Symptoms of chronic renal failure,stages, methods of treatment, drugs

Update: October 2018

Modern medicine manages to cope with the most acute
kidney disease and inhibit the progression of most
chronic. Unfortunately, still about 40% of the renal
pathologies are complicated by the development of chronic renal
insufficiency (CRF).

This term refers to death or substitution.
connective tissue parts of the structural units of the kidneys (nephrons) and
irreversible damage to the kidneys to cleanse the blood of nitrogenous
slag making the erythropoietin responsible for education
red blood elements, remove excess water and salts, and
reverse absorption of electrolytes.

The consequence of chronic renal failure becomes
disorder of water, electrolyte, nitrogen,
acid-base equilibria that entails irreversible shifts in
state of health and often causes death at
terminal variant CKD. The diagnosis is made at violations,
registering for three months and longer.

Today, chronic renal failure is also called chronic kidney disease (CKD).
This term emphasizes the potential for development
severe renal failure even during the initial stages
process, when glomerular filtration rate (GFR) is not yet
reduced. This allows you to more closely engage patients with
low-symptom forms of renal failure and improve their
forecast.

CRF Criteria

The diagnosis of CRF is made if the patient has a period of 3 months and
more observed one of two options for renal impairment:

  • Kidney damage in violation of their structure and function, which
    determined by laboratory or instrumental methods
    diagnostics. In this case, the GFR may decrease or remain
    normal.
  • There is a reduction in GFR less than 60 ml per minute in combination with
    kidney damage or without them. This rate of speed
    filtering corresponds to the death of about half of nephrons
    the kidneys.

What leads to CRF?

Virtually any chronic kidney disease without treatment early
or later can lead to nephrosclerosis with kidney failure
function normally. That is, without timely treatment such
the outcome of any kidney disease like CKD is just a question
of time. However, cardiovascular pathologies, endocrine
diseases, systemic diseases can lead to failure
renal function.

  • Kidney disease: chronic glomerulonephritis, chronic
    pyelonephritis, chronic tubulo-interstitial nephritis, tuberculosis
    kidney, hydronephrosis, polycystic kidney disease, kidney cancer, nephrolithiasis.
  • Pathology of the urinary tract: urolithiasis, strictures
    urethra
  • Cardiovascular diseases: hypertension,
    atherosclerosis, incl. angiosclerosis of the renal vessels.
  • Endocrine pathology: diabetes.
  • Systemic diseases: renal amyloidosis, hemorrhagic
    vasculitis

How is developing chronic kidney disease

The process of replacing the affected kidney glomeruli with scar tissue
simultaneously accompanied by functional compensatory
changes in the remaining. Therefore chronic renal
failure develops gradually with the passage in its
during several stages. Main cause of pathological
changes in the body – reducing the rate of filtration of blood in
ball. The glomerular filtration rate is normally 100-120
ml per minute. Indirect indicator by which you can judge the SCF
– blood creatinine.

  • The first stage of chronic renal failure – the initial

The glomerular filtration rate is maintained at
90 ml per minute (normal option). Confirmed damage is available.
the kidneys.

  • Second stage

It involves kidney damage with a slight decrease in GFR in
limits 89-60. For the elderly in the absence of structural damage
kidney such indicators are considered normal.

  • Third stage

In the third moderate stage, the GFR drops to 60–30 ml per minute.
At the same time the process proceeding in kidneys is often hidden from eyes. Bright
there is no clinic. Possible increase in urine output, moderate
decrease in the number of red blood cells and hemoglobin (anemia) and associated with
these weakness, lethargy, decreased performance, pale skin
and mucous membranes, brittle nails, hair loss, dry skin,
loss of appetite. About half of the patients appear
increase in blood pressure (mainly diastolic, i.e.
lower).

  • Fourth stage

It is called conservative, because it can be contained
drugs and the same as the first, does not require
blood purification apparatus methods (hemodialysis). Wherein
клубочковая фильтрация удерживается на уровне 15-29 ml per minute.
Clinical signs of renal failure appear:
severe weakness, loss of working capacity on the background of anemia.
Increased urine output, significant urination
at night with frequent nocturnal urges (nocturia). About half
patients suffering from increased blood pressure.

  • Fifth stage

The fifth stage of renal failure got the name
terminal, i.e. the ultimate. With a decrease in glomerular filtration
below 15 ml per minute drops the amount of urine (oliguria)
until its complete absence in the outcome of the state (anuria).
There are all signs of poisoning the body with nitrogenous slags
(uremia) on the background of violations of water and electrolyte balance,
lesions of all organs and systems (first of all, the nervous system,
cardiac muscle). With this development, the patient’s life
directly depends on blood dialysis (cleansing it bypassing non-performing
kidney). Without hemodialysis or kidney transplant, patients die.

Symptoms of chronic renal failure

The appearance of patients

Appearance does not suffer to the stage when it significantly decreases
glomerular filtration.

  • Due to anemia, pallor appears due to water-electrolyte
    impaired dry skin.
  • As the process progresses, yellowness of the skin appears and
    mucous membranes, reducing their elasticity.
  • Spontaneous hemorrhages and bruises may appear.
  • Due to the itching of the skin, scratching occurs.
  • Characterized by so-called renal edema with facial puffiness
    down to the common type of anasarki.
  • Muscles also lose their tone, become flabby, which is why
    fatigue is increasing and the working capacity of patients falls.

Nervous system lesions

This is manifested by apathy, night sleep disorders and
sleepy afternoon. Decreased memory, learning ability. As
increased chronic renal failure appears severe inhibition and disorder
abilities to remember and think.

Disturbances in the peripheral part of the nervous system affect
chilliness of the limbs, tingling sensations, goosebumps. AT
further join movement disorders in the hands and
feet.

Urinary function

She first suffers from a type of polyuria (increase in urine volume) with
the prevalence of nocturnal urination. Further, chronic renal failure develops along the way.
reduce urine volumes and the development of edema syndrome up to
complete lack of selection.

ATодно-солевой баланс

  • salt imbalance is manifested by increased thirst, dryness
    mouth
  • weakness, darkening in the eyes when standing up sharply (due to
    sodium loss)
  • muscle paralysis due to excess potassium
  • respiratory disorders
  • reduction of heart rate, arrhythmia, intracardiac blockade right up
    until the heart stops.

Against the background of increased production of parathyroid glands
parathyroid hormone appears high levels of phosphorus and low levels
blood calcium. This leads to softening of the bones, spontaneous
fractures, pruritus.

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Nitrogen balance disorders

They cause the growth of blood creatinine, uric acid and
urea, as a result of:

  • with SCF less than 40 ml per minute enterocolitis develops
    (defeat of the small and large intestine with pain, bloating, frequent liquid
    chair)
  • ammoniac breath odor
  • secondary articular lesions of the type of gout.

The cardiovascular system

  • First, it responds by increasing blood pressure.
  • secondly, lesions of the heart (muscle – myocarditis,
    pericardial bag – pericarditis)
  • dull pains in the heart, irregular heartbeats,
    shortness of breath, swelling in the legs, enlarged liver.
  • with an unfavorable course of myocarditis, the patient may die
    against the background of acute heart failure.
  • pericarditis can occur with fluid accumulation in
    pericardial bag or urinary crystals precipitated in it
    acid, that in addition to pain and expansion of the borders of the heart,
    listening to the chest gives a characteristic (“funeral”) noise
    pericardial friction.

Blood formation

Amid kidney deficiency, erythropoietin slows down
blood formation. The result is anemia, which manifests itself very
early weakness, lethargy, decreased performance.

Pulmonary complications

characteristic of the late stages of chronic kidney disease. This uremic lung –
interstitial edema and bacterial inflammation of the lung in the background
drops of immune protection.

Digestive system

She reacts with decreased appetite, nausea, vomiting, inflammation.
oral mucosa and salivary glands. With uremia, erosive and
ulcers of the stomach and intestines, fraught with bleeding.
Acute hepatitis also becomes a frequent satellite of uraemia.

Renal failure with беременности

Even physiologically occurring pregnancy significantly
increases the load on the kidneys. With Chronic Kidney Disease
pregnancy aggravates the pathology and may contribute to its
rapid progression. This is due to the fact that:

  • during pregnancy, increased renal blood flow stimulates
    overstrain of the renal glomeruli and the death of a part of them,
  • deterioration of conditions for reabsorption in the tubules of the kidney
    salts leads to the loss of high volumes of protein, which is toxic to
    kidney tissue
  • increased blood coagulation helps
    the formation of small blood clots in the capillaries of the kidneys,
  • worsening of arterial hypertension during pregnancy
    promotes necrosis of the glomeruli.

The worse the filtration in the kidneys and the higher the creatinine numbers, the
unfavorable conditions for the onset of pregnancy and her
gestation Pregnant with CKD and its fetus lurks a number
pregnancy complications:

  • Arterial hypertension
  • Nephrotic syndrome with edema
  • Preeclampsia and eclampsia
  • Severe anemia
  • Feto-placental fetal insufficiency and hypoxia
  • Delays and malformations of the fetus
  • Miscarriage and premature birth
  • Infectious diseases of the urinary system of a pregnant woman

To decide on the feasibility of pregnancy in each
a particular patient with CKD involves nephrologists and
obstetrician-gynecologists. Wherein необходимо оценивать риски для
patient and fetus and relate them to the risks that
the progression of chronic renal failure every year reduces the likelihood
the onset of a new pregnancy and its successful resolution.

Treatment methods

The beginning of the fight against CRF is always the regulation of the diet and
water-salt balance

  • Patients are advised to eat with restricted intake.
    protein within 60 grams per day, preferential use
    plant proteins. With the progression of chronic kidney disease to stage 3-5 protein
    limited to 40-30 g per day. Wherein несколько повышают долю
    animal protein, preferring beef, eggs and lean
    fish Popular egg-potato diet.
  • AT это же время ограничивается потребление продуктов, содержащих
    phosphorus (legumes, mushrooms, milk, white bread, nuts, cocoa,
    rice).
  • Excess potassium requires a reduction in the consumption of black bread,
    potatoes, bananas, dates, raisins, parsley, figs).
  • Patients have to manage drinking regime at the level of 2-2.5
    l per day (including soup and washing up the tablets) in the presence of pronounced
    edema or intractable hypertension.
  • It is useful to keep a food diary, which makes it easier to account for protein and
    trace elements in food.
  • Sometimes specialized mixes are added to the ration.
    fats and containing a fixed amount of soy protein and
    balanced by trace elements.
  • Along with the diet, a substitute may be indicated for patients.
    amino acids – Ketosteril, which is usually added when the GFR is less than 25
    ml per minute.
  • Low protein diet is not indicated for exhaustion, infectious
    complications of chronic kidney disease, uncontrolled arterial hypertension, with GFR
    less than 5 ml per minute, increased protein breakdown, after surgery,
    severe nephrotic syndrome, terminal uremia with lesions
    heart and nervous system, poor portability of the diet.
  • Salt is not restricted to patients without severe arterial
    hypertension and edema. In the presence of these syndromes salt limit
    up to 3-5 grams per day.

Enterosorbents

They allow you to slightly reduce the severity of uraemia due to
binding in the intestine and excretion of nitrogenous toxins. It works
in the early stages of chronic kidney disease with relative glomerular safety
filtering. Polyphepane, Enterodez, Enterosgel,
Activated carbon, Polysorb, Filtrum STI.

Treatment of anemia

To relieve anemia, Erythropoietin is administered, stimulating
red blood cell production. Restriction to its use becomes
uncontrolled arterial hypertension. Since the background of treatment
erythropoietin can cause iron deficiency (especially in
menstruating women) supplement therapy with oral medications
gland (Sorbifer Durules, Maltofer and others. See iron preparations with
anemia).

Blood clotting disorder

Correction of blood clotting disorders is carried out by clopidogrel.
Tiklopedinom, Aspirin.

Treatment of hypertension

Preparations for the treatment of arterial hypertension: ACE inhibitors
(Рамиприлом, Эналаприлом, Лизиноприлом) и сартанами (ATалсартаном,
Candesartan, Losartan, Eprozartan, Telmisartan), and
Moxonidine, Felodipine, Diltiazem. in combination with
saluretic (Indapamide, Arifon, Furosemide, Bumetanide).

Disorders of phosphorus and calcium metabolism

It is stopped by calcium carbonate, which impedes absorption.
phosphorus. Calcium deficiency – synthetic vitamin preparations
D.

Correction of water and electrolyte disorders

is carried out in the same way as the treatment of acute renal failure.
The main thing is to get the patient out of dehydration in the background.
restrictions in the diet of water and sodium, as well as the elimination of acidification
blood, which is fraught with severe shortness of breath and weakness. ATводятся
solutions with bicarbonates and citrates, Sodium bicarbonate. Also
5% glucose solution and Trisamine are used.

ATторичные инфекции при ХПН

It requires the prescription of antibiotics, antiviral or
antifungal drugs.

Hemodialysis

With a critical decrease in glomerular filtration, blood purification from
nitrogen metabolism substances are carried out by hemodialysis, when slags
pass into the dialysis solution through the membrane. More often
an “artificial kidney” apparatus is used, less frequently performed
peritoneal dialysis, when the solution is poured into the abdominal cavity,
and the membrane plays the role of the peritoneum. Hemodialysis при ХПН проводится в
Chronic mode. For this, spiders drive for several hours in
day in a specialized center or hospital. Wherein важно
prepare an arterio-venous shunt, which is prepared when
GFR 30-15 ml per minute. Since the fall of the GFR less than 15 ml dialysis
begin in children and patients with diabetes, with GFR less than 10
ml per minute dialysis is performed in other patients. Besides
indications for hemodialysis are:

  • ATыраженная интоксикация азотистыми продуктами: тошнота, рвота,
    enterocolitis unstable blood pressure.
  • Resistant to the treatment of edema and electrolyte disorders. Edema
    brain or lung edema.
  • Pronounced acidification of the blood.

Contraindications to hemodialysis:

  • bleeding disorders
  • persistent hypotension
  • tumors with metastases
  • decompensation of cardiovascular diseases
  • active infectious inflammation
  • mental illness.

Kidney transplant

This is a cardinal solution to the problem of chronic renal disease.
After that, the patient has to use cytostatics for life.
and hormones. There are cases of repeated transplants, if for some
cause the transplant is rejected. Renal failure with
pregnancy on the background of a transplanted kidney is not an indication for
abortion interruptions. pregnancy can be endured
necessary term and is allowed, as a rule, by cesarean section
at 35-37 weeks.

Thus, Chronic Kidney Disease, replacing today
The concept of “chronic renal failure” allows doctors
more timely see the problem (often when external symptoms
still absent) and respond to initiation of therapy. Adequate
treatment can prolong or even save the patient’s life, improve
his prediction and quality of life.

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