Chronic renal failure (CRF): stages, symptoms, diagnosis and effective treatment. Features of the course of chronic renal failure

Chronic renal failure (CRF)- This serious condition kidneys, which is characterized by a gradual loss of their functions.

Our kidneys are constantly filtering excess fluid and toxins from the blood, which are then removed from the body in the urine.

In chronic kidney failure, the body accumulates fluid, electrolytes, and dangerous toxins that the kidneys are unable to eliminate.

In the early stages of CKD, you may not experience any symptoms. Chronic renal failure may not make itself felt until the work of the kidneys is significantly impaired.

Treatment for CKD focuses on slowing the progression of the disease as well as treating the underlying disease that caused the kidney damage. Chronic renal failure gradually progresses to the terminal stage, which is fatal without artificial blood purification (dialysis) or kidney transplantation.

Causes of chronic renal failure

CKD occurs when a disease or toxin damages your kidneys, and the damage worsens over months or years.

Causes of chronic renal failure may include:

Diabetes mellitus type 1 or 2.
. high arterial pressure.
. Recurrent kidney infections.
. Glomerulonephritis, inflammation of the nephrons.
. Polycystic kidney disease.
. Prolonged obstruction urinary tract with urolithiasis, enlarged prostate and some forms of cancer.
. Vesicoureteral reflux, i.e. reflux of urine from Bladder back to the kidneys.

Risk factors for chronic renal failure:

Diabetes.
. Hypertonic disease.
. Heart disease.
. Smoking.
. Obesity.
. High cholesterol.
. Kidney disease in relatives.
. Age over 65 years.

In addition, a racial predisposition to chronic renal failure has been proven. Studies in the United States have shown that CKD is more common among African Americans, North American Indians, and East Asians.

Symptoms of chronic renal failure

The symptoms of CKD develop slowly over months or years. They are mainly due to the accumulation toxic substances in organism.

Symptoms include:

Nausea and vomiting.
. Loss of appetite.
. Sleep disturbance.
. Weakness and fatigue.
. Decreased urine output (oliguria).
. Deterioration of mental activity.
. Muscle twitches and spasms.
. Hypertension that is difficult to control.
. Edema in the lower extremities.
. Chest pain.
. Dyspnea.

Signs of kidney failure are often nonspecific. This means that they can talk about other diseases as well. In addition, the kidneys adapt very well and compensate for the partial loss of function. Therefore, the symptoms of CRF may not appear until such time as the violation of the kidneys becomes very critical and irreversible.

When should you see a doctor?

See your doctor as soon as possible if you notice any suspicious symptoms. If you have a medical condition that increases the risk of CKD, your doctor should keep you under constant observation, do blood and urine tests, and measure your blood pressure. In no case do not start a urinary tract infection - at the first sign of trouble, consult a doctor!

Diagnosis of chronic renal failure

The following tests and procedures are used to diagnose CRF:

1. Blood tests.

Kidney function tests measure the level of toxic metabolic products in the blood, such as urea and creatinine. If their content in the blood is increased, then perhaps the kidneys are not doing their job.

2. Urinalysis.

Urinalysis helps to identify abnormalities characteristic of CRF. In the urine, you can detect protein, red blood cells, white blood cells, sugar - the content of these components may indicate a particular kidney disease or systemic disease.

3. Visualization of the kidneys.

In order to examine the kidneys and urinary tract, ultrasound is most often used. In some cases, computed and magnetic resonance imaging, angiography (examination of blood vessels), etc. are prescribed.

4. Kidney biopsy.

For a biopsy, the doctor does anesthesia, and then, using a special long needle, takes a sample of kidney tissue for analysis. In the laboratory, biopsy cells can be examined for cancer, genetics, and other diseases.

Treatment of chronic renal failure

Some types of CKD can be treated - it all depends on the cause. But often kidney failure is incurable. Treatment for CKD is aimed at relieving symptoms, preventing complications, and slowing the progression of the disease. If your kidneys are very badly damaged, you will need dialysis or a kidney transplant.

Treatment of complications of chronic renal failure includes:

1. Lowering blood pressure.

People with chronic kidney disease tend to have high blood pressure. The doctor may prescribe antihypertensive drugs. Usually these are angiotensin-converting enzyme (ACE) inhibitors or AT-II receptor antagonists. Antihypertensive drugs reduce blood pressure and help preserve the kidneys. The fact is that high pressure damages the filtering apparatus of the kidneys. The doctor can make you frequent tests blood and urine to monitor the condition of the kidneys. A diet is also recommended low content table salt.

2. Control of cholesterol levels.

Your doctor may prescribe statin drugs (simvastatin, atorvastatin) to keep your cholesterol levels under control. People with CKD often have elevated level cholesterol, and this increases the risk of heart attack, stroke and other cardiovascular problems.

3. Treatment of anemia.

In some cases, you may be prescribed iron supplements and the hormone erythropoietin. Erythropoietin enhances the production of red blood cells, which helps to overcome anemia, and with it weakness, fatigue, and pallor will disappear.

4. Treatment of edema.

In chronic renal failure, fluid can be retained in the body, which causes swelling. Edema usually occurs in the arms and legs. To remove fluid, diuretics are prescribed - diuretics.

5. Protection of bones from osteoporosis.

Your doctor may prescribe calcium and vitamin D supplements to help prevent brittle bones. You may also be prescribed medication to lower your blood phosphate levels. This promotes better absorption of calcium in bone tissue.

6. Diet low in protein.

When our body receives proteins from food, it breaks them down into toxic nitrogenous compounds. If the kidneys cannot remove these metabolic products, they accumulate in the blood, poisoning our body. To lower your levels of these substances, your doctor may recommend a low-protein diet.

Treatment of end-stage renal disease

On last stage CRF, when the kidneys can no longer cope with the removal of fluid and toxins, you can either use dialysis or transplant a kidney to the patient.

1. Dialysis.

Dialysis is, in fact, the artificial removal of toxins from the blood. Dialysis is prescribed at the end stage of renal failure. In hemodialysis, a special machine pumps blood through filters, where excess fluid is retained and toxic substances. In peritoneal dialysis, fill with a catheter abdominal cavity dialysis solution that absorbs harmful substances. Then this solution is brought out and replaced with fresh.

2. Kidney transplantation.

If you do not have other serious illnesses, life threatening, then you may be a candidate for a kidney transplant from a healthy donor or a deceased person who donated his organs to others.

If it is not possible to do dialysis or transplantation, then a third option is possible - conservative supportive treatment. But in this case, life expectancy in the terminal stage of chronic renal failure is calculated in weeks.

As part of your treatment, your doctor will recommend special diet to facilitate the work of the kidneys. Ask your dietitian to analyze your diet to remove foods and drinks that are harmful to the kidneys.

A nutritionist may advise you to:

1. Do not eat foods containing a large number of salt.

Avoid salty foods to reduce your sodium intake. Add to list unwanted products canned food, frozen dinners, cheeses, and some processed meats may be included. Fast food should be avoided. Check with your doctor how many grams of salt your daily diet should contain.

2. Choose foods low in potassium.

Your dietitian may advise you to lower your potassium intake as well. Potassium-rich foods include bananas, oranges, potatoes, tomatoes, and spinach. You can replace these products with apples, cabbage, grapes, beans, strawberries, which contain little potassium.

3. Limit the content of proteins (proteins) in the diet.

As already mentioned, diseased kidneys may not be able to cope with protein-rich foods. To control the level of nitrogenous compounds in the blood, you need to limit protein intake. Protein-rich foods: meats, eggs, cheeses, beans. A minimum of proteins is found in vegetables, fruits, cereals. True, some products are artificially enriched with proteins - pay attention to the labels.

Complications of chronic renal failure

Over time, CKD damages almost every organ in a person.

Potential complications of CKD include:

Fluid retention, which leads to swelling in the arms and legs, high blood pressure, and fluid buildup in the lungs.
. A sudden increase in the level of potassium in the blood (hyperkalemia), which can interfere with the normal functioning of the heart.
. The defeat of the central nervous system, which is manifested by a change in personality, a decrease in intelligence, seizures.
. Deterioration of the immune response, which makes the patient's body more susceptible to infections.
. Decrease in the content of red blood cells in the blood (anemia).
. Weakness of bone tissue, frequent fractures.
. Diseases of the heart and blood vessels.
. Decreased libido and impotence.
. Pericarditis, inflammation of the pericardial sac.
. Complications of pregnancy that entail a risk to the mother and fetus.
. Irreversible kidney damage requiring lifelong dialysis or transplantation.

Prevention of chronic renal failure

To reduce the risk of CKD, you need:

1. Give up alcohol.

If you do drink alcohol, be careful. Western doctors believe that for a healthy woman under 65, the norm should not exceed one drink, and for healthy man- no more than two drinks per day. Alcohol is generally not recommended for the elderly, sick and pregnant.

2. Follow the instructions for the medicines.

When using any drugs, including aspirin, ibuprofen, paracetamol, follow the manufacturer's instructions. Taking large doses of medication can damage the kidneys. If you have had kidney disease before, consult your doctor before taking any medication.

3. Maintain a healthy body weight.

If you have problems with overweight start exercising and control your diet. Obesity not only increases the risk of kidney problems, but also contributes to diabetes, leads to hypertension, reduces the duration and quality of life.

4. Give up cigarettes.

If you smoke, check with your doctor about modern methods withdrawals nicotine addiction. Pills, nicotine patches, psychotherapy, and support groups can help you quit.

5. Watch your health.

Don't run infectious diseases, which can affect your kidneys over time.

Konstantin Mokanov

Chronic renal failure is a pathological process in which the kidneys cease to function fully. The disorder is caused by a variety of diseases, the causes and localization of which are not always associated with the kidneys. The disease is characterized by the death of the structural tissue of the kidneys, which consists of nephrons and is responsible for the production and filtration of urine.

Depending on the form of the disease, kidney failure occurs after three or more months. Without proper treatment, it can flow into chronic adrenal insufficiency. Diagnosis of the disease consists of a set of measures, and includes many lab tests and instrumental examinations of the patient. Treatment is based on the elimination of the main disorder that led to this disease, but, in addition, it is necessary to pass repeated courses hemocorrection. For a complete recovery from chronic renal failure in children and adults, it is necessary to perform an organ transplant.

The disorder is an irreversible impairment of some of the functions of the kidneys, including excretion and filtration of urine. At the initial stage, the disease can go unnoticed by a person, but the more it progresses, the brighter the signs will appear - lack of appetite, severe weakness of the body, change in skin tone. But the main thing is an increase in the volume of excreted urine per day. without correct and timely treatment will lead to the progression of complications that can lead to death.

Etiology

Appears as a result of other diseases in the body, including -, or polycystic kidney disease. Also, the reasons for the appearance of such a disorder of the functioning of the kidneys can be:

  • congenital pathologies of the structure or functioning of the kidneys, the presence of only one kidney or irreversible disorders in one of them;
  • deposition;
  • body weight, much higher than normal;
  • late diagnosis of other renal diseases;
  • wide range disorders of the urinary system;
  • non-compliance with instructions or abuse of certain medicines;
  • oncological neoplasms;
  • intoxication of the body;
  • acute poisoning chemicals.

Varieties

There is a classification of chronic renal failure according to the stage of the course of symptoms:

  • latent- the symptoms are almost non-existent. The person may feel slightly tired. Very often it is determined when diagnosing a completely different problem, for the diagnosis of which blood or urine tests were performed;
  • compensated- the volume of excreted urine increases (more than two liters per day), there is a slight swelling in the morning;
  • intermittent- severe fatigue worries a person, as well as dry mouth. Appears muscle weakness;
  • terminal – abrupt change mood of the patient, reduced immunity. There is a violation of work and other internal organs including the heart and lungs. But most clearly, the terminal stage of chronic renal failure is characterized by such a sign as the appearance of the smell of urine from oral cavity the victim.

Symptoms

Each stage, from the above classification, is characterized by its own symptoms of chronic renal failure. As mentioned above, during the initial stage of the disease, a person may not feel any manifestations or may feel very tired, which manifests itself in the late afternoon.

The compensated form is characterized by:

  • a strong feeling of fatigue;
  • a person emits more than two liters of urine per day;
  • dry mouth appears;
  • after sleep there are swelling on the face.

The intermittent type of the disease is accompanied by such signs as:

  • a person gets tired quickly, despite inactive physical actions;
  • sharp decline appetite
  • constant dryness in the mouth, despite intense thirst;
  • appears bad taste in the oral cavity;
  • bouts of nausea and vomiting;
  • the skin changes in color and acquires a pale yellow tint;
  • dryness and peeling of the skin;
  • small involuntary twitching of the fingers and toes;
  • pain in muscles and bones.

With the manifestation of such symptoms of chronic renal failure, there is a possibility of a complicated course of certain diseases, such as, and others inflammatory processes respiratory organs. If treatment with medicines is carried out, it is possible to achieve an improvement in the patient's condition, but any adverse effect in the form of heavy loads, mental disorders, non-compliance with the diet, infection or surgery will be the impetus for sharp deterioration kidney condition, acute manifestation symptoms.

The terminal stage is expressed by the following symptoms:

  • emotional instability;
  • sleep disturbance - during the day a person sleeps, and is awake at night;
  • a change in the shade of the face, it becomes yellow-gray;
  • burning sensation on the skin;
  • strong fallout and brittle hair;
  • weight loss due to lack of appetite;
  • change in the timbre of the voice;
  • diarrhea, with stool bad smell and dark color
  • frequent vomiting;
  • appearance;
  • memory loss;
  • a person is accompanied by an unpleasant odor - the smell of urine comes from the mouth.

Chronic renal failure in children is manifested by:

  • an increase in the volume of urine excreted;
  • swelling of the ankles and face;
  • growth retardation;
  • limb deformity;
  • hands and feet lose their normal sensation;
  • burning sensation on the fingertips of the upper and lower extremities;
  • muscle weakness;
  • dryness and bitterness in the mouth;
  • severe pain in a stomach;
  • seizures;
  • a decrease in immunity, as a result of which the child is susceptible to various infections;

Complications

Late diagnosis or improper treatment can be expressed the following complications from kidney failure:

  • chronic adrenal insufficiency;
  • bleeding disorders, which cause bleeding and bruising on the skin;
  • heart failure;
  • insufficient supply of blood to the heart;
  • violations heart rate;
  • inflammation of the heart bag;
  • slowing down the cleansing and filtration function of the kidneys;
  • loss of sensation in the limbs;
  • persistent increase in blood pressure;
  • impaired absorption of calcium, due to which a person will be prone to increased bone fragility;
  • education or;
  • decreased sexual desire;
  • violation menstrual cycle or such an anomaly as not maturation of the egg;
  • the birth of a dead fetus if chronic renal failure was diagnosed during pregnancy;
  • uremic coma, which can lead to the death of a sick person.

Diagnostics

Diagnosis of chronic renal failure is carried out in several stages, including:

  • clarification of the full history of the disease - when the first signs were revealed, how strong they are, how much urine is emitted per day, how much the person gets tired. Studying the patient's medical history for what could have caused the disease, determining the stage according to the above classification, whether this disease bothered any of the next of kin;
  • examination of the patient for swelling, changes in the sensitivity of the limbs and color skin. In addition, the doctor simply cannot help but notice the unpleasant smell of urine from the mouth of his patient;
  • conducting a urine test. With this disease, the density of the liquid will be lowered, in the analyzes it will be observed a small amount squirrel. With infections, tumors, injuries, the urine will contain erythrocytes, and with autoimmune disorders - leukocytes. If a bacterium has become the cause of the disease, it will be detected during the analysis. In addition, it is possible to define infectious agent, which became the causative agent of the disease, and indicate the degree of its sensitivity to medicines. A urine test is carried out according to Zimnitsky. This is done to determine the density and volume of the released liquid;
  • holding and . With such a disease, the concentration will be increased, decreased, and. At biochemical analysis blood will show up high level uric acid, an increase in the level of potassium, cholesterol and phosphorus, a decrease in calcium and protein;
  • hardware diagnostic methods, including ultrasound, CT and MRI, to find the reasons for the narrowing of the paths that excrete urine. With the help of dopplerography, the passage of blood through the vessels is assessed. Radiography reveals possible violations respiratory system, which in some disorders can cause kidney failure. A biopsy is used to fully confirm the diagnosis. During this process, a small piece of kidney tissue is taken, which will then be examined under a microscope. An ECG helps to detect abnormalities in the heart.

After receiving all the results of the tests that were carried out during the diagnosis, the doctor prescribes treatment.

Treatment

Treatment of chronic renal failure is based on the correct diagnosis and determination of its stage. At the initial stage, drug therapy is carried out, which is aimed at:

  • elimination of high blood pressure;
  • stimulation of urine production;
  • preventing the autoimmune process, in which the body itself attacks its internal organs. This is done with the help of hormonal substances;
  • elimination of anemia with erythropoietins;
  • decrease in acidity in the stomach;
  • medicines containing calcium, vitamin D, which will strengthen the bones and prevent their fractures.

At more serious stages of the disease, other methods of therapy are used:

  • hemodialysis, during which blood is cleaned and filtered. It is carried out outside the body, through a special apparatus. Blood enters it from a vein on one arm, goes through the necessary processes and returns to the human body through a tube attached to the other arm. Such treatment is performed for life several times a week or until the moment of organ transplantation;
  • peritoneal dialysis, in which there is a similar blood purification, only with additional correction water-salt balance. This is done through the patient's abdominal cavity, into which the solution is injected and then sucked out;
  • actually, kidney transplantation - an organ suitable for all criteria is selected from a donor. But it should not be ruled out that the kidney may not take root, then the patient will need to undergo all the methods of therapy again. To prevent this from happening, they carry out a course of treatment with drugs that lower the immune system so that it does not start to reject the new organ.

Diet in chronic renal failure is an important link in therapy. It provides:

  • the use of high-calorie foods, but not fatty, not oversalted and not spicy, but enriched with carbohydrates. In any quantities, you can eat sweets, rice, vegetables and potatoes. It is best if the dishes are steamed or in the oven. Take food in small portions five times a day;
  • decrease in protein intake;
  • the amount of liquid should not exceed two liters per day;
  • refusal to absorb legumes, mushrooms, nuts, which are saturated with protein;
  • reception in limited quantities of grapes, dried apricots, coffee and chocolate.

Prevention

Preventive measures for chronic renal failure include:

In the presence of chronic renal failure, workers cell structures given paired organ stop their work, which is possible only with any life-threatening ailments. It should be noted that this disease is quite common throughout the world.

The number of sick people is steadily increasing every year. The development of this disease provokes many factors that are extremely difficult to completely eliminate from the life of a modern person. So what is chronic kidney failure, how can it be diagnosed and treated?

As noted earlier, this disease means the gradual extinction of all functions assigned to the kidneys. This disease characterized by poor performance of the paired organ, which can lead to a significant disruption of life human body. There are also complications from various organs and systems.

The main culprits for the appearance of CKD are:

  1. diseases characterized by damage to the glomeruli: diabetic nephrosclerosis, impaired protein metabolism, lupus, gout, prolonged septic endocarditis, myeloma, malaria;
  2. Availability hereditary diseases associated with the performance of the kidneys and urinary tract. This is neuromuscular dysplasia of the ureters;
  3. ailments that are different primary lesion tubular apparatus: many diseases of a urological nature that occur simultaneously with a violation of the outflow of urine, congenital and acquired tubulopathies ( renal diabetes, tubular acidosis Albright, Fanconi syndrome, poisoning with various medicines or chemicals);
  4. significant damage to the paired organ in question, which appears due to the presence of serious vascular diseases in the body. These include: narrowing of the lumen renal arteries, high blood pressure, and hypertension malignant course.

Classification and stages

As you know, chronic renal failure has certain bright pronounced signs and appropriate treatment.

CRF is usually classified into several main stages of the course:

The terminal stage is divided into four main periods:

  • more than one liter per day. Thus, glomerular filtration reaches approximately 11 ml / min;
  • II a. The amount of urine produced is reduced to half a liter per day. In addition, there is an increase in the content of sodium in the blood serum. Fluid is retained in the body;
  • II b. Symptoms become more pronounced and more characteristic of heart failure. Are celebrated congestion in the liver and organs of the respiratory system;
  • the patient develops a pronounced uremic intoxication, an increase in the content of potassium in the body, hypermagnesemia, hypochloremia, hyponatremia, heart failure and impaired liver function.
When the first symptoms of chronic renal failure appear, you should immediately consult a doctor. If you delay a visit to him for a long time, then you can get serious complications that can worsen the function of the paired organ in question.

Clinical picture

Patients are characterized by slowness, apathy and drowsiness.

They begin to suffer from severe skin itching, which interferes with normal life. The patient's skin is quite dry and lifeless. Even when excited, there is no sweating.

People feel weakness in the muscles, which in most cases is due to a decrease in the content of potassium in the body. Often there are so-called muscle twitching and convulsions.

Diagnostics

Only the attending physician can make a diagnosis based on a decrease in the level glomerular filtration and an increase in the content of urea and creatinine in the blood.

Isohyposthenuria is very common.

  1. limiting protein intake. Daily ration the patient should contain no more than 65 g of protein. Of course, this prohibition applies only to those patients who suffer from serious forms of the disease;
  2. providing the necessary energy value diet food. The patient's diet should be enriched with fats and healthy carbohydrates that are easily digestible;
  3. increase in the daily volume of vegetables and fruits. It is very important to take into account the salt composition of these products;
  4. right cooking some foodstuffs. This measure can significantly improve the patient's appetite;
  5. regulation of the amount of salt and fluid entering the body. This will help reduce swelling of the face and body.
People suffering from CKD need to eat plenty of vegetables, nuts and legumes.

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 comply with the prescribed drug therapy and an appropriate diet. You should also regularly take all the tests and undergo a special examination.


Currently in foreign literature instead of the term HPN, which is considered obsolete and characterizes only the fact of an irreversible impairment of kidney function, the term is used "chronic kidney disease" with a mandatory indication of the stage. At the same time, it should be emphasized that the establishment of the presence and stage of CKD in no way replaces the main diagnosis.

Clinical picture

The course of chronic renal failure varies, but more often it grows slowly and gradually with periods of exacerbations and remissions. CKD increases rapidly with exacerbation of the underlying pathological process in the kidneys(for example, glomerulonephritis or pyelonephritis), as well as upon infection(ARI, influenza, tonsillitis, pneumonia, furunculosis, etc.). This is important, as timely treatment can improve kidney function. A sign of exacerbation of chronic renal failure is a decrease in diuresis, a significant increase in urea and creatinine, a violation acid-base balance blood and anemia. In the most severe cases of malignant subacute glomerulonephritis, the end stage of chronic renal failure can develop as early as 6-8 weeks from the onset of the disease.

In the initial (latent) stage clinical manifestations little, the body is still more or less able to maintain the constancy of the internal environment. But then deviations begin to grow. In this stage, the symptoms are determined by the underlying disease, often general weakness, fatigue, reduced work capacity.

SKIN

In the initial stage of chronic renal failure, the skin usually pale, which is associated with anemia, tk. produced in the kidneys erythropoietin- a hormone that stimulates the formation of red blood cells. Subsequently, the skin acquires yellowish bronze tint and the urine gradually becomes discolored, which looks like jaundice. However, this change in skin color is associated with urinary urochrome retention in organism. In the terminal stage of chronic renal failure, patients are tormented by itching, and the skin is covered with a kind of white " uremic frost» from white crystals of urea. Let me remind you that normally excreted in the urine 20-35 g of urea per day.

"Uremic frost" from urea crystals on the skin of a negro.

Due to severe itching and a decrease in immunity, there are often pustular infections.

Skin itching with chronic renal failure.

BONE SYSTEM

Due to the violation of phosphorus-calcium metabolism, a lot of parathyroid hormone, which "washes" calcium from the bones. arises osteomalacia- the bones become less strong, hurt, they often have pathological fractures(bones break from small efforts, which normally does not happen). In chronic renal failure, the content also increases uric acid in the blood (hyperuricemia), which leads to the deposition of urate in tissues and periodic bouts of inflammation in the joints - gout.

NERVOUS SYSTEM

Initially, patients realize that they have a severe kidney disease; arises response to disease, which goes through a series of stages, starting with negation. Patients are depressed, mood changes often, thoughts of suicide are possible. This reaction to the disease is more common in cancer patients, but for additional information I'll list those steps here:

  1. Negation or shock ("it can't be").
  2. Anger and aggression(“why me”, “why me”).
  3. « Bargain» (search for methods of treatment, drugs).
  4. Depression and alienation (“I don’t want anything”, “I don’t need anything”, “everything is indifferent”).
  5. Acceptance of your illness and building a new life (rethinking your life).

In the future, as nitrogenous metabolic products accumulate in the blood, muscle twitching sometimes painful cramps calf muscles. In the terminal stage of chronic renal failure, severe nerve damage is characteristic ( polyneuropathy) with pain and atrophy (reduction in volume) of the muscles.

Polyneuropathy in chronic renal failure causes pain and muscle atrophy.

Since chronic renal failure usually causes malignant arterial hypertension (increased and very stable blood pressure), then often there are strokes.

THE CARDIOVASCULAR SYSTEM

The kidneys regulate blood pressure levels. In chronic renal failure due to renal blood flow disorders And activation of the renin-angiotensinogen-aldosterone system the level of blood pressure steadily rises to high numbers and at the same time it is extremely difficult to go astray. This can be regarded as a kind diagnostic feature: if the "non-renal" patient's blood pressure is much more difficult to lower than before, he needs to check the kidneys(at least - to pass a urine test according to Nechiporenko).

There is a headache, dizziness, discomfort And pain in the heart, arrhythmias, shortness of breath up to pulmonary edema due to overload of the left ventricle. In the future, adversely affect anemia and acidosis. May develop uremic myocarditis and pericarditis.

RESPIRATORY SYSTEM

As mentioned just above, it can develop " nephrogenic pulmonary edema due to the accumulation of fluid in the body and weak heart function. due to penetration of urea mucosal irritation, which leads to laryngitis, tracheitis, bronchitis and pneumonia due to reduced immunity.

DIGESTIVE SYSTEM

Mucous membranes of the stomach and small intestine highly permeable to urea, which can hydrolyze to ammonia, annoying and damaging them. There may be taste perversion, nausea, vomiting, ammonia smell in the mouth, increased salivation, ulceration of the oral mucosa, gastrointestinal bleeding. Most frequent infectious complications - stomatitis and parotitis.

Laboratory indicators

BLOOD with uremia (end-stage renal failure): increasing anemia(hemoglobin drops to 40-50 g / l and below), toxic leukocytosis up to 80-100? 10 9 /l with the formula shifted to the left. The number of platelets is reduced ( thrombocytopenia), which is one of the causes of bleeding in uremia and further reduces the level of hemoglobin.

URINE: in the initial period, changes are determined by the underlying disease. As CRF increases, these changes are smoothed out, and urinalysis to determine primary disease becomes difficult. Found in urine protein, leukocytes, erythrocytes, cylinders.

IN initial stages chronic renal failure blood potassium levels are usually low due to polyuria ("forced diuresis"). Sodium levels are also reduced due to the restriction of its use with food, and especially with damage to the tubules (for example, with pyelonephritis). Definitely evolving acidosis(acidification of the internal environment) due to a violation of the excretion of acids by the kidneys, the formation of ammonia in the tubular cells and increased secretion of bicarbonates. Acidosis manifests itself drowsiness, skin itching and low body temperature.

Because the the active form of vitamin D is produced in the kidneys, chronic renal failure leads to a sharp calcium malabsorption in the intestines and to a decrease in the level of calcium in the blood (hypocalcemia). Hypocalcemia may present paresthesia(tingling sensation and "goosebumps" on the skin), muscle twitches and cramps. According to the feedback mechanism, more parathyroid hormone enters the bloodstream, which “washes out” calcium from the bones. In the terminal stage of CRF, the level of magnesium (drowsiness, weakness) and phosphorus (due to the “dissolution” of bones by parathyroid hormone) in the blood increases.

About treatment

First of all, it is necessary to treat the underlying disease that caused chronic renal failure. Without this, the rest of the treatment will be ineffective. Important avoid nephrotoxic medicines (e.g. aminoglycoside antibiotics).

On a diet limit the amount of protein up to 50-40 g (up to 25-18 g) of protein per day, which reduces the formation of nitrogenous metabolic products. High caloric content of food (1800-3000 kcal / day) is provided by carbohydrates and fats. The consumption of meat and fish is completely prohibited, eggs, creamy and vegetable oil, honey, vegetables and fruits. Such a diet with a complete set of essential amino acids allows reuse urea nitrogen for protein synthesis. In a hospital setting, patients with chronic renal failure are prescribed a diet 7a(according to Pevzner), in the terminal stage on hemodialysis - a diet 7g.

In the early stages of chronic renal failure, anticoagulants(heparin) and antiplatelet agents(chimes, trental), which improve blood circulation in the kidneys. In the terminal stage, these drugs are contraindicated, because. increase bleeding.

Necessarily reduce high blood pressure, although this is difficult to do - you have to prescribe antihypertensive drugs from different groups. Furosemide (Lasix) is used high doses, and thiazide diuretics (hydrochlorothiazide) are ineffective in chronic renal failure.

Potassium and sodium imbalance eliminated by diet, the appointment of panangin, glucose with insulin and potassium, as well as the intake of table salt. To combat anemia, the use of erythropoietin preparations is most effective.

Use to reduce azotemia herbal preparations lespenephril and hofitol which increase renal blood flow. May be appointed anabolic steroid , which enhance protein synthesis and reduce the formation of urea. Exists method of excretion of nitrogen metabolism products through the intestines with controlled diarrhea. For these purposes, a choice of magnesium sulfate, sorbitol (xylitol) or a special solution (NaCl, KCl, CaCl 2 , Na 2 CO 3 , mannitol) is used. However, there is a danger here dehydration and electrolyte (ionic) imbalance therefore, it is safer to use hemodialysis. In the absence of arterial hypertension and heart failure, prescribe dry hot air sauna, after which the general condition of many patients improves significantly.

In the terminal stage of chronic renal failure, the so-called substitution renal therapy (RT), which includes program hemodialysis, permanent peritoneal dialysis and kidney transplantation. The methods are complex, they cannot be described here in a nutshell. Mortality among patients with end-stage chronic renal failure is 22% per year.

The conservative stage of chronic renal failure requires the transfer of patients to the II group of disability, the terminal - to the I group.

References:

  1. « Practical Guide to Nephrology» ed. A. S. Chizha, 2001.
  2. « Problems of diagnostics and conservative therapy chronic renal failure", magazine " Medical advice”, No. 11-12 for 2010 http://medi.ru/doc/a240513.htm

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19 comments to the article "Chronic renal failure (CRF)"

    Diabetes mellitus is not main reason HPN.

    On the mentioned page medi.ru/doc/a240513.htm it is claimed that " currently diabetes is the leading cause of development terminal CKD both in developed and developing countries - it is the main disease in 20-40% patients starting renal replacement therapy for the first time.

    They also write on the fence.
    The main cause is essential and symptomatic arterial hypertension. And then diabetes.

    The main cause is essential and symptomatic arterial hypertension. And then diabetes.

    And is it very important? Treatment-resistant hypertension, as a rule, (except for tumors endocrine system, CNS lesions, vascular stenosis) is a consequence of kidney damage.

    Important because both symptomatic and essential are treated effectively. And the presence of a large number of chronic renal failure in the country is a sign of its rapid marginalization and degradation.

    this is no longer a question for medicine ... but for the "country"

    Important because both symptomatic and essential are treated effectively

    POORLY respond to therapy, especially in patients with ESRF. I speak responsibly, because I have to do with it.

    My mother has a terminal stage of chronic renal failure, but she is not given group 1. What law or other document states that the first group is placed at the terminal stage? Something on the Internet I can not find a specific document where this would be clearly indicated.

    The first group of disability is assigned to those patients who cannot serve themselves on their own. If a patient with end-stage renal failure regularly undergoes hemodialysis, then his condition is satisfactory, and he is able to take care of himself.

    If a patient with terminal CRF for some reason lives without renal replacement therapy, then his condition worsens significantly, and here the 1st group of disability may well be put.

    If you do not agree with the decision of the Bureau of Medical and Social Expertise, you can appeal it:
    invalid.ru/expert.htm#appeal

    Group 1 is given to people who have irreversible changes in the body - terminal CRF— is such! And dialysis patients - potential for group 1 disability - definitely! It’s just that in this state the “socially oriented policy” is aimed at eliminating the sick and old ...

    The 1st disability group is given if the patient cannot take care of himself and needs outside help. With regular dialysis should give the 2nd group.

    It is precisely to such doctors that my last words of the commentary apply.

    After all, it is those who sit on the commission who determine how you, the patient, live and how self-service is available to you! They don't see when a dialysis patient is dragged home and also on dialysis! And yet, dialysis is not available in all places - people go God knows where in such a state!

    Interestingly, but they themselves did not try to be in this shoes and “enjoy” disability and still just live on that handout, which they called a pension, the state? Thank God, I got on the commission DOCTOR, MAN! Former military doctor! - He knew for sure that on dialysis - this is 1 group for life!

    And you, dear Emergency Doctor, do not get sick! And remember that NO ONE is immune from such a disaster! Be merciful to the sick, and not to the state - it doesn't matter - they will plunder!

    I am not a member of the commission and will not be able to get into it with all my desire, because they take narrow specialists certain specialties. I'm just trying to convey to patients how they will be looked at and what they can expect.

    Disability is benefits, pension supplements (yes, small, but there are many disabled people) and one of the indicators of health care, so the commission is forced to conduct a strict screening.

    I just have no words for your comment, dear emergency doctor ...

    You try to explain to patients who are in the most difficult life situation about the benefits big number disabled people and so on ... yes, your competence just includes “taking care” of our budget ... So go on, just leave this profession, please don’t treat patients with money in mind, and not about the final result of your profession ...

    Dear my “fellow soldiers” – patients of the hemodialysis department and after transplantation! Living in our country and still finding yourself in a situation of illness, all of you are potentially heroes! Please do not give up, fight for yourself, achieve adequate dialysis and receive all necessary drugs- The Constitution, Laws and the Convention on the Rights of Persons with Disabilities have not yet been canceled! Write to all authorities, to patient nephrological organizations - adequate therapy is the key to the safety of your body!

    Those who got on dialysis - this is 1 gr. disability! Know it! Now, after transplantation, if you came to her with a non-life-long group, they give both groups 2 and 3, so your doctors should write as clearly as possible in the extracts for the commission all vital violations of your health - in detail and truthfully with a recommendation for a high degree of the group! severe diseases of the internal organs, with a progressive course, severe joint deformities, and so on. other

    Know that in the country for a long time already there has been a surplus of budgetary funds, the tax authorities of the regions are collecting a lot of money - and only for the population they will never be! And if you don't make yourself known. apply to the prosecutor's office, the press, etc. - they will simply “forget” about you, and this only plays into the hands of our system - do not let yourself be destroyed!

    Remember that you have loved ones who care about you!

    I live in Belarus, money is tight here. We exist largely thanks to the help of Russia.

    IN Russian Federation The budget surplus is primarily due to high prices for exported oil. If it falls, as it has already happened, the budget will immediately crack at the seams. And what to do when you have to cut sharply social spending how recent in Greece? Psychologically, it is much easier not to receive something at all than to receive it and then return it.

    Whatever the reason for the surplus, sick people should not worry at all - they are citizens of the state! And if there are worthless managers in this state, they need to be changed, the sooner the better.

    In Russia, there is an immensely huge bureaucracy, corruption and fabulous salaries and benefits for officials! And what about the medical market - it's generally Yaroslavna's cry! Even medicines under DLO are actually bought above the commercial retail price, and written off at a price even higher! And you think that patients should take into account something else… Hmm… yes, no, it’s easier to put everything in its place at the place of residence and defend yourself once, another time the officials will not want to contact you. But this is my opinion and my experience - for example, my conscience will not allow me to “rob” my family, forcing me to spend extra money on what can be shaken out of this empty state.

    The fact that somewhere there is some money does not mean that they are in medicine. About 20 cents are allocated for food for one patient per day, the same amount for medicines and about 15 cents per day the doctor receives in his hands for one patient.

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

2) exogenous intoxications (poisons used in national economy and life, bites poisonous snakes and insects, medicines);

4) acute kidney disease ( acute glomerulonephritis and acute pyelonephritis).

5) obstruction urinary tract(acute violation of the outflow of urine);

6) arenal condition (trauma or removal of a single kidney).

Symptoms of acute renal failure

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 clinical course There are several stages of acute renal failure:

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

Stage II - 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, body edema, anemia, and one of characteristic features are progressively increasing azotemia - increased content in the blood of nitrogenous (protein) metabolic products and severe intoxication of the body);

Stage III - recovery:

Phase of early diuresis - the clinic is the same as in stage II;

The phase of polyuria (increased urine production) and restoration of the concentration ability of the kidneys - renal functions are normalized, respiratory and respiratory functions are restored. cardiovascular systems, digestive canal, support and movement apparatus, central nervous system; the stage lasts about two weeks;

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

Chronic renal failure

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

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

Causes of chronic renal failure can be various diseases that lead to damage to the renal glomeruli. This:

  • kidney disease, chronic glomerulonephritis, chronic pyelonephritis;
  • metabolic diseases diabetes mellitus, gout, amyloidosis;
  • congenital diseases kidney 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 that lead to a violation of the outflow of urine from the kidneys urolithiasis disease, 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 biochemical parameters 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 (without surgical intervention) therapy makes it possible to regulate homeostasis, and the general condition of the patient often allows him to still work, but an increase physical activity, mental stress, errors in diet, restriction of drinking, infection, surgery can lead to a deterioration in kidney function and aggravation of symptoms.

4) Terminal (final) stage. This stage is characterized emotional lability(apathy is replaced by excitement), disruption of night sleep, daytime sleepiness, lethargy and inappropriate behavior. Face puffy, grey-yellow, pruritus, there are scratches on the skin, hair is dull, brittle. Dystrophy increases, hypothermia is characteristic ( low temperature bodies). There is no appetite. The voice is hoarse. There is an ammonia smell from the mouth. Arises aphthous stomatitis. 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, occurrence 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. However, acute renal failure is an extremely severe complication 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 a chronic course, important role at the same time the joined pyelonephritis plays.

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

Chronic renal failure should be monitored and treatment initiated at early stages disease, otherwise it can lead to a complete loss 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 with confirmed diagnosis of pyelonephritis, glomerulonephritis, congenital anomalies kidney, systemic disease should be seen regularly 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, everything will be done necessary measures for the treatment and care of the sick.

Treatment of acute renal failure is aimed primarily at eliminating the cause that causes given state. Applicable measures to combat shock, dehydration, hemolysis, intoxication, etc. Patients with acute renal failure are transferred to intensive care unit where they get the help they need.

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