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What is chronic renal failure (CRF), and what are the stages of CKD according to creatinine? Chronic renal failure - irreversible damage kidney function. The kidneys are responsible for the elimination of many harmful metabolic products, the regulation of blood pressure and acid-base balance in organism.

Development of chronic kidney failure happens gradually. At the onset of the disease, there may be no clinical symptoms or they are uncharacteristic this disease(for example, arterial hypertension). To determine the stage of the disease, classification by speed is used. glomerular filtration(SKF).

Kidney dysfunction can occur both as a result of a sudden triggering of a damaging factor, and as a result of prolonged pathological process. In the first case, acute renal failure is diagnosed, which can end complete violation health within a few months, the complete destruction of the structures of this body.

If the kidney is damaged gradually due to the impact of a long-term pathological process lasting at least 3 months, then a chronic one develops with the most severe consequences: severe and advanced stage of renal failure, requiring therapy with hemodialysis.

Among the main factors affecting the functioning of the kidneys, first of all, one can single out: circulatory disorders, specific and nonspecific inflammatory processes and immunological factors acting toxic to the kidneys, diseases urinary tract as well as chronic diseases such as diabetes and arterial hypertension.

Diagnostic methods

The main criteria for laboratory assessment of kidney function are: the amount of filtered plasma per unit time, the level of creatinine and diuresis, that is, the amount of urine produced.

In addition, in the course of chronic renal failure, the patient deals with anemia and thrombocytopenia, hyperphosphatemia, hypocalcemia and hypercalcemia, impaired regulation of blood volume, most often with the development of arterial hypertension and acidosis. The loss of protein leads to numerous disorders associated with its deficiency - endocrine disruption or immunodeficiency.

Symptoms of the disease

The main ones include:

weakness, fatigue, malnutrition;
low body temperature;
violations of hydration of the body;
change in the amount of urine excreted;
decrease in immunity.

Initially, the renal glomeruli undergo hypertrophy. This means that the kidney is increasing in size. However, end-stage renal disease (uremia) is characterized by small kidneys.

As the disease progresses, toxins accumulate in the blood - products of protein metabolism, as a result of which an increase in the concentration of creatinine in the blood serum is observed, which poison the entire body.

Stages of the chronic form

CRF classification:

Kidney disease with normal GFR - latent stage (GFR 90 and > 90 ml/min).
Early stage (GFR 60-89 ml/min).
Middle stage (GFR 30-59 ml/min).
Severe stage (GFR 15-29 ml/min).
End stage (uremia) - GFR below 15 ml/min.

The development of chronic renal failure occurs gradually, with a glomerular filtration rate below 15 ml / min, renal replacement therapy is required. As GFR decreases, symptoms and complications from various organs and systems appear.

Each classification has its own clinical picture.

Stage I - clinical manifestations depend on the underlying disease (eg, diabetes mellitus, arterial hypertension). Raises often arterial pressure. At this stage, the cause should be determined and the risk factors for developing kidney disease should be eliminated.

Stage II increases susceptibility to dehydration and infection urinary tract. Often coexists with vitamin D deficiency, which stimulates parathyroid glands to the secretion of parathyroid hormone and the development of secondary hyperfunction of the parathyroid glands. Some patients develop anemia, mainly caused by reduced production of erythropoietin in the kidneys.

On Stage III polyuria, nocturia, that is, nocturnal urination and increased thirst. Half of the patients develop arterial hypertension. Many patients have anemia, which can cause weakness, reduced physical activity, and easy fatigue.

Stage IV CRF is characterized by symptoms of severe severity. There is discomfort from the gastrointestinal tract: loss of appetite, nausea and vomiting. Arterial hypertension occurs in more than 80% of patients. Many have left ventricular hypertrophy and heart failure.

At stage V of terminal renal failure, the symptoms that arise affect almost all organs and systems. Patients require renal replacement therapy (dialysis or kidney transplant), which causes regression of most symptoms of uremia.

Therapeutic measures

In the event of a sudden impairment of kidney function, the main goal is to eliminate its cause, for example, replenishing the loss of fluid in a state of dehydration, treating heart failure, restoring the patency of the urinary tract and blood vessels. Strict control of the balance of minerals is required, especially the concentration of potassium in the blood serum. It is very important to take into account the degree of kidney failure when taking medications, especially those taken constantly. To avoid severe complications and ensure the regeneration of the damaged parenchyma of the organ, renal replacement therapy is used.

Chronic renal failure is an irreversible process that depends on to a large extent on the type of underlying disease, the coexistence of other diseases, and the age and sex of the patient. Unfavorable factors are: male gender, smoking, hyperlipidemia and the amount of proteinuria. Treatment is aimed primarily at the underlying disease, the main goals are:

normalization of blood pressure;
balancing the level of glycemia in diabetes mellitus;
treatment of hyperlipidemia;
alignment of violations of water electrolyte balance;
discontinuation of drugs and substances with a neurotoxic effect;
treatment of concomitant diseases;
prevention and treatment of complications, in particular anemia.

In addition, it is necessary to strive to reduce the loss of protein in the urine, to optimal value below 0.3 g / day, for this, drugs from the group of inhibitors, receptor blockers are used. To lower the level of cholesterol in the blood, the patient must take statins, fibrates and make lifestyle changes. Ultimately, if chronic renal failure has reached stage 5 of the disease, the patient is treated with a hemodialysis procedure.

Carrying out a hemodialysis procedure

When the level of GFR drops to a value of 15-20 ml/min/1.73 m 2 , the patient undergoes hemodialysis. Indications for dialysis are following states life threatening:

uremic pericarditis;
severe phase of arterial hypertension;
chronic symptoms of nausea and vomiting;
concentration >12 mg/dl or urea >300 mg/dl.

Hemodialysis is carried out using a special device, popularly called an "artificial kidney", it provides a simultaneous flow of blood and fluid, dialysate, separated by a semi-permeable membrane, through which, according to the principle of diffusion (concentration difference) and ultrafiltration (pressure difference), metabolism is possible. Thus, the blood is purified from harmful metabolites and toxic compounds. The process lasts about 4-5 hours and is carried out mainly 3 times a week.

During a hemodialysis procedure, the patient receives heparin to prevent blood from clotting.

The opinions of doctors on the issue are always different, however, average duration life - 20 years. It is not uncommon in medical practice that patients live for more than 35 years.

kidney transplant

Kidney transplant is the only option complete cure diseases of chronic renal failure. The operation entails a significant improvement in the quality of life in people previously treated with dialysis. Unfortunately, a kidney transplant requires tissue compatibility from a living or deceased donor. Therefore, a long waiting time is often required for the operation to take place. An organ transplant is needed for individuals whose serum creatinine concentration exceeds 6 mg/dL. After surgery, patients must take immunosuppressive drugs and steroids to prevent organ rejection. Contraindications for surgery are serious illness organs such as cancer, as well as age, atherosclerosis.

It is necessary to constantly monitor kidney function after surgery. According to the latest research data, after 5 years after the operation, about 80% of transplanted organs perform their functions. Unfortunately, the number of transactions performed is 3 times less than the number of people on the waiting list.

A decrease in kidney function until the complete cessation of their filtration capabilities and the ability to remove toxins from the body is chronic renal failure. The etiology of this disease is a consequence of past diseases or the presence in the body chronic processes. This kidney injury is especially common in the elderly. Chronic renal failure is a fairly common kidney disease and the number of patients is growing every year.

Pathogenesis and causes of chronic renal failure

chronic kidney disease - pyelo- or glomerulonephritis;
systemic metabolic disorders - vasculitis, gout, rheumatoid arthritis;
the presence of cameos or other factors (mucus, pus, blood) that clog the ureter;
malignant neoplasms of the kidneys;
neoplasms of the pelvic organs, in which the ureter is compressed;
developmental disorders urinary system;
endocrine diseases (diabetes);
vascular diseases (hypertension);
complications of other diseases (shock, poisoning with toxic, medicines);
alcohol and drug use.

The pathogenesis of this disease is a consequence of the above reasons, in which chronic damage develops and structural disturbances renal tissue. The process of parenchyma repair is disrupted, which leads to a decrease in the level of functioning kidney cells. The kidney at the same time decreases in size, shrinks.

Symptoms and signs of the disease

Malaise, fatigue, loss of appetite, nausea and vomiting are symptoms of chronic renal failure.

Signs of chronic renal failure occur against the background of the elimination of toxins, as well as the maintenance of metabolic processes, which leads to the failure of all systems and organs of the body. Symptoms of chronic renal failure are initially mild, but as the disease progresses, patients experience malaise, fatigue, dry mucous membranes, changes in laboratory tests, insomnia, nervous twitching of the limbs, tremor, and numbness of the fingertips. With the further development of the disease, the symptoms worsen. Appear persistent (morning and around the eyes), dry skin, loss of appetite, nausea, developing hypertension. Forms of chronic renal failure are divided into five stages depending on the severity of the course.

Classification by stages

CKD stage 1 - latent. Passes without severe symptoms. Patients do not complain about anything, except for increased fatigue. There is a small amount of protein in laboratory tests.
CKD stage 2 - compensated. Patients have the same complaints, but they appear more often. In urine and blood there are changes in laboratory parameters. There is an increase in the excretion of the daily amount of urine (2.5 l).
CKD stage 3 - intermittent. There is a further decrease in kidney function. In blood tests, elevated levels of creatinine and urea. There is a deterioration in the condition.
CKD stage 4 - decompensated. There is a severe and irreversible change in the work of this internal organ.
CKD st. 5 - the terminal stage of chronic renal failure is characterized by the fact that the work of the kidneys almost completely stops. It is observed in the blood high content urea and creatinine. Electrolyte metabolism in the kidneys changes, uremia occurs.

Stages of chronic renal failure are classified depending on the degree of damage to the parenchyma of the organ, its excretory functions and have five degrees. The stages of chronic kidney disease are distinguished according to two criteria - the glomerular filtration rate, creatinine and the level of protein in the urine.

Classification of chronic kidney disease by GFR

CKD indexing by albuminuria

Kidney damage in children

Chronic kidney disease in children is rare, but it is at this age that these disorders are very dangerous.

Chronic kidney disease in children is uncommon, but isolated cases do occur. This is very dangerous disease because it is in childhood with such disorders that the kidneys fail, which leads to lethal outcome. Therefore, the detection of CRF and CKD at the earliest stages is important task pediatric nephrology. The causes of CKD in children are:

low birth weight;
prematurity;
anomalies of intrauterine development;
renal vein thrombosis in newborns;
transferred infectious diseases;
heredity.

The classification of chronic disease in adults and CKD in children is the same. But the main sign that the child has this disease, is that occurs in children school age. The main manifestation of the syndrome is a sharp violation of the kidneys and, as a result, severe intoxication of the body. Urgent hospitalization required.

Complications of the disease

This is a very dangerous disease, the 1st stage of which passes with hidden symptoms, and the 2nd stage with mild signs of the disease. Chronic renal failure should be treated as early as possible. For chronic renal failure initial stage deep changes of renal tissue are not characteristic. With stage 5 CKD, irreversible processes develop that lead to poisoning of the body and deterioration of the patient's condition. Patients have arrhythmia, albuminuria, persistent hypertension, anemia, confusion up to coma, nephrogenic hypertension, angiopathy, heart failure and pulmonary edema may develop. Exacerbation of CKD and CKD leads to the fact that uremia occurs. In this case, urine, entering the bloodstream, leads to uremic shock, which often leads to death.

Diagnosis of the disease

Diagnosis of CKD involves consultations with doctors:

therapist;
urologist;
cardiologist;
endocrinologist;
ophthalmologist;
neuropathologist;
nephrologist.

Diagnosis of CKD involves taking an anamnesis, after consulting a number of specialists, and a fairly objective study.

The doctor will take an anamnesis (all symptoms of the disease, accompanying illnesses, in children - the presence of physical developmental delay, as well as features of a family history). Objective examination includes percussion and palpation of the kidneys. In children - a study of the ridge, the presence of a weight deficit., stunting, the presence of increased pressure, signs of anemia, etc. Chronic renal failure is determined by analysis:

Urinalysis - protein in a small amount, reduced density, the presence of erythrocytes, cylinders and increased amount leukocytes.
Blood test - characterized by an increase in leukocytes and ESR, reduced amount hemoglobin and erythrocytes.
Biochemical analysis - increase in creatinine, urea, nitrogen, potassium and cholesterol in the blood. Decreased protein and calcium.
Determination of glomerular filtration rate - calculated based on a blood test for creatinine, age, race, gender and other factors.
Ultrasound of the kidneys and urinary system will help to see the condition of the kidney.
MRI visualizes the structure of the kidney, its components, the ureter and bladder.
Ultrasound dopplerography assesses the condition of the vessels of the kidneys.
Zimnitsky's test - shows the state of kidney function, and you can also see the volume of urine excreted in the morning and afternoon.

Treatment of kidney failure

Initially, the treatment of chronic kidney disease is aimed at reducing pressure, improving urine formation, lowering the pH of the stomach, and normalizing microelements in the blood. Later, depending on the condition of the patient, hemodialysis, peritoneal dialysis, or kidney transplantation are prescribed. With this disease, you can not supercool, lift weights and succumb to stressful situations. It is very important to adhere proper nutrition. Patients are prescribed diet No. 7. Its main principles are: limited protein intake, reducing the amount of salt and phosphorus in food, reducing and monitoring the amount of potassium, controlling fluid intake in the body (no more than 2 liters), controlling the energy value of food. Nutrition in CKD is not like the usual fasting in case of illness, the menu should have enough fruits and vegetables in the form of soups and compotes.

Restriction of protein intake is already recommended at the beginning of the disease - up to 1 g / kg, then - 0.8 g / kg, and at other stages - 0.6 g / kg. Salt control is very important point in the diet, since an excess of sodium in the blood leads to hypertension and edema, so it is recommended to use it no more than two grams per day. They also limit the intake of phosphorus to 1 g per day (limit the intake of food with a high content of phosphorus). To reduce potassium in the body, which can lead to cardiac arrest, dried fruits, bananas, avocados, potatoes, herbs, nuts, chocolate, legumes are excluded from the diet. Energy value food should be 2.5-3 thousand calories. The diet of patients is fractional (5-6 times, in small portions). The menu should be rich in fruits and vegetables in the form of compotes, soups, etc. Food should be taken boiled or baked.

The diet should include the following foods:

cereals;
whole grain bread;
diet soups;
meat and fish products from low-fat varieties;
vegetables and fruits;
eggs;
milk, cottage cheese;
jellies and mousses;
diluted juice and weak tea, rosehip decoction;
spices.

Contraindicated:

salty and spicy food;
alcoholic drinks, strong teas, coffee.
mushrooms;
greenery;
legumes and pasta;
smoked and canned food;
bananas and dried fruits;
seasonings: mustard and horseradish;
garlic and radish.

Stage 4 chronic kidney disease is a serious stage kidney disease with a glomerular filtration rate of 15-30 ml / min. Severe decline in kidney function will cause systemic symptoms. Patients in this stage, on the one hand, should apply Special attention on a diet, lifestyle changes to manage the disease situation and not burden the kidneys, and on the other, receive treatment to improve the kidney situation and avoid threatening complications.

As kidney function deteriorates, metabolites can accumulate in the bloodstream and cause a medical condition called Anemia. Since the kidneys cannot produce erythropoietin efficiently, and the hormone stimulates the production of blood cells, patients with stage 4 kidney failure will become anemic. The kidneys regulate electrolyte balance and in stage 4 kidney failure it was common that patients suffer from high calorie, high phosphorus, low calcium, high natrogo, etc. . High potassium will lead to arrhythmias, high sodium will threaten fluid retention and increase blood pressure, and increased phosphorus will cause diseased bones.

The symptom of stage 4 chronic renal failure mainly includes:

* Weakness: Feeling tired is the result of anemia symptom in stage 4.

* Change in urination: Urine may be frothy and foam persists for a long time. This is a sign of increased protein in the urine. Blood in the urine will cause the color of the urine to be dark orange, brown, tea-colored, or red. The person may pass more or less urine, or go to the bathroom frequently at night.

* Difficulty falling asleep: Skin itching, restless legs or muscle cramps may keep the patient awake and have difficulty falling asleep.

* Nausea: Chronic renal failure may cause vomiting or nausea.

* Lack of appetite: The patient has no desire to eat and often complains of a metallic or ammonia taste in the mouth.

* Cardiovascular diseases: In stage 4 chronic renal failure, different factors, including high blood pressure, water and salt retention, anemia and toxic substances, will increase the risk of patients to develop heart failure, arrhythmia, myocardial damage, etc. .

* Symptoms in the nervous system A: Early symptoms mainly include insomnia, poor concentration, memory loss. In some cases, patients suffer from tingling, numbness, coma, insanity and others.

Stage 4 patients are usually required to take blood tests, hemoglobin, calcium, potassium and calcium in order to learn how the kidneys work and how to reduce the risk of complications. After determining the result of the analysis, the doctor will advise the patient on the best opinion of the treatment. Because diet is a necessary part of the treatment, so a dietitian will also be necessary for the treatment. And the dietitian will examine the result of the analysis and give the patient his own dietary plan. A proper eating plan helps preserve kidney function and overall health.

Some of the basic dietary advice in stage 4 kidney failure mainly includes the following:

Calculate protein intake. Proteins are sources of nutrition for the human body. However, too much protein is harmful because it will produce more nitrogenous waste. Protein intake of 0.6 g per kilogram per day is beneficial when your glomerular filtration rate falls below 25, or approximately 25% of kidney function remains. You should ask your doctor how much protein is available per day and remember that at least half of the protein comes from high quality outcomes, like egg white, lean meat, fish, etc. .

Sodium restriction. Too much sodium can cause large fluid retention. And this will lead to swelling and shortness of breath in a person. A person in stage 4 kidney failure should avoid processed foods and prepare meals with low sodium or sodium ingredients. Most diets start with a goal of 1500-2000 mg per day or as recommended by your doctor.

Maintain a healthy body weight. If you want to maintain a healthy weight by burning calories, and now you need to exercise regularly.

Taking cholesterol. Replace saturated fat unsaturated fats and make a diet low in overall fat. This may help reduce the risk of cardiovascular disease.

Other Tips: You should limit your potassium intake if the lab results are above the normal range. If the patient has too much fluid content, then he will limit fluid intake. Fluid retention symptoms mainly include swelling in the legs, arms, face, high blood pressure, and shortness of breath.

In order to prolong kidney health, patients in stage 4 kidney failure should take the medicine recommended by the doctor to control blood pressure, anemia and other situations. People in stage 4 will probably lose kidney function further, and end up with dialysis. In addition to a basic management plan to control the progress of the disease, proper treatment can help improve kidney function from poor to better position and therefore dialysis will not be necessary. And this will be done with the combination of Western medicine and traditional Chinese medicine.

Definition

Chronic renal failure (CRF) - end stage various first or secondary chronic diseases kidneys, which leads to a significant decrease in the number of active nephrons due to the death of most of them. For CRF, the kidneys lose the ability to perform their excretory and endocrine functions.

Causes

The most important causes of CKD (more than 50%) in adulthood are diabetes and hypertension. Therefore, they can often be detected by the therapist, family doctor, endocrinologist or cardiologist. In the presence of microalbuminuria and if CKD is suspected, patients should be referred to a nephrologist for consultation and treatment adjustment. Reaching the level of GFR< 30 мл/мин/1,73 м 2 , пациенты обязательно должны консультироваться с нефрологом.

List of major CKD

Pathological characteristic	Causal disease	% among all patients with CKD
Diabetic glomerulosclerosis	Diabetes mellitus types 1 and 2
Vascular lesions	Pathology of large arteries, arterial hypertension, microangiopathy
Glomerular lesions	Autoimmune diseases, systemic infections, exposure to toxic substances and drugs, tumors
cystic lesion	Autosomal dominant and autosomal recessive polycystic kidney disease
Tubulointerstitial pathology	Urinary tract infection, urolithiasis, urinary tract obstruction, exposure to toxic substances and drugs, MCP
Transplanted kidney injury	Rejection reaction, exposure to toxic substances and drugs, (cyclosporine, tacrolimus), graft glomerulopathy

In nephrology, there are 4 groups of risk factors affecting the development and course of CKD. These are factors that may influence the development of CKD; factors that initiate CKD; factors that lead to the progression of CKD; and risk factors for the final degree of CKD.

Risk factors for CKD

Risk factors that have possible impact for the development of CKD	Risk factors that provoke the development of CKD	Risk Factors for CKD Progression	Risk factors for end-stage CKD
Burdensome family history of CKD, reduced kidney size and volume, low birth weight or prematurity, low income or social status	The presence of type 1 and type 2 diabetes, hypertension, autoimmune disease, urinary tract infection, urolithiasis, urinary tract obstruction, drug toxicity	High proteinuria or hypertension, poor glycemic control, smoking and drug use	Late onset renal replacement therapy, low dialysis dose, temporary vascular access, anemia, low blood albumin

Significant progress has now been made in uncovering the pathogenetic mechanisms of the progression of chronic kidney disease. At the same time, special attention is paid to the so-called non-immune factors (functional-adaptive, metabolic, etc.). Such mechanisms act to some extent in chronic kidney lesions of any etiology, their significance increases as the number of active nephrons decreases, and it is these factors that largely determine the rate of progression and outcome of the disease.

Symptoms

1. Defeat of cardio-vascular system Key words: hypertension, pericarditis, uremic cardiopathy, disorders heart rate and conduction, acute left ventricular failure.

2. Neurotic syndrome and CNS damage:

uremic encephalopathy: symptoms of asthenia ( fatigue memory impairment, irritability, sleep disturbance), symptoms of depression (depressed mood, decreased mental activity, suicidal thoughts), phobias, changes in character and behavior (weakness of emotional reactions, emotional coldness, indifference, eccentric behavior), impaired consciousness (stupor, sopor, coma), vascular complications(hemorrhagic or ischemic strokes);
uremic polyneuropathy: flaccid paresis and paralysis, other changes in sensation and motor function.

3. Gastrointestinal syndrome:

damage to the mucous membranes (cheilitis, glossitis, stomatitis, esophagitis, gastropathy, enteritis, colitis, stomach and intestinal ulcers);
organic lesions of the glands (mumps, pancreatitis).

4.Amemic-hemorrhagic syndrome:

anemia (normochromic, normocytic, sometimes erythropoietin-deficient or iron-deficient), lymphopenia, thrombocytopenia, slight thrombocytopenia, pale skin with a yellowish tinge, its dryness, traces of scratching, hemorrhagic rash (petechiae, ecchymosis, sometimes purpura).

5. Clinical manifestations due to metabolic disorders:

endocrine disorders (hyperparathyroidism, libido disorder, impotence, inhibition of spermatogenesis, gynecomastia, oligo- and aminorrhea, infertility);
skeletal muscle pain and weakness, convulsions, proximal myopathy, ossalgia, fractures, aseptic bone necrosis, gout, arthritis, intradermal and dimensional calcifications, deposition of urea crystals in the skin, ammoniacal horn odor, hyperlipidemia, carbohydrate intolerance.

6. Violations of the immune system: susceptibility to intercurrent infections, decreased antitumor immunity.

Timely detection of patients with impaired renal function is one of the main factors determining the tactics of treatment. Indicators advanced level urea, creatinine oblige the doctor to examine the patient in order to establish the cause that caused azotemia, and prescribe a rational treatment.

Signs of CRF

1.Early signs:

clinical: polyuria with nocturia in combination with hypertension and normochromic anemia;
laboratory: a decrease in the concentration ability of the kidneys, a decrease in the filtration function of the kidneys, hyperphosphatemia and hypocalcemia.

2.Late signs:

laboratory: azotemia (increased creatinine, urea and uric acid serum);
instrumental: a decrease in the cortex of both kidneys, a decrease in the size of the kidneys according to ultrasound or an overview uroroentgenogram;

Calt-Cockrof method;
classical, with the determination of the concentration of creatinine in plasma, its daily excretion in the urine and minute diuresis.

Classification of chronic renal failure by severity

Degree	Clinical picture	Main functional indicators
I(Initial)	Efficiency is preserved, increased fatigue. Diuresis is within the normal range or slight polyuria is observed.	Creatinine 0.123-0.176 mmol / l. Urea to 10 mmol/l. Hemoglobin 135-119 g/l. Blood electrolytes are within normal limits. Decreased CF to 90-60 ml/min.
II(Detected)	Working capacity is significantly reduced, insomnia and weakness can be observed. Dyspeptic phenomena, dry mouth, polydipsia.	Hypoisostenuria. Polyuria. Urea 10-17 mmol/l. creatinine 0.176-0.352 mmol / l. CF 60-30 ml/min. Hemoglobin 118-89 g/l. The content of sodium and potassium is normal or moderately reduced, the level of calcium, magnesium, chlorine and phosphorus may be normal.
III(Heavy)	Efficiency is lost, appetite is significantly reduced. Significantly pronounced dyspeptic syndrome. Signs of polyneuropathy, itching, muscle twitches, palpitations, shortness of breath.	Isohyposthenuria. Polyuria or pseudonormal diuresis. Urea 17-25 mmol/l. Creatinine 0.352-0.528 mmol/l, CF 30-15 ml. Hemoglobin 88-86 g/l. The content of sodium and potassium is normal or reduced. The level of calcium is reduced, magnesium is increased. The content of chlorine is normal or low, the level of phosphorus is increased. There is a subcompensated acidosis.
IV (Terminal)	dyspepsia. Hemorrhages. Pericarditis. ILC with NK II Art. Polyneuritis, convulsions, brain disorders.	Oligouria or anuria. Urea > 25 mmol/l. Creatinine > 0.528 mmol/L. KF< 15 мл/мин. Hemoglobin< 88 г/л. Содержание натрия в норме или снижение, калия в норме или повышен. Уровень кальция снижен, магния повышен. Содержание хлора в норме или снижен, уровень фосфора повышен. Наблюдается декомпенсированный ацидоз .

Note : Most precise methods determination of GFR is radiological with inulin, iothalamate, DTPA, EDTA. Can be applied:

Persistent normochromic anemia in combination with polyuria and hypertension should alert the doctor to the possibility of CRF in a patient. IN differential diagnosis such most informative tests help: determination of the maximum relative density and osmolarity of urine, the value of CF, the ratio of urea and creatinine in the blood, the data of a radionuclide study.

A decrease in the reserve of CF (functional renal reserve - FN) due to nephropathy is considered as an early sign of a violation of the filtration function of the kidneys. At healthy person after an acute protein load or CF increases by 10-39%. Decrease or complete absence FNR indicates hyperfiltration in functioning nephrons and should be regarded as a risk factor for the progression of CRF.

Depression of the maximum relative density of urine below 10 18 in Zemnitsky's sample, along with a decrease in CF (daily urine output of at least 1.5 liters) below 60-70 ml/min. and the absence of FNR indicate the initial stage of CRF.

The differential diagnosis of acute renal failure is indicated by a history of kidney damage, polyuria with nocturia, persistent hypertension, as well as a decrease in the size of the kidneys according to ultrasound or radiographs of the kidneys.

Diagnostics

For patients with chronic kidney disease (chronic renal failure), it is necessary to undergo various studies for treatment. Patients are referred for diagnosis in the presence of such symptoms as, for example, signs of anemia, edema, smell of urine, hypertension, and also for patients with diabetes, a mandatory check-up by a specialist is necessary.

An important role in the symptoms of chronic renal failure is played by laboratory research. important substance, which determines the presence of a problem in the kidneys: creatinine. The determination of creatinine is one of many routine tests. This is followed by blood and urine tests to determine the functioning of the kidneys. Using this information, the so-called creatinine clearance can be calculated, which allows an accurate diagnosis of kidney function to be made, and thereby prescribe the necessary treatment.

Other imaging modalities are also used to diagnose chronic renal failure: these include - ultrasonography, computed tomography (CT) and X-ray contrast studies. In addition, such studies allow you to monitor the course of chronic renal failure.

Prevention

Conservative treatment of chronic renal failure

Conservative means and measures of treatment are used at I-II degrees and (the level of CF< 35 мл/мин.). На III-IV degrees resort to renal replacement therapy (chronic hemodialysis, peritoneal dialysis, hemosorption, kidney transplantation).

The principles of conservative treatment of chronic renal failure include:

rational diet;
ensuring water-salt and acid-base balance;
control of blood pressure so that there is neither an increase nor a sharp decrease;
correction of renal anemia;
prevention of hyperparathyroidism;
the use of procedures and drugs that remove nitrogenous slags from the gastrointestinal tract;
treatment of osteodystrophy and acute infectious complications of CRF.

Rational diet and ensuring water-salt and acid-base balance

The choice of diet is determined by the degree of CRF and is based on the restriction in daily diet protein, sodium and liquid. The diet should be low-fat, low-calorie and high-calorie (not less than 2000 kcal / day).

Malobilkova diet (MBD)

Significantly improves the patient's condition on CRF and slows down the progression of CRF. First, even before the azotemic stage, at the level of CF 40 ml / min., It is recommended to reduce protein intake to 40-60 g per day. At stages I-II of chronic renal failure, 30-40 g of protein per day should be consumed. And only in the case of a decrease in CF to 10-20 ml / min. and an increase in serum creatinine to 0.5-0.6 mmol/l. hard MBD is useful when the amount of protein is reduced to 20-25 g per day. At the same time, the total calorie content is maintained mainly due to carbohydrates, and special supplements are advised instead of essential amino acids. However, due to high cost of these drugs in our country more often offer the patient to eat one egg a day.

Close to the optimal ratio of essential amino acids has a mixture of eggs and potatoes 1:3. By significant proteinuria increase the amount of protein in the diet according to this loss, based on one chicken egg for every 6 g of urine protein. Patients with CKD are advised to replace half of the required daily protein with soy supplements and add fish oil.

The effectiveness of MBD is assessed by a decrease in uremic intoxication, dyspeptic symptoms, a decrease in the level of phosphates, urea, creatinine, the absence of hypoalbuminemia, hypotransferinemia, lymphopemia, hyperkalemia, and stability of the pH level and blood bicarbonates.

Contraindications to MBD:

a sharp decline residual function (CF< 5мл/мин.);
sharp infectious complications CRF;
anorexia, cachexia (body weight< 80%);
uncontrolled (malignant) hypertension;
severe nephrotic syndrome;
uremia (oliguria, pericarditis, polyneuropathy).

Patients with CRF without extrarenal manifestations of nephrotic syndrome, cardiovascular insufficiency and in correctable hypertension receive 4-6 g of salt per day.

Calcium-rich foods (cauliflower, cucumber and orange juices) and alkaline mineral waters are introduced into the diet.

The amount of fluid should correspond to a daily diuresis of 2-3 liters, which helps to reduce the reabsorption of metabolites and their excretion.

With a decrease in urine formation, fluid intake is adjusted depending on diuresis: it is 300-500 ml. exceed the amount of urine excreted over the previous day, the occurrence of oligo-or anuria, which leads to overhydration of the body; apply chronic hemodialysis.

During the treatment of chronic renal failure, correction of electrolyte disturbances is necessary. Unsafe for the life of the patient, there are violations of potassium metabolism. With hypokalemia, potassium chloride is prescribed.

Urologist

svetik: 10/24/2013
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The end stage of chronic renal failure has ceased to be a verdict since the appearance and improvement of blood purification devices that replace renal functions. But even with efficient and full treatment the life expectancy of a person in the terminal stage of chronic renal failure is limited to the next 10-15 years. No doctor can say exactly how long a person with broken kidneys will live.

Periods of the terminal stage of chronic renal failure

The reasons for a significant deterioration in the functional state of the kidneys with the formation of CRF are a sharp decrease in the number of nephrons in the parenchyma. Most often, their death occurs against the background of a complicated course of chronic renal diseases, in which proper treatment was not carried out or there were deep anatomical and functional lesions of the kidneys.

Regardless causal factors, the terminal stage of CRF is divided into several periods:

Urinary functions are preserved (about 1 liter of urine is excreted per day), the work of the kidneys to cleanse the blood of toxins is significantly worsened.

The amount of urine decreases to 300 ml per day, there are signs of a violation of important metabolic functions in the body, blood pressure rises, and symptoms of heart failure occur.

Unlike the previous stage, the work of the cardiovascular system deteriorates sharply with the formation of severe heart failure.

There is no urination, the cleansing functions of the kidneys are impaired, against the background of decompensation of all organs, a general tissue edema appears.

Determination of the exact condition of the patient is required for the choice of treatment tactics: at 1 and 2 periods, there are still opportunities for the application of effective therapies. In the 3rd and 4th periods, when irreversible changes occur in vital organs, it is extremely difficult to hope for a positive trend in treatment.

Basic Treatments

All therapeutic measures in the terminal stage of chronic renal failure are carried out in a hospital and are divided into conservative and surgical methods. The vast majority of patients will require all possible options therapy for renal failure, which will be used in stages.

Conservative treatment

To the main techniques used in all patients in last stage CRF, include diet therapy and antitoxic effects on the blood.

Diet. On the one hand, it is necessary to provide the body of a sick person nutrients and energy, and on the other hand, to dramatically reduce the load on the excretory system. To do this, the doctor will use diet therapy with restriction of salt, animal protein and an increase in the amount of fats and carbohydrates. Replenishment of trace elements and vitamins will occur at the expense of vegetables and fruits. Of great importance is the drinking regimen: it is necessary not only to provide the body with water, but also to strictly monitor the excretion of urine, trying to maintain a balance.

Detoxification. Terminal CKD is characterized sharp deterioration the work of the kidneys to cleanse the body of toxins and harmful substances formed in the process of life. Basic treatment implies mandatory detoxification of the blood. The doctor will prescribe various options droppers, with which it will be possible to partially remove toxic substances, replacing the work of diseased kidneys.

Dialysis

Any conservative methods of treatment for chronic renal failure, especially in the terminal stage, are not effective enough. Optimal use modern techniques treatments that almost completely replace lost kidney function. With chronic renal failure, the main type of therapy is dialysis, the essence of which is to pass the liquid through a special filter with the separation and removal of harmful substances. Dialysis can be used in any period of the terminal stage.

peritoneal dialysis. Inner surface The abdomen is made up of the peritoneum, which is a natural filter. It is this property that is used for continuous and effective dialysis. With the help of the operation, a special catheter tube is placed inside the abdomen, in which there is a dissolving liquid (dialysate). Blood flowing through the vessels of the peritoneum gives harmful substances and toxins that are deposited in this dialysate. The solvent liquid must be changed every 6 hours. Replacing the dialysate is technically simple, so the patient can do it on their own.

Hemodialysis. For direct blood purification treatment of chronic renal failure device is needed artificial kidney". The technique involves taking blood from a sick person, cleaning it through the filter of the apparatus and returning it back to the vascular system of the body. The efficiency is much higher, so it is usually necessary to carry out the procedure lasting 5-6 hours 2-3 times a month.

kidney transplant

Operative method of treatment for kidney transplantation is performed only at 1 and 2 periods clinical course terminal stage of CKD. If the doctor at the stage of examination discovered severe and irreversible changes in vital organs (heart, liver, lungs), then it is pointless to do a kidney transplant. In addition, surgery is contraindicated severe pathologies endocrine system, mental illness, gastric ulcer and the presence acute infection anywhere in the body.

Selection is of great importance donor kidney. The best option is a close relative (mother, father, brother or sister). In the absence of relatives, you can try to get a donor organ from a suddenly deceased person.

Medical technologies make it possible to perform a kidney transplant without much difficulty, but the main thing is not an operation at all, but further treatment to prevent rejection of a transplanted organ. If everything went well and without complications, then the prognosis for life is favorable.

Any treatment of end-stage renal failure pursues the main goal - the restoration of basic renal functions. IN initial period terminal stage of the disease, it is best to perform a kidney transplant, especially if all vital important organs. With cardiopulmonary and liver failure Your doctor will prescribe various dialysis options. A prerequisite for therapy is diet and regular detoxification courses. The result of a comprehensive therapeutic effect will be the longest possible preservation of human life.

Stage 4 Chronic Kidney Failure (CKD)

Stage 4 chronic renal failure is a serious stage of renal disease with a glomerular filtration rate of 15-30 ml/min. A severe decrease in kidney function will cause systemic symptoms. Patients in this stage, on the one hand, should pay special attention to diet, lifestyle changes in order to manage the disease situation and not burden the kidneys, and on the other hand, receive treatment to improve the kidney situation and avoid threatening complications.

As kidney function deteriorates, metabolites can accumulate in the bloodstream and cause a medical condition called Anemia. Since the kidneys cannot produce erythropoietin efficiently, and the hormone stimulates the production of blood cells, patients with stage 4 kidney failure will become anemic. The kidneys regulate electrolyte balance, and in stage 4 kidney failure, it was common for patients to suffer from high calorie, high phosphorus, low calcium, high sodium, and the like. High potassium will lead to arrhythmia, high sodium will threaten fluid retention and increase blood pressure, and high phosphorus will cause diseased bones.

The symptom of stage 4 chronic renal failure mainly includes:

* Weakness. Feeling tired is the result of a symptom of anemia in stage 4.

* Change in urination. Urine may be frothy and the foam persists for a long time. This is a sign of increased protein in the urine. Blood in the urine will cause the color of the urine to be dark orange, brown, tea-colored, or red. The person may pass more or less urine, or go to the bathroom frequently at night.

* Difficulty falling asleep. Itchy skin, restless legs, or muscle cramps may keep the sufferer awake and have difficulty falling asleep.

* Nausea. Chronic kidney failure can cause vomiting or nausea.

* Lack of appetite. The patient has no desire to eat and often complains of a metallic or ammonia taste in the mouth.

* Cardiovascular diseases. In stage 4 chronic renal failure, various factors, including high blood pressure, water and salt retention, anemia and toxic substances, will increase the risk for patients to develop heart failure, arrhythmias, myocardial damage, and the like.

* Symptoms in the nervous system. Early symptoms mainly include insomnia, poor concentration, memory loss. In some cases, patients suffer from tingling, numbness, coma, insanity and others.

Stage 4 patients usually require a blood test creatinine. hemoglobin, calcium, potassium and calcium in order to learn how the kidneys work and how to reduce the risk of complications. After determining the result of the analysis, the doctor will advise the patient on the best opinion of the treatment. Because diet is a necessary part of the treatment, so a dietitian will also be necessary for the treatment. And the dietitian will examine the result of the analysis and give the patient his own dietary plan. A proper eating plan helps preserve kidney function and overall health.

Some of the basic dietary advice in stage 4 kidney failure mainly includes the following:

Maintain a healthy body weight. If you want to maintain a healthy weight by burning calories, and now you need to exercise regularly.

Taking cholesterol. Replace saturated fats with unsaturated fats and eat a low-fat diet overall. This may help reduce the risk of cardiovascular disease.

Other Tips. You should limit your potassium intake if the lab results are above the normal range. If the patient has too much fluid content, then he will limit fluid intake. Fluid retention symptoms mainly include swelling in the legs, arms, face, high blood pressure, and shortness of breath.

In order to prolong kidney health, patients in stage 4 kidney failure should take the medicine recommended by the doctor to control blood pressure, anemia and other situations. People in stage 4 will probably lose kidney function further, and end up with dialysis. In addition to a basic management plan to control the progress of the disease, proper treatment will help improve kidney function from a bad state to a better state, and therefore dialysis will not be necessary. And this will be done with the combination of Western medicine and traditional Chinese medicine.

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There may be questions for you to consider:

Renal failure in men

Kidney failure is considered a complex problem even with modern treatments available. This is a potentially reversible, sudden onset impairment or failure of kidney function. insidious disease destroys not only the kidneys, but the body as a whole. The disease affects both sexes regardless of age. But, renal failure in men differs in the nature of development and manifestations from a similar condition in women. This is due to the peculiarities of male and female physiology.

Characteristic differences in the development of PN in men

Prostate cancer;
Excessive alcohol consumption;
tobacco smoking;
Drug use.

With untimely and poor-quality treatment, renal failure progresses and leads to serious disorders in the work of all organs and systems. Intoxication of the body develops, metabolism is disturbed, which leads to irreversible consequences. The trend of increasing the number of men suffering from renal insufficiency is increasing by 10-12% annually.

The concept of kidney failure

This is a terminal pathology in which the function of the kidneys is partially or completely lost and they cease to form, filter and excrete urine. As a result, violations of water-salt, acid-base and osmotic homeostasis develop in the body, which leads to disruption of the work of all organs and systems. In the clinic of the disease, two forms are distinguished - acute and chronic.

Acute renal failure

Causes of acute renal failure

The reasons for the development of ARF in men are diverse. They can be divided into three groups and their corresponding forms:

Symptoms of acute renal failure

Specific, when the amount of urine excreted sharply decreases (oliguria), or until the excretion of urine completely stops (anuria).

Nonspecific, when the patient refuses to eat, he has nausea, vomiting, diarrhea, swelling of the upper and lower extremities, an increase in the liver, lethargy or excitability of the National Assembly.

Stages of acute renal failure

In the clinic of acute renal failure, 4 well-defined stages are distinguished.

Initial

This stage is characterized by symptoms due to the influence of factors that caused acute renal failure. It can be weakly manifested in general malaise, the gradual development of an intoxication syndrome, accompanied by abdominal pain, nausea, and pallor of the skin.

Oligoanuric

The main sign of the development of this stage is a sharp decrease in urine output, or its complete absence. The total amount of urine usually does not exceed 500 ml per day. Urine bloody, big amount draft. The patient's condition deteriorates sharply during the first three days. Such blood indicators as proteinuria, azotemia, hyperphosphatemia, hyperkalemia, hypernatemia, acidosis are characteristic. If pulmonary edema develops, then shortness of breath and moist rales occur. This indicates self-poisoning of the body, the signs of which are lethargy, drowsiness, edema spread throughout the body, adynamia, etc.

From other organs also develop pathological conditions: pericarditis, uremic gastroenterocolitis, pancreatitis, hepatitis, pneumonia, sepsis. The duration of this stage can be from several hours to several days. A longer duration of this period of acute renal failure may indicate the development of complications from the kidneys or other organs and systems.

Diuretic

This is the recovery stage, which is divided into the phase of early diuresis and the phase of polyuria. Daily diuresis gradually increases, which indicates the restoration of the concentration function of the kidneys. At this stage, the patient's condition may be accompanied by cellular dehydration. But as the kidneys recover, the danger of dehydration and related complications passes. The volume of excreted urine returns to normal and reaches 2.5 liters. Together with the kidneys, the functions of other organs are restored. The recovery period lasts up to 2.5 -3 weeks.

Recovery

This stage is quite long and can take up to several months. The functions of the kidneys and other organs are restored in full.

OPN diagnostics

ROP should be differentiated from acute delay urination due to the presence of general symptoms. Great importance in the diagnosis of acute renal failure is attached to the anamnesis. His information will help to establish the presence of diseases that can cause anuria or the fact of poisoning the body. Description of pain in the lumbar region helps the doctor to establish OPN form– renal, postrenal, etc. The absence of urine in the bladder suggests AKI. If it contains at least a small amount of it, then it is examined, which makes it possible to clarify the diagnosis.

Ultrasound examination of the kidneys is the most informative diagnostic method

IN diagnostic purposes biochemistry of blood plasma is carried out for the content of urea, creatinine, electrolytes and acid-base balance is detected.

For the diagnosis of postrenal acute renal failure, instrumental, ultrasound and x-ray examination kidneys. These methods allow you to determine the degree of preservation of kidney function, their size and structure.

The results of diagnostics allow to determine the issues of treatment of acute renal failure.

Treatment of acute renal failure

Methods of treatment of acute renal failure are selected depending on the stage of the disease.

Forecast of acute renal failure

kidney failure in acute form is terminal state and its outcome depends on timely and high-quality treatment. At favorable outcome, restoration of renal functions in full occurs in 35-40% of cases, partial recovery- in 10-15% of cases, and for 1-3% of patients who have undergone acute renal failure, hemodialysis is constantly required.

Chronic renal failure

The syndrome of chronic renal failure is the gradual death of the cellular structures of the kidney - nephrons as a result of a progressive pathology of the kidneys. There is a replacement of functional renal tissue with connective tissue and a decrease in the volume of the organ.

Causes development of CKD are often glomerulonephritis and pyelonephritis in chronic form; diabetes; malformations of the kidneys, vascular diseases, systemic diseases.

The mechanism of development of chronic renal failure is associated with structural changes in the renal parenchyma. As a result of dysfunction of the glomeruli and tubules, there is a decrease in the number of functioning nephrons, damage to the circulatory renal system, inflammatory edema and sclerosis of connective tissue structures. All this leads to disruption of metabolic processes.

CKD symptoms

Signs of chronic renal failure appear depending on the stage of the disease.

Hidden (latent) stage. is usually asymptomatic. The patient develops weakness and fatigue physical activity. At biochemical research blood disorders are not detected, a general urine test may show a small amount of protein.

The compensatory stage is characterized by an increase in the amount of urine excreted (up to 2.5 liters). Urinalysis, and blood biochemistry indicates changes in performance.

intermittent stage. Kidney function is markedly impaired. In the blood there is a persistent increase in urea and creatinine. Symptoms are more pronounced: great weakness, thirst, constant dry mouth, loss of appetite, nausea, vomiting. The skin is dry, with reduced turgor, with a yellowish tinge. Muscle atony, tremor of fingers, involuntary convulsive twitching of muscles, pain in the joints are observed. Periods of deterioration are followed by periods of improvement. supportive conservative therapy allows the patient to be in the same mode of work, but with an increase in physical and psycho-emotional stress, malnutrition, restrictions on drinking, infectious diseases and others stressful situations, deterioration occurs.

The terminal stage is characterized by uremic intoxication. The amount of urine excreted sharply decreases to its complete absence. Organs and systems are damaged by metabolic toxins: cardiac muscle dystrophy, pericarditis, pulmonary edema, encephalopathy, disturbances in the functioning of the circulatory, immune and other systems. These and many other destructive processes are irreversible. There is a release of urea through the skin, the patient smells like urine.

Diagnostics

The diagnosis of CRF is carried out by a set of measures:

Laboratory tests: general and biochemical analysis blood, urine for protein and blood, Reberg-Toreev test (assessment excretory function kidneys). The Rehberg-Toreev test allows you to calculate the glomerular filtration rate - GFR. It is one of the main indicators in determining the degree and stage of the disease. Along with this test, calculations are carried out that are adjusted for gender, age, body weight and other indicators.

Instrumental studies: ultrasound of the kidneys (the degree of damage to the kidney tissue is specified), biopsy (allows you to identify the stage of the disease), R-graphy of the kidneys (only for patients with I-II degree of PN).

A hemodialysis machine used as replacement therapy for kidney failure

Treatment of chronic renal failure

Each stage of chronic renal failure has its own treatment strategy, taking into account all indicators of the diagnostic study.

Treatment at the first stage is aimed at the underlying disease and relief of exacerbation in the kidneys.

The second stage is characterized by the progression of renal failure. Therefore, treatment focuses on reducing the rate of progress. Prescribed drugs that inhibit the development of the pathological process in the kidneys. Along with this, the means aimed at maintaining the vital activity of the whole organism are used.

In the third stage of the disease, when complications develop, in complex treatment drugs are introduced that slow down the progression of PN, and symptomatic therapy other organs and systems.

At the fourth stage of chronic renal failure, the patient is prepared for substitution therapy, and at the fifth stage it is carried out.

Replacement therapy for chronic renal failure is hemodialysis and peritoneal dialysis.

Peritoneal dialysis, used to purify the blood at home by the patient

Hemodialysis is a hardware extrarenal method of blood purification, which allows to remove toxins from the body and normalize water and electrolyte balance. The procedure is carried out in a hospital at least 3 times a week, the duration of each procedure is at least 4 hours.

The procedure for purifying the blood using peritoneal dialysis is to fill abdominal cavity dialysate through the catheter. In the abdominal cavity, there is an exchange between the solution and the patient's blood. As a result toxic substances and water is removed through the catheter. The solution is in the cavity for several hours. The advantages of this method is that the patient does not need to be constantly dependent on the hemodialysis unit. He does the whole process on his own. For control, he visits the dialysis center every month. The method is most often used while waiting for a kidney transplant.

Nutrition in the syndrome of renal failure

Dieting for kidney failure important role, as certain types of products can aggravate its progression. It is developed taking into account the stage and severity of the disease, the presence of exacerbations or complications. A diet with restriction of animal proteins, salt, phosphorus is prescribed. The quantity and quality of the dietary composition of food is compiled by a dietitian together with the attending physician. Animal proteins are recommended to be replaced with vegetable proteins, mainly soy. Norms of consumption of vegetable fats and carbohydrates are also established.

Kidney transplantation is performed at the fifth stage of the development of renal failure