Chronic renal failure - Causes, Symptoms and Treatment .MF .
Renal failure - a violation of secretory (excretory) renal function with the accumulation of toxins in the blood of nitrogen, normally removed from the body in urine.It may be acute or chronic.
Chronic renal failure (CRF) - a syndrome of irreversible renal dysfunction, which is observed for 3 months or more.It arises as a result of the progressive destruction of nephrons, as a consequence of chronic kidney disease.It is characterized by impaired renal excretory function, the formation of uremia related to the accumulation in the body and the toxic effect of products of nitrogen metabolism (urea, creatinine, uric acid).
Causes of chronic renal failure
1. Chronic glomerulonephritis (kidney damage glomerular apparatus).
2. Secondary kidney damage caused by:
- 1 diabetes and Type 2 diabetes;
- connective tissue diseases;
- viral hepatitis "B" and / or "C";
- systemic vasculitis;
3. Chronic pyelonephritis.
4. Kidney stones, urinary tract obstruction.
5. Abnormalities of the urinary system.
6. Polycystic kidney.
7. The action of toxic substances and drugs.
Symptoms of chronic renal failure
Starting malosimptomno chronic renal failure and can be detected only by laboratory research.Only the loss of 80-90% of the nephrons, there are signs of chronic renal failure.Early clinical signs are weakness, fatigue.It appears nocturia (frequent nighttime urination), polyuria (excretion of 2-4 liters of urine per day), with the possible dehydration.As the progression of renal failure in the process involved almost all organs and systems.Weakness increases, appear nausea, vomiting, itching, muscle twitching.
Patients complain of dryness and bitterness in the mouth, loss of appetite, pain and heaviness in the pit of the stomach, loose stools.Concerned about shortness of breath, pain in the heart, increases blood pressure.Disrupted blood clotting, which could result in nasal and gastrointestinal bleeding, skin hemorrhages.
In later stages there are attacks of cardiac asthma and pulmonary edema, impairment of consciousness up to coma.Patients are prone to infections (colds, pneumonia), which, in turn, accelerate the development of renal failure.
cause of renal failure can be progressive liver disease, the combination is called hepatorenal syndrome).This results in the development of renal failure in the absence of clinical, laboratory or anatomical features of any other reasons for renal dysfunction.This is usually accompanied by renal failure oliguria, the presence of normal urine sediment and low concentration of sodium in the urine (less than 10 mmol / l).The disease develops in advanced liver cirrhosis complicated with jaundice, ascites and hepatic encephalopathy.Sometimes, this syndrome can be a complication of fulminant hepatitis.With improvement of liver function in this syndrome often it occurs and improve kidney condition.
Matter in the progression of chronic renal failure: food intoxication, surgery, trauma, pregnancy.
Diagnosis of chronic renal failure
1. Complete blood count shows anemia (decreased hemoglobin and red blood cells), signs of inflammation (ESR acceleration - erythrocyte sedimentation rate, a moderate increase in the number of white blood cells), a tendency to bleeding (decreased platelet count).
2. Biochemical analysis of blood - increased levels of products of nitrogen metabolism (urea, creatinine, residual nitrogen in the blood), violation of electrolyte metabolism (increased levels of potassium, phosphorus and calcium decrease), reduced total protein in the blood anticoagulation (decreased blood clotting)increase in blood cholesterol, total lipids.
3. Analysis of urine - proteinuria (protein in the urine), hematuria (the appearance of red blood cells in the urine of more than 3 in the field of microscopy of urine), cylindruria (indicates the degree of kidney damage).
4. Sample Rehberg - Toreeva conducted to assess renal excretory function.With the help of this sample was calculated glomerular filtration rate (GFR).This indicator is the basis for determining the degree of renal insufficiency, stage of the disease, since it was he who shows the renal function.
At present, to determine the GFR are not only sample Rehberg-Toreeva and special calculation methods, which take into account the age, body weight, sex, level of serum creatinine.
should be noted that at the present time instead of the term CKD, is considered obsolete and is characterized by the mere fact of irreversible renal dysfunction, used the term CKD (chronic kidney disease), with the obligatory indication of the stage.It should be emphasized that the establishment of the presence and stage of CKD in any case not replace the main staging diagnosis.
stages of the disease:
CKD (chronic kidney disease) I: kidney damage with normal or increased GFR (glomerular filtration rate) (90 mL / min / 1.73 m2).Chronic renal failure is not;
CKD II: kidney disease with mild decrease in GFR (60-89 ml / min / 1.73 m2).The initial stage of chronic renal failure.
CRD III: kidney with moderate reduction in GFR (30-59 ml / min / 1.73 m2).CRF compensated;
CRD IV: kidney disease with a significant degree of decline in GFR (15-29 ml / min / 1.73 m2).Decompensated chronic renal failure (not compensated);
CKD V: kidney disease with ESRD (& lt; 15 ml / min / 1.73 m2).
1. Ultrasound examination of the urinary system with pulsed Doppler (determining renal blood flow).Spend for the diagnosis of chronic kidney disease, and to evaluate the severity of kidney damage.
2. Puncture kidney biopsy.The study of kidney tissue allows accurate diagnosis, determine the version of the disease, to assess the degree of damage to the kidneys.On the basis of this information, make a conclusion about the disease prognosis and selection of treatment.
3. X-ray (panoramic, contrast) of the kidneys was performed on the stage of diagnosis, and only patients with I - II degree of renal insufficiency.
1. Nephrology (for diagnosis and choice of treatment strategy).We examine all patients with renal insufficiency.
2. Optometrist (monitors the state of the fundus).
3. Neurologist (for suspected nervous system damage).
Treatment of chronic renal insufficiency
Each stage renal failure involves the implementation of specific actions.
- At I stage treats the underlying disease.Relief of acute inflammatory process in the kidneys reduces the severity of renal failure phenomena.
- In stage II, along with treatment of the underlying disease estimate the speed of progression of renal failure and use drugs to lower its rates.These include lespenefril and hofitol - this herbal preparations, the dose and dosing frequency appoints doctor.
- In stage III detect and treat possible complications, medications used to slow the progression of renal failure.Carry out the correction of hypertension, anemia, calcium - phosphate disorders, treatment of infectious and cardio - vascular complications.
- In stage IV patients are prepared to renal replacement therapy
- and stage V renal replacement therapy is carried out.
Renal replacement therapy includes hemodialysis and peritoneal dialysis.
Hemodialysis - it extrahepatic blood purification method, in which is removed from the body toxins, normalize disorders of fluid and electrolyte balance.This is done by filtering the blood through the semipermeable membrane of the plasma apparatus "artificial kidney".Maintenance hemodialysis treatment is carried out at least 3 times a week, with a duration of one session at least 4 hours.
Peritoneal dialysis .The abdominal cavity is lined with human peritoneum which acts as a membrane through which the water and substances dissolved in it.In the abdomen surgically establish a special catheter, through which the dialysis solution into the abdominal cavity.There is an exchange between the solution and the patient's blood, causing the harmful substances are removed and excess water.The solution is there for a few hours, and then fused.This procedure does not require any special settings and can be carried out independently by the patient at home, while traveling.1 is inspected once a month for a dialysis center control.Dialysis is used as a treatment in the waiting period of kidney transplantation.
Peritoneal dialysis in chronic renal failure
All patients with stage V chronic kidney disease are considered as candidates for a kidney transplant.
chronic renal failure diet plays a very important role in kidney failure.It is determined by the stage, a chronic disease phase (exacerbation, remission).Your doctor (nephrologist, internist, family physician) with the patient make a food diary indicating the quantitative and qualitative composition of food.
low-protein diet with restriction of the use of animal protein, phosphorus, sodium contributes to inhibition of progression of renal failure and reduces the possibility of complications.The use of protein should be strictly dosed.
When I stage the amount of protein is used should be 0.9 -1,0g per kg of body weight per day, up to 3,5g potassium per day, phosphorus - up to 1.0g per day.In stage II reduced the amount of protein per kg to 0,7g weight per day, up to 2,7g potassium per day, up to 0,7g phosphorus per day.On the III, IV and V phases of the amount of protein is reduced to 0.6 g per kg body weight per day, up to 1,6g potassium per day, up to 0,4g phosphorus per day.Preference is given to proteins of plant origin, in which the phosphorus content less.Recommended soy proteins.
major component of the diet of patients are fats and carbohydrates.Fats - preferably of vegetable origin, in an amount sufficient to provide a caloric intake.The source of carbohydrates may be products of vegetable origin (except beans, mushrooms, nuts).An increase in blood potassium levels exclude: dried fruits (apricots, raisins), potatoes (fried and baked), chocolate, coffee, bananas, grapes, fig.To reduce the use of phosphorus limit animal proteins, beans, mushrooms, white bread, milk and rice.
Complications kidney failure
The most frequent complications of kidney failure are infectious disease (up to the development of sepsis) and cardio - vascular insufficiency.
Prevention of renal failure
Preventive measures include early identification, treatment and monitoring of diseases, leading to the development of renal failure.More often renal failure occurs in diabetes mellitus (type 1 and 2), glomerulonephritis and arterial hypertension.All patients with renal insufficiency are observed by a doctor - a nephrologist.Pass examinations: blood pressure monitoring, fundus examination, control of body weight, electrocardiogram, ultrasound of the abdomen, blood and urine tests, obtain advice on lifestyle, sustainable employment and nutrition.
Medical consultation for renal failure
Question: How do you spend a kidney biopsy?
A: The procedure is performed in a specialized medical institution (usually in the Department of Nephrology) physician nephrologist.Under local anesthesia under ultrasound sensor control, a thin disposable needle taken a tiny column of renal tissue.In this case the doctor performing the biopsy, kidney sees on the screen and all the needle movement.Contraindications to renal biopsy are:
1. solitary kidney;
2. hemorrhagic diathesis;
3. polycystic kidney disease;
4. purulent inflammation of the kidney and perinephric fat (purulent pyelonephritis, paranephritis);
5. kidney tumor;
6. tuberculosis kidney;
7. patient's refusal of the study.
Question: Are there any age or other restrictions for transplant (transplant) kidney?
Answer: Age can not be a barrier to the operation.What matters is the psychological readiness of a candidate for a transplant.It is defined by its ability to carry out medical advice after kidney transplantation, since noncompliance immunosuppressive treatment is the most common cause of loss of the transplanted kidney.Absolute contraindications for transplantation are: sepsis, AIDS, uncontrolled malignancy.
therapists Vostrenkova I.N