Chronic renal failure - Causes, symptoms and treatment. MF.

Renal failure is a violation of the excretory function of the kidneys with the accumulation of nitrogenous slags in the blood, normally removed from the body with urine. Can be acute and chronic.

Chronic renal failure ( CRF) is a syndrome of irreversible renal dysfunction that occurs for 3 or more months. It occurs as a result of the progressive death of nephrons, as a consequence of chronic kidney disease. Characterized by a violation of the excretory function of the kidneys, the formation of uremia associated with the accumulation in the body and toxic effects of products of nitrogen metabolism( urea, creatinine, uric acid).

Causes of chronic renal failure

1. Chronic glomerulonephritis( damage to the glomerular apparatus of the kidneys).
2. Secondary kidney damage caused by:
- type 1 and type 2 diabetes mellitus;
- arterial hypertension;
- systemic diseases of connective tissue;
- viral hepatitis "B" and / or "C";
- systemic vasculitis;
- gout;
- malaria.
3. Chronic pyelonephritis.

4. Urolithiasis, obstruction of the urinary tract.
5. Anomalies in the development of the urinary system.
6. Polycystic kidney disease.
7. Effect of toxic substances and drugs.

Symptoms of chronic renal failure

Initial chronic renal failure is low-symptomatic and can be detected only in laboratory studies. Only with the loss of 80-90% of nephrons there are signs of chronic renal failure. Early clinical signs may be weakness, fatigue. Appears nocturia( rapid urination at night), polyuria( excretion of 2-4 liters of urine per day), with possible dehydration. As the progression of renal insufficiency is involved in the process, almost all organs and systems. Weakness increases, there is nausea, vomiting, skin itching, muscle twitching.

Patients complain of dryness and bitterness in the mouth, lack of appetite, pain and heaviness in the epigastric region, loose stools. Disturb shortness of breath, pain in the heart, increases blood pressure. Violated blood clotting, resulting in nasal and gastrointestinal bleeding, skin hemorrhage.

In later stages, there are attacks of cardiac asthma and pulmonary edema, impaired consciousness, even to a coma. Patients are prone to infections( catarrhal diseases, pneumonia), which in turn accelerate the development of renal failure.

The cause of renal failure may be progressive liver damage, a combination called the Hepatorenal Syndrome).In this case, there is a development of renal failure in the absence of clinical, laboratory or anatomical signs of any other causes of kidney dysfunction. Such renal failure is usually accompanied by oliguria, the presence of a normal urine sediment and a low concentration of sodium in the urine( less than 10 mmol / l).The disease develops with advanced liver cirrhosis complicated by jaundice, ascites and hepatic encephalopathy. Sometimes this syndrome can be a complication of fulminant hepatitis. When the liver function improves, the kidneys often improve with this syndrome.

Important in the progression of chronic renal failure: food intoxication, surgical interventions, trauma, pregnancy.

Diagnosis of chronic renal failure

Laboratory studies.

1. The general blood test shows anemia( decrease of hemoglobin and erythrocytes), signs of inflammation( acceleration of ESR - sedimentation rate of erythrocytes, a moderate increase in the number of leukocytes), a tendency to bleeding( decrease in the number of platelets).
2. Biochemical blood tests - increase in the level of nitrogen metabolism products( urea, creatinine, residual nitrogen in the blood), violation of electrolyte metabolism( increase in potassium, phosphorus and calcium loss), the total protein in the blood decreases, hypocoagulation( decrease in blood coagulability),increase in blood cholesterol, total lipids.
3. Urinalysis - proteinuria( the appearance of protein in the urine), hematuria( the appearance of erythrocytes in the urine more than 3 in the field of view with microscopy of urine), cylindruria( indicates the degree of kidney damage).
4. The Reberg-Toreeva test is performed to assess the excretory function of the kidneys. With the help of this sample, the glomerular filtration rate( GFR) is calculated. It is this indicator is the main one for determining the degree of renal failure, the stage of the disease, since it reflects the functional state of the kidneys.

Currently, not only the Reberga-Toreev test, but also special calculation methods that take into account the age, body weight, gender, level of creatinine of the blood are used to determine GFR.

It should be noted that at present, the term CKD( chronic kidney disease) is used instead of the term CRF, considered obsolete and characterizing only the fact of irreversible renal dysfunction, with a mandatory indication of the stage. It should be especially emphasized that the establishment of the presence and stage of CKD does not in any case replace the formulation of the main diagnosis.

Stage of the disease:

CKD( chronic kidney disease) I: renal damage with normal or increased GFR( glomerular filtration rate)( 90 mL / min / 1.73 m2).There is no chronic renal failure;
CKD II: Kidney damage with a moderate decrease in GFR( 60-89 ml / min / 1.73 m2).The initial stage of chronic renal failure.
CKD III: Kidney damage with an average reduction in GFR( 30-59 mL / min / 1.73 m2).CRF is compensated;
CKD IV: renal involvement with a significant reduction in GFR( 15-29 ml / min / 1.73 m2).CRF decompensated( not compensated);
CKD V: renal damage with terminal CRF( & lt; 15 mL / min / 1.73 m2).

Instrumental Research.

1. Ultrasound examination of the urinary system with pulse dopplerometry( determination of renal blood flow).Carried out for the diagnosis of chronic kidney disease, and allows you to assess the severity of kidney damage.
2. Puncture biopsy of the kidneys. The examination of the kidney tissue allows you to make an accurate diagnosis, determine the course of the disease, assess the degree of kidney damage. Based on this information, a conclusion is made about the prognosis of the course of the disease and the choice of the method of treatment.
3. X-ray( overview, contrast) study of the kidneys is carried out at the stage of diagnosis and only for patients with I-II degree of renal insufficiency.

Consultations:

1. Nephrologist( for diagnosis and choice of treatment tactics).All patients with renal insufficiency are examined.
2. The oculist( monitors the condition of the fundus).
3. Neurologist( with suspected involvement of the nervous system).

Treatment of chronic renal failure

Each stage of renal failure involves the implementation of specific actions.

1. In the 1st stage, the main disease is treated. Kupirovanie exacerbation of the inflammatory process in the kidneys reduces the severity of the phenomena of renal failure.
2. In Stage II, along with the treatment of the underlying disease, the rate of progression of renal failure is assessed and drugs are used to reduce its rate. These include lespenefril and hofitol are preparations of plant origin, the dose and frequency of administration is prescribed by the attending physician.
3. In the ІІІ stage, possible complications are detected and treated, drugs are used to slow the progression of renal failure. Carry out correction of arterial hypertension, anemia, calcium - phosphate disorders, treatment of infectious and cardiovascular complications.
4. In the IV stage, the patient is prepared for renal replacement therapy
5. and at V stage, renal replacement therapy is performed.

Replacement renal therapy includes hemodialysis and peritoneal dialysis.

Hemodialysis is an extrahepatic method of blood purification, during which toxic substances are eliminated from the body, normalizes violations of water and electrolyte balances. This is done by filtering blood plasma through the semipermeable membrane of the "artificial kidney" apparatus. Treatment with maintenance hemodialysis is carried out at least 3 times a week, with a duration of one session for at least 4 hours.

Hemodialysis

Peritoneal dialysis .The abdominal cavity of a person lining the peritoneum, which serves as a membrane through which water and dissolved substances enter it. A special catheter is inserted surgically into the abdominal cavity through which the dialysis solution enters the abdominal cavity. There is an exchange between the solution and the blood of the patient, as a result of which harmful substances and excess water are removed. The solution is there for several hours, and then merges. This procedure does not require special facilities and can be performed independently by the patient at home, during travel.1 time a month is inspected in a dialysis center for monitoring. Dialysis is used as treatment for the period of waiting for kidney transplantation.

Peritoneal dialysis for chronic renal failure

All patients with stage V chronic kidney disease are considered candidates for kidney transplantation.

Kidney Transplantation

Nutrition for Chronic Renal Failure

Diet in renal failure plays a very important role. It is determined by the stage, chronic disease, phase( exacerbation, remission).The attending physician( nephrologist, therapist, family doctor) together with the patient make up a diary of nutrition with indication of the quantitative and qualitative composition of the food.

The low protein diet with restriction of the use of animal proteins, phosphorus, sodium promotes inhibition of the progression of renal failure, reduces the possibility of complications. The use of protein should be strictly metered.

At stage I, the amount of protein consumed should be 0.9-1.0 g per kg of body weight per day, potassium to 3.5 grams per day, phosphorus to 1.0 g per day. In Stage II, the amount of protein reduced to 0.7 g per kg of body weight per day, potassium to 2.7 grams per day, phosphorus to 0.7 g per day. In the ІІІ, ІV and V stages the amount of protein was reduced to 0.6 g per kg of body weight per day, potassium to 1.6 g per day, phosphorus to 0.4 g per day. Preference is given to proteins of plant origin, in which the phosphorus content is lower. Soy proteins are recommended.

The main components in the diet of patients are fats and carbohydrates. Fats - preferably of vegetable origin, in sufficient quantities, to ensure the calorie content of food. The source of carbohydrates can be products of vegetable origin( except for legumes, mushrooms, nuts).When raising the blood level of potassium is excluded: dried fruits( dried apricots, raisins), potatoes( fried and baked), chocolate, coffee, bananas, grapes, rice. To reduce the consumption of phosphorus, animal proteins, beans, mushrooms, white bread, milk, rice are limited.

Complications of renal insufficiency

The most common complications of renal failure are infectious disease( up to the development of sepsis) and cardiovascular insufficiency.

Prevention of renal failure

Preventive measures include the timely detection, treatment and observation of diseases leading to the development of renal failure. Most often, renal insufficiency occurs in diabetes mellitus( type 1 and type 2), glomerulonephritis and hypertension. All patients with renal insufficiency are observed with a nephrologist. They undergo examinations: blood pressure monitoring, eye examination, body weight control, electrocardiogram, ultrasound of the abdominal cavity organs, blood and urine tests, receive recommendations on lifestyle, rational employment, nutrition.

Doctor's consultation on renal failure

Question: How are kidney biopsies performed?
Answer: The procedure is conducted by a nephrologist in a specialized medical institution( more often in the department of nephrology).Under local anesthesia, under the control of the ultrasound probe, a small one-shot needle is taken by a tiny column of kidney tissue. In this case, a doctor performing a biopsy, sees on the screen the kidney and all the movements of the needle. Contraindications to the conduct of puncture biopsies of the kidneys are:
1. single kidney;
2. hemorrhagic diathesis;
3. polycystic kidney disease;
4. purulent inflammation of the kidney and pericarp cell( purulent pyelonephritis, paranephritis);
5. Kidney tumors;
6. Kidney tuberculosis;
7. patient's refusal to conduct a study.

Question: Are there age or other limitations for kidney transplantation?
Answer: Age can not be an obstacle to the operation. The psychological readiness of the candidate for transplantation matters. It is determined by its ability to perform medical recommendations after kidney transplantation, since non-compliance with the regime of immunosuppressant treatment is the most common cause of loss of the transplanted kidney. Absolute contraindications for transplantation are: sepsis, AIDS, uncontrolled malignant neoplasms.

Doctor therapist Vostrykova I.N.