Signs of kidney failure. Symptoms of acute renal failure. Diet for acute renal failure

Complications

Patients with kidney failure can experience serious complications if not treated correctly.

Renal failure means a syndrome in which all functions relevant to the kidneys are disrupted, resulting in a disorder various types exchanges in them (nitrogen, electrolyte, water, etc.). Kidney failure, the symptoms of which depend on the course of this disorder, can be acute or chronic, each of the pathologies develops due to exposure great friend from other circumstances.

general description

The main functions of the kidneys, which in particular include the functions of removing metabolic products from the body, as well as maintaining the balance in the acid-base state and water-electrolyte composition, directly involve renal blood flow, as well as glomerular filtration in combination with the tubules. In the latter version, the processes consist of concentration ability, secretion and re-absorption.

What is noteworthy is that not all changes that may affect the listed variants of the processes are the obligatory cause of subsequent pronounced disturbances in kidney function; accordingly, any disturbance in the processes cannot be defined as renal failure, which interests us. Thus, it is important to determine what renal failure actually is and on the basis of what specific processes it is advisable to distinguish it as this type of pathology.

So, by renal failure we mean a syndrome that develops against the background of severe disorders in the renal processes, in which we're talking about about a disorder of homeostasis. Homeostasis generally refers to the maintenance at a level of relative constancy of the internal environment characteristic of the body, which in the variant we are considering is attached to its specific area - that is, to the kidneys. At the same time, azotemia (in which there is an excess of protein metabolic products in the blood, which includes nitrogen), disturbances in the body’s general acid-base balance, as well as disturbances in the water-electrolyte balance, become relevant in these processes.

As we have already noted, the condition we are interested in today can arise against the background of the influence of various causes; these causes, in particular, are determined by what type of renal failure (acute or chronic) we are talking about.

Renal failure, the symptoms of which in children manifest themselves similarly to those in adults, will be discussed below in terms of the course of interest (acute, chronic) in combination with the reasons that provoke their development. The only point that I would like to note against the background of the commonality of symptoms is that in children with a chronic form of renal failure, growth retardation, and this connection has been known for quite a long time, noted by a number of authors as “renal infantilism.”

The actual reasons that provoke such a delay have not been fully elucidated, however, the loss of potassium and calcium against the background of effects provoked by acidosis can be considered as the most likely factor leading to it. It is possible that this also occurs due to renal rickets, which develops as a result of the relevance of osteoporosis and hypocalcemia in the condition under consideration in combination with the lack of conversion to the required form of vitamin D, which becomes impossible due to the death of renal tissue.

• Acute renal failure :
  • Shock bud. This state is achieved through traumatic shock, which manifests itself in combination with massive tissue damage, which occurs as a result of a decrease in the total volume of circulating blood. This condition is provoked by: massive blood loss; abortions; burns; a syndrome that occurs against the background of muscle crushing with their crushing; blood transfusion (in case of incompatibility); wasting vomiting or toxicosis during pregnancy; myocardial infarction.
  • Toxic kidney. In this case, we are talking about poisoning that occurred due to exposure to neurotropic poisons (mushrooms, insects, snake bites, arsenic, mercury, etc.). Among other things, intoxication with radiopaque substances, medications (analgesics, antibiotics), alcohol, and narcotic substances is also relevant for this option. The possibility of acute renal failure in this variant of the provoking factor cannot be ruled out, given the relevance of professional activities directly related to ionizing radiation, as well as heavy metal salts (organic poisons, mercury salts).
  • Acute infectious kidney. This condition is accompanied by the impact of infectious diseases on the body. So, for example, an acute infectious kidney - current status with sepsis, which, in turn, can have a different type of origin (primarily anaerobic origin is relevant here, as well as origin against the background of septic abortions). In addition, the condition in question develops against the background of hemorrhagic fever and leptospirosis; with dehydration due to bacterial shock and such infectious diseases like cholera or dysentery, etc.
  • Embolism and thrombosis, relevant to the renal arteries.
  • Acute pyelonephritis or glomerulonephritis.
  • Ureteral obstruction, caused by compression, the presence of tumor formation or stones in them.

It should be noted that acute renal failure occurs in about 60% of cases as a result of injury or surgery, about 40% occurs during treatment in medical institutions, and up to 2% during pregnancy.

• Chronic renal failure:
  • Chronic form of glomerulonephritis.
  • Secondary kidney damage caused by the following factors:
    • arterial hypertension;
    • diabetes;
    • viral hepatitis;
    • malaria;
    • systemic vasculitis;
    • systemic diseases affecting connective tissues;
    • gout.
  • Urolithiasis, obstruction of the ureters.
  • Renal polycystic disease.
  • Chronic form of pyelonephritis.
  • Current anomalies associated with the activity of the urinary system.
  • Exposure due to a number of medications and toxic substances.

Leadership in the positions of the causes provoking the development of chronic renal failure syndrome is assigned to chronic glomerulonephritis and the chronic form of pyelonephritis.

Acute renal failure: symptoms

Acute renal failure, which we will further abbreviate to the abbreviation ARF, is a syndrome in which there is a rapid decrease or complete cessation of kidney functions, and these functions can decrease/stop in one kidney or in both at the same time. As a result of this syndrome, metabolic processes are sharply disrupted, and an increase in products formed during nitrogen metabolism is noted. Relevant disorders of the nephron, which is defined as a structural renal unit, in this situation arise due to a decrease in blood flow in the kidneys and, at the same time, due to a decrease in the volume of oxygen delivered to them.

The development of acute renal failure can occur either within literally a few hours or within a period of 1 to 7 days. The duration of the condition that patients experience with this syndrome can be 24 hours or more. Timely request for medical care with subsequent adequate treatment, it can ensure complete restoration of all functions in which the kidneys are directly involved.

Turning, in fact, to the symptoms of acute renal failure, it should initially be noted that in the overall picture in the foreground there is precisely the symptomatology that served as a kind of basis for the occurrence of this syndrome, that is, from the disease that directly provoked it.

Thus, we can distinguish 4 main periods that characterize the course of acute renal failure: the shock period, the period of oligoanuria, recovery period diuresis in combination with the initial phase of diuresis (plus the polyuria phase), as well as the recovery period.

Symptoms first period (mostly its duration is 1-2 days) is characterized by the already noted above symptoms of the disease that provoked the OPS syndrome - it is at this moment in its course that it manifests itself most clearly. Along with it, tachycardia and a decrease in blood pressure are also noted (which in most cases is transient, that is, soon stabilizing to normal indicators). Chills occur, pale and yellow skin is noted, and body temperature rises.

Next, second period (oligoanuria, the duration is usually about 1-2 weeks), is characterized by a decrease or absolute cessation of the process of urine formation, which is accompanied by a parallel increase in residual nitrogen in the blood, as well as phenol in combination with other types of metabolic products. What is noteworthy is that in many cases it is during this period that the condition of most patients improves significantly, although, as already noted, there is no urine. Already later there are complaints of severe weakness and headache, in patients the appetite and sleep worsen. Nausea with accompanying vomiting also appears. The progression of the condition is indicated by the smell of ammonia that appears during breathing.

Also, in acute renal failure, patients experience disorders associated with the activity of the central nervous system, and these disorders are quite diverse. The most common manifestations of this type are apathy, although the opposite option is not excluded, in which, accordingly, patients are in an excited state, having difficulty navigating the environment that surrounds them; a general confusion of consciousness can also be a companion to this state. In frequent cases, convulsive seizures and hyperreflexia are also observed (that is, revival or strengthening of reflexes, in which, again, patients are in an overly excitable state due to an actual “shock” to the central nervous system).

In situations where acute renal failure occurs against the background of sepsis, patients may develop a herpetic-type rash concentrated in the area around the nose and mouth. Skin changes in general, they can be very diverse, manifesting both in the form of an urticarial rash or fixed erythema, and in the form of toxicoderma or other manifestations.

Almost every patient experiences nausea and vomiting, and somewhat less frequently, diarrhea. Especially often certain phenomena on the part of digestion occur in combination with hemorrhagic fever along with renal syndrome. Lesions of the gastrointestinal tract are caused, first of all, by the development of excretory gastritis with enterocolitis, whose nature is defined as erosive. Meanwhile, some of the current symptoms are caused by disturbances arising from the electrolyte balance.

In addition to the listed processes, there is the development of edema in the lungs, resulting from increased permeability, which the alveolar capillaries have during this period. It is difficult to recognize it clinically, so diagnosis is made using an x-ray of the chest area.

During the period of oligoanuria, the total volume of urine excreted decreases. So, initially its volume is about 400 ml, and this, in turn, characterizes oliguria; then, with anuria, the volume of urine excreted is about 50 ml. The duration of oliguria or anuria can be up to 10 days, but some cases indicate the possibility of increasing this period to 30 days or more. Naturally, with protracted manifestations of these processes, active therapy is required to maintain human life.

During the same period, acute renal failure becomes a constant manifestation, in which, as the reader probably knows, hemoglobin drops. Anemia, in turn, is characterized by pale skin, general weakness, dizziness and shortness of breath, and possible fainting.

Acute renal failure is also accompanied by liver damage, and this occurs in almost all cases. As for the clinical manifestations of this lesion, they consist of yellowness of the skin and mucous membranes.

The period during which there is an increase in diuresis (that is, the volume of urine formed within a certain time period; as a rule, this indicator is considered within 24 hours, that is, within the framework of daily diuresis) often occurs several days after the end of oliguria/anuria. It is characterized by a gradual onset, in which urine is initially excreted in a volume of about 500 ml with gradual increase, and after that, again, gradually, this figure increases to a mark of about 2000 ml or more per day, and it is from this moment that we can talk about the beginning of the third period of acute renal failure.

WITH third period improvements in the patient’s condition are not immediately observed; moreover, in some cases the condition may even worsen. The phase of polyuria in this case is accompanied by weight loss of the patient, the duration of the phase is on average about 4-6 days. There is an improvement in the appetite of patients; in addition, previously relevant changes in the circulatory system and the functioning of the central nervous system disappear.

Conventionally, the beginning of the recovery period, that is, the next fourth period disease, the day of normalization of urea or residual nitrogen levels is noted (as determined based on appropriate tests), the duration of this period ranges from 3-6 months to 22 months. During this period of time, homeostasis is restored, renal concentration function and filtration improve, along with an improvement in tubular secretion.

It should be taken into account that over the next year or two it is possible that signs indicating functional failure in certain systems and organs (liver, heart, etc.) will persist.

Acute renal failure: prognosis

Acute renal failure, if it does not cause death for the patient, ends with a slow but, one might say, confident recovery, and this does not indicate the relevance for him of a tendency to transition to the development of chronic kidney disease against the background of this condition.

After about 6 months, more than half of the patients reach the state full recovery disability, however, the option of its limitation for a certain part of patients is not excluded, on the basis of which they are assigned disability (group III). In general, ability to work in this situation is determined based on the characteristics of the course of the disease that provoked acute renal failure.

Chronic renal failure: symptoms

CRF, as we will further periodically define the considered variant of the course of chronic renal failure syndrome, is a process indicating an irreversible impairment to which kidney function has been subjected for a duration of 3 months or longer. This condition develops as a result of the gradual progression of the death of nephrons (structural and functional units of the kidneys). Chronic renal failure is characterized by a number of disorders, and in particular these include disturbances in excretory function (directly related to the kidneys) and the appearance of uremia, which occurs as a result of the accumulation of nitrogenous metabolic products in the body and the toxic effects they have.

On initial stage CRF has insignificant, one might say, symptoms, therefore it can only be determined on the basis of appropriate laboratory testing. Already obvious symptoms of chronic renal failure appear at the time of death of about 90% of the total number of nephrons. The peculiarity of this course of renal failure, as we have already noted, is the irreversibility of the process with the exception of subsequent regeneration of the renal parenchyma (that is, the outer layer from the cortex of the organ in question and the inner layer, presented in the form of the medulla). In addition to structural kidney damage against the background of chronic renal failure, other types of immunological changes cannot be excluded. The development of an irreversible process, as we have already noted, can be quite short (up to six months).

With chronic renal failure, the kidneys lose the ability to concentrate urine and dilute it, which is determined by a number of actual lesions of this period. In addition, the secretory function characteristic of the tubules is significantly reduced, and when the terminal stage of the syndrome we are considering is reached, it is completely reduced to zero. Chronic renal failure consists of two main stages, this is the conservative stage (in which, accordingly, it remains possible conservative treatment) and the stage, in fact, terminal (in this case the question arises regarding the choice replacement therapy, which consists of either extrarenal cleansing or a kidney transplant procedure).

In addition to disorders associated with the excretory function of the kidneys, disruption of their homeostatic, blood purification and hematopoietic functions also becomes relevant. Forced polyuria (increased urine production) is noted, on the basis of which one can judge a small number of still surviving nephrons performing their functions, which occurs in combination with isosthenuria (in which the kidneys are unable to produce urine with a higher or lower specific gravity). Isosthenuria in this case is a direct indicator that renal failure is in its final stages own development. Along with other processes relevant to this condition, chronic renal failure, as can be understood, also affects other organs in which, as a result of processes characteristic of the syndrome in question, changes similar to dystrophy develop with simultaneous disruption of enzymatic reactions and a decrease in reactions of an immunological nature.

Meanwhile, it should be noted that the kidneys in most cases do not lose the ability to completely excrete water entering the body (in combination with calcium, iron, magnesium, etc.), due to the corresponding influence of which adequate activities of other bodies.

So, now let's move directly to the symptoms that accompany chronic renal failure.

First of all, patients experience a pronounced state of weakness, drowsiness and general apathy predominate. Polyuria also appears, in which about 2 to 4 liters of urine are excreted per day, and nocturia, characterized by frequent urination at night time. As a result of this course of the disease, patients are faced with dehydration, and as it progresses, with the involvement of other systems and organs of the body in the process. Subsequently, weakness becomes even more pronounced, accompanied by nausea and vomiting.

Among other manifestations of symptoms, one can highlight the puffiness of the patient’s face and severe muscle weakness, which in this state occurs as a result of hypokalemia (that is, a lack of potassium in the body, which, in fact, is lost due to processes relevant to the kidneys). The skin condition of patients is dry, itching appears, excessive agitation is accompanied by excessive sweating. Muscle twitching also appears (in some cases reaching cramps) - this is already caused by loss of calcium in the blood.

Bones are also affected, which is accompanied by pain, disturbances in movement and gait. The development of this type of symptomatology is caused by a gradual increase in renal failure, balance in calcium levels and reduced glomerular filtration function in the kidneys. Moreover, such changes are often accompanied by changes in the skeleton, even at the level of a disease such as osteoporosis, and this occurs due to demineralization (that is, a decrease in the content of mineral components in bone tissue). The previously noted pain in movements occurs against the background of the accumulation of urates in the synovial fluid, which, in turn, leads to the deposition of salts, as a result of which this pain in combination with inflammatory reaction and occurs (this is defined as secondary gout).

Many patients experience chest pain, which can also appear as a result of fibrous uremic pleurisy. In this case, when listening to the lungs, wheezing may be noted, although more often this indicates the pathology of pulmonary heart failure. Against the background of such processes in the lungs, the possibility of secondary pneumonia cannot be ruled out.

Anorexia developing with chronic renal failure can cause patients to develop an aversion to any food, also combined with nausea and vomiting, the appearance of an unpleasant taste in the mouth and dryness. After eating, you may feel fullness and heaviness in the pit of the stomach - along with thirst, these symptoms are also characteristic of chronic renal failure. In addition, patients experience shortness of breath, often high blood pressure, and frequent pain in the heart area. Blood clotting decreases, which causes not only nosebleeds, but also gastrointestinal bleeding, with possible skin hemorrhages. Anemia also develops against the background general processes, affecting the composition of the blood, and in particular, leading to a decrease in the level of red blood cells in it, which is relevant for this symptom.

Late stages of chronic renal failure are accompanied by attacks of cardiac asthma. Edema forms in the lungs, consciousness is impaired. As a result of a number of these processes, the possibility of coma cannot be excluded. An important point There is also the susceptibility of patients to infectious effects, because they easily fall ill with both common colds and more serious diseases, against the background of which the general condition and renal failure, in particular, only worsen.

In the preterminal period of the disease, patients experience polyuria, while in the terminal period there is predominantly oliguria (some patients experience anuria). Kidney functions, as you can understand, decrease with the progression of the disease, and this happens until they disappear completely.

Chronic renal failure: prognosis

The prognosis for a given variant of the course of the pathological process is determined largely on the basis of the course of the disease, which gave the main impetus for its development, as well as on the basis of complications that arose during the process in a complex form. Meanwhile, important role For prognosis, the current phase (period) of chronic renal failure for the patient with its rate of development is also assigned.

Let us highlight separately that the course of chronic renal failure is not only an irreversible process, but also a steadily progressive one, and therefore a significant prolongation of the patient’s life can only be said if he is provided with chronic hemodialysis or a kidney transplant is performed (we will dwell on these treatment options below).

Of course, cases in which chronic renal failure develops slowly with a corresponding clinical picture of uremia cannot be excluded, but these are rather exceptions - in the vast majority of cases (especially with high arterial hypertension, that is high blood pressure) the clinic of this disease is characterized by its previously noted rapid progression.

Diagnosis

As the main marker taken into account in the diagnosis acute renal failure , emit an increase in the level of nitrogenous compounds and potassium in the blood, which occurs with a simultaneous significant decrease in urine output (up to the complete cessation of this process). An assessment of the concentrating ability of the kidneys and the volume of urine excreted during the day is based on the results obtained from the Zimnitsky test.

An important role is also played biochemical analysis blood for electrolytes, creatinine and urea, because it is on the basis of indicators for these components that one can draw specific conclusions regarding the severity of acute renal failure, as well as how effective the methods used in treatment are.

The main task of diagnosing acute renal failure comes down to determining this form itself (that is, its specification), for which an ultrasound of the area is performed Bladder and kidneys. Based on the results of this research measure, the relevance/absence of ureteral obstruction is determined.

If necessary, to assess the state of renal blood flow, an ultrasound ultrasound procedure is performed, aimed at an appropriate study of the renal vessels. A kidney biopsy may be performed if acute glomerulonephritis, tubular necrosis, or systemic disease is suspected.

Regarding diagnostics chronic renal failure, then it uses, again, urine and blood analysis, as well as the Rehberg test. As a basis for confirming chronic renal failure, data indicating a reduced level of filtration, as well as an increase in the level of urea and creatinine are used. In this case, performing the Zimnitsky test determines isohyposthenuria. Ultrasound of the kidney area in this situation reveals thinning of the kidney parenchyma while simultaneously decreasing in size.

Treatment

• Treatment of acute renal failure

Initial phase

First of all, the goals of therapy come down to eliminating the causes that led to disturbances in the functioning of the kidneys, that is, to treating the underlying disease that provoked acute renal failure. If shock occurs, it is urgent to ensure replenishment of blood volumes while simultaneously normalizing blood pressure. Poisoning with nephrotoxins implies the need to lavage the patient’s stomach and intestines.

Modern methods of cleansing the body of toxins have various options, and in particular, the method of extracorporeal hemocorrection. Plasmapheresis and hemosorption are also used for this purpose. In the case of actual obstruction, the normal state of urine passage is restored, which is ensured by removing stones from the ureters and kidneys, and surgically eliminating tumors and strictures in the ureters.

Oliguric phase

Osmotic diuretics, furosemide, are prescribed as a method to stimulate diuresis. Vasoconstriction (that is, narrowing of the arteries and blood vessels) against the background of the condition in question is carried out through the administration of dopamine, in determining the appropriate volume of which not only losses from urination, bowel movements and vomiting are taken into account, but also losses from breathing and sweating. Additionally, the patient is provided with a protein-free diet with limited intake of potassium from food. Wounds are drained and areas with necrosis are eliminated. The selection of antibiotics involves taking into account the overall severity of renal damage.

Hemodialysis: indications

The use of hemodialysis is relevant if urea levels increase to 24 mol/l, as well as potassium to 7 or more mol/l. Symptoms of uremia, as well as overhydration and acidosis are used as indications for hemodialysis. Today, in order to avoid complications that arise against the background of actual disturbances in metabolic processes, hemodialysis is increasingly prescribed by specialists for early stages as well as for prevention purposes.

This method itself consists of extrarenal blood purification, which ensures the removal of toxic substances from the body while normalizing disturbances in electrolyte and water balance. To do this, the plasma is filtered using a semi-permeable membrane for this purpose, which is equipped with an “artificial kidney” apparatus.

• Treatment of chronic renal failure

At timely treatment Chronic renal failure, oriented towards the result in the form of stable remission, often has the possibility of a significant slowdown in the development of processes relevant to this condition with a delay in the appearance of symptoms in its characteristic pronounced form.

Early-stage therapy is focused more on those measures that can prevent/slow down the progression of the underlying disease. Of course, the underlying disease requires treatment for disorders in the renal processes, but it is the early stage that determines the greater role for therapy aimed at it.

As active measures in the treatment of chronic renal failure, hemodialysis (chronic) and peritoneal dialysis (chronic) are used.

Chronic hemodialysis is aimed specifically at patients with this form of renal failure; we noted its general specifics somewhat above. Hospitalization is not required, but a visit to a dialysis unit in a hospital or outpatient center cannot be avoided in this case. The so-called dialysis time is defined within the standard framework (about 12-15 hours/week, that is, for 2-3 visits per week). After completing the procedure, you can go home; this procedure has virtually no effect on the quality of life.

As for peritoneal chronic dialysis, it consists of introducing a dialysate solution into abdominal cavity through the use of a chronic peritoneal catheter. This procedure does not require any special installations; moreover, the patient can carry it out independently in any conditions. Control over general condition produced every month at a direct visit to the dialysis center. The use of dialysis is relevant as a treatment for the period during which a kidney transplant procedure is expected.

Kidney transplantation is the procedure of replacing a diseased kidney with a healthy kidney from a donor. What is remarkable is that one healthy kidney can cope with all those functions that could not be provided by two diseased kidneys. The issue of acceptance/rejection is resolved by conducting a series of laboratory tests.

Any member of the family or environment, as well as a recently deceased person, can become a donor. In any case, the chance of the body rejecting the kidney remains even if the necessary indicators in the previously noted study are met. The likelihood of an organ being accepted for transplantation is determined by various factors (race, age, health status of the donor).

In about 80% of cases, a kidney from a deceased donor survives within a year from the date of surgery, although if we are talking about relatives, the chances of a successful outcome of the operation increase significantly.

Additionally, after kidney transplantation, immunosuppressants are prescribed, which the patient must take constantly throughout his subsequent life, although in some cases they cannot affect organ rejection. In addition, there are a number side effects from taking them, one of which is a weakening of the immune system, due to which the patient becomes especially susceptible to infectious effects.

If symptoms appear that indicate the possible relevance of renal failure in one form or another of its course, consultation with a urologist, nephrologist and attending physician is necessary.

Renal failure (acute and chronic) is a symptom complex leading to rapid or gradual death of nephrons and reduction functionality renal parenchyma.

The disease is life-threatening because it etiological treatment does not exist.

Kinds

Types of kidney failure:

1. Chronic;
2. Spicy.

Chronic kidney failure develops due to the gradual death of nephrons.

Its prevalence in the human population is 300-600 cases per 1 million population.

Acute kidney failure is characterized by a rapid decrease in glomerular filtration, a stable increase in urea and creatinine, hyperkalemia, and metabolic acidosis.

If renal failure is prevented in time, kidney function can be completely preserved, but in most patients the disease enters a chronic stage, in which alternating periods of remissions and exacerbations are observed over several years.

Depending on the pathogenesis, there are the following types renal failure:

1. Prerenal;
2. Renal;
3. Postrenal.

Prerenal renal failure occurs due to changes in the state of the efferent and afferent arterioles of the renal nephron, which is accompanied by a disturbance in the intensity of blood flow in the nephrons.

The filtration rate is not impaired until the intrarenal pressure decreases below 70 mmHg. There are medications that lead to narrowing of arterioles (non-steroidal anti-inflammatory drugs, ACE inhibitors). They are prescribed to prevent a drop in intrarenal pressure.

The renal etiology of the disease occurs in the presence of inflammatory changes in the interstitium, nephron death and viral infections (papillomovirus, HIV).

Renal causes of insufficiency occur even with high blood pressure. In intensive care patients, the cause of failure is sepsis (bacterial blood poisoning).

Postoperative etiological factors:

• Tubular necrosis;
• Stones in the urinary tract;
• Kidney tumors;
• Anomalies of the ureteropelvic segment.

Postrenal causes provoke chronic renal failure in most patients. Only urolithiasis causes an acute urinary block, in which there is a strong dilation of the pelvis and ureter above the narrowing.

Causes

The etiological factors of the disease differ in children, adults and the elderly. If the child’s pathology is caused exclusively by congenital structural anomalies urinary system, then in adults the etiology is more diverse:

• Pyelonephritis (chronic and acute);
• Hypertonic disease;
• Diabetes;
• Obstructive oncological diseases;
• Atherosclerosis;
• Impact of drugs.

In Europe, 20% of kidney failure is due to diabetic nephropathy. In Africa, the cause of the disease is schistosome nephropathy, malaria and HIV infection.

All causes of kidney failure can be divided into 3 groups:

1. Reduced blood flow in the kidneys (40-70%);
2. Damage to the renal parenchyma (10-45%);
3. Narrowing of the urinary tract (8-10%).

The following conditions lead to a decrease in blood flow in the nephrons - collapse and shock. The death of nephrons in the renal parenchyma occurs due to the intake of toxic poisons, the use of drugs (tetracyclines), and insect and snake bites. Infectious diseases can also lead to inflammation of the renal parenchyma (acute and chronic pyelonephritis).

Impaired glomerular filtration of the kidneys

Narrowing of the urinary tract is caused by urolithiasis and congenital narrowing of the ureter. A similar situation arises when traumatic injury kidneys

The causes of chronic renal failure are somewhat different:

• Metabolic diseases (amyloidosis, gout, diabetes);
• Congenital kidney diseases (arterial anomalies, polycystic disease);
• Rheumatic diseases (systemic lupus erythematosus, vasculitis, scleroderma);
• Vascular diseases (hypertension, atherosclerosis);
• Diseases with impaired urine outflow (tumor, hydronephrosis, gout).

Did you know that pyelonephritis and polycystic disease can cause the development? Read about the causes of chronic renal failure in children and adults, as well as how the disease manifests itself in the early stages.

Read about how chronic renal failure manifests itself in children. Symptoms in children and consequences of kidney failure.

And here you can find out how a seemingly harmless salt diathesis, if left untreated, can lead to urolithiasis and kidney failure.

Symptoms of kidney failure

Stages of acute renal failure:

1. Initial– symptoms occur immediately after exposure to the etiological factor and continue until pronounced lesion kidney tissue. Clinical signs the initial stage of the pathology can be considered nausea, pallor and pain in the abdomen;
2. Oligoanuric– combined with partial or complete anuria (lack of urine output). Symptoms of the pathology are combined with the accumulation of creatinine and urea in the blood, as well as the end products of protein metabolism - nitrogenous compounds. Against the background of blood intoxication, swelling of the extremities, damage to the brain and heart appears, which is manifested by dementia and increased heart rate;
3. Restorative stage during early diuresis is manifested by symptoms of oligoanuria, which gradually decrease. The next stage is polyuria, which is accompanied by an increase in urinary volume. The duration of symptoms is about 2 weeks. The final stage of the pathology is the restoration of renal activity, but the degree of regeneration depends on the number of nephrons that have retained functionality. This stage can last up to a year.

Stages of acute renal failure

Stages of chronic renal failure:

1. Latent – external symptoms kidney damage is not observed. The person has no complaints, and fatigue during physical activity and dry mouth are the only signs of the disease;
2. Compensated- accompanied by an increase in the daily volume of urine above 2.5 liters. There is an increase in creatinine and urea in the blood;
3. Intermittent- a decrease in the functionality of the kidneys leads to an increase in nitrogen metabolism. At the same time, there is an increase in the level of creatinine and urea. Against the background of these symptoms, fatigue, vomiting and nausea, dry mouth, and decreased appetite are observed. If the skin turns yellow, anemia is likely to occur. At the same time there are muscle cramps, there is a tremor of the fingers, swelling of the extremities appears;
4. Terminal– there are symptoms of damage not only to the kidney tissue, but also to all internal organs: insomnia, swelling of the face, brittle hair, dystrophy muscle tissue, hoarseness of the voice, ammonia breath appears, diarrhea, an increase in uric acid, creatinine and electrolyte composition of the blood.

In renal failure, damage to internal organs occurs gradually. Not only the severity, but also the multiplicity of lesions leads to death.

Even at the initial stage of the pathology, damage to the nervous system is detected in the form of encephalopathy (depression, decreased memory and intelligence).

External signs of the disease

Before sending the patient to laboratory test, you can determine the external signs of renal failure.

Early symptoms of kidney damage:

• Frequent fatigue;
• Epigastric pain;
• Nocturnal urination;
• Tonic muscle contractions;
• Itching on the skin;
• Headache;
• Decreased vision;
• Fundus changes.

During an external examination of the patient, you should pay attention to the pallor of the skin and the appearance of small petechial rashes on the skin. When decreasing muscle mass the amount of nitrogen compounds in the blood increases due to the breakdown of muscle protein.

Secondary syndromes of renal failure:

1. Cerebral – brain damage leads to the following symptoms: headache, hearing loss, insomnia and emotional lability;
2. Dyspeptic - anorexia with the appearance of an unpleasant odor in the mouth, a feeling of heaviness, nausea and eating disorders. Pathological process V gastrointestinal tract leads to the appearance of erosive and ulcerative defects;
3. Hemorrhagic - minor bleeding and large hemorrhages in different parts bodies;
4. Anemic – leads to a decrease in the number of red blood cells and hemoglobin. External signs anemia - yellowness of the skin, dry mouth and itching of the skin;
5. Serous - the presence of effusion and fibrous plaque on the visceral membranes lungs and internal organs. Specific signs of pathology are friction noise of the pleura and pericardium;
6. Osteoarticular - formed due to impaired absorption of calcium in the intestine. Symptoms of this form are joint pain, limitation of movements and pathological fractures;
7. Cardiovascular - develops against the background of increased blood pressure, left ventricular failure and an increase in toxins in the blood. Damage to the heart muscle is characterized by an increase in its thickness and general expansion of the myocardium (dilatation);
8. Urinary – combined with low glomerular filtration, kidney inflammation and the presence of protein in the urine.

In chronic renal failure, urinary and hemorrhagic syndrome first develops. Subsequent manifestations of the pathology depend on the time of its detection and treatment tactics.

Complications

Complications of kidney failure:

1. Vascular thrombosis;
2. Edema of the lungs and lower extremities;
3. Increased pressure;
4. Damage to the heart muscle;
5. Thickening of the walls of blood vessels;
6. Myocardial ischemia;
7. Brain hemorrhage;
8. Microhematuria (streaks of blood in the urine);
9. Progressive glomerulonephritis;
10. Pyelonephritis.

Diagnostics

Diagnosis of renal failure is based on the following methods:

• Complete blood count (leukocytosis, eosinophilia and thrombocytopenia);
• Zimnitsky test (hypoisosthenuria);
• Biochemical blood test (increased gamma globulins, creatinine and urea);
• Rehberg test (increased tubular reabsorption and glomerular filtration);
• Echocardiography (extension P-Q interval, extension P);
• Ultrasound (increase in kidney size).

Difficulties are caused by the early diagnosis of renal failure, when specific changes are not visible in the tests; it is difficult to establish a diagnosis.

Conservative treatment

Conservative treatment for renal failure involves the following principles:

• Etiological and symptomatic drugs;
• Diet therapy;
• Intravenous infusions.

If there is an increased level of nitrogenous compounds in the blood, it should be excluded from the diet. protein products. In the initial stages, protein intake is limited to 0.8 grams per day. With the progression of pathology, the norm decreases to daily dose 0.5 grams. In severe cases of the disease, the dosage of the protein substrate in the menu should be even less.

If an increase in blood pressure occurs against the background of insufficiency, the prescription of diuretics (hypochlorothiazide, furosemide), ACE inhibitors, calcium blockers and other antihypertensive drugs is required.

These drugs are contraindicated in renal failure.

When conservative measures fail to eliminate blood toxicity, hemodialysis and peritoneal dialysis are recommended. By connecting a device called " artificial kidney“It is possible to temporarily filter toxic compounds from the blood.

Treatment with folk remedies

Treatment of renal failure is carried out with the following folk remedies:

• Lingonberry juice;
• Bearberry decoction;
• Burdock root;
• Dill and fennel;
• Horsetail;
• Flax seed;
• Rose hip decoction;
• Strawberry leaves.

Here is one of the popular folk recipes Treatment of kidney failure with burdock root:

1. Grind the burdock root to a powder;
2. Pour a glass of boiling water over a spoonful of the mixture;
3. Drink during the day.

The use of this recipe and other analogues that are diluted with water requires taking into account the amount of daily urine. You should not consume more fluid than your daily urine output.

Diet for kidney failure

Features of nutrition in renal failure:

1. Limiting protein foods;
2. Including vegetable and butter in the menu (50-100 grams per day);
3. Dairy products are excluded;
4. High-calorie meals are taken in portions (6 times a day);
5. Limiting salt;
6. Fluid intake is equal to daily losses.

Forecast

If treatment of the disease is started in the early stages, the patient can be returned to normal life. Reversible acute failure kidneys. In the chronic version, there is a danger of loss of full kidney functionality with the need for subsequent organ transplantation.

Surely you will be interested in learning about what can manifest itself differently depending on the stage of the disease. About when to start dialysis treatment and whether it is possible to do without it.

Read about the dangers of kidney doubling. Is it possible to get pregnant with this diagnosis and how dangerous is it?

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