Renal failure is a gradual decline in renal function, which is caused by the death of nephrons, provoked by chronic diseases. The gradual fading of functions can lead, as a rule, to disruption of the whole organism, as well as to the appearance of various complications from some systems and organs.
There are several forms of this pathology: latent, intermittent, compensated and terminal. Diagnostic measures to determine this disease include special clinical and biochemical tests, Reberg and Zimnitsky tests, ultrasound, ultrasound of the kidney vessels, etc. The treatment of this pathology is based on the fight against the underlying disease, as well as symptomatic treatment and extracorporeal hemocorrection.
Chronic form
Chronic renalinsufficiency is considered an irreversible violation of their excretory and filtration functions, up to the complete death of the renal tissue. The pathological process has a progressive course. With the development of the disease, an increase in its symptoms is observed, which are weakness, loss of appetite, vomiting, swelling, nausea, dry skin, etc. Diuresis sharply decreases, in some cases - until its complete cessation. In the later stages, heart failure, pulmonary edema, a tendency to bleeding, encephalopathy, and uremic coma may develop. In this case, the patient is shown hemodialysis and kidney removal.
Causes of kidney failure
What are the reasons? Depending on them, acute renal failure is divided into:
- Prerenal. It arose due to impaired renal blood flow.
- Renal. The reason is the pathology of the kidney tissue.
- Postrenal. The outflow of urine is impaired due to an obstruction in the urethra.
Chronic form due to:
- Congenital and hereditary kidney disease.
- Kidney lesions in chronic pathologies. These include gout, urolithiasis, diabetes mellitus, metabolic syndrome, scleroderma, liver cirrhosis, obesity, systemic lupus erythematosus, etc.
- Various pathologies of the urinary system, when the urinary tract gradually overlaps: tumors, urolithiasis.
- Kidney disease: chronic glomerulonephritis, chronic pyelonephritis.
- Misuse, overdosemedicines.
- Chronic poisoning with toxic substances.
Pathogenesis
Renal failure can be the result of glomerulonephritis, hereditary nephritis, inflammation of the kidneys in systemic diseases of chronic pyelonephritis, amyloidosis or polycystic disease, glomerulosclerosis in diabetes mellitus, nephroangiosclerosis and a number of other diseases that affect both or one kidney at once.
The main characteristic of this pathological process is the progression of nephron death. At an early stage of the disease, renal functions become more weakened, after which there is a significant decrease in their functions. Histological studies confirm the death of the kidney parenchyma, which is gradually replaced by connective tissue cells.
What precedes this?
The development of kidney failure in a patient is usually preceded by the onset of chronic diseases in the period from 3 to 10 years, and sometimes more. The development of kidney pathology before the onset of their chronic insufficiency is conditionally divided into certain stages, and the choice of tactics for treating this disease directly depends on them.
Disease classification
The following stages of this pathological process are distinguished:
- Latent stage. In this period, the disease proceeds without particularly pronounced symptoms. As a rule, it is detected only after the results of an in-depth clinical study. Glomerular filtration of the kidneysin this case, it is reduced to 60-70 ml / min. There is also some proteinuria.
- Compensated stage of renal failure. At this stage, the patient is concerned about fatigue and a feeling of dry mouth. The volume of urine increases with a decrease in its density. The decrease in the level of glomerular filtration is up to 50-40 ml / min. Creatinine and urea levels also rise.
- Intermittent stage of chronic renal failure. There are pronounced clinical symptoms of the disease. There are specific complications that are caused by an increase in kidney failure. The patient's condition may change in waves. Glomerular filtration during this period decreases to 25-15 ml / min., acidosis and persistence of high creatinine levels are observed.
- Terminal renal failure. It, in turn, is divided into four stages:
- I. Diuresis is more than 1 liter per day. Filtration - 15-10 ml/min.
- II-a. The volume of urine is reduced to 500 ml, there is hypernatremia and hypercalcemia and an increase in symptoms of fluid retention and decompensated acidosis.
- II-b. Signs become even more pronounced, heart failure develops, congestion in the lungs and liver is noted.
- III. Severe uremic intoxication develops, hyponatremia, hypermagnesemia, liver dystrophy, hyperkalemia, hypochloremia, polyserositis.
Body damage
Changes occurring in the patient's blood: anemia, which is caused by inhibition of hematopoiesis and a reduction in the period of lifeerythrocytes. Coagulation disorders are also noted: thrombocytopenia, prolongation of the bleeding period, a decrease in the amount of prothrombin.
Complications that develop in the lungs and heart: arterial hypertension (in almost half of patients), heart failure, myocarditis, pericarditis, uremic pneumonitis (in the late stages).
Changes in the nervous system: in the early stages - sleep disturbance and distraction, in the later stages - inhibition of reactions, confusion, delirium, hallucinations, peripheral polyneuropathy.
Disturbances in the work of the digestive system: in the early stages - loss of appetite, dryness of the oral mucosa, belching, nausea, stomatitis. Due to irritation of the mucosa, enterocolitis and atrophic gastritis can develop. Ulcerative lesions of the stomach and intestines are formed, which often become sources of bleeding.
Pathologies of the musculoskeletal system: kidney failure in men and women is characterized by different forms of osteodystrophy - osteosclerosis, osteoporosis, fibrous osteitis, etc. The clinical manifestations of osteodystrophy are spontaneous fractures, compression of the vertebrae, skeletal deformity, arthritis, muscle and bone pain.
On the part of immunity, the development of lymphocytopenia is often observed. A decrease in immune defense causes an increase in the incidence of purulent-septic formations.
Let's look at how kidney failure manifests itself in women and men.
Symptomspathology
In the period that precedes the development of this pathological process, renal functions are preserved in full. Glomerular filtration levels are not affected. In subsequent stages, glomerular filtration begins to decrease, and the kidneys lose the ability to concentrate urine, which affects the renal processes. Homeostasis at these stages is not yet disturbed. However, subsequently the number of functional nephrons decreases sharply, and the patient begins to show the first signs of renal failure.
Signs depending on the stage
Patients with a latent stage of this disease usually do not complain. In some cases, they may note mild weakness and loss of strength. Patients with compensated stage renal failure may experience increased fatigue. With the development of the intermittent stage, more pronounced symptoms of the disease are observed. Weakness increases, patients may complain of constant thirst and decreased appetite. Their skin is pale and dry. At the terminal stage, patients, as a rule, lose weight, their skin acquires a gray-yellow hue, becomes flabby. Also for this stage of the pathology are characteristic: itching, decreased muscle tone, hand tremor, muscle twitching, increased thirst and dry mouth. The occurrence of apathy, drowsiness, absent-mindedness may also be noted.
With intensification of intoxication processes, a characteristic smell from the mouth, nausea begins to appear. Periods of apathy, as a rule, are replacedexcitement, inadequacy. Also in this case, manifestations of dystrophy, hoarseness, hypothermia, and aphthous stomatitis are characteristic. The patient's abdomen is swollen, there is frequent vomiting and dark liquid stools. Patients may also complain of excruciating itching of the skin and muscle twitches. The degree of anemia increases, hemorrhagic syndromes develop, as well as renal osteodystrophy. Typical manifestations of renal failure in women of this stage are: ascites, myocarditis, encephalopathy, pericarditis, uremic coma, pulmonary edema.
Diagnosis of pathology
If you suspect the development of this pathology, it is necessary to conduct certain laboratory tests:
- biochemical blood test;
- Rehberg's samples;
- determination of the level of creatinine and urea;
- Zimnitsky test.
Tests for kidney failure ordered by a doctor.
In addition, ultrasound is needed to determine the size of the thickness of the parenchyma and the total size of the kidneys. Ultrasound of the vessels will reveal intraorganic and main blood flows. In addition, a study such as radiopaque urography is also used, but this should be used with caution, since many contrast agents are highly toxic to kidney cells.
Treatment
What is timely therapy to slow the development of kidney failure and reduce the clinical symptoms of the disease?
The main aspect here is the treatment of the underlying disease that provoked the development of this pathology. The patient needs a special diet. If necessary, he can be prescribed antibacterial drugs and antihypertensive drugs. Sanatorium and resort treatment is also shown. In addition, careful monitoring of glomerular filtration rate, renal blood flow, renal concentration function, urea and creatinine levels is required.
With changes in homeostasis, it is possible to correct the acid-base composition, water and s alt balance of the blood. It should be noted that symptomatic therapy consists, as a rule, in the treatment of anemic, hemorrhagic and hypertensive syndromes, as well as in maintaining cardiac functions.
Diet for kidney failure
Patients who have this pathology are prescribed a low-protein, high-calorie diet that includes a large amount of essential amino acids. It is necessary to reduce the amount of s alt consumed as much as possible, and with the development of hypertension, completely eliminate s alt intake.
Protein content in the patient's diet should depend on the degree of damage to renal functions: with glomerular filtration below 60 ml / min, the amount of protein should be reduced to 40 grams per day, and if this figure is below 30 ml / min - up to 25 grams per day.
Symptomatic treatment
When renal osteodystrophy occurs, patients are prescribed vitamin D,preparations with a high calcium content, however, one should be aware of organ calcification, a very dangerous morphological process caused by high doses of vitamin D. Sorbitol and aluminum hydroxide are prescribed to reduce hyperphosphatemia. And a prerequisite here is the control during treatment of the level of calcium in the blood and phosphorus.
For anemia
When anemia is prescribed, as a rule, drugs with a high content of iron, folic acid, androgens. With a decrease in hematocrit, transfusions of erythrocyte masses are carried out. The use of chemotherapeutic drugs and antibacterial drugs is determined depending on how they will be excreted. The dose of sulfanilamide, ampicillin, cephaloridine, penicillin and methicillin is reduced in this case by several times, and when taking polymyxin, monomycin, neomycin and streptomycin, certain complications may develop in the form of, for example, neuritis of the auditory nerve, etc. Nitrofurans are contraindicated in patients with renal insufficiency.
The use of glycosides in the treatment of such consequences of this pathology as heart failure should occur strictly under the supervision of a specialist and laboratory parameters. The dosage of such drugs is reduced with the development of hypokalemia. Patients with intermittent renal failure, especially during periods of exacerbations, are prescribed hemodialysis.
