Renal failure symptoms
are acute and chronic renal failure.
Acute renal failure (ARF) - The sudden impairment of renal function with a delay of excretion products of nitrogen metabolism and disorders of water, electrolytes, osmotic and acid-base balance.These changes occur as a result of acute severe violations of renal blood flow, glomerular filtration rate and tubular reabsorption usually occur simultaneously.How to use traditional medicine with the illness, see here.
Acute renal failure occurs when both kidneys suddenly stop functioning.The kidneys adjust the balance of chemicals and body fluids and waste filtered from the blood, bringing them into urine.Acute renal failure may occur for various reasons, including kidney disease, partial or complete blockage of the urinary tract and the reduction of blood volume, for example, after a severe blood loss.Symptoms may develop over several days: the amount of urine output may decrease dramatically and the fluid to be output is stored entirely in the tissues, causing ede
Acute renal failure is a life-threatening disease, as excessive amounts of water, minerals (particularly potassium) and wastes which are usually derived tyuchkami in the urine accumulate in the body.The disease usually responds well to treatment;Kidney function can be completely restored within a few days or weeks, if properly identified the cause and appropriate treatment.However acute renal failure due to renal disease can sometimes lead to chronic renal failure, in which case the prospect of developing the disease depends on the possibility to cure the underlying disease.
Currently, there are several groups of aetiological ARF.
• prerenal acute renal failure (ischemic)
• Renal ARF.
• postrenal arrester.
in the development of acute renal failure is divided into four periods: the initial action of the etiological factor, oligoanurichesky period, the period of recovery of diuresis and recovery.
The first period dominated by symptoms of the condition, which leads to acute renal failure.For example, a person has a fever, vomiting, collapse, anemia, hemolytic jaundice anaerobic sepsis associated with unsafe abortion, or the clinical picture of the overall action of either poison (vinegar essence, carbon tetrachloride, salts of heavy metals, etc.).
Second period - the period of a sharp decrease in or cessation of urine output - usually develops soon after exposure to the causative factor.Azotemia is growing, there are nausea, vomiting, coma, due to sodium and water retention develops extracellular hyperhydration, shown weight gain, cavitary edema, pulmonary edema, brain.
After 2-3 weeks followed by a period oligoanuria recovery diuresis.Usually the amount of urine increases gradually 3-5 days diuresis exceed 2 liters / day.First, the liquid is removed, accumulated in the body during oligoanuria, and then as a result of polyuria arises dangerous dehydration.Polyuria usually lasts 3-4 weeks, after which, as a rule, the level of nitrogenous wastes normal and begins a long (6 to 12 months), the period of recovery.
Thus, from a clinical point most difficult and dangerous for the life of a patient with acute renal failure - during oligoanuria, when the picture of the disease is characterized primarily by azotemia with a sharp accumulation in blood urea, creatinine, uric acid and electrolyte imbalance (especially hyperkalemia, andas hyponatremia, hyposalemia, gipermagniemiya, gipersulfat- and fosfatemiya), the development of extracellular hyperhydration.Oligoanurichesky period is always accompanied by metabolic acidosis.During this period, a number of serious complications may be associated with inadequate treatment conducted primarily with the uncontrolled introduction of saline solution when sodium accumulation of extracellular hydration is first, and then the intracellular overhydration, leading to a coma.Severe condition is often exacerbated by the uncontrolled use of hypotonic or hypertonic glucose solution, reducing the osmotic pressure of the plasma and enhances cell overhydration due to the rapid transition of glucose, followed by the water and into the cell.
During recovery diuresis due to severe polyuria also have a risk of serious complications, especially in relation to developing electrolyte disorders (hypokalemia, etc.).
The clinical picture of acute renal failure may dominate the signs of disorders of heart activity and hemodynamic deployed uremic intoxication symptomatic gastroenterocolitis, mental changes, anemia.Often the severity of the condition is exacerbated by pericarditis, respiratory failure, nephrogenic (hyperhydration) and cardiac pulmonary edema, gastrointestinal bleeding, and especially infectious complications.
To assess the severity of the patient with acute renal failure have major importance nitrogen metabolism, especially serum creatinine level in the blood which does not depend on the characteristics of the patient's diet and therefore more accurately reflects the degree of renal dysfunction.Latency is usually ahead of creatinine elevation of urea, although the dynamics of the last level is also important for the assessment of prognosis in acute renal failure (especially with the involvement of the liver process).
However, in many clinical manifestations of acute renal failure, in particular, signs of damage to the nervous system and muscles (especially infarction) related to violations of exchange of potassium.Often there is an understandable and hyperkalemia increases the excitability of the myocardium with the advent of high, with a narrow base and the pointed apex of the T wave on the ECG, slowing of atrioventricular and intraventricular conduction up to a cardiac arrest.In some cases, however, instead of hyperkalemia can develop hypokalemia (after repeated vomiting, diarrhea, alkalosis), the latter is also dangerous for the myocardium.
Clarification etiological factors arresters allows to carry out more targeted therapeutic effects.Thus, prerenal ARF develops mainly under shock conditions characterized by severe impairment of microcirculation due to hypovolemia, low central venous pressure and other hemodynamic changes;the elimination of the latter and should be sent to the main therapeutic measures.Similar in mechanism to these states and cases of acute renal failure associated with a large loss of fluid and NaCl in severe extensive lesions gastrointestinal tract (infections, anatomical abnormalities) with uncontrollable vomiting, diarrhea, which also defines the range of therapeutic effects.Renal AKI develops due to the toxic effect of various factors, especially a series of chemical, drugs (sulfonamides, mercury compounds, an antibiotic) and radiopaque agents, and may actually be due to renal diseases (nephritis and AGN associated with systemic vasculitis).Prevention and treatment of acute renal failure in these cases should include measures restricting the impact of these factors, as well as effective methods of dealing with the above kidney disease.Finally, therapeutic tactics when postrenal arrester is reduced mainly to the elimination of acute emerged hindered the flow of urine in connection with urolithiasis, bladder tumors, etc.
should be borne in mind that for various reasons OPN ratio may change due to these or other features of their effects on the kidney.At the present time is still a core group of cases, OPN make sharp shock and toxic kidney damage, but within each of these subgroups, together with post-traumatic acute renal failure, acute renal failure with obstetric and gynecological pathology (abortion, complications of pregnancy and childbirth), acute renal failure due to transfusion transmissible complicationsand nephrotoxic effect of factors (vinegar essence poisoning, ethylene glycol) quickens OPN associated with an increase in surgical interventions, particularly in older age groups, as well as the use of new drugs.In endemic areas the cause of acute renal failure may be a viral hemorrhagic fever with renal involvement in the form of severe acute tubulointerstitial nephritis.
While studying the mechanisms of acute renal failure in a large number of works, however the pathogenesis of this condition can not be considered definitively clarified.
however, proved that a variety of etiological variants of OPN are characterized by a number of common mechanisms:
Emerging with morphological changes relate mainly tubular apparatus of the kidneys, especially the proximal tubule, and presented dystrophy, often severe necrosis of the epithelium, accompanied by moderate changes in renal interstitial.Glomerular disorders usually minor.It should be noted that even in the most deep necrotic changes very quickly arises renal epithelial regeneration, aided by the use of hemodialysis, prolonging the life of these patients.
When developing common processes predominance of one or another level defines features of the pathogenesis of acute renal failure in each of these options it.Thus, when shock OPN plays a major role ischemic renal tissue damage, except when nephrotoxic ARF hemodynamic disorders immediate action has a value of toxic substances during their tubular epithelium secretion or reabsorption in hemolytic uremic syndrome, thrombotic microangiopathy predominates.
In some cases, acute renal failure develops as a consequence of the so-called hepatorenal syndrome and acute due to severe liver disease or surgery on the liver and biliary tract.
hepatorenal syndrome - a variant of acute functional renal failure that develops in patients with severe liver disease (with fulminant hepatitis or cirrhosis far come), but without any visible organic kidney changes.Apparently, in the pathogenesis of this condition changes play a role in blood renal cortex or humoral neurogenic origin.Heralded the beginning of the hepatorenal syndrome are gradually increasing oliguria and azotemia.From acute tubular necrosis hepatorenal syndrome usually characterized by a low concentration of sodium in the urine, and the absence of significant changes in the sediment, but from prerenal ARF differentiate it significantly more difficult.In cases of doubt, it helps kidney response to volume replacement - if renal failure does not respond to the increase in BCC, it is almost always progresses to death.Develop in the terminal stage of hypotension can cause tubulonekroz, which further complicates the clinical picture.
• Treatment of the disease, which can cause acute renal failure.
Chronic renal failure (CRF) - renal dysfunction, caused a significant decrease in the number of properly functioning nephrons and leads to self-poisoning organism products of their own activity.
Chronic renal failure occurs when both kidneys gradually cease to function.In the kidney, there are numerous tiny structure (glomerulus), which filter wastes from the blood and maintain it in large substances, such as proteins.Waste substances and excess water accumulates in the bladder and then excreted in urine.In chronic renal failure, the kidneys are damaged gradually over months or years.Since the kidney tissue is destroyed as a result of injury or inflammation, the remaining healthy tissue compensates for its work.Additional work leads to an overload of previously undamaged parts of the kidneys, causing even more damage as long until all the kidney stops functioning (a condition known as end-stage renal disease).
have kidney large margin;more than 80-90 percent of the kidneys can be damaged before symptoms appear (although symptoms can appear before if weakened kidney will be subjected to sudden stress, such as infection, dehydration or the use of drugs that have devastating effects on the kidneys).As excessive amounts of fluid, such as potassium minerals and waste acid accumulating in the organism, chronic renal failure becomes a life-threatening disease.However, if the underlying disease is cured and further damage to the kidneys can be controlled, the beginning of the final stage of renal failure can be delayed.At the final stage of kidney failure treated with dialysis or by a kidney transplant;Any of these methods can prolong life and allow a person to lead a normal life.
of CRF can cause a variety of diseases and disorders of the kidneys.These include chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, renal tuberculosis, amyloidosis, and hydronephrosis due to the presence of different kinds of obstacles to the flow of urine.
In addition, chronic renal failure may occur not only as a result of kidney disease, but also for other reasons.Among them are the diseases of the cardiovascular system - hypertension, renal artery stenosis;Endocrine - diabetes and diabetes insipidus, hyperparathyroidism.The cause of chronic renal failure may be systemic connective tissue disease - systemic lupus erythematosus, scleroderma, etc., rheumatoid arthritis, hemorrhagic vasculitis..
should be noted that, regardless of the cause, chronic renal failure is associated, on the one hand, with a decrease in the number of operating nephrons and, on the other hand, working with a reduction of activity in the nephron.External manifestation of chronic renal failure, as well as laboratory signs of renal failure starting to be identified with the loss of 65-75% of the nephrons.However, kidneys have amazing spare capacity because the vital activity of the body is retained even when the death of 90% of the nephrons.compensation mechanisms include increased activity of the surviving nephrons and adaptive reorganization of the work of all other organs and systems.
ongoing process of destruction of nephrons causes a number of disorders, especially the nature of the exchange on which the condition of the patient depends.These include violations of water-salt metabolism, the delay in the body of its metabolic products, organic acids, phenolic compounds and other substances.
characteristic feature of chronic renal failure is an increase in the volume of urine - polyuria that occurs even in the early stages at primary tubular damage of the nephron.This polyuria is permanent, even when restricted fluid intake.
salts Disorders affect metabolism in chronic renal failure, especially sodium, potassium, calcium, phosphorus.sodium excretion in the urine can be both increased and reduced.Potassium normally excreted mainly by the kidneys (95%), so the CRF potassium can accumulate in the body, despite the fact that its function by removal of the intestines takes.Calcium, on the contrary, lost, therefore it is insufficient in CRF levels.
addition to water and salt imbalance in the mechanism of CRF importance belongs to the following factors:
• violation of renal excretory function leads to a delay of products of nitrogen metabolism (urea, uric acid, creatinine, amino acids, phosphates, sulfates, phenols), which are toxic forall organs and tissues, primarily the nervous system;
• violation of the hematopoietic function of kidneys causes anemia;
• the activation of the renin-angiotensin system and the stabilization of arterial hypertension;
• disturbed acid-base balance in the blood.
As a result, in all the organs and tissues there are profound degenerative disorders.
should be noted that most often the immediate cause of chronic renal failure becomes chronic pyelonephritis.
in asymptomatic chronic pyelonephritis chronic renal failure develops relatively late (after 20 years or more after onset of the disease).