Renal failure: symptoms, treatment and prevention. Chronic renal failure - causes, treatment and complications of renal failure How CKD manifests itself in humans

Kidney failure is a disease state in which the function of passing urine is difficult or completely absent.

Constant stagnation of fluid inside the urinary system leads to disturbances in osmotic pressure, acid-base balance and the accumulation of toxic nitrogenous substances in the human body.

The disease can be of two types:

1. Acute renal failure;
2. Chronic renal failure.

Let's consider both types of the disease in more detail.

Acute renal failure

With this disease, the amount of urine is sharply reduced, or reduced to zero (anuria occurs).

Acute type of renal failure occurs due to several reasons associated with impaired functioning of various organs:

• Prerenal. In this case, we are talking about problems not related to . These can be severe arrhythmias, heart failure, collapse, or a decrease in blood volume after heavy blood loss.
• Renal causes directly. They arise due to toxic poisoning with poisons, causing large-scale necrosis of the renal tubules, as well as chronic and, pyelonephritis and other diseases. Infectious agents play an important role in this etiological group.
• Postrenal causes of renal failure are manifested in the form of blockage of the ureters in urolithiasis (usually bilateral).

It should be noted that in children of different ages the disease has a different nature.

Acute renal failure is a multi-phase disease, namely, there are 4 stages.

1. Stage one, the symptoms of which may be different. In all cases, there is a decrease in the amount of urine.
2. The second stage is characterized by a very small amount of urine or its complete absence and is therefore designated as. This stage may be final in the absence of urgent medical intervention.
3. At the next, third, stage, the amount of urine is restored (in addition, there are cases when the daily volume goes beyond the usual limits). Otherwise, this stage is called polyuric or recovery. So far, urine consists mainly of water and salts dissolved in it, and is not capable of removing substances toxic to the body. In the third stage of acute renal failure, the danger to the life of the patient remains.
4. Within 2-3 months, the excretory function of the kidneys normalizes and the person returns to his former life.

Clinical manifestations

Acute renal failure has specific and nonspecific symptoms.

Oliguria and anuria are specific.

For non-specific:

• Lack of appetite;
• Liquid stool;
• swelling of the extremities;
• Nausea and vomiting;
• Lethargy or agitation of a person;
• Enlargement of the liver.

Diagnostics

• Clinical picture (oliguria, anuria);
• Indicators of potassium, creatinine and urea in the blood;
• Ultrasonic research, X-ray and radionuclide methods.

Treatment of acute renal failure

Treatment of acute renal failure is carried out in urological hospitals. Therapeutic measures are aimed primarily at the causes of the disease, ascertained through the patient's history, and also based on the patient's blood counts and clinical symptoms.

Thus, medical intervention is aimed at eliminating toxicosis, collapse, heart failure, hemolysis and dehydration of the patient.

In intensive care units, where patients often end up, either peritoneal dialysis is performed.

Chronic renal failure

In chronic renal failure, the decrease in the amount of daily urine occurs gradually. The functional tissue of the kidney is replaced by connective tissue due to long-term chronic inflammatory processes, while the kidney itself acquires a wrinkled appearance.

The reasons

• Kidney disease and damage to the glomerular apparatus: and pyelonephritis.
• Diseases associated with metabolic disorders: diabetes mellitus, gout.
• Hereditary and congenital renal diseases associated with anatomical disorders of the conduction of the renal system.
• Arterial hypertension and other vascular diseases.
• Urolithiasis and other causes that prevent the free excretion of urine.

The first four places among all these reasons are occupied by:

1. Congenital renal anomalies;
2. Diabetes;
3. Pyelonephritis.

These reasons are the most frequent messengers of chronic renal failure.

The disease is staged. There are 4 stages:

1. The latent stage (chronic kidney disease 1) is the very first, hidden. Among the complaints, one can single out only increased fatigue by the end of the working day, dry mouth. In the analysis of blood in such patients, a moderate electrolyte shift and the presence of protein in the urine are detected.
2. The compensated stage (chronic kidney disease 2) is accompanied by the same complaints as in the previous case. In addition, there may be an increase in the volume of daily urine up to 2.5 liters (as we know, the normal daily volume of urine is 1.5-2.0 liters). Biochemical indicators change for the worse.
3. The intermittent stage (azotemic) is manifested by a slowdown in the functioning of the kidneys. This phenomenon is accompanied by the following symptoms:

- Elevated levels of nitrogenous compounds in the blood;

- In the urine there is a high concentration of creatinine and urea;

- general weakness, fatigue and dry mouth, loss of appetite and nausea, vomiting is possible.

1. The terminal stage, leading to the following symptoms: increased daytime sleepiness, emotional imbalance, lethargy, sleep disturbances at night.

Clinical manifestations of chronic renal failure

Let us consider in detail the processes that occur at each stage of the disease.

In the first stage, lower back pain, swelling and increased blood pressure can be observed. At night there is insomnia and frequent urination. Part of the glomeruli dies, while the remaining part begins to compensate for the dysfunction of the dead, exhausting itself, as a result of which the fluid ceases to be absorbed. Reduced urine density in this case is a clear symptom of the first stage.

At the next stage, the glomerular filtration rate drops, the kidneys are no longer able to compensate for the missing function. At this stage, a decrease in the level of vitamin D and an excess of parathyroid hormone can be detected.

The third stage will reveal itself by reducing the synthesis of renin, as a result of which blood pressure will be elevated. The intestines will partially take up the function of removing fluid and waste, which was inherent in the kidneys, which will entail loose stools with a specific fetid odor. Insufficient amount of erythropoietin will lead to anemia. A further decrease in the concentration of vitamin D will lead to calcium deficiency and, as a result, osteoporosis. In addition, at the late azotemic stage, lipid metabolism is disturbed: the synthesis of triglycerides and cholesterol is activated, which increase the risk of vascular complications.

Potassium deficiency leads to irregular heart rhythm. Enlargement of the salivary glands gives the face a puffy shape, the mouth smells of ammonia.

Thus, a patient with chronic renal failure looks characteristic of his diagnosis:

• Puffy face;
• Brittle, dull hair, gray-yellow skin color;
• regurgitation, smell of ammonia from the mouth;
• Abdominal bloating and diarrhea, dark in color, with a fetid odor;
• Hypothermia with increasing dystrophy;
• Skin itching.

The disease affects the entire body, leads to atrophy of the heart muscle, pericarditis, pulmonary edema, encephalopathy, decreased immunity with all the ensuing consequences. The densities of urine and blood become equal, as a result of which the absorption of substances is impossible.

The above changes appear in the last stages of the disease and are irreversible. The prognosis in this case is extremely sad - the death of the patient, which occurs at the 4th stage of the disease due to sepsis, uremic coma and hemodynamic disturbances.

Treatment

Timely treatment leads to the recovery of the patient. The life of patients experiencing the terminal stage of the disease depends on the hemodialysis machine. In other cases, help can be provided with medication or one-time hemodialysis procedures.

13.1. ACUTE RENAL FAILURE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

13.2. CHRONIC RENAL

FAILURE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reducing the load on the remaining functioning nephrons;

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

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

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

Carrying out substitution treatment - kidney transplantation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

test questions

1. What are the causes of acute renal failure?

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

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

4. How is chronic renal failure classified?

Kidney failure refers to a number of pathologies that pose a significant threat to human life. The disease leads to a violation of the water-salt and acid-base balance, which entails deviations from the norm in the work of all organs and tissues. As a result of pathological processes in the renal tissue, the kidneys lose their ability to fully excrete the products of protein metabolism, which leads to the accumulation of toxic substances in the blood and intoxication of the body.

By the nature of the course, the disease can be acute or chronic. Causes, treatments and symptoms of kidney failure for each of them have certain differences.

Causes of the disease

The causes of kidney failure are varied. For acute and chronic forms of the disease, they differ significantly. Symptoms of acute renal failure (ARF) occur due to trauma or significant blood loss, complications after surgery, acute kidney pathologies, poisoning with heavy metals, poisons or drugs, and other factors. In women, the development of the disease can be triggered by childbirth or by infection and spread outside the pelvic organs as a result of an abortion. With acute renal failure, the functional activity of the kidneys is disturbed very quickly, there is a decrease in the glomerular filtration rate and a slowdown in the process of reabsorption in the tubules.

Chronic renal failure (CRF) develops over a long period of time with a gradual increase in the severity of symptoms. Its main causes are chronic diseases of the kidneys, blood vessels or metabolism, congenital anomalies in the development or structure of the kidneys. At the same time, there is a violation of the function of the organ for the removal of water and toxic compounds, which leads to intoxication and, in general, causes a disruption in the functioning of the body.

Tip: If you have chronic kidney disease or other factors that can provoke kidney failure, you should be especially careful about your health. Regular visits to the nephrologist, timely diagnosis and implementation of all doctor's recommendations are of great importance to prevent the development of this serious disease.

Characteristic symptoms of the disease

Signs of renal failure in the case of an acute form appear abruptly and have a pronounced character. In the chronic variant of the disease, in the early stages, the symptoms may not be noticeable, but with the gradual progression of pathological changes in the tissues of the kidney, their manifestations become more intense.

Symptoms of acute renal failure

Clinical signs of acute renal failure develop over a period of a couple of hours to several days, sometimes weeks. These include:

• a sharp decrease or absence of diuresis;
• weight gain due to excess fluid in the body;
• the presence of edema, mainly in the ankles and face;
• loss of appetite, vomiting, nausea;
• pallor and itching of the skin;
• feeling tired, headaches;
• excretion of urine with blood.

In the absence of timely or inadequate treatment, shortness of breath, coughing, confusion and even loss of consciousness, muscle spasms, arrhythmias, bruising and subcutaneous hemorrhages appear. This condition is fraught with death.

Symptoms of chronic renal failure

The period of development of chronic renal failure before the onset of characteristic symptoms, when there have already been significant irreversible changes in the kidneys, can range from several to tens of years. Patients with this diagnosis have:

• violations of diuresis in the form of oliguria or polyuria;
• violation of the ratio of night and day diuresis;
• the presence of edema, mainly on the face, after a night's sleep;
• increased fatigue, weakness.

The last stages of CRF are characterized by the appearance of massive edema, shortness of breath, cough, high blood pressure, blurred vision, anemia, nausea, vomiting and other severe symptoms.

Important: If you find symptoms that indicate a violation of the kidneys, you should contact a specialist as soon as possible. The course of the disease has a more favorable prognosis with timely therapy.

Fatigue and headache may be due to kidney failure

Treatment of the disease

In case of renal failure, treatment should be comprehensive and aimed primarily at eliminating or controlling the cause that provoked its development. The acute form of renal failure, unlike chronic, responds well to treatment. Properly selected and timely therapy makes it possible to almost completely restore kidney function. To eliminate the cause and treat acute renal failure, the following methods are used:

• taking antibacterial drugs;
• detoxification of the body with the help of hemodialysis, plasmaphoresis, enterosorbents, etc.;
• fluid replenishment during dehydration;
• restoration of normal diuresis;
• symptomatic treatment.

Therapy for CKD includes:

• control of the underlying disease (hypertension, diabetes mellitus, etc.);
• maintaining kidney function;
• elimination of symptoms;
• body detoxification;
• adherence to a special diet.

At the last stage of CRF, patients are shown regular hemodialysis or donor kidney transplantation. Such treatments are the only way to prevent or significantly delay death.

Hemodialysis is a method of blood purification from electrolytes and toxic metabolic products.

Features of nutrition in the presence of renal failure

A special diet for kidney failure helps reduce the burden on the kidneys and stop the progression of the disease. Its main principle is to limit the amount of protein, salt and liquid consumed, which leads to a decrease in the concentration of toxic substances in the blood and prevents the accumulation of water and salts in the body. The degree of rigidity of the diet is determined by the attending physician, taking into account the patient's condition. The basic rules of nutrition for kidney failure are as follows:

• limiting the amount of protein (from 20 g to 70 g per day, depending on the severity of the disease);
• high energy value of food (vegetable fats, carbohydrates);
• high content in the diet of vegetables and fruits;
• control of the amount of fluid consumed in the amount, calculated from the volume of urine excreted per day;
• restriction of salt intake (from 1 g to 6 g, depending on the severity of the disease);
• fasting days at least once a week, consisting in the use of only vegetables and fruits;
• steam method of cooking (or cooking);
• fractional diet.

In addition, foods that cause kidney irritation are completely excluded from the diet. These include coffee, chocolate, strong black tea, cocoa, mushrooms, spicy and salty foods, fatty meat or fish and broths based on them, smoked meats, and alcohol.

Diet is a very important element in the treatment of kidney failure.

Folk methods of treatment

With renal failure, treatment with folk remedies in the early stages gives a good effect. The use of infusions and decoctions of medicinal plants that have a diuretic effect helps to reduce swelling and remove toxins from the body. For this purpose, birch buds, rose hips, chamomile and calendula flowers, burdock root, dill and flax seeds, lingonberry leaves, horsetail herb, etc. are used. Various collections can be made from these plants and kidney teas can be prepared on their basis.

In case of kidney failure, the use of pomegranate juice and a decoction of pomegranate peel, which has a tonic effect and improves immunity, also gives a good effect. The presence of seaweed in the diet helps to improve kidney function and promote the excretion of metabolic products.

Tip: The use of alternative methods of treatment for renal failure must be agreed with the attending physician.

Pay attention to changes in urination. Both acute and chronic forms of renal failure are often accompanied by an increase or decrease in diuresis. In particular, chronic renal failure is accompanied by urinary incontinence and/or recurrent urinary tract infection. Damage to the renal tubules leads to polyuria. Polyuria is an excessive production of urine that usually occurs early in kidney failure. Chronic renal failure can also cause a decrease in daily urination, which usually occurs in more advanced forms of the disease. Other changes include the following:

• Proteinuria: In kidney failure, protein passes into the urine. Due to the presence of protein, urine foams.
• Hematuria: Dark orange urine is the result of red blood cells in the urine.

Watch for sudden feelings of fatigue. One of the first signs of chronic kidney failure is fatigue. This is due to anemia, when there are not enough red blood cells in the body to carry oxygen. Due to the decrease in oxygen, you will feel tired and cold. Anemia is attributed to the fact that the kidneys produce a hormone called erythropoietin, which causes your bone marrow to produce red blood cells. But because the kidneys are damaged, they produce less of this hormone, therefore, less red blood cells are also produced.

Pay attention to swelling of body parts. Eden is an accumulation of fluid in the body that can occur in both acute and chronic renal failure. When the kidneys stop working properly, fluid begins to accumulate in the cells, which leads to swelling. Most often, swelling occurs in the hands, feet, legs and face.

Call your doctor if you experience dizziness or slow thinking. Dizziness, poor concentration, or lethargy can be caused by anemia. All due to the fact that not enough blood cells enter your brain.

Look for pain in your upper back, legs, or side. Polycystic kidney disease causes fluid-filled cysts to form in the kidneys. Sometimes cysts can also form in the liver. They cause severe pain. The fluid in the cysts contains toxins that can damage the nerve endings in the lower extremities and lead to neuropathy, dysfunction of one or more peripheral nerves. In turn, neuropathy causes pain in the lower back and legs.

Watch for shortness of breath, bad breath, and/or a metallic taste in your mouth. When your kidneys begin to fail, metabolic end products, most of which are acidic, will begin to accumulate in the body. The lungs will begin to compensate for this increased acidity by removing carbon dioxide through rapid breathing. This will make you feel like you can't catch your breath.

Pay attention if you suddenly start to itch or have dry skin. Chronic kidney failure causes pruritis (the medical term for itchy skin). This itching is caused by the accumulation of phosphorus in the blood. All foods contain some phosphorus, but some foods, such as dairy, contain more phosphorus than others. Healthy kidneys are able to filter and remove phosphorus from the body. However, in chronic renal failure, phosphorus lingers in the body and phosphorus crystals begin to form on the surface of the skin, which cause itching.

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?

• 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

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.