Complications

Patients with kidney failure can experience serious complications if not treated correctly.

Afer Dima

Kidney failure: how to treat, what diet and nutrition

Kidney failure is pathological condition kidneys, in which they do not fully perform their work to the required extent as a result of any disease. This process leads to a change in the constancy of the body’s self-regulation, and as a result, the functioning of its tissues and organs is disrupted.
Renal failure can occur in acute (ARI) and chronic (CRF) forms.

The causes of kidney failure vary depending on the form of the disease. There are several reasons that cause acute renal failure:

• Prerenal, that is, the disease is caused by heart failure, collapse, shock, severe arrhythmias, a significant reduction in circulating blood volume (possibly in case of blood loss).
• Renal, in which the death of the renal tubules is caused by the action heavy metals, poisons, alcohol, drugs or due to insufficient blood supply to the kidney; sometimes the reason is acute glomerulonephritis or tubulointerstitial nephritis.
• Postrenal, that is, as a result of acute bilateral blockage of the ureters due to urolithiasis.

The causes of chronic renal failure are considered chronic glomerulonephritis and pyelonephritis, systemic diseases, urolithiasis, neoplasms in the urinary system, diseases with impaired metabolism, vascular changes (high blood pressure, atherosclerosis) and genetic diseases.

Symptoms of the disease

Signs of renal failure depend on the severity of changes in renal function, the duration of the disease and the general condition of the body.

There are four degrees of acute renal failure:

1. Signs of renal failure in the initial phase: decreased amount of urine, decreased blood pressure, increased heart rate.
2. The second phase (oliguric) consists of reducing the amount of urine or until its production stops. The patient’s condition becomes severe, as almost all body systems are affected and complete violation metabolism, life-threatening.
3. The third phase (restorative or polyuric) is characterized by an increase in the amount of urine to normal level, but it almost does not remove any substances from the body except salts and water, so in this phase there remains a danger to the patient’s life.
4. Renal failure of the 4th degree consists in the normalization of urine output, kidney function returns to normal after 1.5-3.5 months.

Signs of kidney failure in people who have a chronic form include a significant decrease in the amount of working kidney tissue, which leads to azotemia (increased levels of nitrogenous substances in the blood). Since the kidneys can no longer cope with their work, these substances are eliminated in other ways, mainly through the mucous membranes of the gastrointestinal tract and lungs, which are not designed to perform such functions.

Renal failure syndrome quickly leads to the development of uremia, when self-poisoning of the body occurs. Rejection arises meat food, attacks of nausea and vomiting, regular feeling of thirst, sensation of muscle cramps and bone pain. A jaundiced tint appears on the face, and the smell of ammonia is felt when breathing. The amount of urine excreted and its density are greatly reduced. Kidney failure in children follows the same principles as in adults.

Complications of the disease

End-stage renal failure is caused by a complete loss of kidney function, which causes toxic products to accumulate in the patient's body. Terminal renal failure provokes complications such as gastroenterocolitis, myocardial dystrophy, hepatorenal syndrome, and pericarditis.

Hepatorenal failure means progressive oliguric renal failure secondary to liver disease. With hepatorenal syndrome, vasoconstriction occurs in the cortical region of the kidneys. This syndrome in cirrhosis, it is considered the last stage of development of the disease, which leads to the retention of water and sodium ions.

Diagnostic methods

Diagnosis of kidney failure includes determining the amount of creatinine, potassium and urea in the blood, as well as constant monitoring of the amount of urine excreted. Ultrasound, radiography and radionuclide methods can be used.

To diagnose chronic renal failure, a complex of advanced biochemical research blood and urine, filtration rate analysis, urography.

Treatment with medications

Treatment of renal failure is carried out in the intensive care unit or intensive care wards of a hospital. In case of the slightest complications, you should immediately contact medical care. Today it is possible to cure patients with acute renal failure using the device artificial kidney, while renal function is restored.

If treatment is started promptly and carried out in full, the prognosis is usually favorable.
During therapy, impaired metabolic processes are treated, diseases that aggravate chronic renal failure are identified and treated. On late stage require constant hemodialysis and kidney transplantation.

Medicines for renal failure are used to reduce metabolic processes: anabolic hormones - testosterone propionate solution, methylandrostenediol. To improve renal microcirculation, you need long time use trental, chimes, troxevasin and complamin. To stimulate urine output, a glucose solution with insulin or diuretics from the furosemide group is prescribed. If there is a high concentration of nitrogen in the blood, then rinsing is used gastrointestinal tract sodium bicarbonate solution, due to which nitrogenous waste is removed. This procedure is carried out on an empty stomach, before meals, once a day.

Antibiotics for renal failure are used in reduced doses, since their rate of elimination is significantly reduced. The degree of chronic renal failure is taken into account and the dose of antibiotics is reduced to 2 or 4 times.

Treatment of the disease with traditional methods

How to treat kidney failure without the use of antibiotics and other medications is described in the recipes below.

1. Take lingonberry leaves, chamomile, motherwort herb, string flowers, dandelion and violet, half a teaspoon each. This fee pour a glass of boiled water, leave for about 1 hour and take a third of a glass 5 times a day.
2. Second recipe: mix mint, St. John's wort, lemon balm, calendula 1 tbsp. l. Pour into a saucepan herbal mixture Add 2 cups boiled water and bring to a boil. Pour the prepared infusion into a thermos and leave overnight. Take 100 ml per day.
3. Treatment with folk remedies for kidney failure includes the use of watermelon rinds having a diuretic effect. Take 5 tbsp. l. chopped watermelon rinds per liter of water. You need to fill the crusts with water, leave for an hour and take several times throughout the day.
4. Pomegranate peel and rose hips also have a mild diuretic effect. Take them in equal parts and pour two glasses of boiled water. Leave in a warm place for half an hour and take up to 2 glasses per day.

Principles of diet therapy for renal failure

Diet for kidney failure plays an important role - it is necessary to adhere to a diet with low content proteins and table salt, exclude drugs that have a toxic and damaging effect on the kidneys. Nutrition for kidney failure depends on several general principles:

• It is necessary to limit protein intake to 65 g per day, depending on the phase of kidney disease.
• The energy value of food increases due to increased consumption of fats and carbohydrates.
• The diet for kidney failure boils down to eating a variety of fruits and vegetables. In this case, it is necessary to take into account the content of proteins, vitamins and salts in them.
• Proper culinary processing of products is carried out to improve appetite.
• The amount of sodium chloride and water entering the body is regulated, the amount of which affects the presence of swelling and blood pressure indicators.

Sample diet menu for kidney failure:

First breakfast: boiled potatoes – 220g, one egg, sweet tea, honey (jam) – 45g.

Lunch: sweet tea, sour cream – 200g.

Dinner: rice soup - 300g ( butter– 5-10g, sour cream - 10g, potatoes - 90g, carrots - 20g, rice - 20g, onions - 5g and tomato juice– 10g). For the second course, serve 200g vegetable stew (from carrots, beets and rutabaga) and a glass of apple jelly.

Dinner: milk porridge from rice - 200g, sweet tea, jam (honey) - 40g.

Prognosis for the disease

With timely and adequate treatment, the prognosis for acute renal failure is quite favorable.

In the chronic version of the disease, the prognosis depends on the stage of the process and the degree of renal dysfunction. If renal function is compensated, the prognosis for the patient’s life is favorable. But in the terminal stage, the only options to maintain life are continuous hemodialysis or transplantation of a donor kidney.

It has been established that human kidney nephrons have a unique ability to survive. Even in the event of the death of one part, the other compensates for their lost function until restoration. Therefore, treatment must be carried out at any stage.

The developed treatment methods include an emergency scheme necessary measures in the acute form of the disease and the effect on pathogenetic mechanisms impaired kidney function. The choice of how to treat renal failure is based on the results of an examination of the patient, determining the degree of loss of function, reserve paired organ when only one kidney is affected.

The doctor is obliged to think about the nephrotoxicity of each drug he prescribes. medicine, special sensitivity of the body, participation of other organs in big picture diseases. Let us consider approaches and methods of treating acute and chronic forms of insufficiency separately.

Treatment for shock

Acute kidney failure in 90% of cases is a consequence sharp fall blood pressure in shock conditions. Therefore, targeted protective therapy of the kidneys is necessarily involved in the scheme for removing the patient from shock.

To replenish the volume of blood loss, use:

• plasma;
• protein solutions.

Reopolyglucin is a large molecular dextran

The patient's central venous pressure is simultaneously measured. It is important not to “overfill” the amount of liquid; you cannot exceed +10 cm of water. Art. This may cause pulmonary edema.

During heart surgery and large vessels To prevent kidney damage, the following is administered:

• Mannitol solution - is able to maintain blood circulation in the kidneys and prevent the formation of cylinders in the tubules;
• loop diuretics (Furosemide) have a similar effect.

Recent studies suggest that anesthesiologists and resuscitators prescribe Dopamine and Norepinephrine with great caution. They are administered to increase blood pressure. It has been proven that even small doses can cause myocardial ischemia and vasospasm of the intestines and kidneys. In this case, bacteria from the intestinal cavity pass into the general bloodstream.

Even in emergency situations the administration of these drugs should be stopped if it is not possible to achieve an increase in urine output and the concentration of creatinine in the blood serum increases.

What is the treatment for acute kidney failure that has already developed?

In the presence of acute renal failure, medications must ensure resistance to all threatened consequences of damage to the body:

• water retention in cells (hyperhydration);
• hyperkalemia (increased potassium concentration in the blood);
• uremia (accumulation of nitrogenous waste, determined by the level of urea and creatinine);
• anemia (drop of red blood cells);
• disturbed electrolyte balance;
• acidosis (deviation acid-base balance on the sour side);
• addition of infection.

For moderately severe deficiency, conservative treatment is used.

Water regime - the total volume of fluid administered should replenish losses through urine, vomiting, diarrhea + have a reserve of 400 ml. Control is carried out by weighing the patient daily. It is better if the liquid comes with drinking water.

The following rules should be followed:

• an increase in the patient’s temperature for each degree above 37 requires 500 ml more fluid;
• for shortness of breath with a respiratory rate of 10 more than 20 per minute, another 400 ml of water is added.

Intravenous solutions help provide the required volume. In the presence of reduced plasma sodium concentrations, overhydration will require fluid restriction.

A good indicator of therapy is a weight loss of 250–500 g daily

To avoid hyperkalemia in a patient with an operated kidney, timely treatment of the wound, removal of necrotic tissue, and drainage of cavities is necessary. Foods containing potassium are limited in the diet.

You can learn more about nutritional problems in kidney failure.

To reduce the breakdown of protein compounds, it is prescribed anabolic steroid, carry out prevention infectious infection. The patient's diet should be protein-free, but the calorie content of food should be within the range of 1500–2000 kcal/day. In cases of persistent vomiting, parenteral intravenous nutrition is provided with glucose solutions, amino acid mixtures, and Intralipid.

It should be taken into account that antibiotics in conditions of cessation of kidney function and increased vascular permeability become more toxic. It has been shown that even relatively low-toxic drugs of the penicillin series and cephalosporins cause hemorrhagic complications (bleeding) in patients due to increased influence on platelet aggregation and prothrombin levels. Therefore, the prescription of these drugs for renal failure should be strictly dosed in accordance with the severity of the renal pathology.

How does therapy depend on the level of kidney damage?

The attending physician must clearly understand the cause of renal failure. As you know, 3 types of acute disorders are possible:

• prerenal;
• postrenal;
• renal

Prerenal insufficiency is regarded as a secondary phenomenon and is associated with circulatory disorders. Treatment requires restoration of renal blood flow. If there is a significant loss of fluid, compensation and therapy for hypovolemia will be required.

Prescribing standard medications without taking into account the root cause can worsen the severity of the patient’s condition:

• diuretics such as saluretics, with hypovolemia lead to a vicious circle during insufficiency;
• in the case of small output syndrome in the presence of heart failure, copious administration of solutions is contraindicated.

Diuretics are not always useful for kidney damage

For postrenal oliguria intensive therapy carried out against the background of instrumental or surgical intervention in surgical hospitals with a urological profile. Through catheterization and puncture of the pelvis, it is necessary to ensure the outflow of urine through the urinary tract.

Uremia creates high risk development of the infectious process in renal tissue. A common infection is immediate cause mortality in 1/3 of patients with postrenal insufficiency in postoperative period. More often infectious process develops in the trachea and bronchi, affecting the urinary tract.

For antibacterial therapy it is advisable to use:

• combinations of Metronidazole and third-generation cephalosporin antibiotics (Claforan, Ceftriaxone, Fortum, Longacef);
• in severe sepsis with state of shock therapy with Thienam (Meronem) is indicated.

When is hemodialysis performed?

The question of the need for dialysis therapy is decided if there is no effect from conservative treatment acute kidney failure, an increase in the content of nitrogenous compounds in the blood.

Hemodialysis is indicated for:

• exceeding the potassium threshold concentration of 7 mmol/l;
• state of oligoanuria for five days or more;
• developing pulmonary edema or brain;
• pronounced uremia and acidosis.

The procedures are carried out daily or once every 2 days, while the amount of protein consumed from food and the volume of liquid drunk increases. In treatment practice, methods of slow but constant blood purification using hemofiltration and hemodiafiltration are used.

If the cause of deficiency is acute poisoning or sepsis, hemodialysis is combined with hemosorption, which helps remove toxins and microorganisms from the blood.

The use of "" is contraindicated if there are:

• decompensation of hypovolemia;
• presence of internal bleeding;
• cerebral hemorrhage.

Hemofiltration equipment provides for significant replacement of the liquid part of the patient’s blood

Using detoxification methods

Hemofiltration is a technique for removing intoxication, which involves removing more than 20 liters of water while simultaneously replacing it with polyionic solutions containing the necessary set of electrolytes. It is believed that this method is more physiological, since filtration membranes and pressure close to the renal glomeruli are used. Effectively removes substances with medium molecular sizes from the body, better improves gas exchange in the lungs.

Plasmapheresis is used as one of the components of dialysis. In the treatment of acute renal failure the following is manifested:

• direct removal toxic substances from plasma;
• removal of excess fluid from the vascular bed.

It is considered especially effective in the phase of relieving oligoanuria (before hemodialysis) for an additional opportunity to increase the amount of fluid administered and remove nephrotoxic and hemolytic poisons. Plasmapheresis is especially indicated:

• patients with myeloma, thrombocytopenic purpura, complicated by acute renal failure;
• with DIC syndrome;
• patients with rapidly progressing glomerulonephritis.

Enterosorption method - involves the use of tablets, powder, which, when they enter the intestines, collect toxic substances, metabolic products, and nitrogenous wastes. An example of a drug from the group of sorbents is Enterosgel. It has practically no contraindications. Used by the course to enhance other techniques during the period of oligoanuria.

A teaspoon of Enterosgel is dissolved in water before taking

How is renal insufficiency treated?

Renal (intrarenal) damage involves the use of any method of reducing the degree of destruction of the renal epithelium in countermeasures. At the beginning of treatment it is necessary:

• restore blood circulation in the arterial system and microcirculation in the tissue; for this, a combination of Reopoliglucin with Pentoxifylline is recommended;
• stop administering nephrotoxic drugs to the patient;
• establish control over the content of nitrogenous waste and electrolytes in the blood, the specific gravity and acidity of urine.

To use the reserve capabilities of the kidneys, it is necessary to stimulate the function of working nephrons with the help of:

• antispasmodics (Eufillin, Papaverine are administered 6–12 times a day, combination with a small dose of Dopamine is allowed);
• alkalizing agents (sodium bicarbonate solution intravenously);
• loop diuretics (diuretics) - Lasix, Furosemide.

To combat hyperkalemia, the following are used:

• Amburge mixture intravenously (composed of 40% glucose solution, insulin, calcium chloride);
• repeated administration of calcium gluconate 2-3 times with a break of 5 minutes while monitoring the ECG;
• administration of sodium bicarbonate;
• taking ion exchange resins;
• stimulation of diuresis.

Therapy is carried out for six hours in anticipation of the transition of potassium into the cellular space.

If you suspect high concentration sodium 4% solution is diluted by half

Basic principles of treatment of chronic kidney failure

Consider therapy based on participation various factors defeats.

Features of treatment of the underlying disease

In the pathogenesis of the chronic form, the main role is played by long-term diseases, ultimately leading to kidney failure. Therefore, in treatment it is necessary to achieve improvement or stable remission of diseases such as:

• urolithiasis;
• glomerulonephritis;
• diabetic nephropathy;
• hypertension.

A feature of their therapy is the desire to avoid toxic effect medications for already reduced kidney function. This should be taken into account when choosing:

• cytostatics for glomerulonephritis;
• antibiotics for urinary infections;
• diuretics for hypertension.

At chronic glomerulonephritis it is necessary to resolve the question of whether exacerbation of the disease or nephrosclerosis led to uremia. In case of exacerbation, cytostatics and corticosteroid drugs are indicated. But in case of nephrosclerosis, they are inappropriate or contraindicated.

Ensuring protection of renal reserve

In order to prevent irreversible progressive changes in the kidneys, it is necessary to pay attention to counteracting:

• intraglomerular hypertension;
• hyperfiltration;
• development of systemic arterial hypertension.

For this purpose:

• angiotensin-2 receptor blockers;
• ACE inhibitors;
• low protein diet;
• antihypertensive drugs.

The role of ACE inhibitors is:

• providing hypotensive effect through inhibition of the synthesis of angiotensin-2 as a powerful vasoconstrictor;
• reducing hypertension inside the glomeruli, eliminating hyperfiltration by dilating arterioles;
• inhibition of parenchyma sclerosis by influencing the processes of cell proliferation and collagen synthesis;
• reducing protein loss in urine.

The treatment regimen, medications and dosage are selected by the attending physician

The effect of drugs increases in case of restriction of salt in food and combined action with diuretics. Angiotensin-2 receptor blockers have similar properties.

The dose of drugs is selected individually based on the results of systematic monitoring of the level of creatinine and potassium in the blood. ACE inhibitors not shown:

• in the terminal stage of the disease;
• with hyperkalemia;
• in cases of bilateral narrowing of the renal arteries;
• pregnant women.

A low-protein diet slows down the rate of development of renal failure by reducing the formation of internal toxic substances from breakdown products and restoring intraglomerular hemodynamics.

Treatment of high blood pressure of renal origin

The use of medications for impaired renal function is reduced to life-saving measures. important drugs. Hypertension must be treated. High blood pressure promotes the development of nephrosclerosis.

It should be remembered that patients with kidney damage are contraindicated:

• thiazide diuretics (Hypothiazide);
• a group of potassium-sparing diuretics (Veroshpiron, Triampur).

It is less often recommended to use Clonidine, Dopegit.

The most acceptable combinations:

• ACE inhibitor + Furosemide + blocker;
• calcium antagonist + β-blocker + sympatholytic, taking into account the mandatory restriction of salt in food.

There is ongoing debate among nephrologists and cardiologists regarding the required level of reduction in blood pressure numbers:

• some argue for the need to bring it to a normal level;
• others point to known cases of failure compensatory mechanisms kidneys with a significant decrease in pressure.

Conclusion: the pressure cannot be reduced sharply; selection of the dose of drugs requires the skill of the doctor and the patience of the patient.

Symptomatic treatment

Symptoms do not manifest themselves in the same way, so the means of correction have an individual choice.

1. To eliminate anemia, drugs containing erythropoietin are prescribed.
2. For the purpose of detoxification, courses of enterosorbents (Enterosgel, Polyphepan) are indicated.
3. As acidosis increases, a soda solution is administered intravenously.
4. If the patient is bothered by painful cramps in the muscles of the legs, this indicates a decrease in calcium in the blood. Calcium forte and calcium carbonate are used for compensation.
5. Chronic patients often develop hyperfunction parathyroid glands, therefore requiring the use of vitamin D or surgical removal of the glands.

In the treatment of renal failure, drugs with nephrotoxic effects and aggravating metabolic disorders are contraindicated. These include:

• antibiotics - aminoglycosides, tetracyclines;
• X-ray contrast agents;
• non-steroidal anti-inflammatory drugs;
• potassium preparations;
• thiazide and potassium-sparing diuretics;
• ACE inhibitors in inappropriately large doses;
• protein preparations (except for special nephrological and emergency indications).

For a patient with chronic renal failure, the plasma creatinine level is about 1.0 mmol/L and the filtration rate is reduced to 10 ml/min. are indications for regular replacement hemodialysis and kidney transplantation. At the pre-dialysis stage, it is advisable to vaccinate the patient against viral hepatitis IN.

What plants can be used for folk remedies?

Treatment of renal failure with folk remedies does not have an evidence base for effectiveness. In practice, information exists at the advertising level. We can confidently say that there is no grass with healing properties, restoring dead kidney tissue.

Usage folk remedies effective only in the recovery stage

Urologists recommend herbal decoctions and preparations during the recovery stage after acute kidney failure. They are also suitable for chronics to prevent kidney infections. Doctors offer plants with anti-inflammatory and disinfectant effects on urinary tract. These include herbal teas from:

• sequences;
• lingonberry leaves;
• dandelion and calendula;
• lemon balm;
• coltsfoot;
• chamomile and violet flowers;
• dill seeds;
• mint;
• St. John's wort;
• bay leaf;
• bearberry;
• rose hips and hawthorn fruits;
• parsley root.

It must be taken in the form of a decoction. Count the liquid you drink in the total volume. The patient may have diseases that have contraindications to herbal treatment. Therefore, you should consult your doctor.

Every year new drugs and methods for the treatment of renal failure appear. Effectiveness depends on the severity of the underlying disease. Any renal pathology requires careful attention to therapy and compliance with preventive measures.