Symptoms of chronic renal failure. Renal failure (acute, chronic) Renal failure causes of the disease

Distinguish between acute and chronic renal failure.
Acute renal failure (ARF)- a sudden violation of kidney function with a delay in the excretion of nitrogen metabolism products from the body and a disorder of the water, electrolyte, osmotic and acid-base balance. These changes occur as a result of acute severe disturbances in renal blood flow, GFR, and tubular reabsorption, usually occurring simultaneously.

Acute renal failure occurs when both kidneys suddenly stop functioning. The kidneys regulate the balance of chemicals and fluids in the body and filter waste from the blood into the urine. Acute kidney failure can occur for a variety of reasons, including kidney disease, partial or complete blockage of the urinary tract, and reduced blood volume, such as after severe blood loss. Symptoms may develop over several days: the amount of urine excreted may decrease dramatically, and the fluid to be excreted accumulates entirely in the tissues, causing weight gain and swelling, especially in the ankles.

Acute kidney failure is a life-threatening condition because excessive amounts of water, minerals (particularly potassium), and waste products that are normally excreted in urine accumulate in the body. The disease usually responds well to treatment; Kidney function can be fully restored in a few days or weeks if the cause is correctly identified and treated appropriately. However, acute kidney failure due to kidney disease can sometimes lead to chronic kidney disease, in which case the outlook for the disease depends on the ability to cure the underlying disease.

Currently, there are several etiological groups of acute renal failure.

Prerenal acute renal failure (ischemic)

- shock kidney (trauma, fluid loss, massive tissue breakdown, hemolysis, bacteremic shock, cardiogenic shock). - Loss of extracellular volume (gastroenteric loss, urinary loss, burns). - Loss of intravascular volume or its redistribution (sepsis, bleeding, hypoalbuminemia). - Decreased cardiac output (heart failure, cardiac tamponade, heart surgery). - Other causes of reduced GFR (hypercalcemia, hepatorenal syndrome).

Renal OPN.

- Exogenous intoxications (kidney damage by poisons used in industry and everyday life, bites of poisonous snakes and insects, intoxication with drugs and radiopaque substances). - Acute infectious-toxic kidney with indirect and direct action on the kidneys of an infectious factor - Damage to the renal vessels (hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, scleroderma, systemic necrotizing vasculitis, thrombosis of arteries or veins, atherosclerotic embolism in severe atherosclerosis of the main vessels - primarily aorta and renal arteries). - Open and closed kidney injuries. - Postischemic acute renal failure.

Postrenal acute renal failure.

- Extrarenal obstruction (occlusion of the urethra; tumors of the bladder, prostate, pelvic organs; blockage of the ureters with stone, pus, thrombus; urolithiasis, blockade of the tubules by urates in the natural course of leukemia, as well as their treatment, myeloma and gouty nephropathy, treatment with sulfonamides; accidental ligation of the ureter during surgery). - Urination retention not caused by an organic obstruction (impaired urination in diabetic neuropathy or as a result of the use of M-anticholinergics and ganglionic blockers).

Symptoms

Passing only small amounts of urine. . Weight gain and swelling of the ankles and face due to fluid accumulation. . Loss of appetite. . Nausea and vomiting. . Itching all over body. . Fatigue. . Abdominal pain. . Urine with blood or dark color. . Symptoms of the final stage in the absence of successful treatment: shortness of breath due to the accumulation of fluid in the lungs; unexplained bruising or bleeding; drowsiness; confusion; muscle spasms or cramps; loss of consciousness.

In the development of acute renal failure, four periods are distinguished: the period of the initial action of the etiological factor, the oligoanuric period, the period of recovery of diuresis and recovery.

In the first period, the symptoms of the condition leading to acute renal failure predominate. For example, they observe fever, chills, collapse, anemia, hemolytic jaundice in anaerobic sepsis associated with community-acquired abortion, or a clinical picture of the general effect of one or another poison (acetic essence, carbon tetrachloride, salts of heavy metals, etc.).

The second period - the period of a sharp decrease or cessation of diuresis - usually develops soon after the action of the causative factor. Azotemia increases, nausea, vomiting, coma appear, due to the retention of sodium and water, extracellular hyperhydration develops, manifested by an increase in body weight, abdominal edema, pulmonary edema, and brain.

After 2-3 weeks, oligoanuria is replaced by a period of recovery of diuresis. The amount of urine usually increases gradually, after 3-5 days diuresis exceeds 2 l / day. First, the fluid accumulated in the body during the period of oligoanuria is removed, and then dangerous dehydration occurs due to polyuria. Polyuria usually lasts 3-4 weeks, after which, as a rule, the level of nitrogenous wastes normalizes and a long (up to 6-12 months) recovery period begins.

Thus, from a clinical standpoint, the most difficult and life-threatening patient with acute renal failure is the period of oligoanuria, when the picture of the disease is characterized primarily by azotemia with a sharp accumulation of urea, creatinine, uric acid in the blood and electrolyte imbalance (primarily hyperkalemia, as well as hyponatremia). , hypochloremia, hypermagnesemia, hypersulfate- and phosphatemia), the development of extracellular hyperhydration. The oligoanuric period is always accompanied by metabolic acidosis. During this period, a number of severe complications may be associated with inadequate treatment, primarily with uncontrolled administration of saline solutions, when sodium accumulation first causes extracellular hydration, and then intracellular overhydration, leading to coma. A severe condition is often aggravated by the uncontrolled use of a hypotonic or hypertonic glucose solution, which reduces the osmotic pressure of the plasma and increases cellular overhydration due to the rapid transition of glucose, and then water into the cell.

During the recovery period of diuresis due to severe polyuria, there is also a risk of severe complications, primarily due to developing electrolyte disorders (hypokalemia, etc.).

The clinical picture of acute renal failure may be dominated by signs of disorders of the heart and hemodynamics, advanced uremic intoxication with severe symptoms of gastroenterocolitis, mental changes, anemia. Often, the severity of the condition is aggravated by pericarditis, respiratory failure, nephrogenic (hyperhydration) and cardiac pulmonary edema, gastrointestinal bleeding, and especially infectious complications.

To assess the severity of the condition of a patient with acute renal failure, indicators of nitrogen metabolism, primarily creatinine, the level of which in the blood does not depend on the patient's diet and therefore more accurately reflects the degree of impaired renal function, are of primary importance. Creatinine retention usually outpaces the increase in urea, although the dynamics of the level of the latter is also important for assessing the prognosis in acute renal failure (especially when the liver is involved in the process).

However, in many ways, the clinical manifestations of acute renal failure, in particular signs of damage to the nervous system and muscles (primarily myocardium), are associated with impaired potassium metabolism. Often occurring and quite understandable hyperkalemia leads to an increase in myocardial excitability with the appearance of a high, with a narrow base and a pointed top of the T wave on the ECG, slowing atrioventricular and intraventricular conduction up to cardiac arrest. In some cases, however, instead of hyperkalemia, hypokalemia may develop (with repeated vomiting, diarrhea, alkalosis), the latter is also dangerous for the myocardium.

The reasons

. Decreased blood volume due to severe injury with blood loss or dehydration is a common cause of acute kidney injury. Reduced blood flow to the kidneys due to reduced blood volume can damage the kidneys. . Other kidney diseases, such as acute glomerulonephritis, can cause acute kidney failure. . Tumors, kidney stones, or an enlarged prostate can block the ureter or urethra, obstructing the flow of urine and causing damage to the kidneys. . Other illnesses can lead to kidney failure, including polycystic kidney disease, systemic lupus erythematosus, diabetes mellitus, congestive heart failure, heart attack, liver disease, acute pancreatitis, and multiple myeloma. . Heavy metal poisoning (cadmium, lead, mercury, or gold) can damage the kidneys. . Chemotherapy drugs and some antibiotics such as gentamicin can lead to kidney failure, especially in those who have some kind of kidney disease. . High doses of non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can cause kidney damage. . Contrast agents used in x-rays of blood vessels or organs may stimulate kidney failure in those at risk. . The release of the myoglobin protein from muscles as a result of injury, heatstroke, or drug or alcohol overdose, or as a result of a serious infectious disease, can lead to acute kidney failure. . Sometimes acute renal failure can develop in women as a complication after childbirth.

Diagnostics

. Medical history and physical examination. . Ultrasound examination. . Blood and urine tests. . A kidney biopsy may be done. Under local anesthesia, the doctor inserts a needle into the kidney through the back to remove a small sample of tissue for analysis under a microscope.

Clarification of the etiological factors of acute renal failure allows more targeted therapeutic interventions. So, prerenal acute renal failure develops mainly in shock conditions, characterized by severe microcirculation disorders due to hypovolemia, low central venous pressure and other hemodynamic changes; the elimination of the latter and it is necessary to direct the main therapeutic measures. Similar in mechanism to these conditions are cases of acute renal failure associated with a large loss of fluid and NaCl in severe extensive lesions of the gastrointestinal tract (infections, anatomical disorders) with indomitable vomiting, diarrhea, which also determines the range of therapeutic effects. Renal acute renal failure develops due to the action of various toxic factors, primarily a number of chemical, medicinal (sulfonamides, mercury compounds, antibiotics) and radiopaque substances, and can also be caused by renal diseases proper (AGN and nephritis associated with systemic vasculitis). Prevention and treatment of acute renal failure in these cases should include measures that limit the possibility of exposure to these factors, as well as effective methods of dealing with these kidney diseases. Finally, the therapeutic tactics for postrenal acute renal failure is mainly to eliminate the acute obstructed outflow of urine due to urolithiasis, bladder tumors, etc.

It should be borne in mind that the ratios of various causes of acute renal failure may change due to certain features of their impact on the kidneys. Currently, the main group of cases of acute renal failure is still made up of acute shock and toxic kidney damage, but within each of these subgroups, along with post-traumatic acute renal failure, acute renal failure in obstetric and gynecological pathology (abortion, complications of pregnancy and childbirth), acute renal failure due to blood transfusion complications and the action of nephrotoxic factors (poisoning with acetic essence, ethylene glycol), acute renal failure is becoming more frequent, associated with an increase in surgical interventions, especially in older age groups, as well as with the use of new drugs. In endemic foci, the cause of acute renal failure can be viral hemorrhagic fever with kidney damage in the form of severe acute tubulointerstitial nephritis.

Although a large number of works have been devoted to the study of the mechanisms of development of acute renal failure, nevertheless, the pathogenesis of this condition cannot be considered definitively elucidated.

However, it has been proven that various etiological variants of AKI are characterized by a number of common mechanisms:

Violation of the renal (especially cortical) blood flow and a drop in GFR; . total diffusion of the glomerular filtrate through the wall of the damaged tubules; . compression of the tubules by edematous interstitium; . a number of humoral effects (activation of the renin-angiotensin system, histamine, serotonin, prostaglandins, other biologically active substances with their ability to cause hemodynamic disturbances and damage to the tubules); . shunting of blood through the juxtamedullary system; . spasm, thrombosis of arterioles.

The resulting morphological changes relate mainly to the tubular apparatus of the kidneys, primarily the proximal tubules, and are represented by dystrophy, often severe necrosis of the epithelium, accompanied by moderate changes in the interstitium of the kidneys. Glomerular disorders are usually minor. It should be noted that even with the deepest necrotic changes, regeneration of the renal epithelium occurs very quickly, which is facilitated by the use of hemodialysis, which prolongs the life of these patients.

With the commonality of developing processes, the predominance of one or another link in pathogenesis determines the features of the development of acute renal failure in each of its named variants. Thus, in shock acute renal failure, ischemic damage to the renal tissue plays the main role; in nephrotoxic acute renal failure, in addition to hemodynamic disorders, the direct effect of toxic substances on the tubular epithelium during their secretion or reabsorption is important; in hemolytic-uremic syndrome, thrombotic microangiopathy predominates.

In some cases, acute renal failure develops as a consequence of the so-called acute hepatorenal syndrome and is caused by severe liver diseases or surgical interventions on the liver and biliary tract.

Hepatorenal syndrome is a variant of acute functional renal failure that develops in patients with severe liver damage (with fulminant hepatitis or advanced cirrhosis of the liver), but without any visible organic changes in the kidneys. Apparently, changes in blood flow in the renal cortex of neurogenic or humoral origin play a certain role in the pathogenesis of this condition. Harbingers of the onset of hepatorenal syndrome are gradually increasing oliguria and azotemia. Hepatorenal syndrome is usually distinguished from acute tubular necrosis by a low concentration of sodium in the urine and the absence of significant changes in sediment, but it is much more difficult to differentiate it from prerenal acute renal failure. In doubtful cases, the reaction of the kidneys to the replenishment of BCC helps - if renal failure does not respond to an increase in BCC, it almost always progresses and leads to death. Arterial hypotension developing in the terminal stage can cause tubulonecrosis, which further complicates the clinical picture.

Treatment

. It is necessary to cure the disease that is the main cause of kidney failure. Urgent medical attention may be required in case of serious damage; it consists of surgery to repair damaged tissue, intravenous fluids to completely eliminate dehydration, and blood transfusions for severe blood loss. . Surgery may be needed to break the blockage of the urinary tract. . Diuretics may be prescribed to reduce fluid accumulation and increase urine production. . There are many measures that are important for a full recovery after emergency care. For example, limited fluid intake may be required. . Antibiotics may be prescribed to treat associated bacterial infections; they must be taken within the prescribed period. . Blood pressure medications may be prescribed for high blood pressure. . Glucose, sodium bicarbonate, and other substances may be given intravenously to maintain proper blood levels of these substances until kidney function is restored. Temporary dialysis, an artificial blood filtering process, may be needed until kidney function is restored. There are several types of dialysis. In hemodialysis, blood is pumped out of the body into an artificial kidney, or dialyzer, where it is filtered and then returned to the body. Hemodialysis is usually performed for three to four hours three times a week. The first hemodialysis is carried out for two to three hours two days in a row. . Peritoneal dialysis is rarely used in acute renal failure. In this procedure, a catheter is inserted into the abdomen and a special fluid called dialysate is pumped through the peritoneum (the membrane that lines the abdominal cavity) to remove contaminants from the blood. If necessary, peritoneal dialysis should be performed for 24 hours a day. . Attention! Call your doctor immediately if you develop symptoms of acute kidney failure, including reduced urine production, nausea, shortness of breath, and swollen ankles.

Prevention

Treatment of a disease that may be the cause of acute kidney failure.

Chronic renal failure (CRF)- impaired renal function caused by a significant decrease in the number of adequately functioning nephrons and leading to self-poisoning of the body by the products of its own vital activity.

Chronic renal failure occurs when both kidneys gradually stop functioning. The kidneys have numerous tiny structures (glomeruli) that filter waste from the blood and store large substances such as proteins in the blood. Waste substances and excess water accumulate in the bladder and are then excreted in the form of urine. In chronic kidney failure, the kidneys are damaged gradually over many months or years. Since kidney tissue is destroyed by damage or inflammation, the remaining healthy tissue compensates for its work. The extra work overworks previously undamaged parts of the kidney, causing even more damage until the entire kidney stops functioning (a condition known as end stage kidney failure).

The kidneys have a large margin of safety; more than 80-90 percent of the kidney may be damaged before symptoms appear (although symptoms may appear sooner if the weakened kidney is subjected to sudden stress, such as infection, dehydration, or use of a kidney-damaging drug). As excessive amounts of fluid, minerals such as potassium, acids, and waste products build up in the body, chronic kidney failure becomes a life-threatening disease. However, if the underlying disease is cured and further kidney damage can be controlled, the onset of end-stage renal disease may be delayed. End-stage kidney failure is treated with dialysis or a kidney transplant; any of these ways can prolong life and allow a person to lead a normal life.

Various diseases and disorders of the kidneys can lead to the development of chronic renal failure. These include chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, kidney tuberculosis, amyloidosis, and hydronephrosis due to the presence of various kinds of obstacles to the outflow of urine.

In addition, CRF can occur not only due to kidney disease, but also for other reasons. Among them, diseases of the cardiovascular system can be noted - arterial hypertension, stenosis of the renal arteries; endocrine system - diabetes and diabetes insipidus, hyperparathyroidism. The cause of CRF can be systemic diseases of the connective tissue - systemic lupus erythematosus, scleroderma, etc., rheumatoid arthritis, hemorrhagic vasculitis.

The reasons

. Diabetes mellitus and hypertension are the most common causes of chronic renal failure. . Primary kidney diseases such as acute and chronic glomerulonephritis, polycystic kidney disease, or recurring kidney infections can lead to chronic kidney failure. . High blood pressure can cause damage to the kidneys or be caused by kidney damage itself. . Left untreated, a tumor, kidney stones, or an enlarged prostate can block the urinary tract, obstruct the flow of urine, and thus cause damage to the kidneys. . Long-term use of high doses of non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen can lead to chronic kidney failure. . Heavy metal poisoning, such as cadmium, lead, mercury, or gold, can lead to kidney failure. . Some antibiotics, antifungals, and immunosuppressants can damage the kidney and lead to kidney failure. . The contrast agents used in some types of x-rays can stimulate kidney failure in patients whose kidneys have been damaged. . Patients who have had one kidney removed are more vulnerable to complications from kidney damage than people with both kidneys.

It should be noted that, regardless of the cause, chronic renal failure is associated, on the one hand, with a decrease in the number of active nephrons and, on the other hand, with a decrease in the working activity in the nephron. External manifestations of CRF, as well as laboratory signs of renal failure, begin to be detected with the loss of 65-75% of nephrons. However, the kidneys have amazing reserve capabilities, because the vital activity of the body is preserved even with the death of 90% of the nephrons. Compensation mechanisms include an increase in the activity of the remaining nephrons and an adaptive restructuring of the work of all other organs and systems.

The ongoing process of nephron death causes a number of disorders, primarily of an exchange nature, on which the patient's condition depends. These include violations of water-salt metabolism, retention in the body of its waste products, organic acids, phenolic compounds and other substances.

Symptoms

. Frequent urination, especially at night; passing only small amounts of urine. . General malaise. . Symptoms of end-stage kidney failure due to accumulation of waste products in the blood (uremia): swelling of the ankles or tissues around the eyes due to accumulation of fluid; shortness of breath due to accumulation of fluid in the lungs; nausea and vomiting; loss of appetite and weight; frequent hiccups; bad breath; chest and bone pain; itching; yellowish or brownish shade of pale skin; tiny white crystals on the skin; unexplained bruising or bleeding, including bleeding gums; cessation of menstruation in women (amenorrhea); fatigue and drowsiness; confusion; muscle spasms or cramps; loss of consciousness.

A characteristic feature of CRF is an increase in the volume of urine excreted - polyuria, which occurs even in the early stages with predominant damage to the tubular nephron. At the same time, polyuria is permanent even with limited fluid intake.

Salt metabolism disorders in CRF primarily affect sodium, potassium, calcium, and phosphorus. The excretion of sodium in the urine can be either increased or decreased. Potassium is normally excreted mainly by the kidneys (95%), therefore, in chronic renal failure, potassium can accumulate in the body, despite the fact that the function of its excretion is taken over by the intestines. Calcium, on the contrary, is lost, so it is not enough in the blood during CRF.

In addition to the water-salt imbalance in the mechanism of development of chronic renal failure, the following factors are important:

Violation of the excretory function of the kidneys leads to a delay in the products of nitrogen metabolism (urea, uric acid, creatinine, amino acids, phosphates, sulfates, phenols), which are toxic to all organs and tissues and, first of all, to the nervous system;

Violation of the hematopoietic function of the kidneys causes the development of anemia;

There is an activation of the renin-angiotensin system and stabilization of arterial hypertension;

The acid-base balance is disturbed in the blood.

As a result, deep dystrophic disorders occur in all organs and tissues.

It should be noted that the most common cause of CRF is chronic pyelonephritis.

In the asymptomatic course of chronic pyelonephritis, chronic renal failure develops relatively late (20 or more years after the onset of the disease). Less favorable is the cyclical course of bilateral chronic pyelonephritis, when the developed manifestations of renal failure occur after 10-15 years, and its early signs in the form of polyuria - already after 5-8 years from the onset of the disease. An important role belongs to the timely and regular treatment of the inflammatory process, as well as the elimination of its immediate cause, if possible.

CRF caused by chronic pyelonephritis is characterized by an undulating course with periodic deterioration and improvement in kidney function. Deterioration, as a rule, are associated with exacerbations of pyelonephritis. Improvements come after the full treatment of the disease with the restoration of the disturbed outflow of urine and the suppression of the activity of the infectious process. Arterial hypertension aggravates renal dysfunction in chronic pyelonephritis, which often becomes a factor determining the intensity of nephron death.

Urolithiasis also leads to the development of chronic renal failure, as a rule, with late onset or inadequate treatment, as well as with concomitant arterial hypertension and pyelonephritis with frequent exacerbations. In such cases, chronic renal failure develops slowly, within 10-30 years from the onset of the disease. However, with special forms of urolithiasis, for example, with staghorn kidney stones, the death of nephrons is accelerated. Provoke the development of CRF in urolithiasis, repeated stone formation, a large stone, its long stay in the kidney with a latent course of the disease.

At any rate of development of CRF, a number of stages pass sequentially: latent, compensated, intermittent and terminal. The main laboratory indicator that separates one stage from another is the endogenous (intrinsic) creatinine clearance, which characterizes the glomerular filtration rate. Normal creatinine clearance is 80-120 ml per minute.

The latent stage of chronic renal failure is detected with a decrease in glomerular filtration (according to creatinine clearance) to 60-45 ml / min. During this period, the main clinical signs of CRF are polyuria and nocturia - the release of more urine at night, and not during the day. Mild anemia may develop. Patients usually do not present other complaints or note increased fatigue, weakness, and sometimes dry mouth.

The compensated stage is characterized by a decrease in glomerular filtration to 40-30 ml/min. Complaints of weakness, drowsiness, increased fatigue, apathy join. Daily urine output usually reaches 2-2.5 liters, increased excretion of sodium in the urine may begin, as well as changes in phosphorus-calcium metabolism with the development of the first signs of osteodystrophy. At the same time, the level of residual nitrogen in the blood corresponds to the upper limits of the norm.

The intermittent stage is characterized by an undulating course with alternating periods of deterioration and a clear improvement after full treatment. The glomerular filtration rate is 23-15 ml/min. The level of residual nitrogen in the blood is persistently elevated. Patients constantly complain of weakness, sleep disturbances, increased fatigue. Anemia is a typical symptom.

The terminal stage is characterized by intoxication of the body with its own nitrogenous waste products - uremia. The glomerular filtration rate is 15-10 ml/min. Typical signs are skin itching, bleeding (nasal, uterine, gastrointestinal, subcutaneous hemorrhages), "uremic gout" with joint pain, nausea, vomiting, loss of appetite, up to food aversion, diarrhea. The skin is pale, yellowish, dry, with traces of scratching, bruises. The tongue is dry, brown in color, a specific sweetish "uremic" smell comes from the mouth. For the most part, these symptoms occur because other organs, such as the skin, the gastrointestinal tract, etc., are trying to take over the function of the kidneys to remove nitrogenous waste and cannot cope with it.

The whole body suffers. Disturbances in the balance of sodium and potassium, persistently high blood pressure and anemia lead to deep damage to the heart. With an increase in the amount of nitrogenous wastes in the blood, symptoms of damage to the central nervous system increase: convulsive muscle twitches, encephalopathy up to uremic coma. In the lungs in the terminal stage, uremic pneumonia may develop.

Violations of phosphorus-calcium metabolism cause leaching of calcium from bone tissue. Osteodystrophy develops, which is manifested by pain in the bones, muscles, spontaneous fractures, arthritis, compression of the vertebrae and deformation of the skeleton. Children stop growing.

There is a decrease in immunity, which significantly increases the body's susceptibility to bacterial infections. One of the most common causes of death in patients with chronic renal failure in the terminal stage are purulent complications, up to sepsis, caused by opportunistic bacteria, such as intestinal daddy.

Diagnostics

. Medical history and physical examination. . Blood and urine tests. . Ultrasound examination, computed tomography or magnetic resonance examination of the abdominal region. . A kidney biopsy may be done. Under local anesthesia, the doctor inserts a needle into the kidney through the back to remove a small sample of tissue for analysis under a microscope.

Treatment

. Foods low in salt, protein, phosphorus, limited fluid intake, and vitamin supplements may be recommended. . Surgery may be needed to break the blockage of the urinary tract. . Blood pressure medications may be prescribed for high blood pressure. . Medicines may be needed to treat congestive heart failure. . Anemia due to kidney disease can be treated with erythropoietin, a drug that stimulates the formation of blood cells. . Sodium bicarbonate is prescribed to fight an excessive buildup of acids in the body (renal acidosis). . Phosphate- and vitamin-D-binding calcium supplements are given to prevent secondary hyperparathyroidism, which can lead to further kidney damage. . Dialysis, an artificial blood filtering process, may be necessary when a significant portion of kidney function is not performed. There are several types of dialysis. In hemodialysis, blood is pumped out of the body into an artificial kidney, or dialyzer, where it is filtered and then returned to the body. . Hemodialysis should be performed for 9-12 hours weekly (usually in three sessions). . Another way is peritoneal dialysis. There are two types of peritoneal dialysis. In continuous ambulatory peritoneal dialysis, two to three liters of a sterile solution is infused into the peritoneum through a catheter four to five times a day, seven days a week. Automated peritoneal dialysis uses a mechanism to automatically pour sterile fluid through a catheter into the peritoneum while the patient is sleeping. This process usually takes 9 to 12 hours a day. . In the case of end-stage renal failure, the patient is offered a kidney transplant as an alternative to dialysis. Most patients who undergo transplantation have a longer life expectancy than patients undergoing dialysis. A successful transplant can cure kidney failure, but potential donors must be carefully screened for compatibility; the best donors are usually family members, but spouses and friends who wish to donate can also be screened. Donor kidney recipients must take immunosuppressive drugs to prevent transplant rejection. . Attention! Call your doctor if you experience decreased urination, nausea and vomiting, swelling around your ankles, shortness of breath, or any other sign of chronic kidney disease.

In the initial stages, the treatment of chronic renal failure coincides with the treatment of the underlying disease, the purpose of which is to achieve a stable remission or slow down the progression of the process. If there are obstructions in the path of urine outflow, it is optimal to eliminate them surgically. In the future, against the background of continuing treatment of the underlying disease, a large role is given to the so-called symptomatic drugs - antihypertensive (pressure-reducing) drugs of the ACE inhibitor groups (Capoten, Enam, Enap) and calcium antagonists (Cordaron), antibacterial, vitamin agents.

An important role is played by the restriction in the diet of protein foods - no more than 1 g of protein per kilogram of the patient's weight. In the future, the amount of protein in the diet is reduced to 30–40 g per day (or less), and with a glomerular filtration rate of 20 ml/min, the amount of protein should not exceed 20–24 g per day. Table salt is also limited - up to 1 g per day. However, the calorie content of the diet should remain high - depending on the patient's weight, from 2200 to 3000 kcal (a potato-egg diet without meat and fish is used).

Iron preparations and other drugs are used to treat anemia. With a decrease in diuresis, it is stimulated with diuretics - furosemide (lasix) in doses up to 1 g per day. In a hospital, in order to improve blood circulation in the kidneys, intravenous drip-concentrated glucose solutions, gemodez, reopoliglyukin with the introduction of aminofillin, chimes, trental, papaverine are prescribed. Antibiotics are used with caution in chronic renal failure, reducing doses by 2-3 times, aminoglycosides and nitrofurans are contraindicated in chronic renal failure. For the purpose of detoxification, gastric and intestinal lavage, gastrointestinal dialysis are used. The washing liquid can be a 2% solution of baking soda or solutions containing sodium, potassium, calcium, magnesium salts with the addition of soda and glucose. Gastric lavage is performed on an empty stomach, using a gastric tube, for 1-2 hours.

In the terminal stage, the patient is shown regular (2-3 times a week) hemodialysis - an "artificial kidney" apparatus. The appointment of regular hemodialysis is necessary when the level of creatinine in the blood is over 0.1 g / l and its clearance is less than 10 ml / min. Kidney transplantation significantly improves the prognosis, however, in the terminal stage, poor survival of the organ is possible, so the issue of donor kidney transplantation should be addressed in advance.

Prevention

. Treatment of potential causes (especially high blood pressure drug therapy and careful control of diabetes) can prevent or delay the development of chronic kidney disease.

CKD prognosis

The prognosis of CRF has recently lost its fatality due to the use of hemodialysis and kidney transplantation, but the life expectancy of patients remains significantly lower than the average for the population.

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No matter how different kidney diseases are initially, the symptoms of chronic kidney failure are always the same.

What diseases most often lead to kidney failure?

Pyelonephritis, if left untreated, can lead to chronic renal failure.

• Diabetes
• Hypertonic disease.
• Polycystic kidney disease.
• Systemic lupus erythematosus.
• Chronic pyelonephritis.
• Urolithiasis disease.
• Amyloidosis.

Symptoms of kidney failure in the latent stage

At the first stage kidney failure (otherwise - chronic kidney disease of the 1st degree), the clinic depends on the disease - whether it be swelling, hypertension or back pain. Often, for example, with polycystic or glomerulonephritis with an isolated urinary syndrome, a person is not aware of his problem at all.

• At this stage, there may be complaints of insomnia, fatigue, loss of appetite. Complaints are not too specific, and without a serious examination, they are unlikely to help make a diagnosis.
• But the appearance of more frequent and abundant urination, especially at night, is alarming - this may be a sign of a decrease in the ability of the kidney to concentrate urine.
• The death of some of the glomeruli causes the remaining ones to work with repeated overload, as a result of which the liquid is not absorbed in the tubules, and the density of urine approaches the density of blood plasma. Normally, morning urine is more concentrated, and if the specific gravity is less than 1018 during a repeated study in the general analysis of urine, this is a reason to take an analysis according to Zimnitsky. In this study, all urine is collected per day in three-hour portions, and if in none of them the density reaches 1018, then we can talk about the first signs of kidney failure. If in all portions this indicator is equal to 1010, then the violations have gone far: the density of urine is equal in density to blood plasma, the reabsorption of fluid has practically ceased.

Next stage (chronic kidney disease 2) the compensatory abilities of the kidneys are exhausted, they are not able to remove all the end products of protein and purine base metabolism, and a biochemical blood test reveals an increased level of toxins - urea, creatinine. It is the concentration of creatinine in normal clinical practice that determines the glomerular filtration rate index (GFR). A decrease in the glomerular filtration rate to 60-89 ml / min is a mild renal insufficiency. At this stage, there is still no anemia, no electrolyte shifts, no hypertension (if it is not a manifestation of the underlying disease), only general malaise, sometimes thirst, worries. However, even at this stage, with a targeted examination, a decrease in the level of vitamin D and an increase in parathyroid hormone can be detected, although osteoporosis is still far away. At this stage, the reverse development of symptoms is still possible.

Symptoms of renal failure in the azotamic stage

If efforts to treat the underlying disease and protect residual kidney function fail, then kidney failure continues to increase, and GFR drops to 30-59 ml/min. This is the third stage of CKD (chronic kidney disease), it is already irreversible. At this stage, symptoms appear that undoubtedly indicate a decrease in kidney function:

• Blood pressure rises due to a decrease in the synthesis of renin and renal prostaglandins in the kidney, headaches, pain in the heart area appear.
• The work of removing toxins, which is unusual for him, is partly taken over by the intestines, which is manifested by unstable stools, nausea, and a decrease in appetite. May lose weight, lose muscle mass.
• Anemia appears - the kidney does not produce enough erythropoietin.
• The level of calcium in the blood decreases as a result of a lack of the active form of vitamin D. Muscle weakness, numbness of the hands and feet, as well as the area around the mouth appear. There may be mental disorders - both depression and agitation.

In severe renal failure (CKD 4, GFR 15-29 ml/min)

• lipid deception disorders join hypertension, the level of triglycerides and cholesterol increases. At this stage, the risk of vascular and cerebral catastrophes is very high.
• The level of phosphorus in the blood rises, calcifications may appear - the deposition of phosphorus-calcium salts in the tissues. Osteoporosis develops, pain in the bones and joints is disturbing.
• In addition to toxins, the kidneys are responsible for the excretion of purine bases, as they accumulate, secondary gout develops, typical acute attacks of joint pain can develop.
• There is a tendency to increase the level of potassium, which, especially against the background of developing acidosis, can provoke cardiac arrhythmias: extrasystole, atrial fibrillation. As the level of potassium rises, the heartbeat slows down, and "heart attack-like" changes may appear on the ECG.
• There is an unpleasant taste in the mouth, the smell of ammonia from the mouth. Under the influence of uremic toxins, the salivary glands enlarge, the face becomes puffy, as with mumps.

Symptoms of kidney failure in the terminal stage

Patients with end-stage chronic renal failure should receive replacement therapy.

CKD grade 5, uremia, GFR less than 15 ml/min. Actually, at this stage, the patient should receive substitution treatment - hemodialysis or peritoneal dialysis.

• The kidneys practically cease to produce urine, diuresis decreases up to anuria, edema appears and increases, pulmonary edema is especially dangerous.
• The skin is icteric-gray, often with traces of scratching (skin itching appears).
• Uremic toxins tend to bleed more easily, bruise easily, bleed gums, and bleed from the nose. Gastrointestinal bleeding is not uncommon - black stools, vomiting in the form of coffee grounds. This exacerbates the existing anemia.
• Against the background of electrolyte shifts, neurological changes occur: peripheral - up to paralysis, and central - anxiety-depressive or manic states.
• Hypertension is not amenable to treatment, severe cardiac arrhythmias and conduction disturbances, congestive heart failure is formed, and uremic pericarditis may develop.
• Against the background of acidosis, noisy arrhythmic breathing is noted, a decrease in immunity and congestion in the lungs can provoke pneumonia.
• Nausea, vomiting, loose stools are manifestations of uremic gastroenterocolitis.

Without hemodialysis, the life expectancy of such patients is calculated in weeks, if not days, so patients should come to the attention of a nephrologist much earlier.

Thus, the specific symptoms that allow a diagnosis of renal failure to develop develop quite late. The most effective treatment is possible at stages 1-2 of CKD, when there are practically no complaints. But minimal examinations - urine and blood tests - will give fairly complete information. Therefore, it is so important for patients at risk to be regularly examined, and not just to see a doctor.

Which doctor to contact

Chronic renal failure or chronic kidney disease is treated by a nephrologist. However, a therapist, pediatrician, family doctor can also suspect kidney damage and refer the patient for additional examination. In addition to laboratory tests, ultrasound of the kidneys and plain radiography are performed.

Kidney failure is a dangerous disease, the result of which is a metabolic disorder. According to medical statistics, about 3% of the population currently suffers from pathology. These figures are increasing exponentially every year. Both women and men are equally susceptible to the disease. The disease does not bypass even small children. In this article, we will try to figure out what symptoms accompany kidney failure in men, what kind of disease it is, how to treat it.

general information

The kidneys perform an important function in the human body. They continuously produce urine, which subsequently removes harmful substances. Such a filtering structure ensures that two balances are kept in balance: water-salt and acid-base. Renal failure is a dangerous pathological condition characterized by mass death of nephron cells. In the future, the body loses the ability to form and excrete urine. The disease is a consequence of acute damage to the tissues of the organ, therefore it develops suddenly. The volume of urine produced is sharply reduced, sometimes it is completely absent. It is very important to recognize the symptoms of kidney failure in men in a timely manner in order to exclude the occurrence of complications. The sooner the doctor prescribes treatment, the higher the chances of recovery.

The main causes of the disease

Kidney failure has two forms of development: acute and chronic. Based on this, physicians identify factors predisposing to the development of the disease. Among the causes of the acute variant of the disease, the most common are the following:

• Intoxication of the body with food and alcohol, drugs.
• Renal circulatory disorder.
• Diseases of an infectious nature.
• Damage or removal of a single kidney.
• Blockage of the urinary tract.

Chronic renal failure in men, the causes of which differ from the acute form of the disease, develops gradually. Usually it is preceded by serious pathologies of the internal organs. It can be diabetes, hypertension, congenital nephropathy, pyelonephritis, or any of the above diagnoses requires constant monitoring by a doctor. The implementation of his recommendations and appointments can prevent the occurrence of renal failure.

How does the disease manifest itself?

The development of the pathological process and its causes affect the symptoms of renal failure in men. Initially, the patient pays attention to the fact that the fluid is excreted from the body irregularly. Urination may be accompanied by pain discomfort. The man begins to inexplicably lose weight, the skin becomes yellow. Appetite disappears, nausea and vomiting appear after eating. Anemia can be clearly observed in the blood test. A similar clinical picture is characteristic of a disease such as renal failure. Symptoms in men can vary depending on the form of the disease - acute or chronic. Next, we consider each case in more detail.

Acute course

The disease in this case is manifested by a sharp decrease in the amount of urine or a complete cessation of its excretion from the body. Signs of intoxication gradually increase: loss of appetite, indigestion, under the influence of toxins, the liver enlarges. Kidney dysfunction is accompanied by the appearance of specific edema under the eyes.

The clinical picture of the acute form of the disease develops in the following sequence:

• First stage. The appearance of signs of the disease is due to its root cause. As a rule, symptoms of general intoxication appear: the skin is pale, the patient's duration of this stage may vary. In some patients, the disease begins to manifest itself a few hours after the death of nephrons, in others - after 2-3 days.
• Second stage. At this stage, the volume of urine output is sharply reduced, so the likelihood of death is high. Urea and other products of protein metabolism gradually accumulate in the blood. The result of such a violation is severe swelling. The body starts poisoning itself. What are the symptoms of kidney failure in the second stage? In men, lethargy, drowsiness, and possibly a disorder of the stool appear. The leading symptom of the disease is an increase in nitrogen levels in the blood.
• Third stage. At this stage, diuresis gradually normalizes, but the symptoms still persist. The body's ability to concentrate urine and remove metabolic products is restored. The work of the lungs, cardiac system and gastrointestinal tract also returns to normal. Puffiness, pastosity of the legs goes away. The duration of this stage is approximately 14 days.
• Fourth stage. Gradually recedes renal failure. Symptoms in men do not disappear immediately, it takes from one to three months for the final recovery.

If there are signs indicating acute renal failure, it is necessary to immediately call a team of medical workers. All subsequent therapeutic measures are carried out in a hospital setting.

chronic process

The chronic form of the disease is characterized by a latent course. Initially, the patient notices a deterioration in well-being. He quickly gets tired, appetite disappears, headaches appear. The skin becomes dry, and the muscles lose their tone. The patient is constantly sick, worried about frequent seizures. Hands, feet and face are very swollen. Symptoms in men increase gradually. The skin turns yellow, and sores appear in the oral cavity. The patient may suffer from diarrhea and severe flatulence. The smell of urine begins to be felt by the surrounding people. In parallel, the work of the cardiac and respiratory systems is disrupted. Immunity suffers from the pathological process.

Conservative treatment allows you to maintain full-fledged work. However, an increase in psycho-emotional / physical activity, neglect of the prescribed diet, improper drinking regimen - all these factors can cause a deterioration in the patient's condition.

Diagnostic methods

In order to avoid complications of the disease, it is necessary to diagnose it in a timely manner, to determine the causes. The medical examination of the patient begins with the collection of a clinical history. The doctor should know how long ago the signs of kidney failure appeared. In men with one kidney, the clinical picture practically does not differ from that in patients with a full-fledged organ (both kidneys). It is mandatory to study the state of the urinary system. Comprehensive diagnostics includes ultrasound, biochemistry of blood and urine, radiography, CT. An early comprehensive examination of the body allows you to start treatment in a timely manner and prevent the transition of the disease into a chronic form.

What is dangerous pathology?

Renal failure in men, the treatment and diagnosis of which were not carried out in a timely manner, may be accompanied by complications. The body gradually stops working, which is fraught with intoxication of the body with metabolic products. An extremely unpleasant complication is the narrowing of the vessels of the kidneys. This pathology is considered as the last degree of development of the disease, as a result of which sodium accumulates in the body.

Therapy of the acute form of the disease

Kidney failure is a dangerous disease that requires treatment in a hospital setting. At the initial stages, therapy is reduced to the elimination of the causes of the disease, the restoration of homeostasis and impaired system functions. Depending on the patient's condition, you may need:

• antibacterial drugs;
• detoxification therapy (hemodialysis, infusion of saline solutions);
• fluid replacement (transfusion of blood and its substitutes);
• hormonal agents.

With the diagnosis of "renal failure" in men, the treatment and dosage of drugs are selected by a specialist. To remove nitrogenous slags and detoxify the body, they resort to hemosorption, plasmapheresis, and hemodialysis. To normalize diuresis, use diuretic medications ("Furosemide"). Depending on the type of violation of the water-electrolyte balance, solutions of calcium, sodium and potassium salts are administered.

Treatment of a chronic process

Therapy of the chronic variant of renal failure involves the impact on the underlying cause of the disease, the maintenance of organ functions and detoxification procedures. At the initial stages, the main goal of treatment is to slow down the progression of the pathological process. In hypertension, antihypertensive drugs are used. If the main cause of renal failure is hidden in an autoimmune disease, glucocorticoid hormones and cytostatics are prescribed. With anatomical changes in the excretory system, an operation is performed to improve the patency of the urinary tract or remove the calculus.

Against the background of constant therapy, an additional one is prescribed to reduce the symptoms of renal failure in men. How to treat the disease, the doctor determines. For example, diuretics are used to reduce swelling. With severe anemia, vitamin complexes and iron preparations are prescribed.

In the last stages, the patient is transferred to permanent hemodialysis. The procedures are repeated every 14 days. Kidney transplantation is an alternative to hemodialysis. With good compatibility and a successful operation, the patient has a chance to recover and return to normal life.

Principles of Diet Therapy

We have already talked about the symptoms of kidney failure in men. Diet in this disease is an important component of treatment. Patients are advised to follow a low protein diet. Changing the habitual diet can slow down the development of the pathological process and reduce the burden on the kidneys. Diet therapy includes several principles:

1. Limit protein intake to 65 g per day.
2. Increasing the energy value of nutrition by increasing carbohydrate foods in the diet.
3. The main focus should be on fruits and vegetables. It is important to take into account the content of vitamins, salts and protein component in them.

It is necessary to constantly monitor the amount of fluid consumed and excreted. This parameter can be calculated by the formula: the amount of urine excreted per day + 800 ml. In this case, all liquids (soups, cereals, drinks, fruits, vegetables) should be taken into account. The absence of pronounced edema and the preserved water balance allow the patient to receive 6 g of salt per day.

Preventive actions

How to prevent kidney failure? First of all, it is necessary to observe the indications and the scheme for the use of drugs. It is necessary to refuse nephrotoxic products, which include surrogate alcohol and narcotic substances. It is important to treat infectious and inflammatory pathologies in a timely manner

In order to prevent the transition of the disease into a chronic form, you should know what symptoms of kidney failure have. In men, the disease is manifested by problems with urination and deterioration of well-being. When such disorders appear, you should seek help from a specialist.

Conclusion

Timely identification of the causes of renal failure, competent diagnosis and appropriate treatment can save the patient's health. The acute form of the disease has a favorable prognosis if the patient follows all the doctor's instructions and follows a diet. In a chronic course, the chances of recovery depend on the stage of the pathological process. In the case of full compensation for the work of the kidneys, the prognosis for life is favorable. In the end stage, the only option to maintain health is permanent hemodialysis or

Renal failure by itself means such a syndrome in which all functions relevant to the kidneys are violated, as a result of which a disorder of various types of exchanges in them (nitrogen, electrolyte, water, etc.) is provoked. Kidney failure, the symptoms of which depend on the variant of the course of this disorder, can be acute or chronic, each of the pathologies develops due to the influence of different circumstances.

general description

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

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

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

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

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

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

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

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

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

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

Acute renal failure: symptoms

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

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

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

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

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

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

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

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

Almost every patient has nausea and vomiting, somewhat less often - diarrhea. Especially often certain phenomena from the side of digestion occur in combination with hemorrhagic fever along with renal syndrome. Lesions of the gastrointestinal tract are caused, first of all, by the development of excretory gastritis with enterocolitis, whose character is defined as erosive. Meanwhile, some of the actual symptoms are caused by disorders arising from the electrolyte balance.

In addition to these processes, there is a development in the lungs of edema resulting from increased permeability, which is present in the alveolar capillaries during this period. Clinically, it is difficult to recognize it, because the diagnosis is made using an x-ray of the chest area.

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

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

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

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

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

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

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

Acute renal failure: prognosis

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

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

Chronic renal failure: symptoms

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

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

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

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

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

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

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

Among other manifestations of symptoms, one can single out the puffiness of the patient's face and severe muscle weakness, which in this condition occurs as a result of hypokalemia (that is, a lack of potassium in the body, which, in fact, is lost due to processes relevant to the kidneys). The condition of the skin of patients is dry, itching appears, excessive excitement is accompanied by increased sweating. Muscle twitches also appear (in some cases reaching convulsions) - this is already caused by calcium losses in the blood.

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

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

Anorexia, which develops with CRF, can reach the appearance of aversion to any products in patients, also combined with nausea and vomiting, the appearance of an unpleasant aftertaste in the mouth and dryness. After eating, fullness and heaviness in the area "under the pit of the stomach" can be felt - along with thirst, these symptoms are also characteristic of CRF. In addition, patients develop shortness of breath, often high blood pressure, pain in the heart area is not uncommon. Blood clotting decreases, which causes not only nosebleeds, but also gastrointestinal bleeding, with possible skin hemorrhages. Anemia also develops against the background of general processes affecting the composition of the blood, and in particular, leading to a decrease in the level of red blood cells in it, which is relevant for this symptom.

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

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

Chronic renal failure: prognosis

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

Let us single out separately that the course of CRF is not only an irreversible process, but also steadily progressing, and therefore a significant extension of the patient's life can be said only if he is provided with chronic hemodialysis or a kidney transplant is performed (we will dwell on these treatment options below).

Of course, cases in which CRF develops slowly with a corresponding uremia clinic are not excluded, but these are rather exceptions - in the vast majority of cases (especially with high arterial hypertension, that is, high pressure), the clinic of this disease is characterized by the previously noted rapid progression.

Diagnosis

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

An important role is also given to the biochemical analysis of blood for electrolytes, creatinine and urea, because it is on the basis of indicators for these components that specific conclusions can be drawn regarding the severity of acute renal failure, as well as how effective the methods used in treatment are.

The main task of diagnosing acute renal failure is to determine this form itself (that is, to specify it), for which ultrasound of the bladder and kidneys is done. Based on the results of this study measure, the relevance/absence of ureteral obstruction is determined.

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

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

Treatment

• Treatment of acute renal failure

Initial phase

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

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

Oliguria phase

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

Hemodialysis: indications

The use of hemodialysis is relevant in case of an increase in urea to 24 mol / l, as well as potassium to 7 or more mol / l. As an indication for hemodialysis, symptoms of uremia, as well as hyperhydration and acidosis, are used. Today, in order to avoid complications that occur against the background of actual disturbances in metabolic processes, hemodialysis is increasingly prescribed by specialists in the early stages, as well as for the purpose of prevention.

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

• Treatment of chronic renal failure

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

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

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

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

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

Kidney transplantation is the process of replacing an affected kidney with a healthy kidney from a donor. Remarkably, one healthy kidney can cope with all those functions that could not be provided by two diseased kidneys. The issue of acceptance / rejection is solved by conducting a series of laboratory tests.

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

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

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

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

Modern medicine manages to cope with most acute kidney diseases and restrain the progression of most chronic ones. Unfortunately, about 40% of renal pathologies are still complicated by the development of chronic renal failure (CRF).

This term refers to the death or replacement of part of the structural units of the kidneys (nephrons) by the connective tissue and the irreversible impairment of the kidneys' functions in cleansing the blood of nitrogenous toxins, the production of erythropoietin, which is responsible for the formation of red blood elements, the removal of excess water and salts, as well as the reverse absorption of electrolytes.

The consequence of chronic renal failure is a disorder of water, electrolyte, nitrogen, acid-base balance, which leads to irreversible changes in the state of health and often causes death in the terminal variant of CRF. The diagnosis is made with violations that are recorded for three months or longer.

Today, CKD is also called chronic kidney disease (CKD). This term emphasizes the potential for the development of severe forms of renal failure, even in the initial stages of the process, when the glomerular filtration rate (GFR) has not yet been reduced. This allows you to more closely deal with patients with asymptomatic forms of renal failure and improve their prognosis.

Criteria for CRF

The diagnosis of CRF is made if the patient has had one of two types of renal disorders for 3 months or more:

• Damage to the kidneys with a violation of their structure and function, which are determined by laboratory or instrumental diagnostic methods. At the same time, GFR may decrease or remain normal.
• There is a decrease in GFR less than 60 ml per minute with or without kidney damage. This indicator of the filtration rate corresponds to the death of about half of the kidney nephrons.

What leads to CKD

Almost any chronic kidney disease without treatment, sooner or later, can lead to nephrosclerosis with kidney failure to function normally. That is, without timely therapy, such an outcome of any kidney disease as CRF is just a matter of time. However, cardiovascular pathologies, endocrine diseases, and systemic diseases can lead to renal failure.

• kidney disease: chronic glomerulonephritis, chronic tubulointerstitial nephritis, kidney tuberculosis, hydronephrosis, polycystic kidney disease, nephrolithiasis.
• Pathologies of the urinary tract: urolithiasis, urethral strictures.
• Cardiovascular diseases: arterial hypertension, atherosclerosis, incl. angiosclerosis of the renal vessels.
• Endocrine pathologies: diabetes.
• Systemic diseases: renal amyloidosis, .

How CKD develops

The process of replacing the affected glomeruli of the kidney with scar tissue is simultaneously accompanied by functional compensatory changes in the remaining ones. Therefore, chronic renal failure develops gradually with the passage of several stages in its course. The main cause of pathological changes in the body is a decrease in the rate of blood filtration in the glomerulus. The glomerular filtration rate is normally 100-120 ml per minute. An indirect indicator by which one can judge GFR is blood creatinine.

• The first stage of CKD is the initial

At the same time, the glomerular filtration rate remains at the level of 90 ml per minute (normal variant). There are confirmed kidney damage.

• Second stage

It suggests kidney damage with a slight decrease in GFR in the range of 89-60. For the elderly, in the absence of structural damage to the kidneys, such indicators are considered the norm.

• Third stage

In the third moderate stage, GFR drops to 60-30 ml per minute. At the same time, the process taking place in the kidneys is often hidden from view. There is no bright clinic. Perhaps an increase in the volume of urine excreted, a moderate decrease in the number of red blood cells and hemoglobin (anemia) and associated weakness, lethargy, decreased performance, pale skin and mucous membranes, brittle nails, hair loss, dry skin, decreased appetite. Approximately half of the patients have an increase in blood pressure (mainly diastolic, i.e. lower).

• Fourth stage

It is called conservative, as it can be restrained by drugs and, like the first one, does not require blood purification by hardware methods (hemodialysis). At the same time, glomerular filtration is kept at the level of 15-29 ml per minute. There are clinical signs of renal failure: severe weakness, decreased ability to work against the background of anemia. Increased urine output, significant urination at night with frequent nocturnal urges (nocturia). Approximately half of patients suffer from high blood pressure.

• Fifth stage

The fifth stage of renal failure got the name terminal, i.e. final. With a decrease in glomerular filtration below 15 ml per minute, the amount of urine excreted (oliguria) drops until it is completely absent in the outcome of the condition (anuria). All signs of poisoning the body with nitrogenous slags (uremia) appear against the background of disturbances in water and electrolyte balance, lesions of all organs and systems (primarily the nervous system, heart muscle). With such a development of events, the life of the patient directly depends on dialysis of the blood (cleansing it bypassing non-working kidneys). Without hemodialysis or kidney transplantation, patients die.

Symptoms of chronic renal failure

Appearance of patients

Appearance does not suffer until the stage when glomerular filtration is significantly reduced.

• Due to anemia, pallor appears, due to water and electrolyte disorders, dry skin.
• As the process progresses, yellowness of the skin and mucous membranes appears, a decrease in their elasticity.
• Spontaneous hemorrhages and bruising may occur.
• Because of the scratches.
• Characterized by the so-called renal edema with puffiness of the face up to the common type of anasarca.
• Muscles also lose their tone, become flabby, due to which fatigue increases and the patient's ability to work decreases.

Nervous System Damage

This is manifested by apathy, night sleep disorders and drowsiness during the day. Decreased memory, ability to learn. As chronic renal failure increases, pronounced lethargy and disorders of the ability to remember and think appear.

Violations in the peripheral part of the nervous system affect the chilliness of the limbs, tingling sensations, crawling. In the future, movement disorders in the arms and legs join.

urinary function

She initially suffers from a type of polyuria (an increase in the volume of urine) with a predominance of nocturnal urination. Further, CRF develops along the path of reducing the volume of urine and the development of edematous syndrome up to the complete absence of excretion.

Water-salt balance

• salt imbalance is manifested by increased thirst, dry mouth
• weakness, darkening of the eyes when standing up abruptly (due to sodium loss)
• excess potassium explains muscle paralysis
• respiratory disorders
• slowing of heartbeats, arrhythmias, intracardiac blockade up to cardiac arrest.

Against the background of an increase in the production of parathyroid hormones by the parathyroid glands, a high level of phosphorus and a low level of calcium in the blood appear. This leads to softening of the bones, spontaneous fractures, itchy skin.

Nitrogen imbalances

They cause an increase in blood creatinine, uric acid and urea, as a result of:

• with GFR less than 40 ml per minute, enterocolitis develops (damage to the small and large intestine with pain, bloating, frequent loose stools)
• ammonia smell from the mouth
• secondary articular lesions of the type of gout.

The cardiovascular system

• first, it reacts with an increase in blood pressure
• secondly, heart lesions (muscles -, pericardial sac - pericarditis)
• there are dull pains in the heart, cardiac arrhythmias, shortness of breath, swelling in the legs, liver enlargement.
• with an unfavorable course of myocarditis, the patient may die on the background of acute heart failure.
• pericarditis can occur with the accumulation of fluid in the pericardial sac or the precipitation of uric acid crystals in it, which, in addition to pain and expansion of the boundaries of the heart, gives a characteristic ("funeral") pericardial rub when listening to the chest.

hematopoiesis

Against the background of a deficiency in the production of erythropoietin by the kidneys, hematopoiesis slows down. The result is anemia, which manifests itself very early in weakness, lethargy, and decreased performance.

Pulmonary complications

characteristic of the late stages of CKD. This is a uremic lung - interstitial edema and bacterial inflammation of the lung against the background of a fall in immune defenses.

Digestive system

It reacts with decreased appetite, nausea, vomiting, inflammation of the oral mucosa and salivary glands. With uremia, erosive and ulcerative defects of the stomach and intestines appear, fraught with bleeding. Acute hepatitis also becomes a frequent companion of uremia.

Kidney failure during pregnancy

Even a physiological pregnancy significantly increases the load on the kidneys. In chronic kidney disease, pregnancy exacerbates the course of the pathology and can contribute to its rapid progression. This is due to the fact that:

• during pregnancy, increased renal blood flow stimulates the overstrain of the renal glomeruli and the death of some of them,
• deterioration of conditions for reabsorption of salts in the tubules of the kidney leads to the loss of high volumes of protein, which is toxic to the kidney tissue,
• increased work of the blood coagulation system contributes to the formation of small blood clots in the capillaries of the kidneys,
• deterioration in the course of arterial hypertension during pregnancy contributes to glomerular necrosis.

The worse the filtration in the kidneys and the higher the creatinine numbers, the more unfavorable the conditions for the onset of pregnancy and its bearing. A pregnant woman with chronic renal failure and her fetus are faced with a number of pregnancy complications:

• Arterial hypertension
• nephrotic syndrome with edema
• Preeclampsia and eclampsia
• severe anemia
• and fetal hypoxia
• Delays and malformations of the fetus
• and premature birth
• Infectious diseases of the urinary system of a pregnant woman

Nephrologists and obstetricians-gynecologists are involved to decide on the appropriateness of pregnancy in each individual patient with CRF. At the same time, it is necessary to assess the risks for the patient and the fetus and correlate them with the risks that the progression of chronic renal failure every year reduces the likelihood of a new pregnancy and its successful resolution.

Treatment Methods

The beginning of the fight against CRF is always the regulation of diet and water-salt balance.

• Patients are advised to eat with a restriction of protein intake within 60 grams per day, with the predominant use of vegetable proteins. With the progression of chronic renal failure to stage 3-5, the protein is limited to 40-30 g per day. At the same time, they slightly increase the proportion of animal proteins, giving preference to beef, eggs and lean fish. The egg and potato diet is popular.
• At the same time, the consumption of foods containing phosphorus (legumes, mushrooms, milk, white bread, nuts, cocoa, rice) is limited.
• Excess potassium requires reducing the consumption of black bread, potatoes, bananas, dates, raisins, parsley, figs).
• Patients have to manage with a drinking regimen at the level of 2-2.5 liters per day (including soup and drinking pills) in the presence of severe edema or intractable arterial hypertension.
• It is useful to keep a food diary, which makes it easier to record protein and trace elements in food.
• Sometimes specialized mixtures are introduced into the diet, enriched with fats and containing a fixed amount of soy proteins and balanced in trace elements.
• Patients, along with the diet, may be shown an amino acid substitute - Ketosteril, which is usually added at GFR less than 25 ml per minute.
• A low-protein diet is not indicated for malnutrition, infectious complications of CRF, uncontrolled arterial hypertension, with GFR less than 5 ml per minute, increased protein breakdown, after surgery, severe nephrotic syndrome, terminal uremia with damage to the heart and nervous system, poor diet tolerance.
• Salt is not limited to patients without severe arterial hypertension and edema. In the presence of these syndromes, salt is limited to 3-5 grams per day.

Enterosorbents

They allow you to somewhat reduce the severity of uremia due to the binding in the intestine and the removal of nitrogenous toxins. This works in the early stages of chronic renal failure with the relative safety of glomerular filtration. Polyphepan, Enterodez, Enterosgel, Activated carbon, are used.

Anemia treatment

To stop anemia, Erythropoietin is administered, which stimulates the production of red blood cells. Uncontrolled arterial hypertension becomes a limitation to its use. Since iron deficiency may occur during treatment with erythropoietin (especially in menstruating women), therapy is supplemented with oral iron preparations (Sorbifer durules, Maltofer, etc., see).

Blood clotting disorder

Correction of blood clotting disorders is carried out with Clopidogrel. Ticlopedin, Aspirin.

Treatment of arterial hypertension

Drugs for the treatment of arterial hypertension: ACE inhibitors (Ramipril, Enalapril, Lisinopril) and sartans (Valsartan, Candesartan, Losartan, Eprosartan, Telmizartan), as well as Moxonidine, Felodipine, Diltiazem. in combinations with saluretics (Indapamide, Arifon, Furosemide, Bumetanide).

Phosphorus and calcium metabolism disorders

It is stopped by calcium carbonate, which prevents the absorption of phosphorus. Calcium deficiency - synthetic preparations of vitamin D.

Correction of water and electrolyte disorders

carried out in the same way as the treatment of acute renal failure. The main thing is to rid the patient of dehydration against the background of a restriction in the diet of water and sodium, as well as the elimination of acidification of the blood, which is fraught with severe shortness of breath and weakness. Solutions with bicarbonates and citrates, sodium bicarbonate are introduced. A 5% glucose solution and Trisamine are also used.

Secondary infections in chronic renal failure

This requires the appointment of antibiotics, antiviral or antifungal drugs.

Hemodialysis

With a critical decrease in glomerular filtration, the purification of blood from substances of nitrogen metabolism is carried out by hemodialysis, when slags pass into the dialysis solution through the membrane. The most commonly used apparatus is an "artificial kidney", less often peritoneal dialysis is performed, when the solution is poured into the abdominal cavity, and the peritoneum plays the role of a membrane. Hemodialysis for CRF is carried out in chronic mode. For this, patients travel for several hours a day to a specialized Center or hospital. At the same time, it is important to timely prepare an arterio-venous shunt, which is prepared at a GFR of 30-15 ml per minute. From the moment the GFR falls below 15 ml, dialysis is started in children and patients with diabetes mellitus, with GFR less than 10 ml per minute, dialysis is performed in other patients. In addition, indications for hemodialysis will be:

• Severe intoxication with nitrogenous products: nausea, vomiting, enterocolitis, unstable blood pressure.
• Treatment-resistant edema and electrolyte disturbances. Cerebral edema or pulmonary edema.
• Severe acidification of the blood.

Contraindications for hemodialysis:

• clotting disorders
• persistent severe hypotension
• tumors with metastases
• decompensation of cardiovascular diseases
• active infectious inflammation
• mental illness.

kidney transplant

This is a cardinal solution to the problem of chronic kidney disease. After that, the patient has to use cytostatics and hormones for life. There are cases of repeated transplants, if for some reason the transplant is rejected. Renal failure during pregnancy against the background of a transplanted kidney is not an indication for interruption of gestation. pregnancy can be carried to the required term and is usually resolved by caesarean section at 35-37 weeks.

Thus, Chronic Kidney Disease, which today replaced the concept of “chronic renal failure”, allows doctors to see the problem more timely (often when there are no external symptoms yet) and respond with the start of therapy. Adequate treatment can prolong or even save the patient's life, improve his prognosis and quality of life.