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Chronic renal failure (CRF): stages, symptoms, diagnosis and effective treatment

The content of the article:

Chronic renal failure (hereinafter referred to as chronic renal failure) – serious disease urine excretory system, in which the kidneys are deprived of the ability to fully perform a physiological function - the excretion of nitrogen metabolism products. As a result of impaired excretory ability, these toxins accumulate in the blood rather than being excreted in the urine. Deficiency is considered chronic if it lasts 3 months or longer. The pathology is characterized by irreversible processes - nephrons die, which implies a complete cessation of the activity of the urinary system.

Reasons for the development of chronic renal failure

The development of chronic kidney failure is preceded by more serious factors than excessive salt intake or simple hypothermia. The main causes are pre-existing urinary tract disease. But in some clinical cases, the infection present in the human body may not be associated with the kidneys, although it ultimately affects this paired organ. Then chronic renal failure is defined as a secondary disease.

Diseases leading to kidney failure:

1. Glomerulonephritis (especially chronic form). The inflammatory process covers the glomerular apparatus of the kidneys.
2. Polycystic disease. The formation of multiple vesicles - cysts - inside the kidneys.
3. Pyelonephritis. Inflammation of the kidney parenchyma of bacterial origin.
4. The presence of congenital or acquired (post-traumatic) malformations.
5. Nephrolithiasis. The presence inside the kidneys of multiple or single stone-like deposits - calculi.

The disease develops against the background of such infections and conditions:

Diabetes mellitus of the insulin-dependent type.
Connective tissue damage (vasculitis, polyarthritis).
Viral hepatitis B, C.
Malaria.
Uric acid diathesis.
Increased blood pressure (arterial hypertension).

Also, regular intoxication with medications (for example, uncontrolled, chaotic use of medications) predisposes to the development of chronic renal failure. chemicals(work in paint and varnish production).

Classification of the disease

Like all diseases, chronic renal failure has its own code according to ICD 10. According to the generally accepted system, pathology has the following classification:

N18 Chronic renal failure.
N18.0 – End-stage kidney damage.
N18.8 – Other chronic renal failure.
N18.9 – Chronic renal failure not specified.
N19 – Renal failure not specified.

Each of the codes is used to encrypt the disease in medical documentation.

Pathogenesis and stages of the disease

With chronic renal failure, the ability of the kidneys to excrete products of physiological metabolism and breakdown gradually stops uric acid. The paired organ cannot independently cleanse the blood of toxins, and their accumulation leads to the development of cerebral edema, depletion of bone tissue, and dysfunction of all organs and systems. This pathogenesis is caused by an imbalance of electrolytic metabolism, for the usefulness of which the kidneys are responsible.

Considering the level of concentration of nitrogenous substances in the blood, there are 4 stages of creatinine:

The first stage – the blood creatinine level does not exceed 440 µmol/l.
The second stage - the creatinine concentration corresponds to 440-880 µmol/l.
The third stage – does not reach 1320 µmol/l.
The fourth stage is more than 1320 µmol/l.

Indicators determine laboratory method: The patient donates blood for biochemical testing.

Symptoms of chronic renal failure

At the first stage of the disease, it is almost impossible to detect the disease. The following symptoms are noteworthy:

Increased fatigue, weakness;
urination occurs more often at night, the volume of urine released exceeds daytime diuresis;
dyspeptic disorders occur - periodically nausea, vomiting at this stage occurs rarely;
Itchy skin bothers me.

As the disease progresses, indigestion appears (diarrhea is repeated frequently, preceded by dry mouth), lack of appetite, increased blood pressure (even if the patient had not previously noted such changes in the body). When the disease progresses to a more severe stage, pain occurs in the epigastric region (“in the pit of the stomach”), shortness of breath, loud and rapid heartbeat, and the tendency to bleed increases.

For severe stage of chronic renal failure there is practically no urine output, the patient falls into a coma. If consciousness is preserved, symptoms of the disorder are relevant cerebral circulation(due to persistent pulmonary edema). The immune system is reduced, so there are infectious lesions different organs and systems.

One of the manifestations of chronic renal failure in children is a lag in intellectual and physical development, the inability to absorb even school curriculum, frequent pain due to weak body resistance.

End stage chronic renal failure

Another wording terminal stage CRF – anuric or uremic. At this stage, irreversible consequences occur in the patient’s body, since urea and createnine in the blood are increased to a critical concentration.

To prolong a person’s life, you need to worry about a kidney transplant or regular hemodialysis. Other methods will not have the desired effect at this stage. Considering high cost surgery involving transplantation healthy organ, in the Russian Federation, patients (and their relatives) increasingly prefer to resort to the “artificial kidney” method. The essence of the procedure is that a person with chronic renal failure is connected to a device that cleanses the blood of toxic (poisonous) products: by and large, it performs the same functions that the kidneys would perform independently, but under the condition of full health.
The advantage of hemodialysis compared to a transplant is its cheaper cost, which means accessibility. The disadvantage is the need to undergo the procedure with a certain regularity (it is determined by the doctor).

End-stage chronic renal failure is characterized by the following symptoms:

1. Uremic encephalopathy. Since the nervous system suffers, severe kidney disease affects primarily the condition of its main center - the brain. Memory decreases, the patient is deprived of the ability to perform basic arithmetic operations, insomnia occurs, and difficulties in recognizing close people are relevant.

2. Uremic coma. Occurs at the late stage of chronic renal failure, its development is caused by massive swelling of brain tissue, as well as a persistent increase in blood pressure (overhydration and hypertensive crisis).

3. Hypoglycemic coma. In the majority clinical cases this pathological phenomenon occurs against the background of chronic renal failure in those patients who suffered from diabetes mellitus even before kidney disease. The condition is explained by a change in the structure of the kidneys (wrinkling of the lobes occurs), as a result of which insulin is deprived of the ability to be excreted during metabolism. If the patient's blood glucose level was normal before the development of chronic renal failure, the risk of such a problem is minimal.

4. Restless legs syndrome. The condition is characterized by an imaginary sensation of goosebumps on the surface of the skin of the legs, a feeling of touching them; later muscle weakness develops, in the most severe cases– paresis.

5. Autonomic neuropathy. An extremely complex condition that manifests itself with profuse intestinal upset, predominantly at night. With chronic renal failure in men, impotence occurs; In patients, regardless of gender, there is a high probability of spontaneous cardiac arrest and gastric paresis.

6. Acute pneumonia of bacterial origin. The disease takes on a staphylococcal or tuberculosis form.

7. End-stage chronic renal failure syndrome is characterized by severe problems in the functional activity of the gastrointestinal tract. The mucous tissue of the tongue and gums becomes inflamed; so-called jams appear in the corners of the lips. The patient is constantly bothered by dyspeptic disorders. Due to the fact that food is not digested, a person does not receive the required amount nutrients, and frequent and massive diarrhea, coupled with regularly recurring vomiting, removes a large volume of fluid from the body, anorexia soon occurs. The decisive factor in its development is the practically complete absence appetite due to intoxication of tissues and blood with nitrogenous substances.

8. Acidosis. The pathological phenomenon is caused by the accumulation of phosphates and sulfates in the patient’s blood.

9. Pericarditis. Inflammation outer shell hearts. The disease manifests itself severe pain behind the sternum when a patient with chronic renal failure tries to change body position. To make sure the assumption is correct, the doctor listens to the heart and recognizes a pericardial friction rub. Together with other symptoms, including a feeling of severe lack of air and irregular heart rhythm, pericarditis serves as an indication for immediate hemodialysis for the patient. This level of urgency is explained by the fact that inflammation of the outer lining of the heart, consisting of connective tissue, is a common cause of death in patients with chronic renal failure.

10. Problems with the functioning of the respiratory system.

Complications of the disease: insufficiency of heart function and condition blood vessels, development of infectious processes (usually sepsis). Considering the combination of all the listed signs of the stage under consideration, in general the prognosis for the patient is unfavorable.

Examination of the patient to determine chronic renal failure

Contacting a specialist involves an examination and interview. It is important for the doctor to find out whether any of the patient’s relatives suffered from diseases of the urinary tract. Then follows the main part of the diagnosis, which consists of two subtypes.

Laboratory diagnostics

It is possible to determine whether a patient has a predisposition to the transition of renal failure to a protracted form based on the results of the analysis. The meaning of the disease is that the kidneys cannot cope with their natural function of excreting toxic substances from the body. As a result of this disorder, harmful compounds are concentrated in the blood. To understand how high the content of toxins is in the patient’s body and to determine the degree of impairment of the kidney’s excretory system, the patient will have to undergo the following tests:

1. Blood on clinical trial. In a sample of the material, the laboratory technician will determine a reduced number of red blood cells and an insufficient level of hemoglobin. This combination of indicators indicates the development of anemia. Leukocytosis will also be detected in the blood - an increase in the number of white blood cells This indicates the presence of an inflammatory process.
2. Blood for biochemical testing. The procedure for taking venous blood and subsequent examination of a sample of the material can reveal an increase in the concentration of urea, createnine, potassium, phosphorus and cholesterol. A reduced amount of calcium and albumin will be detected.
3. Blood to determine its clotting ability. The analysis makes it clear that the patient has a tendency to develop bleeding, since blood clotting is impaired.
4. Urine for general clinical examination. Allows you to visualize the presence of protein and red blood cells, on the basis of which you can determine the stage of destructive changes in the kidneys.
5. The Reberg-Toreev analysis allows you to determine the degree of usefulness of the excretory capacity of the kidneys. Thanks to this study, the glomerular filtration rate of the glomeruli is established (under normal condition and kidney function, it corresponds to 80-120 ml/min).

Despite the fact that during the diagnostic process, the urologist (nephrologist) takes into account the results of all types laboratory research, the determining factor is precisely the analysis to determine the filtration rate of the glomeruli of the kidneys.

Instrumental diagnostics

Before receiving data laboratory tests, the patient undergoes the following types of research:

1. Ultrasound of the urinary system. Their condition, size, location, contours, and level of blood supply are determined.
2. X-ray examination with the use of a contrast agent (relevant for the first two stages of development of chronic renal failure).
3. Needle biopsy of the kidneys. The procedure allows you to determine the degree of the disease and the overall prognosis.

If the patient consults a general practitioner, then to plan treatment, a consultation with a nephrologist, ophthalmologist and neurologist will also be required.

Treatment of chronic renal failure

Therapeutic tactics depend on the stage of the disease at the time it is detected by the doctor. First of all, it is important to comply bed rest, avoid physical activity in all its forms. Folk remedies are useless and unsafe here. Treatment is medicinal and is planned very carefully by the doctor. The following effective drugs exist:

Epovitan. The drug is available in a syringe and is a combination of human erythropoietin (produced by the bone marrow) and albumin (a blood protein).

Hofitol. Antiazotemic agent of plant origin.

Lespenefril. Helps remove urea from the body. Administered intravenously or by infusion.

Furosemide. Diuretic. Stimulates urine production by the kidneys. Also helps reduce cerebral edema.
Retabolil. Belongs to the group of anabolic drugs. It is used intramuscularly to remove nitrogenous compounds from the blood.

Ferummlek, ferroplex - iron preparations necessary to increase hemoglobin levels and eliminate anemia.

Antibiotic therapy - ampicillin, carbenicillin.

For severe chronic renal failure, sodium bicarbonate is used ( baking soda) in order to reduce peritoneal dropsy. Hypertension is reduced with drugs such as Dibazol (in combination with Papaverine), Magnesium sulfate. Further treatment– symptomatic: antiemetic drugs, anticonvulsants, nootropics to improve cerebral circulation, sleeping pills to improve the quality and duration of sleep.

Nutrition

To reduce the symptoms of the disease, the doctor will prescribe a special nutrition program for the patient. A diet for chronic renal failure involves eating foods containing fats and carbohydrates. Proteins of animal origin are strictly prohibited, and proteins of plant origin are strictly prohibited in very limited quantities. The use of salt is completely contraindicated.

When drawing up a nutrition program for a patient with chronic renal failure, the doctor takes into account the following factors:

Stage of the disease;
rate of progression;
daily loss of protein through diuresis;
the state of phosphorus, calcium, and water-electrolytic metabolism.

In order to reduce the concentration of phosphorus, dairy products, white rice, legumes, mushrooms and baked goods are prohibited. If the primary task is to regulate the balance of potassium, it is recommended to abandon the content of dried fruits, cocoa, chocolate, bananas, buckwheat, and potatoes in the diet.

Kidney failure becomes protracted if not treated promptly. acute inflammation this paired organ. It is quite possible to prevent complications if you do not interrupt the course prescribed by your doctor and feel an improvement in your well-being. Chronic renal failure in women is a contraindication to pregnancy, since there is a high probability of miscarriage or intrauterine death. This is another reason to take your health more seriously.

CRF is caused by the death of a large number of nephrons, which negatively affects the excretory function of the kidneys and also provokes the development of uremic intoxication. This process is irreversible, and over time leads to exacerbations in various organs.

Causes of chronic renal failure in children and adults - what pathological conditions can provoke chronic renal failure?

In the adult population, this pathology is diagnosed much more often than in children.

According to global medical statistics, the number of patients increases annually by an average of 12%.

In young patients of preschool age, chronic renal failure may be a consequence of congenital defects. However similar phenomenon in practice it is quite rare: children get sick much less often than adults.

There are many factors that can cause chronic renal failure.

1. Chronic kidney damage:

• , during which the glomerular canal of the kidneys is involved in the degenerative process.
• , which is a consequence of the harmful effects of bacterial agents.
• Interstitial nephritis, which is not of a bacterial nature and in which the pyelocaliceal system is damaged.

2. Kidney pathologies due to diseases caused by malfunction of the thyroid gland

Such diseases may be:

• Diabetes
• Gout.
• Errors in the functioning of the thyroid gland.

3. Systemic diseases during which the kidneys are involved in the pathological process:

• Systemic lupus erythematosus.
• Rheumatoid arthritis.
• Systemic scleroderma.

4. Defects in the structure of the urinary system organs from birth:

• Formation of multiple cysts on the kidneys.
• Having one kidney at birth that does not function properly.
• Enlargement of the ureter, which is caused by dystrophy/absence muscle tissue on its layers.

5. Conditions in which the lumen of the urinary tract becomes blocked:

• Reduction in the diameter of the ureters or urethra.
• Malignant or benign neoplasms in the kidneys, prostate gland, urinary tract, bladder.
• The presence of stones in the organs of the urinary system.
• Prostate hyperplasia.

6. Poisoning with chemical agents, which negatively affects kidney function

Video: Chronic kidney disease: can progression be stopped?

Stages of chronic renal failure - signs and symptoms of chronic renal failure

Chronic renal failure goes through several stages in its development, each of which is characterized by a certain set of characteristics:

1. Latent

It is also called the latent stage.

Often this form is detected purely by chance: with a thorough clinical diagnosis.

Symptoms in in rare cases limited to fatigue and weakness at the end of the day.

2. Compensated

The amount of urine excreted increases during the day. If glomerular filtration decreases to 40 ml/min, patients develop anemia.

At the same time, the skin dries out, loses its elasticity, and acquires a yellow tint. During a medical examination, the presence of marks on the skin from scratching is noted.

The symptomatic picture is complemented by a regular feeling of thirst, dry mouth, and fatigue.

3. Intermittent

The main symptom of this stage is acidosis.

The course of the disease has a wave-like nature: relief is replaced by worsening general condition. There is also a decrease defensive reactions body, which leads to exacerbation of existing chronic pathologies.

Characteristic manifestations of the intermittent stage are:

• Decreased appetite.
• Pungent odor from the mouth.
• Bad dream.
• Poor concentration.
• Swelling on the face.
• Nausea and vomiting.
• Significant deterioration of the skin and muscle tissue. In rare cases, patients complain of joint pain.
• Complicated course respiratory diseases. This is due to weakening of the immune system.

4. Terminal

Depending on the clinical picture, this pathology at this stage may have 4 periods:

1. The beginning of the development of oliguria: the volume of urine excreted during the day does not exceed 1 liter.
2. A. Daily diuresis is about 500 ml. On the background this state calcium and sodium accumulate in the body.
3. IN. The symptomatic picture at this stage becomes more expressed forms. The accumulated fluid in the body favors the development of heart failure and pathological breathing (congestive processes in the lungs). Metabolites that are intensively produced destroy the integrity of the gastrointestinal mucosa: the surface of the stomach and intestines is dotted small sores which may bleed periodically. At the same time, the abdomen swells, and attacks of vomiting are common. There are also changes in the stool: it becomes dark and foul-smelling.
4. The level of potassium and magnesium in the blood increases, and signs of uremic intoxication become apparent. Characteristic symptoms are:
   - Uremic pneumonitis.
   — Hallucinations, as well as a slow reaction to external stimuli.
   — Dystrophy of bone tissue, which causes painful sensations in bones and can cause spontaneous fracture. Changes occur in the structure of the bone skeleton.
   — Bleeding various localizations: uterine, intestinal, nasal, and bruises. They are a consequence of blood clotting disorders.
   — Serious disruptions in the functioning of the heart, which manifests itself in the form of shortness of breath, cough, increased heart rate, changes skin pale bluish, swelling of the face, lower and upper extremities.
   — Increased smell of urine from the patient, which is caused by an excess of nitrogenous metabolic products in the body.

At the terminal stage, patients' immunity is greatly weakened, which can lead to the development of cancer.

Patients noticeably lose weight, experience tremors in their hands, and often their mood changes.

In young patients The disease in question does not manifest itself for a long time.

Symptoms for more late stages represented by the following phenomena:

• Retarded physical development: the child grows slowly and practically does not gain weight.
• Paleness and dryness of the skin.
• Frequent attacks of hiccups.
• Diarrhea, flatulence.
• Minor skin injury. The resulting wounds always become inflamed.

The clinical picture of the terminal stage in children is similar to the symptoms of uremia in adults.

Complications and consequences of chronic renal failure - why is the condition dangerous for children and adults?

On advanced stages the main symptom of the disease in question is poisoning of the body with uremic toxins. It is this intoxication that causes damage to almost all systems in the body, and can also provoke coma and death.

Most frequent complications chronic renal failure are:

1. Myocardial infarction.
2. Increased blood pressure levels. Therapeutic measures in this case will be useless.
3. Loss of sensation in the upper and lower extremities.
4. Increased bone fragility. It is a consequence of poor calcium absorption.
5. Decreased sexual desire.

Video: Chronic renal failure

Basic methods for diagnosing chronic renal failure - all tests and studies that the doctor will prescribe

Diagnosing chronic renal failure in people suffering from chronic kidney pathologies is not a problem. Such patients regularly visit the doctor, undergo tests, undergo instrumental studies condition of the urinary system organs.

There are several factors based on which a doctor can determine the presence of chronic renal failure and determine the stage of its development:

• Presence at the patient urological disease within 5 years.
• Decreased urine density and osmolarity.
• Protein in urine.
• Elevated levels of creatinine and urea in the blood.

If the patient turns to the doctor for the first time, then in this case it will not be difficult to diagnose chronic renal failure. The nephrologist, first of all, pays attention to the patient’s complaints, examines his skin, measures blood pressure, palpates the abdomen, and taps the kidneys from the lower back.

Kidneys – important organ urinary system, which is a filter human body. With their help, it is removed from the body excess liquid, medications, breakdown products formed during the digestion process and harmful compounds. Kidney failure- This is a syndrome of impaired renal function and the inability to perform the listed functions.

What is kidney failure? This pathology does not develop independently, and is a consequence of the body’s inability to maintain normal internal processes. Decreased kidney function leads to the slow accumulation of waste products and toxins. This entails intoxication of the body and disruptions in the functioning of other organs and systems. The slow process of “poisoning” the body leads to the fact that the symptoms of renal failure are difficult to diagnose at the beginning of the development of the pathology.

Based on the characteristics of the pathology, acute renal failure and chronic renal failure are distinguished. The first type develops against the background of infections and inflammations already existing in the kidneys. This type is characterized by a sudden appearance and rapid development. Treatment required. In the absence of timely treatment, the acute form of the disease develops into chronic renal failure.

Types of renal failure with acute form leakage:

1. The prerenal type of the disease is the most common. It is characterized by impaired blood flow in the kidneys, which leads to a lack of blood and, as a result, disruption of the process of urine formation.
2. Renal failure occurs due to pathology renal tissue. As a result, the kidney is unable to produce urine. This type is the second most frequently diagnosed.
3. Postrenal pathology indicates the presence of obstacles to the outflow of urine from the kidneys. It is diagnosed quite rarely, since if an obstruction occurs in one urethra, the healthy kidney takes over the functions of the diseased kidney - the disease does not occur.

Causes kidney disease acute form:

1. Causes of prerenal appearance:

• disturbances in the functioning of the heart and its pathologies;
• a sharp decrease in blood pressure against the background of infectious diseases and allergic reactions;
• dehydration of the body with long-term disorders Gastrointestinal tract or violation of taking diuretics;
• liver diseases that lead to impaired blood flow and, as a result, renal and hepatic failure.

2. Renal form and its causes:

• intoxication with toxic substances and chemical compounds;
• disintegration of red blood cells and their coloring matter;
• diseases caused by impaired immune function;
• inflammation in the kidneys;
• vascular disorders of the kidneys;
• injury to a healthy kidney when the functioning of another is impaired.

3. Renal failure causes postrenal form:

• tumor formations of organs genitourinary system;
• injury to the genitourinary system;
• the occurrence of barriers to the outflow of urine.

Chronic renal failure develops as a result of:

• hereditary kidney pathologies;
• renal failure during pregnancy (during intrauterine development);
• kidney complications due to other chronic diseases;
• the formation of barriers to the outflow of urine from the kidneys;
• chronic inflammation in the kidneys;
• overdose of medications;
• poisoning with harmful chemical compounds.

Stages and symptoms of acute renal failure

Acute and chronic renal failure are characterized by different symptomatic picture and the duration of the course. Each type of disease goes through four stages.

Stages of acute renal failure: initial, oliguric, polyuric and complete recovery.

The initial stage is characterized by the start of the process of deformation of the kidney tissue. At this stage, it is difficult to determine the disease, since the patient is concerned about the symptoms of the underlying disease.

The second stage is oliguric. At this stage of pathology development, the condition of the renal tissue deteriorates. The formation of urine and its excreted volume decreases, which leads to the accumulation of substances harmful to humans in the body. The water-salt balance is disturbed. The duration of the severe period of illness is one to two weeks.

Signs of renal failure of the oliguric stage:

• reduction of daily urine to 500 ml;
• pain in the abdomen and lower back;
• loss of appetite, digestive disorders and the appearance of an unpleasant bitter taste in the mouth;
• absent-mindedness and inhibited reaction;
• muscle spasms;
• increased blood pressure, heart rate, shortness of breath;
• in some cases, internal bleeding may occur in the stomach or intestines;
• decreased immunity and development of related infectious diseases organs of other systems.

The polyuric stage is characterized by restoration of the patient’s general health and an increase in the volume of daily urine excreted. However, at this stage there is high danger development of dehydration of the body after the second stage and infection of the weakened body.

Restoration of kidney function and the general condition of the patient occurs at the last stage. This stage usually takes a long period - from six months to a year. In case of significant deformation of the kidney tissue, complete recovery is impossible.

Stages and symptoms of the chronic form

Renal failure - stages in a chronic form: latent, compensated, decompensated and terminal.

At the first stage of the chronic form, it is possible to recognize the disease only by passing general analysis blood and urine. The first will show changes in electrolyte composition, the second will indicate the presence of protein in urine.

Compensated stage

At the second compensated stage, the following symptoms occur:

• weakness and rapid loss of strength;
• constant feeling of thirst;
• disturbance of urination (increased urge, especially at night, increased volume of urine excreted).

There is a dramatic deterioration in blood and urine counts. Thus, urine tests indicate an increase in nitrogen, urine, creatinine, protein and salts.

At chronic pathology the kidneys gradually shrink

Decompensated renal failure symptoms:

• weakening of the body;
• sleep disturbance (constant drowsiness or insomnia);
• decreased reactions;
• constant desire to drink;
• dryness of the oral mucosa;
• lack of appetite;
• disorders of the digestive system;
• swelling of the face and lower extremities;
• the occurrence of dryness, peeling, itching of the skin;
• bowel dysfunction;
• decreased immunity, resulting in an increased likelihood of developing diseases of various natures;
• deterioration of blood and urine parameters.

Terminal stage

In end-stage renal failure, the following symptoms are noted:

• the accumulation of toxins leads to deviations in all urine parameters;
• the patient is diagnosed with urine in the blood - poisoning occurs;
• lack of urination;
• deterioration of work and development of pathologies of other organs and systems, hepatic-renal failure develops;
• lack of appetite and normal sleep;
• memory impairment;
• depression.

Diagnostics

Kidney failure - diagnosis begins with a doctor examining the patient and collecting information about the patient's health status. During the examination, the doctor examines the condition of the skin and the smell of the mouth. During the interview, it is necessary to find out whether the patient has cramps, abdominal and lower back pain, what is the quality of sleep and appetite.

Next stage diagnostic procedures includes: general and bacteriological urine analysis, general and biochemical blood analysis.

In acute and chronic renal failure, urine density changes, an increase in protein levels, red and white blood cells. An increase in red blood cells in urine may indicate the formation of kidney stones and urinary ducts, tumor neoplasms and injuries of the genitourinary system. An increase in leukocytes in the urine indicates the development of infections and inflammation.

A bacteriological analysis of urine will help to identify the causative agent of the infectious disease, as well as determine its resistance to antibacterial agents.

Renal dysfunction syndrome is diagnosed when there is an increase in white blood cells in the blood, a decrease in the number of red blood cells and an imbalance in plasma protein fractions. Also pathological condition can lead to the development of anemia and a decrease in platelets.

In the acute form of the disease, the results biochemical analysis blood indicate changes in the mineral balance, as well as an increase in the products of creatine-phosphate reactions and a decrease in blood acidity.

In case of chronic insufficiency, the indicators of a biochemical blood test are as follows:

• growth of urea, nitrogen, products of creatine-phosphate reactions, minerals and cholesterol;
• decrease in calcium and protein levels.

The next stage of diagnosing renal failure includes ultrasound examination with Doppler ultrasound, computed tomography and magnetic resonance imaging. These methods make it possible to study the condition and structure of the kidneys, urinary tract and Bladder. Also, using these studies, it is possible to determine the cause of narrowing of the ureters or the occurrence of an obstacle to the outflow of urine.

Dopplerography is necessary to assess the condition and patency of the renal vessels

In addition to the basic methods of diagnosing the disease, the doctor may prescribe additional studies:

1. X-ray chest necessary to determine the condition lower organs breathing.
2. Renal syndrome can be diagnosed using contrast - chromocystoscopy. A special substance is injected into the patient's vein, which leads to a change in the color of urine, then using an endoscope inserted through urethra, perform a study of the bladder.
3. When the diagnosis cannot be made using the main diagnostic methods listed above, a kidney tissue biopsy may be performed. This type of study involves examining kidney tissue under a microscope. To do this, a special needle is inserted through the skin into the kidney.
4. To determine abnormalities in the functioning of the heart muscle, the patient is given a referral for electrocardiography.
5. In the chronic form, a patient with renal failure must take a urine test according to Zimnitsky. To do this, throughout the day you need to collect urine in eight containers (3 hours for each). The Zimnitsky test allows you to determine kidney dysfunction, urine density, as well as the ratio of the volume of night-time and daytime urine.

Treatment

Based on the data obtained during the diagnosis, the causes of renal failure are determined, which will be treated. When choosing the direction of treatment, it is also important to determine the stage of the disease. Therapy is always carried out comprehensively and in a hospital under the supervision of the attending physician.

Kidney failure requires comprehensive and effective treatment. In case of significant blood loss, a blood transfusion should be started. This method It is also most effective for serious disorders in the functioning of organs and systems.

The renal form of the disease is treated depending on the symptoms:

1. In case of malfunctions immune system administered intravenously hormonal drugs or medications that stimulate the production of hormones by the adrenal cortex.
2. Renal insufficiency with high blood pressure is treated by taking blood pressure-lowering medications.
3. When the syndrome of liver and kidney failure is caused by poisoning with harmful toxic and chemical compounds, the patient needs blood purification using hemosorption or plasmapheresis and gastric lavage. After the procedures, sorbents are prescribed.
4. The renal form, which arises against the background of infectious kidney diseases, can be treated only with the use of antibiotics and antiviral drugs.
5. For diabetes, treatment includes lowering blood sugar levels by taking medications and following a special diet.
6. When the pathology is accompanied by a decrease in hemoglobin, the patient is prescribed iron and vitamins. It is also necessary to increase the proportion of iron-containing foods in the diet.
7. Diuretics are used to normalize urine output.
8. If the water-electrolyte balance is disturbed, the patient is prescribed medications with a high mineral composition.

It is most often possible to treat postrenal renal failure only by surgical intervention, since the cause of the pathology is an obstacle to the outflow of urine.

Treatment of chronic renal failure is aimed at eliminating the root cause of the disease.

Disease prevention

In addition to basic treatment methods, prevention of renal failure is important, which includes:

• exclusion of physical activity during the recovery period;
• rejection of bad habits;
• try to avoid stressful situations;
• maintain bed rest;
• eat according to your doctor’s recommendations (follow a diet);
• if necessary, achieve weight loss;
• treat concomitant diseases.

1. Reduce your intake of protein foods, which put stress on the kidneys.
2. Eat more carbohydrates (vegetables, cereals, sweets), which are necessary to maintain strength.
3. Limit salt intake.
4. Drink enough fluid.
5. Eliminate legumes, nuts, and mushrooms from your diet.
6. Limit consumption of coffee and chocolate.

Thus, the syndrome of kidney dysfunction is called renal failure. Develops as a consequence of infectious, inflammatory diseases, disturbances in the outflow of urine and other reasons. There are two forms of pathology: acute and chronic. The stages of renal failure in acute and chronic forms are different and are characterized by different symptoms.

Treatment for each type of disease is different and should be aimed at eliminating the cause of the pathology and its consequences.

Chronic renal failure (CRF) is a serious disease that leads to irreversible impairment of kidney function. Treatment of the pathology should be started at an early stage, because without helping your health, the kidney tissues die, the body suffers from intoxication, and the consequences of this condition can be fatal.

Treatment of chronic renal failure

If a patient is diagnosed, the filtration and excretory functions of the kidneys are seriously impaired. This leads to the accumulation of nitrogenous wastes in the blood, which in a healthy person are excreted from the body in the urine. The diagnosis of chronic renal failure is made if the disease has existed for more than 3 months. The causes are inflammatory and autoimmune pathologies kidney, diabetes mellitus, viral hepatitis, urolithiasis and many other pathologies.

Comprehensive treatment of pathology is extremely important. The earlier it is started, the faster the water-salt balance will be corrected, and, if possible, the causes of renal failure will be eliminated.

Without adequate therapy exacerbations of kidney disease are possible, and the progression of the death of renal nephrons will become inevitable. With chronic renal failure, a person is given disability. People with any stage of the disease are sent to the commission, and after the necessary examinations, one or another disability group is assigned.

The selection of treatment methods will depend on the degree of fall:

1. In the first stages, with filtration rates up to 40-15 ml/minute, conservative therapy is possible.
2. At the terminal stage with filtration rates less than 15 ml/minute, hemodialysis or kidney transplantation is recommended.

Basic principles

The goals of therapy for chronic renal failure are:

• Recovery normal environment body ( water-salt balance, composition of microelements).
• Reduced symptoms.
• Reducing the presence of nitrogen metabolism products in the blood.
• Removing stagnant harmful toxins from tissues.
• Reducing the burden on healthy people.
• Correction of blood pressure.
• Optimization of urine formation and excretion.

If possible, the underlying disease that caused the development of renal failure is treated. For example, when urolithiasis remove stones from the kidneys, when hormone therapy, for pyelonephritis, intensive antibiotic therapy is carried out. On initial stage In case of renal failure, it is usually sufficient to eliminate the causes, because kidney damage is reversible. At the second stage, medications are used to reduce the rate of development of chronic renal failure; at the third, existing complications are treated using procedures and medications. In more severe stages, only surgery or constant dialysis can help a person.

Patients with renal failure are given a special daily regimen, since physical activity, heavy lifting, and stress are contraindicated. It is necessary to follow a special diet, with sufficient rest and adequate drug treatment. This approach usually allows one to achieve stable remission, and, if the causes of the pathology are eliminated, recovery. Typically, therapy is carried out at home; only in the terminal stage or with exacerbation of chronic renal failure is hospitalization necessary.

• Avoid taking medications with nephrotoxic effects.
• Sanitation of sources of infection in the body.
• Taking drugs to bind protein metabolites in the intestine.
• Adequate fluid intake.
• Correction of acidosis, anemia, osteodystrophy and other complications.
• Spa treatment.

Drug therapy

The intake or administration of any medications must be combined with regular testing. This is necessary to monitor indicators of renal concentration function, urea, creatinine, and glomerular filtration.

To correct electrolyte imbalances, the patient may need the administration of potassium chloride (if hypokalemia develops). On the contrary, if there is an excess of potassium, the drug Resonium is taken, and glucose with insulin is administered intravenously.

In order to reduce the products of protein metabolism in the body, the following drugs are prescribed:

1. Sorbents. Absorb ammonia and other toxins. Enterodes, Karbolen, Polysorb are used.
2. Colon lavage with sodium bicarbonate, glucose, potassium chloride, taking xylitol and sorbitol as laxatives.
3. Antiazotemic agents (Hofitol, Lespenefril). Needed to increase the release of nitrogen metabolism products.
4. Antihypertensive drugs to lower blood pressure. Diuretics are used (Lasix, Furosemide), as well as Dopegin, Clonidine, Inderal, Obzidan, Capoten.
5. Anemia drugs. The patient is recommended iron supplements (Conferon, Ferroceron), androgens (increase the production of red blood cells - Testosterone, Sustanon), in severe cases - transfusion of red blood cells.
6. Vitamins to restore normal functioning of organs and systems. Multivitamin complexes are recommended.
7. Medicines for the treatment of uremic osteodystrophy (Calcium D3, vitamin D, Oxidevit, Osteochin). Necessary for normalizing calcium and phosphorus levels.
8. Treatment of infectious complications. This direction of therapy is required when an infection occurs. Aminoglycosides are usually used as the most non-toxic antibiotics for the kidneys - Kanamycin, Tobramycin, Gentamicin, as well as nitrofurans (Furamag, Furadonin).
9. Hormonal therapy. Prescribed for glomerulonephritis or after a kidney transplant (Prednisolone, Methylprednisolone).

Traditional methods

Treatment folk remedies can only help sick kidneys maintain their functions, but we must not forget about taking medications. Before starting such treatment, consultation with a doctor is mandatory.

Recipes traditional medicine with chronic renal failure they may be:

1. Mix a tablespoon of mint, St. John's wort, lemon balm, calendula, 2 tablespoons of the mixture, pour 600 ml of water in a thermos, leave for 2 hours. Take 100 ml of infusion twice a day. This remedy is especially recommended if renal failure has developed against the background of chronic pyelonephritis.
2. Combine equal parts of hawthorn fruits, laurel leaves, parsley roots, dill seeds, rose hips. Brew a tablespoon of the mixture in a thermos with 300 ml of water, leave for 4 hours. Drink the collection for any form of illness, 50 ml three times a day.
3. Grind the watermelon rinds, pour half a liter of water into 3 tablespoons of pieces. Leave for an hour and drink this liquid instead of water. This method will be needed to flush the kidneys and remove harmful substances from the body.

In the video, traditional methods of treating chronic renal failure:

Physiotherapy

Physiotherapy methods are usually aimed at influencing the underlying disease and improving the functioning of the renal nephrons. They may be included in complex treatment CRF, if prescribed by the attending physician. Physiotherapy improves the outflow of urine, relieves kidney spasms if present, and reduces the severity of inflammation.

Usually practiced the following types physiotherapy:

• Therapeutic baths;
• Reception of mineral waters;
• Amplipulse therapy;
• Magnetotherapy;
• Electrophoresis of various preparations.

Replacement therapy

When glomerular filtration rates decrease below 15-5 ml/minute, the kidneys should be treated with replacement therapy methods. If available, the decision to proceed with dialysis can be made even at higher rates.

Indications for hemodialysis in chronic renal failure:

• Hyperkalemia more than 6.5-7 mmol/l.
• The creatinine content is above 700-1200 mmol/l.

Hemodialysis or peritoneal dialysis is recommended for the patient. Hemodialysis is the main treatment for end-stage renal failure. It is based on the removal from the blood into a special solution of harmful substances that are retained in the body during uremia. The device is used " artificial kidney» - hemodialyzer - and a device for supplying the solution.

Most often, hemodialysis is performed in a hospital, but there are devices for home use. When plasma is filtered through a semi-permeable membrane, its duration is from 4 hours, and the number of procedures is at least 3 per week.

Peritoneal dialysis is carried out by introducing into abdominal cavity a special catheter through which the solution is injected into the peritoneum. As a result of the operation of the device, all harmful elements are removed from the blood. After the solution remains in the peritoneum for several hours, it is excreted. The procedure can be done even at home, but once a month you need to carefully examine the medical institution. In the final phase of end-stage chronic renal failure, the patient is indicated for a kidney transplant, which improves the prognosis for 10-20 years or more.
Description of the hemodialysis procedure:

Medical nutrition

The diet is selected individually and depends on the stage of the disease and kidney function indicators. The most important point in therapy is correction water regime(less than 2 liters per day) and reducing the amount of table salt in the diet. A low-protein diet is used - the amount of animal proteins and phosphorus in the menu is seriously reduced, which reduces the severity of complications and slows down the progression of renal failure.

The amount of protein in the diet does not exceed 20-60 g, depending on the severity of the disease. The calorie content of the diet should be sufficient, but the amount of potassium is strictly controlled. The diet of a person with chronic renal failure includes very limited white bread, rice, nuts, cocoa, and mushrooms and legumes are completely excluded. Lean meat is consumed in small quantities, fatty meat is completely excluded. If there is an excess of potassium in the blood, bananas, dried fruits, potatoes, and parsley are removed from the menu. Along with the diet, patients are advised to take the amino acid substitute Ketosteril, which does not affect nitrogen metabolism. Products such as: fresh vegetables, fruits, with the exception of those rich in potassium, cereals, dietary soups, low-fat fish.

Positive effect of a meloprotein diet in chronic renal failure

Rehabilitation

Unfortunately, even the diagnosis itself - chronic renal failure - implies the further course and development of the disease, except in cases of complete elimination of its cause. Therefore, a person will have to learn to live with this pathology and change their lifestyle. Many will have to undergo dialysis, while everyone needs to follow a diet and stop smoking and drinking alcohol. A person’s nutrition must be strictly scheduled, calculated in relation to the amount of salt and protein. You should strictly monitor your blood pressure and do exercises if recommended by your doctor. It is imperative to undergo regular examinations to adjust the doses of medications and types of treatment.

It is customary to divide kidney failure into acute and chronic.

Causes and symptoms of acute renal failure

Acute renal failure (ARF) develops as a result of infectious diseases, injuries, blood loss, diarrhea, toxic effects of poisons or certain medicines. Main symptoms of acute renal failure:

• reducing the amount of urine excreted to 300-500 ml. per day;
• increase in nitrogenous metabolic products in the blood (azotemia);
• diarrhea;
• changes in blood pressure;
• nausea, vomiting;
• available pulmonary edema with the appearance of severe shortness of breath and moist rales;
• drowsiness, obvious lethargy;
• predisposition due to decreased immunity to the development of infectious diseases - pneumonia, sepsis, stomatitis, pneumonia.

Causes and symptoms of chronic renal failure

Chronic renal failure (CRF) is an irreversible impairment of the functional activity of the kidneys, resulting from necrosis of their tissue and death of nephrons. Develops against the background of kidney stones, polycystic disease, chronic forms of glomerulonephritis and pyelonephritis, diabetes mellitus and other pathologies affecting the kidneys.

Symptoms of chronic renal failure:

• latent stage: visible signs there is no pathology, according to the test results, proteinuria can be detected, sometimes absent-mindedness, lethargy and lethargy are observed;
• compressed stage: manifested by reduced density of urine with a simultaneous increase in its volume, thirst, dry mucous membranes, fatigue, increased levels of urea and creatinine;
• intermittent stage: glomerular filtration rate decreases significantly, acidosis develops (shift acid-base balance organism), azotemia, creatinine level increases greatly.;
• terminal stage: signs of heart failure, increasing edema, congestive process in internal organs and tissues, intoxication and poisoning of the body with unremoved metabolic products, often accompanied by infectious complications, anemia, a characteristic odor of ammonia from the mouth, vomiting, and diarrhea.

Treatment of acute renal failure

Medical care for patients with acute renal failure consists primarily in eliminating the causes of acute renal dysfunction and in carrying out symptomatic treatment: lowering blood pressure, replenishing the volume of circulating blood, removing stones, tumors, cleansing the body of poisonous toxins using plasmapheresis and hemosorption (cleansing the blood of harmful impurities and poisons).

To facilitate the outflow of urine, diuretics are prescribed. At the same time, strict control is maintained over the liquid drunk and excreted in the urine. Patients are prescribed a diet that excludes protein foods and limits potassium in food. Mandatory antibacterial therapy. To prevent the development of complications of acute renal failure, hemodialysis with the organization dynamic observation for the most important indicators - blood pressure, pulse, respiratory rate, etc.

Possible complications and consequences:

• hyperkalemia (increased potassium content in blood plasma);
• bradycardia - a type of arrhythmia, decreased heart rate;
• anemia;
• decreased immunity;
• development of infectious diseases, sepsis;
• violations by nervous system: alternation of apathy and lethargy with attacks of anxiety, excitement and fear;
• congestive heart failure;
• gastroenterocolitis, bleeding.

Treatment of chronic renal failure

The sooner a patient with chronic renal failure seeks help, the less severe the symptoms of the disease and the risk of complications. It is very important to determine the cause of the development of chronic renal failure and do everything possible to eliminate the effect of the underlying disease on kidney function.

Drugs that normalize blood pressure, support cardiac activity, and antibacterial agents are used. It is recommended to follow a protein-free, high-calorie diet, with sodium restriction and sufficient amino acid content in food. In the terminal stage, it is advisable to perform hemodialysis or kidney transplantation.

Complications of chronic renal failure:

• defeat peripheral nerves;
• osteoporosis, arthritis;
• damage to the stomach and intestines due to impaired excretory function of the kidneys and accumulation of metabolic products, with the development of ulcers, gastritis and colitis;
• decreased immunity;
• myocarditis, pericarditis;
• arterial hypertension.

Prevention of kidney failure

Prevention of renal failure should consist of a thorough examination of persons with hereditary nephropathies or chronic infectious and inflammatory pathologies of the kidneys. Upon receipt severe injuries, burns, after toxic effects on the body, it is necessary to contact the nearest medical facility as soon as possible.

Kidney failure completely changes a person's life. This disease forces you to reconsider past habits, change your diet, and take a more responsible approach to your health. A lot depends on the patient’s behavior. Renal failure is not a death sentence at all, even in the final stages of pathology, when hemodialysis and surgical treatment. This disease requires timely treatment. The prognosis and effectiveness of therapy depend on this. The desire of the sick person to be cured and to live full life, combined with well-chosen drug treatment, can overcome renal failure or make it less severe and life-threatening.

Video

Symptoms and treatment of kidney failure.