The author - Chuklin Olga, general practitioner, internist. Work experience since 2003.
Chronic renal failure is a condition in which the basic function of kidneys - excretory. These disorders are associated with the fact that in kidney tissue cells progressively die, resulting accumulate nitrogenous substances (urea, creatinine). In the body, develop toxic processes. Chronic process is called when the duration of more than three months, with the absence of treatment develops its irreversible progression.
CKD stage
There are several stages of chronic renal failure, they are determined by the clinical manifestations and degree of developmental disorders.
- The latent (hidden) stage.
- Compensated.
- Intermittent.
- Terminal (asthma) - the most severe degree of chronic renal failure.
Causes
Chronic renal failure is the result of many causes, it is the result of the following diseases:
- kidney - chronic glomerulonephritis, chronic pyelonephritis, multicystic kidney disease;
- diseases in which there are disturbances in the metabolic processes - diabetes, goutThyroid pathology;
- a disease in which blood flow of urine for urinary tract - urolithiasis disease, Malformations ureter, kidney, urinary tract tumor compression formations;
- systemic connective tissue disease - rheumatoid arthritis, Systemic lupus lupus, scleroderma;
- as a result of poisoning action of toxic substances, medications.
Symptoms of chronic renal failure
Clinical manifestations of chronic renal failure depend on the stage of the disease, how many kidney cells died.
CRF latent stage
The latent stage chronic renal failure in a patient may be completely absent clinical manifestations. Changes can be detected by chance during examination. Sometimes the patient can observe fatigue or general weakness.
Symptoms compensated step
When the compensated stage the patient is:
- often there is a general weakness, fatigue observed in everyday physical activities;
- It increases the amount of urine (polyuria) more than 2 liters per day;
- worried about frequent nighttime urination (nocturia);
- there is swelling on the face, around the eye area.
Intermittent form of CRF
Here, patients experience the following clinical manifestations:
- marked weakness constant;
- drowsiness;
- nausea, vomiting;
- dry mouth and dry skin;
- loss of appetite;
- bitter taste in the mouth;
- pronounced swelling of the face;
- muscle twitching legs (restless legs syndrome);
- high blood pressure;
- subcutaneous bleeding, nasal bleeding, anemia, due to the fact that disrupted the hemopoietic system in the kidney;
- frequent respiratory infections.
Signs of the last stage of chronic renal failure
When the terminal (decompensated) stage indicated the existence of such clinical manifestations:
- reduced the body weight;
- reducing body temperature;
- loss of appetite;
- acetone breath odor;
- diarrhea, vomiting;
- mood swings;
- pronounced odor of urine from the patient;
- dyspnea;
- edema syndrome;
- severe anemia and bleeding disorders (bleeding);
- when expressed violations can occur coma;
- the development of pneumonia.
Speed zabolevnaiya transition from one form to another depends on the cause of chronic renal failure.
Diagnostics
For the diagnosis of chronic renal failure are used:
- Questioning the patient (existence of specific complaints, comorbidity, clinical manifestations duration);
- Examination of the patient;
- General blood analysis - decrease hemoglobin, erythrocytes, platelet;
- General urine analysis - protein detection, Urobilin;
- Sample Zimnitsky (analysis of daily urine) - an increase in the amount of urine, increasing the number of detachable urine at night;
- Biochemical analysis of urine - increase creatinine, urea;
- Calculation of glomerular filtration rate by means of special formulas - its observed decline;
- Renal ultrasound study;
- X-ray examination of the kidneys with radiopaque material;
- Ultrasonography vessels with renal blood flow estimation;
- Kidney biopsy;
- CT scan;
- Examination of the kidneys and the urinary tract using an endoscope (a tube with a video camera on the end).
treatment of chronic renal failure
Treatment is carried out physician-nephrologist and depends on the immediate causes of chronic renal failure. In the presence of other pathologies treatment is carried out in conjunction with other specialists.
Treatment is divided into two types:
- conservative;
- Active.
By conservative treatment includes:
- Dieting - limiting the amount of protein consumed, limit salt or complete ban;
- Lowering blood pressure levels in the presence of hypertension;
- Hormone therapy in autoimmune diseases;
- Diuretics (furosemide, Veroshpiron);
- Erythropoietin for anemia;
- Blood transfusion with severe anemia;
- Essential amino acids (Ketosteril).
For active treatment include:
- Hemodialysis - performed using the apparatus of "artificial kidney", by purifying the blood outside the body. The frequency of about two to three times a week.
- Peritoneal dialysis - is carried out by introducing the solution into the peritoneal cavity using a special catheter and then the suction of the liquid. Through this removes harmful substances.
- Kidney transplantation.
By resorting to active treatment in end form of chronic renal failure, when it is not effective conservative treatment.
Treatment is always long, and in severe cases can last for years.
complications
- Intoxication nitrogenous substances - with the development of uremia uraemic coma and can be fatal;
- Hypertension, poorly amenable to therapy;
- Severe anemia;
- Cardiac arrhythmias;
- Pulmonary edema;
- Acute myocardial infarction;
- Severe inflammatory and infectious diseases (pneumonia, sepsis);
- Acute heart failure.
prevention
Preventing the development of diseases, leading to the development of chronic renal failure.
Maintain a healthy lifestyle.
Medication strictly prescribed by a doctor, in compliance with the dosage and duration of reception.
If there are conditions which may lead to chronic renal failure, required control of the kidney function.
