Severe hpn. Gradual death of the kidneys, or chronic renal failure: stages, causes, symptoms and principles of treatment. Conservative treatment of chronic renal failure

Forecast

The effectiveness of treatment depends not only on the measures taken, but also on the course of the underlying disease. Complications arising from renal failure can also have a significant impact on the outcome of therapy. If the course of the disease progresses, then only a kidney transplant can prolong the life of the patient.

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Stages of acute and chronic renal failure:

As you can see from this article, chronic renal failure is not only a serious, but also a dangerous disease that can lead to death. In order to avoid this, it is necessary to follow the prescribed drug therapy and an appropriate diet. You should also regularly take all the tests and undergo a special examination.

Acute and chronic pathologies of the kidneys began to be diagnosed more and more often. Now medicine is more developed and therefore more successfully helps patients.

But the pathologies are so serious that 40% of them are complicated by chronic renal failure.

general information

Chronic renal failure (CRF) is an irreversible disorder of the kidneys. It occurs due to progressive dying off.

At the same time, the work of the urinary system is disrupted, it develops under the influence of the accumulation of toxins after nitrogen metabolism -, creatinine and.

In chronic insufficiency, a large number of structural units of the organ die and are replaced by connective tissue.

This provokes irreversible dysfunctions of the kidneys, which do not allow the blood to be cleansed of decay products, and the production of erythropoietin, which is responsible for the formation of red blood cells, for removing excess salt and water, is also disrupted.

The main consequence of kidney failure is serious changes in water, electrolyte, acid-base, nitrogen balance. All this provokes pathologies in the human body and often causes deaths with.

The diagnosis of CKD is made when the disturbances do not stop for three months or longer. Even with a slight manifestation of imbalance, the doctor must carefully monitor the patient in order to improve the prognosis of the disease and, if possible, avoid irreversible changes.

Disease statistics

The risk group for developing CKD includes:

• people with tissue dysembryogenesis of the kidneys;
• with severe uropathy;
• with tubulopathies;
• with nephritis of a hereditary nature;
• with sclerosing nephritis.

Reasons for development

The main reasons for development are:

• chronic course of glomerulonephritis;
• violations of the structure of the organs of the urinary system;
• the influence of toxins and certain drugs.

Secondary organ pathologies that were provoked by other diseases:

• diabetes mellitus of any type;
• pathologically high blood pressure;
• systemic pathologies of connective tissue;
• hepatitis type B and C;
• systemic vasculitis;
• gout;
• malaria.

The rate of active development of chronic renal failure depends on the rate of sclerosis of the tissues of the organ, on the causes and identified activity.

The fastest rate of manifestation of insufficiency is observed with lupus nephritis, with amyloid or.

CRF develops much more slowly with pyelonephritis, polycystic and gouty form of nephropathy.

Chronic insufficiency is often complicated by exacerbations during dehydration, loss of sodium by the body, and hypotension.

Classification and types

Chronic kidney failure is classified into several types in accordance with the severity of the course of symptoms:

The nature of the clinical picture

Many patients with chronic renal failure do not complain of pathological symptoms, because at first the body compensates for even a strong deterioration in kidney function.

Obvious manifestations of the disease develop only in its last stages.

The kidneys have a huge potential for compensatory disorders, sometimes they work much more than a person needs for normal life.

It happens that the kidney continues to work for both organs, so for a long time the symptoms do not make themselves felt.

A slight violation of the functioning of the body is diagnosed only when passing blood and urine tests. In this case, the doctor suggests undergoing regular examinations to monitor pathological changes in the organ.

The treatment process requires relief of symptoms and prevention of subsequent deterioration. When even with correction, the work of the kidneys worsens, then they appear:

• weight loss, lack of appetite;
• hard breath;
• the presence of protein in urine and blood tests;
• , especially at night;
• skin itching;
• muscle cramps;
• increase in pressure;
• nausea;
• erectile dysfunction in males.

Similar symptoms are characteristic of other diseases. In any case, if you find one or more signs, you need to visit a doctor.

Flow stages

The replacement of glomeruli with connective tissue is first accompanied by a partial dysfunction of the organ and compensatory changes in healthy glomeruli. Thus, insufficiency develops in stages under the influence of a decrease in the glomerular filtration rate.

Also, manifestations of insufficiency develop, namely:

• severe weakness;
• deterioration in performance due to anemia;
• increase in urine volume;
• frequent urge to urinate at night;
• rise in blood pressure.

Diagnostic methods

The diagnostic process is implemented on the basis of a careful study of the clinical picture and the history of the disease. The patient must undergo the following examinations:

• echodopplerography of the vessels of the organ;
• nephroscintigraphy;
• general and detailed blood test;

All these diagnostic methods help the doctor to establish the presence and stage of CRF, choose the right treatment and significantly alleviate the patient's condition.

Methods of therapy

Methods of treatment completely depend on its causes. At first, outpatient treatment is carried out, that is, you do not need to go to the hospital.

But for prevention, planned hospitalization is implemented - at least 1 time per year to conduct complex examinations.

The treatment of chronic renal failure is always controlled by the therapist, who, if necessary, refers to.

Proper treatment involves the mandatory correction of lifestyle and sometimes the use of special drugs to normalize blood pressure indicators, reduce the concentration of cholesterol in the blood.

This complex allows you to prevent the progression of the disease and damage to blood flow.

Common drugs and traditional approaches

The treatment process for chronic renal failure in the first stages of the lesion is based on drug therapy. She helps:

• normalize high blood pressure;
• stimulate urine production;
• prevent the occurrence of autoimmune processes when the body begins to attack itself.

These effects can be achieved with:

• drugs based on hormones;
• erythropoietins - they eliminate the effects of anemia;
• preparations with calcium and vitamin D - they help strengthen the skeletal system and prevent fractures.

With a more serious lesion, other methods are implemented:

1. Hemodialysis to purify and filter the blood. It is implemented outside the body through the apparatus. It is supplied with venous blood from one hand, it undergoes purification and returns through a tube in the other hand. This method is implemented for life or until organ transplantation.
2. Peritoneal dialysis- the process of cleansing the blood by normalizing the water-salt balance. It is carried out through the abdominal section of the patient, where a special solution is first introduced, and then sucked back. . In this case, it is very important that the organ take root.

Treatment at different stages

Each degree of severity of kidney failure provides for different methods of therapy:

1. At 1st degree lesions, acute inflammation is relieved and the severity of symptoms of CRF is reduced.
2. At 2 degrees simultaneously with the treatment of chronic renal failure, the rate of its progression is assessed, and means are used to slow down the pathological process. These include Hofitol and Lespenefril - these are herbal remedies, the dose and duration of which are prescribed only by the doctor.
3. At 3 degrees additional treatment of complications is being implemented, medications are needed to slow down the progression of chronic renal failure. Correction of blood pressure indicators, anemia, disorders of calcium and phosphate levels, treatment of concomitant infections and malfunctions of the cardiovascular system is carried out.
4. At 4 degrees the patient is prepared and carried out renal replacement therapy.
5. At 5 degrees replacement therapy and, if possible, organ transplantation are also implemented.

Folk methods

At home to alleviate the condition.

They help to normalize, cleanse the blood, relieve swelling and restore urine output.

Before starting treatment, a doctor's approval is required so as not to harm your condition even more.

Collections from herbs

Medicinal herbs effectively relieve the symptoms of deficiency. To obtain the product, mix parsley roots, juniper buds,. 250 ml of water is added to this mixture and boiled in a container with a closed lid for 2 minutes, then infused for another 5 minutes and filtered.

It is necessary to drink a decoction 3 times a day, without skipping, preheating. This therapy is carried out for a month.

Cranberry

The composition contains components such as fructose, tannins. They prevent urinary tract infections in chronic renal failure. In addition, the berry helps to speed up the elimination of bacteria. For the expected result, you should drink 300 ml of berry juice daily.

Parsley

This is an affordable product, but it is very effective for the condition of the kidneys. The sap of the plant plant helps to stimulate the excretion of urine. There are cases when parsley helped to significantly alleviate the condition even with advanced chronic renal failure. But it takes a long time to get results.

dietary prescriptions

Nutrition in chronic renal failure is an important treatment step, regardless of the severity of the disease. It assumes:

• the use of high-calorie foods, low-fat, not too salty, not spicy, but enriched with carbohydrates, which means that potatoes, sweets and rice can and should even be consumed.
• steamed, baked;
• eat in small portions 5-6 times a day;
• include less protein in the diet;
• do not consume a lot of liquid, its daily volume is no more than 2 liters;
• give up mushrooms, nuts, legumes;
• limit the consumption of dried fruits, grapes, chocolate and coffee.

Therapy for children

For the treatment of chronic renal failure in a child, homeostatic dietary remedies are required.

To begin with, urine and blood biochemistry is implemented to quickly determine the need for potassium, water, protein and sodium.

Treatment involves slowing down the rate of filling the kidneys with nitrogenous decay products. At the same time, maintaining the acid-base balance and electrolyte balance is required.

If a restriction of proteins in the diet is indicated for a child, he is given only animal proteins with a low concentration of essential amino acids.

When the clearance rates are too low, water can only be drunk fractionally, the sodium content in the blood is constantly monitored.

With hypocalcemia, oral administration of calcium, vitamin D intake is required. In advanced cases, dialysis is implemented. Hemodialysis is required until the organ transplant is decided and performed.

Consequences and difficulties

The main difficulty in diagnosing and treating chronic renal failure is that at the first stages of development, the pathology does not manifest itself in any way. Almost all patients seek help with advanced forms of insufficiency, the presence of concomitant complications in the body.

Such a course is reflected in many organs of the patient, the urinary system suffers the most, respiratory function is depressed, attacks of loss of consciousness develop.

The consequences of the wrong approach in the treatment or neglect of the CRF process include:

• uremia - self-poisoning by decay products, while there is a risk of uremic coma - loss of consciousness, serious abnormalities in the respiratory system and blood circulation;
• complications in the work of the heart and blood vessels: heart failure, ischemia, myocardial infarction, palpitations, pericarditis;
• a steady increase in blood pressure over 139/89 mm Hg, which cannot be corrected;
• acute forms of gastritis;
• complications as a result of the organization: hypertension, anemia, impaired sensitivity of the hands and feet, improper absorption of calcium and bone fragility;
• decreased libido.

Preventive measures

Kidney failure often accompanies diabetes mellitus, glomerulonephritis, and hypertension, so doctors monitor these people very carefully, they are additionally observed by a nephrologist.

All people at risk who have even minimal kidney problems should constantly:

• control blood pressure;
• do an electrocardiogram;
• do an ultrasound of the abdominal organs;
• take general urine and blood tests;
• follow the doctor's recommendations regarding lifestyle, nutrition and work.

To prevent damage to the kidneys of chronic renal failure or with an advanced form of the disease to severe stages, timely treatment of any violations in the functioning of the organ is required, constant monitoring of the condition by a doctor.

To identify kidney problems and choose treatment tactics for chronic renal failure, the doctor will conduct a whole range of diagnostic studies. Among all methods of examination, one of the most important is the determination of the level of nitrogenous compounds in the blood. By the amount of nitrogen-containing wastes that must be excreted from the body through the urinary tract, it is possible to determine with high certainty the degree of impaired renal function. Determining the stages of chronic renal failure by creatinine concentration is very indicative and highly informative, therefore it is widely used in the complex diagnosis of renal failure.

Variants of nitrogenous slags

The urinary function of the kidneys ensures the constant removal from the human body of harmful substances and toxic compounds that are formed in the process of life. If this does not happen, then gradual poisoning occurs with disruption of the work of all organs and systems. Some unnecessary substances are very difficult to identify, some are quite simple. One of the main diagnostic criteria for the detection of chronic renal failure were nitrogen-containing slags, which include:

• residual nitrogen;
• urea;
• uric acid;
• creatinine.

Of these biochemical compounds, the latter is the most indicative for the diagnosis of chronic renal failure: the creatinine concentration can be used to confidently stage the disease. The levels of other nitrogenous slags are ineffective and do not affect the determination of the stage of CRF. However, urea and residual nitrogen concentrations may help in the diagnosis of renal failure.

azotemia

In the treatment of CRF, the doctor will dynamically determine the level of azotemia, a significant increase in which occurs when the condition worsens or in the absence of the effect of therapeutic measures. The concentration of creatinine in the blood is the most specific sign, but it is desirable to take into account the levels of urea and uric acid. Sometimes it depends on the definition of the cause of the disease.

With high blood urea and normal creatinine values, the doctor will look for conditions that are not associated with renal pathology:

• excessive consumption of protein foods;
• severe malnutrition and hunger;
• severe loss of body fluid;
• excessive metabolic processes.

If all nitrogen-containing compounds rise synchronously, then we can confidently speak of chronic renal failure.

CRF classifications

Quite a few types of classification of chronic renal failure have been proposed, in which different indicators are taken into account. Of the laboratory classifications, doctors widely and actively use the following 2 options:

1. According to the degree of decrease in glomerular filtration.

• Initial. The decrease in the cleansing capacity of the kidneys reaches almost 50% of normal values.
• Conservative. Kidney cleansing significantly deteriorates and is only 20-50% of the required.
• Terminal. The filtration capacity of the kidney parenchyma drops to less than 20%, reaching extremely low levels in the worst case.

1. According to the concentration of blood creatinine (at a rate of 0.13 mmol / l).

• latent or reversible stage (the level of the nitrogenous compound is from 0.14 to 0.71);
• Azotemic or stable (creatinine level from 0.72 to 1.24);
• uremic or progressive stage (if the indicator exceeds 1.25 mmol / l).

In each classification, all stages are divided into phases, which are used to select the most effective methods of therapy. Both for diagnosis and for monitoring the treatment of chronic renal failure, it is best to use biochemical studies to identify the characteristics of nitrogen metabolism.

Treatment of chronic renal failure, taking into account the level of creatinine

One of the most important directions in the treatment of chronic renal failure is the correction of azotemia: it is necessary to improve the filtration capacity of the renal parenchyma so that toxins and harmful substances are removed from the body. In addition, a decrease in the level of nitrogenous compounds in the blood can be achieved using the following treatments:

1. Diet therapy.

With minimal concentrations of creatinine in the latent stage of chronic renal failure, it is necessary to use a diet with a moderate protein content. It is advisable to consume vegetable protein, preferring soy and avoiding meat and fish. It is necessary to maintain normal calorie content of food to maintain energy expenditure.

In the azotemic and uremic stages of chronic renal failure, a significant decrease in protein food, a restriction in the nutrition of phosphorus and potassium are shown. To maintain the level of vital amino acids, the doctor will prescribe special drugs. Be sure to exclude the following products:

• mushrooms;
• legumes and nuts;
• White bread;
• milk;
• chocolate and cocoa.

1. Detoxification.

Purification of the blood from nitrogenous compounds is achieved by intravenous administration of solutions that help bind and remove harmful substances that accumulate in the vascular bed. Sorbent solutions and preparations of calcium salts (carbonate) are usually used. However, if chronic renal failure therapy does not bring the desired effect (which will be seen by the level of azotemia), then replacement methods of treatment should be used.

1. Hemodialysis.

An important criterion for starting blood purification by dialysis is the concentration of nitrogenous compounds. Against the background of concomitant serious illnesses (diabetes mellitus, arterial hypertension), hemodialysis can be started at stage 2, when the creatinine level exceeds 0.71 mmol / l. However, a typical indication for dialysis is stage 3 with severe azotemia.

After each blood purification session, diagnostic studies are mandatory, in which indicators such as:

• general clinical tests of urine and blood;
• assessment of the level of azotemia by creatinine and urea 1 hour after the end of the hemodialysis session;
• determination of minerals (calcium, sodium, phosphorus) in the blood after hardware cleaning.

1. Treatment of concomitant diseases.

Improving the general condition of the body with the correction of pathological changes will help restore the processes of removal of nitrogenous compounds. Sometimes it is the harmful substances that accumulate in the blood during CRF that contribute to the following problems:

• anemia;
• erosive gastritis;
• diseases of the joints and bones;
• accumulation of phosphate compounds with an increased risk of urolithiasis.

All variants of pathologies detected in chronic renal failure require a course of therapy taking into account the capabilities of the kidneys. You can not use drugs that have even a minimal nephrotoxic effect. Treatment should be carried out in a hospital under the constant supervision of a physician with regular monitoring of laboratory parameters. An important factor in therapy will be the correction of sugar and blood pressure in people with diabetes, obesity and hypertension.

Among all the classifications used for the diagnosis and treatment of chronic renal failure, one of the optimal, fairly simple and informative, is the determination of the stage of the disease by the level of azotemia. In a biochemical blood test, the concentration of creatinine and urea are the most indicative for assessing the urinary function of the kidneys and for monitoring during the course of treatment of CRF. Almost always, an assessment of azotemia is used for any methods of replacement therapy carried out in the hemodialysis unit. The best option for predicting future complications is dynamic monitoring of the concentration of nitrogen-containing compounds in the blood. That is why the doctor at all stages of the examination and treatment of renal failure will use laboratory tests with the obligatory determination of creatinine concentration.

According to the clinical course, acute and chronic renal failure are distinguished.

Acute renal failure

Acute renal failure develops suddenly, as a result of acute (but most often reversible) damage to the tissues of the kidneys, and is characterized by a sharp drop in the amount of urine excreted (oliguria) to its complete absence (anuria).

Causes of acute renal failure

Symptoms of acute renal failure

• small amount of urine (oliguria);
• complete absence (anuria).

The patient's condition worsens, this is accompanied by nausea, vomiting, diarrhea, lack of appetite, swelling of the extremities occurs, and the liver increases in volume. The patient may be inhibited, or vice versa, excitation occurs.

In the clinical course of acute renal failure, several stages are distinguished:

I stage- initial (symptoms due to the direct effect of the cause that caused acute renal failure), lasts from the moment the underlying cause is affected until the first symptoms from the kidneys have a different duration (from several hours to several days). Intoxication may appear (pallor, nausea,);

II stage- oligoanuric (the main symptom is oliguria or complete anuria, also characterized by a severe general condition of the patient, the occurrence and rapid accumulation of urea and other end products of protein metabolism in the blood, causing self-poisoning of the body, manifested by lethargy, weakness, drowsiness, diarrhea, arterial hypertension, tachycardia , swelling of the body, anemia, and one of the characteristic features is progressively increasing azotemia - an increased content of nitrogenous (protein) metabolic products in the blood and severe intoxication of the body);

III stage- recovery:

• phase of early diuresis - the clinic is the same as in stage II;
• the phase of polyuria (increased urine formation) and restoration of the concentration ability of the kidneys - renal functions are normalized, the functions of the respiratory and cardiovascular systems, the digestive canal, the support and movement apparatus, and the central nervous system are restored; the stage lasts about two weeks;

IV stage- recovery - anatomical and functional restoration of renal activity to the initial parameters. It can take many months, sometimes it takes up to one year.

Chronic renal failure

Chronic renal failure is a gradual decrease in kidney function until its complete disappearance, caused by the gradual death of kidney tissue as a result of chronic kidney disease, the gradual replacement of renal tissue with connective tissue and kidney shrinkage.

Chronic renal failure occurs in 200-500 out of one million people. Currently, the number of patients with chronic renal failure is increasing annually by 10-12%.

Causes of chronic renal failure

The causes of chronic renal failure can be various diseases that lead to damage to the renal glomeruli. It:

• kidney disease chronic glomerulonephritis, chronic pyelonephritis;
• metabolic diseases diabetes mellitus, gout, amyloidosis;
• congenital kidney disease polycystic, underdevelopment of the kidneys, congenital narrowing of the renal arteries;
• rheumatic diseases, scleroderma, hemorrhagic vasculitis;
• vascular diseases arterial hypertension, diseases leading to impaired renal blood flow;
• diseases leading to impaired outflow of urine from the kidneys urolithiasis, hydronephrosis, tumors leading to gradual compression of the urinary tract.

The most common causes of chronic renal failure are chronic glomerulonephritis, chronic pyelonephritis, diabetes mellitus and congenital malformations of the kidneys.

Symptoms of chronic renal failure

There are four stages of chronic renal failure.

1. latent stage. At this stage, the patient may not complain, or there may be fatigue during physical exertion, weakness that appears in the evening, dry mouth. In a biochemical study of blood, small violations of the electrolyte composition of the blood are revealed, sometimes protein in the urine.
2. compensated stage. At this stage, the complaints of patients are the same, but they occur more often. This is accompanied by an increase in urine output up to 2.5 liters per day. Changes are found in the biochemical parameters of blood and in.
3. intermittent stage. The work of the kidneys is further reduced. There is a persistent increase in the blood products of nitrogen metabolism (protein metabolism), an increase in the level of urea, creatinine. The patient develops general weakness, fatigue, thirst, dry mouth, appetite decreases sharply, an unpleasant taste in the mouth is noted, nausea and vomiting appear. The skin acquires a yellowish tint, becomes dry, flabby. Muscles lose their tone, there are small muscle twitches, tremors of the fingers and hands. Sometimes there are pains in the bones and joints. The patient may have a much more severe course of ordinary respiratory diseases, tonsillitis, pharyngitis.

   In this stage, periods of improvement and deterioration in the patient's condition can be expressed. Conservative (non-surgical) therapy makes it possible to regulate homeostasis, and the general condition of the patient often allows him to still work, but increased physical activity, mental stress, diet errors, drinking restriction, infection, surgery can lead to deterioration of kidney function and aggravation of symptoms.

4. Terminal (final) stage. This stage is characterized by emotional lability (apathy is replaced by excitement), disruption of night sleep, daytime sleepiness, lethargy and inappropriate behavior. The face is puffy, gray-yellow in color, skin itching, there are scratches on the skin, hair is dull, brittle. Dystrophy is growing, hypothermia (low body temperature) is characteristic. There is no appetite. The voice is hoarse. There is an ammonia smell from the mouth. Aphthous stomatitis occurs. The tongue is coated, the abdomen is swollen, vomiting and regurgitation are often repeated. Often - diarrhea, fetid, dark-colored stools. The filtration capacity of the kidneys drops to a minimum.

   The patient may feel satisfactory for several years, but at this stage the amount of urea, creatinine, uric acid in the blood is constantly increased, the electrolyte composition of the blood is disturbed. All this causes uremic intoxication or uremia (uremia in the urine in the blood). The amount of urine excreted per day decreases to its complete absence. Other organs are affected. There is dystrophy of the heart muscle, pericarditis, circulatory failure, pulmonary edema. Violations of the nervous system are manifested by symptoms of encephalopathy (disturbance of sleep, memory, mood, the occurrence of depressive states). The production of hormones is disrupted, changes occur in the blood coagulation system, immunity is impaired. All these changes are irreversible. Nitrogenous metabolic products are excreted with sweat, and the patient constantly smells of urine.

Prevention of kidney failure

Prevention of acute renal failure is reduced to the prevention of the causes that cause it.

Prevention of chronic renal failure is reduced to the treatment of such chronic diseases as: pyelonephritis, glomerulonephritis, urolithiasis disease.

Forecast

With the timely and correct use of adequate methods of treatment, most patients with acute renal failure recover and return to normal life.

Acute renal failure is reversible: the kidneys, unlike most organs, are able to restore completely lost function. At the same time, acute renal failure is an extremely serious complication of many diseases, often portending death.

However, in some patients, the decrease in glomerular filtration and the concentration ability of the kidneys remains, and in some patients, renal failure takes on a chronic course, with an important role played by the associated pyelonephritis.

In advanced cases, death in acute renal failure most often occurs from uremic coma, hemodynamic disturbances, and sepsis.

Chronic renal failure must be monitored and treated early in the disease, otherwise it may lead to complete loss of renal function and require a kidney transplant.

What can you do?

The main task of the patient is to notice in time the changes that occur to him both in terms of general well-being and in terms of the amount of urine, and consult a doctor for help. Patients who have confirmed the diagnosis of pyelonephritis, glomerulonephritis, congenital anomalies of the kidney, systemic disease, should be regularly observed by a nephrologist.

And, of course, you must strictly follow the doctor's prescription.

What can a doctor do?

The doctor will determine first of all the cause that caused the kidney failure and the stage of the disease. After that, all necessary measures for the treatment and care of the patient will be taken.

Treatment of acute renal failure is aimed primarily at eliminating the cause that causes this condition. Applicable measures to combat shock, dehydration, hemolysis, intoxication, etc. Patients with acute renal failure are transferred to the intensive care unit, where they receive the necessary assistance.

Treatment of chronic renal failure is inseparable from the treatment of the kidney disease that has led to kidney failure.