necessary documents to the ITU for disability registration. A disability entitles you to free medicines, benefits, and certain other benefits.

If your condition requires dialysis or a kidney transplant, these services should be provided to you free of charge. Read more about the rules for receiving high-tech medical care.

Sex and pregnancy in kidney failure

The symptoms of kidney failure and the stress caused by the disease can affect your sex life. Some families become stronger after the diagnosis, while others move away from each other. Both men and women may have difficulty with body image and self-esteem, which can affect relationships.

In the early stage, kidney failure does not affect the ability to conceive in either men or women. At a later stage, chronic renal failure can affect a woman's periods, which somewhat reduces the likelihood of conception. In men at a later stage of kidney failure, the number of sperm in seminal fluid may decrease. However, kidney failure does not exclude the possibility of pregnancy. Therefore, it is extremely important to use contraceptives.

Rest and insurance for chronic renal failure

Chronic renal failure or a kidney transplant should not prevent you from traveling, but they do impose a number of restrictions. If you're on dialysis, it's important to check before you travel to see if you'll be able to use your artificial kidney machine while you're on vacation. In many regions of the country, the ability to travel for dialysis patients is limited due to the lack of treatment equipment. If you are traveling abroad, it is usually easier to arrange treatment in a short period of time, as hospitals in other countries are better equipped.

Before traveling, you should take out travel medical insurance. People with kidney disease must indicate their disease when filling out a standard application when applying for an insurance policy. This may limit some of the services it covers.

Contraindications to taking medications for kidney failure

Some drugs have the potential to harm the kidneys. Before taking any over-the-counter medicine, check with your physician. You are more likely to be harmed by certain over-the-counter medicines if you:

• you have advanced kidney failure (stage four or five, kidneys are working less than 30% of normal);
• you have early or middle stage kidney failure (stage three, kidneys are working between 30% and 60% of normal) and you are an older person with another serious illness, such as coronary artery disease.

Listed below are the main medications that people with CKD can take, as well as medications that should be avoided. For more information, contact your doctor.

Paracetamol is safe and the best medicine for headaches, but avoid medicines that need to be dissolved in water as they are high in sodium. If your kidneys are less than 50% functional, do not use aspirin, ibuprofen, or similar drugs such as diclofenac. These drugs can worsen the functioning of damaged kidneys. Low-dose aspirin (75–150 mg per day) can be taken as directed by a physician to help prevent vascular disease. You should also not take ibuprofen if you have recently had a kidney transplant and are taking medication to prevent kidney rejection.

Many cough and cold medicines contain a mixture of ingredients, so read the label carefully. Some drugs contain paracetamol, while others contain a large dose of aspirin, which you should avoid. Many cold medicines contain nasal congestion medicines that should not be taken if you have high blood pressure. The best way to get rid of nasal congestion is steam inhalation with menthol or eucalyptus. To get rid of a cough, try a regular cough mixture or a mixture of glycerin, honey, and lemon to soothe your throat.

If you have muscle or joint pain, topical medications (applied to the skin) are best. Do not take tablets containing ibuprofen or similar drugs, such as diclofenac, if your kidneys are less than 50% functional. Ibuprofen in the form of a gel or spray is preferable to tablets, but it is not completely safe, as a small amount of the drug penetrates the skin and enters the bloodstream.

Kidney Failure: Dialysis or Kidney Transplant?

Approximately 1% of people with stage 3 CKD develop kidney failure. It has a huge impact on your life and the lives of your loved ones. People who are diagnosed with kidney failure typically go through shock, grief, and denial before coming to terms with their diagnosis.

If you have chronic kidney disease, you need to decide whether to start dialysis (cleansing the blood with an artificial kidney machine) or a kidney transplant. You can opt out of both options and opt for supportive care.

For people who want to recover from kidney failure, a kidney transplant is the best option. However, only 10-15% of those in need have such an opportunity. This is due to two reasons: contraindications for health reasons (for example, a serious general condition or the presence of another potentially fatal disease) and a lack of donor organs in our country.

Elderly people with slowly progressive CKD and other serious illnesses often refuse dialysis. In these cases, supportive care is given to keep the kidneys working, maintaining a high quality of life for as long as possible.

Dialysis carried out in the hospital. It consists in filtering the blood from unnecessary metabolic products and excess water. It is not as efficient as the human kidney, so people with kidney failure usually have to limit fluid intake and certain foods. Dialysis also requires additional medications such as iron supplements, phosphate binders, and antihypertensives (for high blood pressure). There are two types of dialysis: peritoneal dialysis and hemodialysis.

The abdominal cavity has a membrane - the peritoneal peritoneum, which can be used as a filter to remove metabolic products and water. If you choose peritoneal dialysis, a tube (catheter) will be placed in your abdomen. This will allow you to infuse and drain dialysis fluid from your abdomen on your own. You will not need to go to the hospital for treatment, but you will need to spend 1-2 hours a day pumping and pumping fluid. The procedure can be carried out in two ways: either you change the fluid four times a day (which takes half an hour), or you connect yourself to a machine at night that pumps and pumps fluid out of you.

Hemodialysis clears your body of waste products and excess fluids that accumulate in it if the kidneys have stopped working. Your blood is cleaned in a filter called a dialyzer. Basically, it's an artificial kidney. The entire procedure takes about four hours and should generally be done three times a week. Hemodialysis is done in a hospital (hemodialysis centers).

It is important that large volumes of blood pass through the machine during hemodialysis. To do this, it is necessary to carry out a certain procedure in order to gain access to sufficiently large blood vessels. To do this, patients who choose hemodialysis require a small operation to connect one of the deep arteries to a superficial vein (fistula). The operation is performed in a surgical day hospital at least six weeks before the start of dialysis, as it will take time before the fistula forms.

Sometimes dialysis may be needed even before the fistula has formed. In this case, a temporary solution is found, usually the use of an indwelling plastic dialysis catheter. A catheter is a surgical tube inserted into the body that carries fluids. All these issues will be discussed in detail with you before any decision is made.

kidney transplant is the best treatment for chronic renal failure. A kidney for transplantation can be obtained from a deceased or living donor, currently the survival rate after the procedure is very high. Five years after transplantation, 90% of donor kidneys are still working, many kidneys have been serving perfectly for more than 20 years. However, in our country there is a large shortage of donor organs, so no more than 10-15% of patients in need of transplantation manage to wait for the operation.

The main risk of surgery is organ rejection, when the immune system attacks the donor kidney, mistaking it for a foreign body. To prevent this, strong drugs are used to suppress the immune system. These drugs must be taken regularly and strictly according to the instructions. They are generally well accepted by the body, but can cause side effects, including greater susceptibility to infections and some types of cancer. Therefore, patients after transplantation regularly undergo examinations in a specialized clinic for transplantation.

Where to go for chronic renal failure?

Using the NaPopravku service, you can find a nephrologist for the diagnosis and treatment of kidney failure, as well as get information about specialized clinics in the city that deal with kidney problems.

On our website you can find all clinics where dialysis is performed, as well as choose a nephrology clinic for hospitalization.

Localization and translation prepared by Napopravku.ru. NHS Choices provided the original content for free. It is available from www.nhs.uk. NHS Choices has not been reviewed, and takes no responsibility for, the localization or translation of its original content

Copyright notice: “Department of Health original content 2019”

All materials on the site have been checked by doctors. However, even the most reliable article does not allow taking into account all the features of the disease in a particular person. Therefore, the information posted on our website cannot replace a visit to the doctor, but only complements it. Articles are prepared for informational purposes and are advisory in nature.

Stably high blood pressure against the background of various kidney diseases is a dangerous condition for both health and life, and requires immediate medical attention. Early diagnosis of renal hypertension and determination of the optimal timely course of treatment will help to avoid many negative consequences.

Renal hypertension (renal pressure, renal hypertension) belongs to the group of symptomatic (secondary) hypertension. This type of arterial hypertension develops as a result of certain kidney diseases. It is important to correctly diagnose the disease and take all necessary medical measures in time to prevent complications.

Disease prevalence

Renal hypertension is diagnosed in about 5-10 cases out of every 100 in patients who have evidence of stable hypertension.

Characteristic features

Like another type of disease, this pathology is accompanied by a significant increase in blood pressure (starting from 140/90 mm Hg. Art.)

Additional signs:

• Stable high diastolic pressure.
• No age restrictions.
• High risk of acquiring malignant hypertension.
• Difficulties in treatment.

Renal hypertension. Principles of disease classification

For practical use in medicine, a convenient classification of the disease has been developed.

Reference. Since hypertension is a very diverse pathology, it is customary to use disease classifications that take into account one or a group of existing criteria. Diagnosing a specific type of disease is a top priority. Without such actions, it is generally not possible to choose a competent correct tactics of therapy and designate preventive measures. Therefore, doctors determine the type of hypertension according to the causes that caused the disease, according to the characteristics of the course, specific blood pressure indicators, possible damage to the target organ, the presence of hypertensive crises, as well as the diagnosis of primary or essential hypertension, which is allocated to a separate group.

It is impossible to determine the type of disease on your own! Contacting a specialist and undergoing complex comprehensive examinations are mandatory for all patients.

Treatment with home methods in case of any manifestation of an increase in blood pressure (episodic, and even more so regular) is unacceptable!

Renal hypertension. Principles of disease classification

Group of renoparenchymal hypertension

The disease is formed as a complication of certain types of functional renal disorders. We are talking about unilateral or bilateral diffuse damage to the tissues of this important organ.

List of renal lesions that can cause renal hypertension:

• Inflammation of some areas of the kidney tissue.
• Polycystic kidney disease, as well as other congenital forms of their anomalies.
• Diabetic glomerulosclerosis as a severe form of microangiopathy.
• A dangerous inflammatory process with localization in the glomerular renal apparatus.
• Infectious lesion (tuberculous nature).
• Some diffuse pathologies proceeding according to the type of glomerulonephritis.

The cause of the parenchymal type of hypertension in some cases are also:

• inflammatory processes in the ureters or in the urethra;
• stones (in the kidneys and urinary tract);
• autoimmune damage to the renal glomeruli;
• mechanical obstacles (due to the presence of neoplasms, cysts and adhesions in patients).

Group of renovascular hypertension

Pathology is formed due to certain lesions in one or two renal arteries. The disease is considered rare. Statistics confirms only one case of renovascular hypertension out of a hundred manifestations of arterial hypertension.

Provoking factors

You should be wary of:

• atherosclerotic lesions with localization in the renal vessels (the most common manifestations in this group of pathologies);
• fibromuscular hyperplasia of the renal arteries;
• anomalies in the renal arteries;
• mechanical compression

Group of mixed renal hypertension

As the immediate cause of the development of this type of disease, doctors often diagnose:

• nephroptosis;
• tumors;
• cysts;
• congenital anomalies in the kidneys themselves or vessels in this organ.

Pathology manifests itself as a negative synergistic effect from a combination of damage to the tissues and vessels of the kidneys.

Group of mixed renal hypertension

Conditions for the development of renal pressure

Studying the process of development of various types of renal hypertension, scientists have identified three main factors of influence, these are:

• insufficient excretion of sodium ions by the kidneys, leading to water retention;
• the process of suppression of the depressor system of the kidneys;
• activation of the hormonal system that regulates blood pressure and blood volume in the vessels.

The pathogenesis of renal hypertension

Problems arise when there is a significant decrease in renal blood flow and reduced glomerular filtration efficiency. This is possible due to the fact that diffuse changes in the parenchyma occur or the blood vessels of the kidneys are affected.

How do the kidneys react to the process of reducing blood flow in them?

1. There is an increase in the level of reabsorption (reabsorption process) of sodium, which then causes the same process in relation to the liquid.
2. But pathological processes are not limited to sodium and water retention. Extracellular fluid begins to increase in volume and compensatory hypervolemia (a condition in which blood volume increases due to plasma).
3. A further development scheme includes an increase in the amount of sodium in the walls of blood vessels, which, as a result, swell, while showing increased sensitivity to angiotensin and aldosterone (hormones, regulators of water-salt metabolism).

Why does blood pressure increase in some kidney pathologies?

We should also mention the activation of the hormonal system, which becomes an important link in the development of renal hypertension.

The kidneys secrete a special enzyme called renin. This enzyme promotes the transformation of angiotensinogen into angiotensin I, from which, in turn, angiotensin II is formed, which constricts blood vessels and increases blood pressure. .

Development of renal hypertension

Effects

The algorithm for increasing blood pressure described above is accompanied by a gradual decrease in the compensatory capabilities of the kidneys, which were previously aimed at lowering blood pressure if necessary. For this, the release of prostaglandins (hormone-like substances) and KKS (kallikrein-kinin system) was activated.

Based on the foregoing, an important conclusion can be drawn - renal hypertension develops according to the principle of a vicious circle. At the same time, a number of pathogenic factors lead to renal hypertension with a persistent increase in blood pressure.

Renal hypertension. Symptoms

Renal hypertension. Symptoms

When diagnosing renal hypertension, one should take into account the specifics of such concomitant diseases as:

• pyelonephritis;
• glomerulonephritis;
• diabetes.

Also pay attention to a number of such frequent complaints of patients, such as:

• pain and discomfort in the lower back;
• problems with urination, increased volume of urine;
• periodic and short-term increase in body temperature;
• persistent feeling of thirst;
• feeling of constant weakness, loss of strength;
• swelling of the face;
• gross hematuria (visible admixture of blood in the urine);
• fast fatiguability.

In the presence of renal hypertension in the urine of patients often found (during laboratory tests):

• bacteriuria;
• proteinuria;
• microhematuria.

Typical features of the clinical picture of renal hypertension

Typical features of the clinical picture of renal hypertension

The clinical picture depends on:

• from specific indicators of blood pressure;
• functional abilities of the kidneys;
• the presence or absence of concomitant diseases and complications affecting the heart, blood vessels, brain, etc.

Renal hypertension is invariably accompanied by a constant increase in the level of blood pressure (with the dominance of an increase in diastolic pressure).

Patients should be seriously wary of the development of malignant hypertensive syndrome, accompanied by spasm of arterioles and an increase in total peripheral vascular resistance.

Renal hypertension and its diagnosis

The diagnosis is based on taking into account the symptoms of concomitant diseases and complications. For the purpose of differential analysis, laboratory research methods are mandatory.

Renal hypertension and its diagnosis

The patient may be given:

• OAM (general urinalysis);
• urinalysis according to Nechiporenko;
• urinalysis according to Zimnitsky;
• Ultrasound of the kidneys;
• bacterioscopy of urinary sediment;
• excretory urography (X-ray method);
• scanning of the kidney area;
• radioisotope renography (X-ray examination using a radioisotope marker);
• kidney biopsy.

The conclusion is drawn up by the doctor based on the results of the patient's interview (history taking), his external examination and all laboratory and hardware studies.

Treatment of renal hypertension

The course of treatment of renal hypertension must necessarily include a number of medical measures to normalize blood pressure. At the same time, pathogenetic therapy is carried out (the task is to correct the impaired functions of organs) of the underlying pathology.

One of the main conditions for effective assistance to nephrological patients is a salt-free diet.

What does this mean in practice?

The amount of salt in the diet should be kept to a minimum. And for some kidney diseases, a complete rejection of salt is recommended.

Attention! The patient should not consume salt more than the allowed norm of five grams per day. Keep in mind that sodium is also found in most foods, including their flour products, sausages, and canned food, so salting cooked food will have to be abandoned altogether.

Treatment of renal hypertension

In what cases is a tolerant salt regime allowed?

A slight increase in sodium intake is allowed for those patients who are prescribed as a medicine. salturetics (thiazide and loop diuretics).

It is not necessary to severely restrict salt intake in symptomatic patients:

• polycystic kidney disease;
• salt-wasting pyelonephritis;
• some forms of chronic renal failure, in the absence of a barrier to sodium excretion.

Diuretics (diuretics)

Therapeutic effect	Name of the drug
High	Furosemide, Trifas, Uregit, Lasix
Average	Hypothiazide, Cyclomethiazide, Oxodoline, Hygroton
not pronounced	Veroshpiron, Triamteren, Diakarb
Long (up to 4 days)	Eplerenone, Veroshpiron, Chlortalidone
Average duration (up to half a day)	Diacarb, Clopamid, Triamteren, Hypothiazid, Indapamide
Short efficiency (up to 6-8 hours)	Manit, Furosemide, Lasix, Torasemide, Ethacrynic acid
Quick result (in half an hour)	Furosemide, Torasemide, Ethacrynic acid, Triamterene
Average duration (one and a half to two hours after ingestion)	Diacarb, Amiloride
Slow smooth effect (within two days after administration)	Veroshpiron, Eplerenone

Classification of modern diuretic drugs (diuretics) according to the features of the therapeutic effect

Note. To determine the individual salt regimen, the daily release of electrolytes is determined. It is also necessary to fix the volume indicators of blood circulation.

Three basic rules for the treatment of renal hypertension

Studies conducted in the development of a variety of methods to reduce blood pressure in renal hypertension have shown:

1. A sharp decrease in blood pressure is unacceptable due to the significant risk of impaired renal function. The baseline must not be lowered more than one quarter at a time.
2. Treatment of hypertensive patients with the presence of pathologies in the kidneys should be aimed primarily at lowering blood pressure to an acceptable level, even against the background of a temporary decrease in kidney function. It is important to eliminate the systemic conditions for hypertension and non-immune factors that worsen the dynamics of renal failure. The second stage of treatment is medical assistance aimed at strengthening renal functions.
3. Arterial hypertension in a mild form suggests the need for stable antihypertensive therapy, which is aimed at creating positive hemodynamics and creating barriers to the development of renal failure.

The patient may be prescribed a course of thiazide diuretics, in combination with a number of adrenergic blockers.

Several different antihypertensive drugs are approved for the treatment of nephrogenic arterial hypertension.

Pathology is treated:

• angiotensin-converting enzyme inhibitors;
• calcium antagonists;
• b-blockers;
• diuretics;
• a-blockers.

Medicines to lower blood pressure in kidney failure

Medicines to lower blood pressure in kidney failure

The treatment process must comply with the principles:

• continuity;
• long duration in time;
• dietary restrictions (special diets).

Determining the severity of renal failure is an important factor

Before prescribing specific drugs, it is imperative to determine how severe renal failure is (the level of glomerular filtration is being studied).

Duration of medication

The patient is determined for long-term use of a specific type of antihypertensive drug (for example, dopegyt). This drug affects the brain structures that regulate blood pressure.

Duration of medication

End stage renal failure. Features of therapy

Chronic hemodialysis is required. The procedure is combined with antihypertensive treatment, which is based on the use of special medications.

Important. With the ineffectiveness of conservative treatment and the progression of renal failure, the only way out is transplantation of a donor kidney.

Preventive measures for renal hypertension

In order to prevent renal arterial genesis, it is important to follow simple, but effective, precautions:

• systematically measure blood pressure;
• at the first signs of hypertension, seek medical help;
• limit salt intake;
• to ensure that obesity does not develop;
• give up all bad habits;
• lead a healthy lifestyle;
• avoid hypothermia;
• pay enough attention to sports and exercise.

Preventive measures for renal hypertension

conclusions

Arterial hypertension is considered an insidious disease that can cause various complications. In combination with damage to the renal tissue or blood vessels, it becomes deadly. Careful adherence to preventive measures and consultation with medical specialists will help reduce the risk of pathology. Everything possible should be done to prevent the occurrence of renal hypertension, and not to deal with its consequences.