Chronic renal failure is a progressive extinction of renal function associated with the death of nephrons or with their replacement with connective tissue against the background of chronic pathology.
Nephrons are important structural units of the kidneys that are involved in cleansing the blood of nitrogenous toxins, promoting the production of erythropoietin, removing excess salt and water, and absorbing electrolytes.
In this regard, as the functioning of the kidneys deteriorates, the functioning of the body as a whole is disrupted. Various organs and systems are affected. Although modern medicine has expanded capabilities in terms of treating kidney pathologies, nevertheless, up to 40% of them sooner or later turn into chronic renal failure.
- The causes of chronic renal failure.
- Chronic renal failure symptoms.
- Stages of chronic renal failure.
- Complications of chronic renal failure.
- Diagnosis of chronic renal failure.
- How is kidney failure treated?
- What kind of treatment can be arranged at home?
- What drugs are used to treat chronic renal failure?
- Which doctor treats kidney failure?
The Causes of Chronic Renal Failure
The causes of chronic renal failure lie in various diseases. Almost any lingering kidney disease of the way, after a while, lead to the inability of organs to function normally or to complete failure. In other words, we can say that chronic renal failure is only a matter of time, provided that the person has kidney disease and does not receive adequate treatment. However, not only diseases of the kidneys themselves can lead to the inability of these organs to function normally.
Therefore, the complete list of reasons provoking this pathological process is as follows:
- In the first place are various renal diseases: glomerulonephritis, pyelonephritis, chronic tubulointerstitial nephritis. Dangerous kidney tuberculosis, hydronephrosis, polycystic, kidney neoplasms, nephrolithiasis;
- Diseases of the urinary tract, including urethral strictures, kidney and bladder stones;
- Diseases of the cardiovascular system, for example, angiosclerosis of the renal vessels. Hypertension, although rare, but still leads to the development of renal failure;
- Diabetes mellitus.
- Systemic pathologies – hemorrhagic vasculitis, renal amyloidosis.
The pathogenesis of the disease is based on the progressive death of nephrons. At first, the process of the organs becomes less productive, after which more pronounced renal dysfunctions begin to increase. The parenchyma is gradually replaced by connective tissue, with its subsequent atrophy and wrinkling of the organ. A distinctive feature of this process is the inability of the kidney to recover, that is, the parenchyma does not regenerate, the compensatory capabilities of the kidneys are depleted. This can happen in a short time (a few months), but it is possible that the process will take many years.
Chronic Renal Failure Symptoms
The symptoms of chronic renal failure are as follows:
Patient appearance. Almost no characteristic external signs will be noticeable until the moment when there is a pronounced decrease in glomerular filtration of organs. The following violations can then be visualized.
The pallor of the skin is due to anemia, which gradually increases. Violations of the water and electrolyte balance lead to increased dryness of the skin. For the same reason, the skin loses its elasticity, it is possible to acquire an icteric color.
Subcutaneous hematomas often begin to develop. Bruising appears without prior trauma or bruising.
On the skin of patients there are scratches, which are caused by severe excruciating itching.
The face becomes very swollen. Swelling extends to the limbs, to the abdomen.
Muscle tone decreases, they become flabby, which affects their functionality. This negatively affects a person’s ability to work. Muscle twitching and cramps against a background of clear consciousness are due to a drop in blood calcium levels.
The skin remains dry even when the patient is experiencing intense excitement or stress.
Nervous system disorders. Patients become lethargic, do not sleep well at night, and during the daytime they feel tired and overwhelmed. Cognitive functions suffer, primarily memory and attention. The ability to learn and perceive information deteriorates. Patients often complain of coldness in the extremities, tingling sensation, and “goose bumps”. It is associated with a disorder of the peripheral nervous system. As the pathological process progresses, movement disorders are observed in the upper and lower extremities.
Urinary system. The volume of urine at the initial stages of the development of the disease increases, and the patient often goes to the toilet at night. As the deficiency develops, the volumes of urine excreted become less and less, edema continues to increase, complete anuria is possible.
Water-salt balance disorders. The thyroid gland begins to produce parathyroid hormone in large volumes. As a result, phosphorus levels rise and calcium levels fall. This becomes the cause of frequent spontaneous fractures against the background of softening of the bone tissue.
There is constant thirst, the patient’s mouth is dry.
With a sharp rise from a place, darkening occurs in the eyes, muscle weakness. This is due to the leaching of sodium from the body.
Against the background of excess potassium in the blood, muscle paralysis increases.
Respiratory dysfunction is possible.
The water-salt balance is essential for the functioning of the body as a whole. Failures can lead to serious problems in the work of the heart, up to and including cardiac arrest.
Nitrogen imbalance. If the glomerular filtration rate falls below 40 ml per minute, the patient has signs of enterocolitis. Against the background of an increase in the level of urea and uric acid in the blood, as well as an increase in creatinine, an ammonia smell will emanate from the patient’s mouth, and articular lesions will begin to develop.
Manifestations from the cardiovascular system. The function of hematopoiesis suffers, which is expressed in anemia, lethargy, increased fatigue and weakness.
Pericarditis and myocarditis develop.
Blood pressure rises.
There are pains in the heart of a dull and aching character, shortness of breath increases, the heart rhythm is disturbed.
Acute heart failure is a complication of renal failure and can cause death of the patient.
At a late stage of the development of renal failure, the “uremic lung” develops. Interstitial edema increases, a bacterial infection joins, which is associated with a drop in immunity.
As for the digestive system, its work is disrupted. Appetite disappears, nausea and vomiting may occur. Often, the salivary glands and the oral mucosa react with inflammation. Sometimes patients reach the stage of anorexia due to aversion to food. Uremia causes stomach and intestinal ulcers, which can be complicated by bleeding. Acute hepatitis also often accompanies uremia.
Stages of Chronic Renal Failure
The stages of chronic renal failure are characterized by the steady destruction of the renal glomeruli with their replacement by scar tissue. In this case, compensatory changes occur in the remaining intact glomeruli.
Therefore, the pathological process develops gradually, passing through several stages:
The initial or latent stage. The glomerular filtration rate is about 60-70 ml per minute. This is considered a normal variant, but kidney damage is already present, and there is also an imbalance between night and day diuresis. Patients, as a rule, do not present complaints at this time, although some decrease in working capacity is possible.
Compensated stage. Efficiency becomes worse, fatigue increases, and the mouth feels dry. Moreover, the filtration rate varies from 30 to 60 ml / min. It should be noted that for the elderly, such a rate is a variant of the norm, if there is no other structural damage to the kidneys. Nocturnal diuresis predominates, urine osmolarity falls, creatinine and urea in the blood are still at the normal level, but the number of working nephrons is decreasing.
The intermittent stage is characterized by an increase in symptoms, since the filtration rate does not exceed 15-30 ml per minute, and sometimes it can drop up to 30 ml / min. Depending on this, one or another degree of brightness of the clinical picture will be observed. Nevertheless, there is always an increase in the volume of urine excreted, appetite worsens, and excessive dryness of the skin appears. In 50% of cases, an increase in blood pressure is observed. The daily urine output falls, the content of creatinine and urea in the blood increases.
The terminal stage is characterized by a drop in the filtration rate to 15 ml / min and less. Anuria may develop. The skin acquires a yellow-gray tint, becomes flabby. Patients fall into apathy, sleepy, inactive. Signs of poisoning are increasing due to an increase in the level of nitrogenous toxins in the blood. The water-electrolyte balance is disturbed, organs and systems work intermittently. First of all, this concerns the heart and nervous system. If dialysis is not performed at this stage, the patient dies.
Complications of Chronic Renal Failure
Complications of chronic renal failure are as follows:
- Anemia against the background of oppression of the hematopoietic system. Violation of the coagulation properties of blood, the development of thrombocytopenia;
- Hypertension, myocarditis, pericarditis, uremic pneumonia;
- Congestive heart failure;
- Confusion of consciousness, delirium, hallucinations, peripheral polyneuropathy;
- Stomatitis, enterocolitis, atrophic gastritis, gastric ulcer and duodenal ulcer with possible bleeding;
- Osteoporosis, osteomalacia, skeletal deformities, bone fractures, arthritis;
- Lymphocytopenia, impaired functioning of the immune defense and the development of purulent-septic conditions.
Diagnosis of Chronic Renal Failure
The diagnosis of chronic renal failure is in the competence of a nephrologist and is based on laboratory tests.
- Biochemical analysis of urine;
- Blood chemistry;
- Rehberg test;
- Zimnitsky test.
In addition, ultrasound of the kidneys, ultrasound of the kidney vessels is shown. As for radiopaque urography, it should be done very carefully, since most of the substances used for this purpose have a toxic effect on the kidneys.
How is Kidney Failure Treated?
Treatment of chronic renal failure directly depends on the stage at which the pathological process is, and whether the patient has other diseases.
It has been established that the initial, latent stage of pathology may not give itself out for a long time. Therefore, therapy in most cases is absent.
When the disease is detected at a compensated stage, then very serious treatment is required. They resort to surgical intervention in order to normalize the output of urine from the organs. This is necessary in order to return the disease to its initial stage. If there is no treatment at this stage, then the compensatory mechanisms of the kidneys will soon run out, and the disease will move on to the next stage.
Surgical interventions at the intermittent stage are not performed, as they are associated with high risks. At this stage, palliative treatment and detoxification therapy are carried out. The operation can be performed only when the kidney function is restored.
If the disease has progressed for a long time and is at its last stage, then the struggle will go on for a person’s life. In this case, the treatment must be very careful, planned and targeted. This is the only way to achieve success.
To prevent disturbances in the functioning of the nephrons, the following treatment is indicated:
- Remove the functional load from nephrons that have not yet lost their performance;
- Activate the immune defense, which will rid the body of nitrogenous toxins;
- Correct the vitamin, mineral and electrolyte balance in the body;
- Engage in blood purification using hemodialysis and peritoneal dialysis;
- Choose replacement therapy, organ transplantation is possible.
Physiotherapy measures are shown to accelerate the removal of nitrogenous toxins. This can be a visit to an infrared sauna, taking medicinal baths, spa treatment. Enterosorbent drugs, for example, Polyphepan, help to correct the pathological process. Lespenephril is prescribed to normalize protein metabolism.
Cleansing enemas and the appointment of laxatives help to get rid of excess potassium in the body. This allows you to reduce the concentration of the microelement in the intestine and accelerate its excretion.
Up to 4 times a year, patients are admitted to a hospital for the purpose of performing infusion therapy. A course of administration of glucose, Reopolyglucin, diuretics, anabolic steroids, sodium bicarbonate, vitamin B and ascorbic acid is carried out.
Although hemodialysis is a complex procedure, many patients cannot do without it.
The mechanism is as follows:
- Arterial blood enters the dialysis machine, where it interacts with a membrane that is incompletely permeable. On the other side of the membrane is the dialysis solution;
- Nitrogenous toxins from the patient’s blood gradually pass into this solution, and the blood is purified;
- Not only toxins go away, but also excess water, which brings the body’s water-salt balance back to normal;
- The purified blood is returned to its owner.
The duration of the procedure is from 4 to 5 hours, the frequency is once every two days.
As for peritoneal dialysis, it is performed in patients who have severe concomitant pathologies and cannot tolerate heparin. A special sterile solution is injected into the abdominal cavity through a catheter, it is saturated with decay products, after which it is taken back through the same catheter. This method can be applied even at home.
Kidney transplant surgery is the most radical treatment. It is carried out in specialized nephrological medical centers. Almost all patients with chronic renal failure require transplantation. But the problem lies in the selection and search for a donor. Therefore, you can wait for your turn for decades. The kidney is transplanted into the iliac region with the implantation of the ureter into the bladder, into its lateral wall. It is very important that compatibility is matched for tissue type, Rh factor, cross sample and HLA typing system. However, there is always a risk of organ rejection, therefore, after the operation, preventive measures are taken with the help of immunosuppressive drugs – these are Prednisolone and Methylprednisolone. It is also possible to use anti-lymphocyte globulin and cytostatics – Imuran, Azathiopin.
What Kind of Treatment Can Be Arranged at Home?
In a hospital setting, patients are treated during an exacerbation of a chronic process, as well as in the last stages of the disease. In all other cases, a person can receive treatment at home, regularly visiting a doctor to monitor therapy.
To relieve the load from the working undamaged nephrons, the following measures are taken:
- Refuse from drugs that have a toxic effect on the kidneys;
- Reduce physical activity, but this does not mean a complete rejection of them;
- Sources of infection should be promptly eliminated and treated;
- It is necessary to use drugs that allow you to remove toxins from the intestines;
- It is important to stick to a dietary diet plan. Avoid salt and control your daily protein intake.
It is impossible to consume more than 60 gm of protein per day, and in conditions of exceeding the level of nitrogenous compounds in the body, this figure is reduced to 20 gm. However, amino acids must enter the body in a normal, balanced amount. If you have high blood pressure, you cannot get rid of edema, then you should not consume more than 4 gm of salt per day. However, this restriction is lifted as soon as the patient’s condition improves, since the lack of sodium in the body is no less dangerous. It has been found that the rejection of salt provokes hypokalemia and disrupts filtration.
The more a person sweats, the faster nitrogenous toxins are eliminated from the body. Therefore, you should not refuse physiotherapy if there are no other contraindications for their implementation. This is an infrared sauna, therapeutic baths, treatment in sanatoriums.
Hemodialysis can also be done at home. For this, specialized devices have been created that make this procedure easier and safer. However, this practice is not common, so patients are forced to regularly visit medical institutions. In addition, peritoneal dialysis can be performed at home, which removes uremic waste products from the body.
What Medicine & Drugs Are Used to Treat Chronic Renal Failure?
- Cleansing enemas with sodium bicarbonate (2% solution).
- Correction of homeostasis in a hospital: glucose (20%) + sodium bicarbonate (4%) + Rheopolyglucin + anabolic steroids + ascorbic acid and B vitamins.
- Normalization of platelet function – adenosine triphosphoric acid is injected intramuscularly for 30 days, or magnesium oxide for the same period at a dosage of 1 gm.
- Immunosuppressants for the prevention of transplanted kidney rejection are Methylprednisolone, Prednisolone, Imuran, Azathioprine, antilymphocytic globulin.
- Decrease in the level of potassium in the blood – buckthorn, sorbitol, rhubarb, liquid paraffin.
- To accelerate the withdrawal of protein compounds – Lespenephril three times a day, a teaspoon.
- Diuretic infusion therapy in hospital – ethacrynic acid, Lasix.
- And as an enterosorbent – Polyphepan for a month.
- To normalize the level of heparin – protamine sulfate.
Which Doctor Treats Kidney Failure?
A urologist and a nephrologist are involved in the treatment of the disease. Kidney transplantation is the responsibility of the nephrology surgeon.