Heart failure symptoms. Symptoms of kidney failure

Complications

Patients with renal insufficiency with improper treatment can get serious complications.

PN is a severe disease of the urinary system associated with a decrease or complete absence of its functional activity. Symptoms of kidney failure in women depend on the type of pathology or the stage at which the disease is located. The consequence of the disease is a violation of the water electrolyte balance, poisoning the body with metabolic products. In the absence of adequate treatment, the result is death.

Features of renal failure in women

Pathology, according to statistics, is more common in women than in men. This pattern is fully explained by the anatomical features of the genitourinary system.

The female urethra is larger in diameter and shorter in length, it is she who is the entrance gate for pathogenic microflora. Further spread infection occurs in ascending path, that is, from the urethra through the bladder and ureters. It is active infectious inflammation, further growth of connective tissue that leads to disruption of the kidneys.

Types and stages of renal failure in women

There are two main forms of the disease: acute and chronic. Each type goes through several stages, differing in clinical presentation and diagnostic data.

When (OPN) there are four periods:

• elementary;
• oligoanuric;
• polyuric;
• recovery period.

Chronic renal failure or CRF also consists of four stages:

• initial or latent;
• compensated;
• intermittent;
• terminal.

Causes of PN in women

In the etiology of this disease, it is worth highlighting two main points: the reasons due to which deficiency was directly formed and risk factors that determine the predisposition of a woman to the development of pathology, but do not cause it.

Causes include the following:

• damage to the pelvicalyceal system by bacteria or viruses (Staphylococcus aureus, Koch's bacillus or tuberculosis mycobacterium, influenza virus, and others);
• active autoimmune process - inadequate work immune system, in which antibodies are produced to their own healthy cells;
• active growth of a benign or malignant tumor that compresses surrounding tissues;
• violation of the blood supply to the kidney with thromboembolism of the arteries, their spasm, atherosclerotic process or gradual sclerosis;
• removal of the kidney, after which an adequate process of blood filtration in the paired organ was not restored;
• transferred surgical intervention, severe postoperative period;
• pregnancy;
• urolithiasis disease.

Risk factors include:

• malnutrition, overuse protein food, products supplied with dyes and preservatives;
• sedentary lifestyle, passivity;
• Availability bad habits: abuse of alcoholic beverages, smoking, drug addiction;
• hereditary predisposition;
• old age: from fifty years and older;
• obesity;
• diabetes leading to all kinds of metabolic disorders;
• long-term use of drugs that have a toxic effect on the body;
• congenital anomalies in the development of the kidneys and the urinary system as a whole.

Symptoms of acute renal failure

Signs of renal failure in women directly depend on the course of the pathology and the phase of development. The initial period of acute renal failure has an acute onset, characterized by:

• severe pain in the lumbar region;
• decrease in diuresis;
• nausea;
• vomiting;
• weakness;
• dizziness;
• less often - the patient's lethargy and impaired consciousness.

Some changes also occur in the organs of the cardiovascular system:

• the heart rate increases;
• gradually increases blood pressure;
• systolic murmur appears on auscultation of the heart;
• the muffledness of the first and second tones is determined;
• cardiac arrhythmia develops.

In the oligoanuric phase, it is noted:

• decrease in diuresis up to anuria;
• increase in signs of intoxication;
• change in the color of urine to a pink or red hue.

With adequate treatment, at the end of this phase, there is some improvement in the patient's well-being.

In the polyuric period, diuresis is gradually restored, laboratory parameters return to normal. Clinical manifestations mostly include:

• weakness;
• lethargy;
• arterial hypertension with a heart rate of 60-80 beats per minute.

The recovery period speaks for itself, the body is fully restored, the work of the urinary system is preserved.

During pregnancy

During gestation, some women develop renal failure syndrome due to squeezing of the ureters or vessels supplying the organ. In this case, the main symptoms are:

• a sharp decrease in the volume of urine excreted up to its complete absence;
• arterial hypertension;
• proteinuria - the appearance of a large amount of protein in the urine;
• swelling of tissues, mainly on the lower extremities and face;
• weakness, nausea, vomiting, unusual for the second and third trimester;
• pallor of the skin.

With the development of such a clinical picture, it is urgent to consult a doctor who will decide on the issue of hospitalization in the urological department.

Signs of chronic renal failure

Compared with acute renal failure, this type of disease develops slowly, due to various pathologies, for example, sluggish inflammation of the parenchyma.

In the latent stage of chronic renal failure, symptoms in women are practically absent, in rare cases, fatigue may gradually increase during normal physical or mental stress, and dry mouth appears. Changes in blood and urine tests are minor.

In the compensated stage, the body activates compensatory mechanisms that increase the functioning of the renal apparatus. Due to this, the volume of excreted urine increases to 2.5-3 liters. Together with it, there is a loss of protein, microelements, which negatively affects the water-electrolyte balance and metabolism in cells.

During the intermittent phase, the following changes occur:

• oliguria or anuria appears;
• indicators of blood and urine sharply differ from normal values;
• increasing intoxication of the body.

Complaints mostly include:

• dizziness;
• weakness;
• nausea;
• vomiting;
• drowsiness;
• impaired consciousness up to stupor and stupor;
• tachycardia;
• increased sweating;
• pallor of the skin;
• a sharp increase in blood pressure.

At the terminal stage:

• intoxication encephalopathy and other structural disorders are formed nervous system;
• are celebrated mental disorders in the form of apathy, mutism (silence);
• there is a complete lack of appetite;
• from the organs of the gastrointestinal tract: diarrhea, regurgitation of food, vomiting, flatulence;
• urine is not excreted.

The endocrine, cardiovascular system functions inadequately. The pathological process ends in death.

Diagnosis of kidney failure

Without fail, it begins with a survey of the patient, collecting an anamnesis of the disease and life, general inspection, after which the doctor decides which study to write out. To confirm the presence of renal failure in a woman, you need to take tests and undergo an instrumental examination.

Among the laboratory methods, the most important is the general, biochemical blood test, general urinalysis. The markers of this disease include:

• proteinuria - the presence of protein in the urine, in particular, albumin;
• change in urine sediment - fragments of erythrocytes, leukocytes are determined;
• violation of water and electrolyte balance, a decrease in the amount of certain microelements in the blood.

IN biochemical analysis there is an increase in the concentration of creatinine, urea and a decrease in the glomerular filtration rate of GFR.

In order to visualize the affected organ, the doctor sends the patient to ultrasound of the kidneys and X-ray with contrast. During the survey, you can determine:

• the presence of a tumor, stones;
• change in the contour of the organ due to the growth of connective tissue, wrinkling of the kidney during the infectious process;
• structural violation of the pyelocaliceal system;
• blockage of the ureter;
• decrease in blood supply to tissues for one reason or another.

Complications

Complications of renal failure should be divided depending on the form of the disease. In acute renal failure, in the absence of adequate medical care, the following consequences are observed:

• suppression of the immune response with the further development of sepsis and infectious-toxic shock;
• pulmonary edema;
• violation of the heart rhythm;
• pericarditis;
• malignant hypertension;
• uremic gastroenterocolitis;
• peripheral or central polyneuropathy.

With chronic renal failure, complications are expressed at the third and fourth stages of development. Often formed:

• thrombocytopenia;
• uremic pneumonitis;
• myocarditis or pericarditis;
• congestive heart failure;
• encephalopathy with subsequent neurological and mental disorders;
• osteomalacia;
• sepsis and infectious-toxic shock.

Treatment

Therapy is based on two main points: diet and the use of specialized medications. It is worth remembering that the treatment is selected individually by the doctor, taking into account the age of the woman and the severity of the disease. The use of folk methods is prohibited, if you treat kidney failure with herbs alone, you can only achieve the development of complications that were described just above.

Diet

The diet includes a balanced diet, eating foods low in protein and salt. The amount of fluid that has entered the patient's body per day is taken under control. The goal pursued by the doctor in this case is to reduce blood pressure and reduce the load on the renal glomeruli.

The set of recommended products may vary depending on which microelement needs to be replenished in the body. For example, with a decrease in the level of potassium, the diet should contain more dried fruits, nuts, and with a deficiency of magnesium, it is worth focusing on fresh vegetables, fruits, and cereals.

Medical

When it comes to medications, it often comes to the fore infusion therapy- intravenous administration of solutions of trace elements, glucose to restore water and electrolyte balance. Additionally, in rare cases, the doctor recommends oral tablets with a complex of vitamins and minerals.

For the relief of arterial hypertension, two main groups are prescribed medicines: sartans (angiotensin receptor blockers) and angiotensin-converting enzyme inhibitors (ACE inhibitors). Treatment of arrhythmias is selected by a cardiologist depending on the type of disorder.

With widespread edema, anuria, to restore daily diuresis, drink diuretics - diuretics. IN clinical practice Loop and potassium-sparing medications are most often prescribed.

The rehabilitation period after acute renal failure usually takes six months or a year. During this time, the woman must be registered with the dispensary. The chronic form of the disease implies constant monitoring of the patient's well-being, but a complete recovery cannot be achieved through outpatient or inpatient treatment.

Distinguish between acute and chronic renal failure.
Acute renal failure (ARF)- a sudden violation of kidney function with a delay in the excretion of nitrogen metabolism products from the body and a disorder of the water, electrolyte, osmotic and acid-base balance. These changes occur as a result of acute severe disturbances in renal blood flow, GFR, and tubular reabsorption, usually occurring simultaneously.

Acute renal failure occurs when both kidneys suddenly stop functioning. The kidneys regulate the balance chemical substances and body fluids and filter waste from the blood into the urine. Acute renal failure can occur different reasons including kidney disease, partial or complete blockage of the urinary tract, and reduced blood volume, such as after severe blood loss. Symptoms may develop over several days: the amount of urine excreted may decrease dramatically, and the fluid to be excreted accumulates entirely in the tissues, causing weight gain and swelling, especially in the ankles.

Acute kidney failure is a life-threatening condition because excessive amounts of water, minerals (particularly potassium), and waste products that are normally excreted in urine accumulate in the body. The disease usually responds well to treatment; Kidney function can be fully restored in a few days or weeks if the cause is correctly identified and treated appropriately. However, acute kidney failure due to kidney disease can sometimes lead to chronic kidney disease, in which case the outlook for the disease depends on the ability to cure the underlying disease.

Currently, there are several etiological groups of acute renal failure.

Prerenal acute renal failure (ischemic)

- shock kidney (trauma, fluid loss, massive tissue breakdown, hemolysis, bacteremic shock, cardiogenic shock). - Loss of extracellular volume (gastroenteric loss, urinary loss, burns). - Loss of intravascular volume or its redistribution (sepsis, bleeding, hypoalbuminemia). - Decreased cardiac output (heart failure, cardiac tamponade, heart surgery). - Other causes of reduced GFR (hypercalcemia, hepatorenal syndrome).

Renal OPN.

- Exogenous intoxications (damage to the kidneys by poisons used in industry and everyday life, bites of poisonous snakes and insects, intoxication medicines and radiopaque agents). - Acute infectious-toxic kidney with indirect and direct action on the kidneys of an infectious factor - Damage to the renal vessels (hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, scleroderma, systemic necrotizing vasculitis, thrombosis of arteries or veins, atherosclerotic embolism in severe atherosclerosis main vessels- primarily aorta and renal arteries). — Open and closed injuries kidneys. - Postischemic acute renal failure.

Postrenal acute renal failure.

- Extrarenal obstruction (occlusion of the urethra; tumors of the bladder, prostate, pelvic organs; blockage of the ureters with a stone, pus, thrombus; urolithiasis, blockade of tubules by urates in the natural course of leukemia, as well as their treatment, myeloma and gouty nephropathy, treatment with sulfonamides; accidental ligation of the ureter during surgery). - Retention of urination, not caused by an organic obstruction (impaired urination with diabetic neuropathy or as a result of the use of M-anticholinergics and ganglion blockers).

Symptoms

Passing only small amounts of urine. . Weight gain and swelling of the ankles and face due to fluid accumulation. . Loss of appetite. . Nausea and vomiting. . Itching all over body. . Fatigue. . Abdominal pain. . Urine with blood or dark color. . Symptoms final stage in the absence of successful treatment: shortness of breath due to the accumulation of fluid in the lungs; unexplained bruising or bleeding; drowsiness; confusion; muscle spasms or cramps; loss of consciousness.

In the development of acute renal failure, four periods are distinguished: the period of the initial action of the etiological factor, the oligoanuric period, the period of recovery of diuresis and recovery.

In the first period, the symptoms of the condition leading to acute renal failure predominate. For example, observe fever, chills, collapse, anemia, hemolytic jaundice in anaerobic sepsis associated with community-acquired abortion, or clinical picture general action one or another poison (vinegar essence, carbon tetrachloride, salt heavy metals etc.).

The second period - the period of a sharp decrease or cessation of diuresis - usually develops soon after the action of the causative factor. Azotemia increases, nausea, vomiting, coma appear, due to the retention of sodium and water, extracellular hyperhydration develops, manifested by an increase in body weight, abdominal edema, pulmonary edema, and brain.

After 2-3 weeks, oligoanuria is replaced by a period of recovery of diuresis. The amount of urine usually increases gradually, after 3-5 days diuresis exceeds 2 l / day. First, the fluid accumulated in the body during the period of oligoanuria is removed, and then dangerous dehydration occurs due to polyuria. Polyuria usually lasts 3-4 weeks, after which, as a rule, the level of nitrogenous wastes normalizes and a long (up to 6-12 months) recovery period begins.

Thus, from a clinical standpoint, the most difficult and life-threatening patient with acute renal failure is the period of oligoanuria, when the picture of the disease is characterized primarily by azotemia with a sharp accumulation of urea, creatinine in the blood, uric acid and electrolyte imbalance (primarily hyperkalemia, as well as hyponatremia, hypochloremia, hypermagnesemia, hypersulfate and phosphatemia), the development of extracellular overhydration. The oligoanuric period is always accompanied by metabolic acidosis. During this period, a number of severe complications may be associated with inadequate treatment, primarily with uncontrolled administration of saline solutions, when sodium accumulation first causes extracellular hydration, and then intracellular overhydration, leading to coma. Severe condition often exacerbated by uncontrolled use of hypotonic or hypertonic saline glucose, which reduces the osmotic pressure of plasma and enhances cellular overhydration due to the rapid transition of glucose, and after it, water into the cell.

During the recovery period of diuresis due to severe polyuria, there is also a risk of severe complications, primarily due to developing electrolyte disorders (hypokalemia, etc.).

The clinical picture of acute renal failure may be dominated by signs of disorders of the heart and hemodynamics, advanced uremic intoxication with severe symptoms gastroenterocolitis, mental changes, anemia. Often, the severity of the condition is aggravated by pericarditis, respiratory failure, nephrogenic (hyperhydration) and cardiac pulmonary edema, gastrointestinal bleeding, and especially infectious complications.

To assess the severity of the condition of a patient with acute renal failure, indicators of nitrogen metabolism, primarily creatinine, the level of which in the blood does not depend on the patient's diet and therefore more accurately reflects the degree of impaired renal function, are of primary importance. Creatinine retention usually outpaces the increase in urea, although the dynamics of the level of the latter is also important for assessing the prognosis in acute renal failure (especially when the liver is involved in the process).

However, in many ways, the clinical manifestations of acute renal failure, in particular signs of damage to the nervous system and muscles (primarily myocardium), are associated with impaired potassium metabolism. Often occurring and quite understandable hyperkalemia leads to an increase in myocardial excitability with the appearance of a high, with a narrow base and a pointed top of the T wave on the ECG, slowing atrioventricular and intraventricular conduction up to cardiac arrest. In some cases, however, instead of hyperkalemia, hypokalemia may develop (with repeated vomiting, diarrhea, alkalosis), the latter is also dangerous for the myocardium.

Causes

Diagnostics

Clarification of the etiological factors of acute renal failure allows more targeted therapeutic interventions. So, prerenal acute renal failure develops mainly with shock states characterized by severe microcirculation disorders due to hypovolemia, low central venous pressure and other hemodynamic changes; to eliminate the latter, and it is necessary to direct the main medical measures. Similar in mechanism to these conditions are cases of acute renal failure associated with a large loss of fluid and NaCl in severe extensive lesions of the gastrointestinal tract (infections, anatomical disorders) with indomitable vomiting, diarrhea, which also determines the range of therapeutic effects. Renal acute renal failure develops due to the action of various toxic factors, primarily a number of chemical, medicinal (sulfonamides, mercury compounds, antibiotics) and radiopaque substances, and may also be due to kidney disease(AGN and nephritis associated with systemic vasculitis). Prevention and treatment of acute renal failure in these cases should include measures that limit the possibility of exposure to these factors, as well as effective methods of dealing with these kidney diseases. Finally, the therapeutic tactics for postrenal acute renal failure is mainly to eliminate the acute obstructed outflow of urine due to urolithiasis, bladder tumors, etc.

It should be borne in mind that the ratios of various causes of acute renal failure may change due to certain features of their impact on the kidneys. Currently, the main group of cases of acute renal failure is still made up of acute shock and toxic kidney damage, but within each of these subgroups, along with post-traumatic acute renal failure, acute renal failure in obstetric and gynecological pathology (abortion, complications of pregnancy and childbirth), acute renal failure due to blood transfusion complications and the action of nephrotoxic factors (poisoning with acetic essence, ethylene glycol), acute renal failure is becoming more frequent, associated with an increase in surgical interventions, especially in older age groups, as well as with the use of new drugs. In endemic foci, the cause of acute renal failure can be viral hemorrhagic fever with kidney damage in the form of severe acute tubulointerstitial nephritis.

Although a large number of works have been devoted to the study of the mechanisms of development of acute renal failure, nevertheless, the pathogenesis of this condition cannot be considered definitively elucidated.

However, it has been proven that various etiological variants of ARF are characterized by a number of common mechanisms:

Violation of the renal (especially cortical) blood flow and a drop in GFR; . total diffusion of the glomerular filtrate through the wall of the damaged tubules; . compression of the tubules by edematous interstitium; . a number of humoral effects (activation of the renin-angiotensin system, histamine, serotonin, prostaglandins, other biologically active substances with their ability to cause hemodynamic disturbances and damage to the tubules); . shunting of blood through the juxtamedullary system; . spasm, thrombosis of arterioles.

The resulting morphological changes relate mainly to the tubular apparatus of the kidneys, primarily the proximal tubules, and are represented by dystrophy, often severe necrosis of the epithelium, accompanied by moderate changes in the interstitium of the kidneys. Glomerular disorders are usually minor. It should be noted that even with the deepest necrotic changes, regeneration of the renal epithelium occurs very quickly, which is facilitated by the use of hemodialysis, which prolongs the life of these patients.

With the commonality of developing processes, the predominance of one or another link in pathogenesis determines the features of the development of acute renal failure in each of its named variants. Thus, in shock acute renal failure, ischemic damage to the renal tissue plays the main role; in nephrotoxic acute renal failure, in addition to hemodynamic disorders, the direct effect of toxic substances on the tubular epithelium during their secretion or reabsorption is important; in hemolytic-uremic syndrome, thrombotic microangiopathy predominates.

In some cases, acute renal failure develops as a consequence of the so-called acute hepatorenal syndrome and is caused by severe liver diseases or surgical interventions on the liver and biliary tract.

Hepatorenal syndrome is a variant of acute functional renal failure that develops in patients with heavy defeat liver (with fulminant hepatitis or advanced cirrhosis of the liver), but without any visible organic changes in the kidneys. Apparently, changes in blood flow in the renal cortex of neurogenic or humoral origin play a certain role in the pathogenesis of this condition. Harbingers of the onset of hepatorenal syndrome are gradually increasing oliguria and azotemia. Hepatorenal syndrome is usually distinguished from acute tubular necrosis by a low concentration of sodium in the urine and the absence of significant changes in sediment, but it is much more difficult to differentiate it from prerenal acute renal failure. In doubtful cases, the reaction of the kidneys to the replenishment of BCC helps - if renal failure does not respond to an increase in BCC, it almost always progresses and leads to lethal outcome. Developing in the terminal stage arterial hypotension can cause tubulonecrosis, which further complicates the clinical picture.

Treatment

Prevention

Treatment of a disease that may be the cause of acute kidney failure.

Chronic renal failure (CRF)- impaired renal function caused by a significant decrease in the number of adequately functioning nephrons and leading to self-poisoning of the body by the products of its own vital activity.

Chronic renal failure occurs when both kidneys gradually stop functioning. The kidneys have numerous tiny structures (glomeruli) that filter waste from the blood and store large substances such as proteins in the blood. Waste substances and excess water accumulate in the bladder and are then excreted in the form of urine. In chronic kidney failure, the kidneys are damaged gradually over many months or years. Since kidney tissue is destroyed by damage or inflammation, the remaining healthy tissue compensates for its work. The extra work overworks previously undamaged parts of the kidney, causing more damage until the entire kidney stops functioning (a condition known as end stage kidney failure).

The kidneys have a large margin of safety; more than 80-90 percent of the kidney may be damaged before symptoms appear (although symptoms may appear sooner if the weakened kidney is subjected to sudden stress, such as infection, dehydration, or use of a kidney-damaging drug). As excessive amounts of fluid, minerals such as potassium, acids, and waste products build up in the body, chronic kidney failure becomes a life-threatening disease. However, if the underlying disease is cured and further kidney damage can be controlled, the onset of end-stage renal disease may be delayed. End-stage kidney failure is treated with dialysis or a kidney transplant; any of these ways can prolong life and allow a person to lead a normal life.

Can lead to the development of CKD various diseases and disorders of the kidneys. They include chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, kidney tuberculosis, amyloidosis, and hydronephrosis due to the presence of different kind obstruction to the outflow of urine.

In addition, CRF can occur not only due to kidney disease, but also for other reasons. Among them, diseases of the cardiovascular system can be noted - arterial hypertension, stenosis of the renal arteries; endocrine system- Diabetes and diabetes insipidus, hyperparathyroidism. The cause of CKD can be systemic diseases connective tissue - systemic lupus erythematosus, scleroderma, etc., rheumatoid arthritis, hemorrhagic vasculitis.

Causes

It should be noted that, regardless of the cause, chronic renal failure is associated, on the one hand, with a decrease in the number of active nephrons and, on the other hand, with a decrease in the working activity in the nephron. External manifestations of CRF, as well as laboratory signs of renal failure, begin to be detected with the loss of 65-75% of nephrons. However, the kidneys have amazing reserve capabilities, because the vital activity of the body is preserved even with the death of 90% of the nephrons. Compensation mechanisms include an increase in the activity of the remaining nephrons and an adaptive restructuring of the work of all other organs and systems.

The ongoing process of nephron death causes a number of disorders, primarily of an exchange nature, on which the patient's condition depends. These include violations of water-salt metabolism, retention in the body of its waste products, organic acids, phenolic compounds and other substances.

Symptoms

characteristic feature CRF is an increase in the volume of urine excreted - polyuria, which occurs even on early stages with predominant damage to the tubular part of the nephron. At the same time, polyuria is permanent even with limited fluid intake.

Salt metabolism disorders in CRF primarily affect sodium, potassium, calcium, and phosphorus. The excretion of sodium in the urine can be either increased or decreased. Potassium is normally excreted mainly by the kidneys (95%), therefore, in chronic renal failure, potassium can accumulate in the body, despite the fact that the function of its excretion is taken over by the intestines. Calcium, on the contrary, is lost, so it is not enough in the blood during CRF.

In addition to water-salt imbalance in the mechanism of development of CRF importance belongs to the following factors:

Violation of the excretory function of the kidneys leads to a delay in the products of nitrogen metabolism (urea, uric acid, creatinine, amino acids, phosphates, sulfates, phenols), which are toxic to all organs and tissues and, first of all, to the nervous system;

Violation of the hematopoietic function of the kidneys causes the development of anemia;

There is an activation of the renin-angiotensin system and stabilization of arterial hypertension;

The acid-base balance is disturbed in the blood.

As a result, deep dystrophic disorders occur in all organs and tissues.

It should be noted that the most common cause of CRF is chronic pyelonephritis.

At asymptomatic course chronic pyelonephritis CRF develops relatively late (20 or more years after the onset of the disease). Less favorable is the cyclic course of bilateral chronic pyelonephritis, when the developed manifestations of renal failure occur after 10-15 years, and its early signs in the form of polyuria - after 5-8 years from the onset of the disease. Important role belongs to the timely and regular treatment of the inflammatory process, as well as the elimination of its immediate cause, if possible.

CRF caused by chronic pyelonephritis is characterized by an undulating course with periodic deterioration and improvement in kidney function. Deterioration, as a rule, are associated with exacerbations of pyelonephritis. Improvements come after the full treatment of the disease with the restoration of the disturbed outflow of urine and the suppression of the activity of the infectious process. Arterial hypertension aggravates renal dysfunction in chronic pyelonephritis, which often becomes a factor determining the intensity of nephron death.

Urolithiasis also leads to the development of chronic renal failure, as a rule, with late onset or inadequate treatment, as well as with concomitant arterial hypertension and pyelonephritis with frequent exacerbations. In such cases, chronic renal failure develops slowly, within 10-30 years from the onset of the disease. However, when special forms urolithiasis, for example, with staghorn kidney stones, the death of nephrons is accelerated. Provoke the development of CRF in urolithiasis, repeated stone formation, a large stone, its long stay in the kidney with a latent course of the disease.

At any rate of development of CRF, a number of stages pass sequentially: latent, compensated, intermittent and terminal. Main laboratory indicator, separating one stage from another, is the clearance of endogenous (own) creatinine, which characterizes the glomerular filtration rate. Normal creatinine clearance is 80-120 ml per minute.

The latent stage of chronic renal failure is detected with a decrease in glomerular filtration (according to creatinine clearance) to 60-45 ml / min. During this period, the main clinical signs of CRF are polyuria and nocturia - the release of more urine at night, and not during the day. Mild anemia may develop. Patients usually do not present other complaints or note fatigue, weakness, sometimes occurring dry mouth.

The compensated stage is characterized by a decrease in glomerular filtration to 40-30 ml/min. Complaints of weakness, drowsiness, increased fatigue, apathy join. Daily urine output usually reaches 2-2.5 liters, increased excretion of sodium in the urine may begin, as well as changes in phosphorus-calcium metabolism with the development of the first signs of osteodystrophy. At the same time, the level residual nitrogen in the blood corresponds upper bounds norms.

The intermittent stage is characterized by an undulating course with alternating periods of deterioration and a clear improvement after full treatment. The glomerular filtration rate is 23-15 ml/min. The level of residual nitrogen in the blood is persistently elevated. Patients constantly complain of weakness, sleep disturbances, increased fatigue. Anemia is a typical symptom.

The terminal stage is characterized by intoxication of the body with its own nitrogenous waste products - uremia. The glomerular filtration rate is 15-10 ml/min. Typical features are pruritus, bleeding (nasal, uterine, gastrointestinal, subcutaneous hemorrhages), "uremic gout" with joint pain, nausea, vomiting, loss of appetite, up to aversion to food, diarrhea. The skin is pale, yellowish, dry, with traces of scratching, bruises. The tongue is dry, brown in color, a specific sweetish "uremic" smell comes from the mouth. For the most part, these symptoms occur because other organs, such as the skin, the gastrointestinal tract, etc., are trying to take over the function of the kidneys to remove nitrogenous waste and cannot cope with it.

The whole body suffers. Disturbances in the balance of sodium and potassium, persistently high blood pressure and anemia lead to deep damage to the heart. With an increase in the amount of nitrogenous wastes in the blood, symptoms of damage to the central nervous system increase: convulsive muscle twitches, encephalopathy up to uremic coma. In the lungs in the terminal stage, uremic pneumonia may develop.

Violations of phosphorus-calcium metabolism cause leaching of calcium from bone tissue. Osteodystrophy develops, which is manifested by pain in the bones, muscles, spontaneous fractures, arthritis, compression of the vertebrae and deformation of the skeleton. Children stop growing.

There is a decrease in immunity, which significantly increases the body's susceptibility to bacterial infections. One of the most common causes of death in patients with chronic renal failure in the terminal stage are purulent complications, up to sepsis, caused by opportunistic pathogenic bacteria, for example intestinal daddy.

Diagnostics

Treatment

In the initial stages, the treatment of chronic renal failure coincides with the treatment of the underlying disease, the purpose of which is to achieve a stable remission or slow down the progression of the process. If there are obstructions in the path of urine outflow, it is optimal to eliminate them surgically. In the future, against the background of continuing treatment of the underlying disease, a large role is given to the so-called symptomatic drugs - antihypertensive (pressure-reducing) drugs of the ACE inhibitor groups (Capoten, Enam, Enap) and calcium antagonists (Cordaron), antibacterial, vitamin agents.

An important role is played by the restriction in the diet of protein foods - no more than 1 g of protein per kilogram of the patient's weight. In the future, the amount of protein in the diet is reduced to 30–40 g per day (or less), and with a glomerular filtration rate of 20 ml/min, the amount of protein should not exceed 20–24 g per day. table salt also limit - up to 1 g per day. However, the calorie content of the diet should remain high - depending on the patient's weight, from 2200 to 3000 kcal (a potato-egg diet without meat and fish is used).

Iron preparations and other drugs are used to treat anemia. With a decrease in diuresis, it is stimulated with diuretics - furosemide (lasix) in doses up to 1 g per day. In a hospital, in order to improve blood circulation in the kidneys, intravenous drip-concentrated glucose solutions, gemodez, reopoliglyukin with the introduction of aminofillin, chimes, trental, papaverine are prescribed. Antibiotics are used with caution in chronic renal failure, reducing doses by 2-3 times, aminoglycosides and nitrofurans are contraindicated in chronic renal failure. For the purpose of detoxification, gastric and intestinal lavage, gastrointestinal dialysis are used. The washing liquid can be a 2% solution of baking soda or solutions containing sodium, potassium, calcium, magnesium salts with the addition of soda and glucose. Gastric lavage is performed on an empty stomach, using a gastric tube, for 1-2 hours.

In the terminal stage, the patient is shown regular (2-3 times a week) hemodialysis - an "artificial kidney" apparatus. The appointment of regular hemodialysis is necessary when the level of creatinine in the blood is over 0.1 g / l and its clearance is less than 10 ml / min. Kidney transplantation significantly improves the prognosis, however, in the terminal stage, poor survival of the organ is possible, so the issue of donor kidney transplantation should be addressed in advance.

Prevention

CKD prognosis

CKD prognosis in Lately lost fatality due to the use of hemodialysis and kidney transplantation, however, the life expectancy of patients remains significantly lower than the average for the population.

Pay attention to changes in urination. Both sharp and chronic form renal failure is often accompanied by an increase or decrease in diuresis. In particular, chronic renal failure is accompanied by urinary incontinence and/or recurrent urinary tract infection. Damage to the renal tubules leads to polyuria. Polyuria is an excessive production of urine that usually occurs early in kidney failure. Chronic renal failure can also cause a decrease in daily urination, which usually occurs in more advanced forms of the disease. Other changes include the following:

• Proteinuria: In kidney failure, protein passes into the urine. Due to the presence of protein, urine foams.
• Hematuria: Dark orange urine is the result of red blood cells in the urine.

Watch for sudden feelings of fatigue. One of the first signs of chronic kidney failure is fatigue. This is due to anemia, when there are not enough red blood cells in the body to carry oxygen. Due to the decrease in oxygen, you will feel tired and cold. Anemia is attributed to the fact that the kidneys produce a hormone called erythropoietin, which causes your bone marrow to produce red blood cells. But because the kidneys are damaged, they produce less of this hormone, therefore, less red blood cells are also produced.

Pay attention to swelling of body parts. Eden is an accumulation of fluid in the body that can occur in both acute and chronic renal failure. When the kidneys stop working properly, fluid begins to accumulate in the cells, which leads to swelling. Most often, swelling occurs in the hands, feet, legs and face.

Call your doctor if you experience dizziness or slow thinking. Dizziness, poor concentration, or lethargy can be caused by anemia. All due to the fact that not enough blood cells enter your brain.

Look for pain in your upper back, legs, or side. Polycystic kidney disease causes fluid-filled cysts to form in the kidneys. Sometimes cysts can also form in the liver. They call severe pain. The fluid in the cysts contains toxins that can damage the nerve endings in the lower extremities and lead to neuropathy, dysfunction of one or more peripheral nerves. In turn, neuropathy causes pain in the lower back and legs.

Watch for shortness of breath bad smell from the mouth and/or a metallic taste in the mouth. When your kidneys begin to fail, metabolic end products, most of which are acidic, will begin to accumulate in the body. The lungs will begin to compensate for this increased acidity by removing carbon dioxide through rapid breathing. This will make you feel like you can't catch your breath.

Pay attention if you suddenly start to itch or have dry skin. Chronic kidney failure causes pruritis (the medical term for itchy skin). This itching is caused by the accumulation of phosphorus in the blood. All food products contain some phosphorus, but some foods, such as dairy, contain more phosphorus than others. healthy kidneys able to filter and remove phosphorus from the body. However, in chronic renal failure, phosphorus lingers in the body and phosphorus crystals begin to form on the surface of the skin, which cause itching.

This pathological condition can be characterized as a serious disease of the organ of the genitourinary system, which leads to disturbances in acid-base, osmotic and water-salt homeostasis. The disease affects all the processes that occur in the body, which ultimately leads to the appearance of secondary damage.

What is kidney failure

There are two main ways of the course of the disease, the result of which will be either a complete loss of kidney function, or ESRD. Renal failure is a syndrome that causes disturbances in the functioning of the kidneys. The disease is the main cause of the disorder of most types of metabolism in the human body, including nitrogen, water or electrolyte. The disease has two forms of development - it is chronic and acute, as well as three stages of severity:

• risk;
• damage;
• failure.

Causes of kidney failure

Based on the opinions of doctors, the main causes of kidney failure in humans affect only two areas - high blood pressure and diabetes. In some cases, the disease may occur due to heredity or be suddenly triggered by unknown factors. Such patients seek help from the clinic in very advanced cases, when it is extremely difficult to establish the source and cure the disease.

Stages of kidney failure

Chronic illness kidney disease occurs in five hundred out of a million patients undergoing treatment, however, this figure is steadily increasing every year. As a result of the disease, there is a gradual death of the tissue and the loss of all its functions by the organ. Medicine knows four stages of chronic renal failure that accompany the course of the disease:

1. The first stage proceeds almost imperceptibly, the patient may not even be aware of the development of the disease. For latent period characterized by increased physical fatigue. It is possible to identify the disease only with a biochemical study.
2. At the compensated stage, there is an increase in the number of urination against the background of general weakness. The pathological process can be detected by the results of blood tests.
3. For the intermittent stage, a sharp deterioration in the work of the kidneys is typical, which is accompanied by an increase in the concentration of creatinine and other products of nitrogen metabolism in the blood.
4. According to the etiology, end-stage renal failure causes irreversible changes in the functioning of all body systems. The patient feels constant emotional instability, lethargy or drowsiness, appearance worsens, appetite disappears. Consequence last stage CKD is uremia, aphthous stomatitis or dystrophy of the heart muscle.

Acute renal failure

The reversible process of kidney tissue damage is known as acute renal failure. It is possible to determine acute renal failure by referring to the symptoms of kidney failure in a person, which are expressed by a complete or partial cessation of urination. The constant deterioration of the patient's condition at the terminal stage is accompanied by poor appetite, nausea, vomiting and other painful manifestations. The causes of the syndrome are the following factors:

• infectious diseases;
• renal condition;
• decompensated violation of renal hemodynamics;
• obstruction of the urinary tract;
• exogenous intoxications;
• acute kidney disease.

Chronic renal failure

Chronic renal failure gradually leads to a complete loss of functioning for this organ, causes shrinkage of the kidney, death of nephrons and complete replacement of its tissues. Being at the terminal stage of the disease, the patient's body begins to refuse to excrete urine, which affects the electrolyte composition of the blood. Damage to the renal glomeruli can occur due to a number of reasons, the most common of which are:

• systemic lupus erythematosus;
• tumors;
• chronic glomerulonephritis;
• hydronephrosis;
• gout;
• urolithiasis disease;
• amyloid chronic pyelonephritis;
• diabetes;
• arterial hypertension;
• polycystic;
• hemorrhagic vasculitis;
• underdevelopment of the kidneys;
• scleroderma;

Kidney failure - symptoms

In order to figure out how to treat kidney failure, it's worth learning the main symptoms of CRF first. At first, it is problematic to identify the disease on your own, although timely medical intervention can reverse the development of dangerous pathological processes, eliminating the need for surgery. Most patients complain of symptoms of kidney failure, such as severe swelling, high blood pressure, or pain syndrome.

The first signs of kidney failure

The syndrome of disorders in the functioning of the kidneys has a phased stage of development, therefore, each stage is characterized by more pronounced manifestations of the disease. The first signs of kidney failure are considered to be weakness or fatigue without good reason, refusal to eat, sleep problems. In addition, you can check for the presence of an ailment based on the frequency of urination at night.

Kidney failure - symptoms in women

Disorders in the functioning of the kidneys can cause a variety of manifestations, depending on at what stage pathological process the patient is located. Symptoms of kidney failure in women manifest themselves in a special, specific way. The first alarm signal is emotional instability caused by a deficiency in the body of the substance progesterone. Against this background, a number of complications associated with the work of the genitourinary system are actively developing.

Kidney failure - symptoms in men

The syndrome affects the body even in the early stages of onset, so how to determine kidney failure and what to do can be found by comparing some key facts. Symptoms of renal failure in men practically do not differ from the reactions of other groups of patients. At the initial stages, it is characteristic: decreased urination, diarrhea, loss of appetite, skin itching, clearly traced signs of a disorder of the nervous system.

Kidney failure in children - symptoms

Kidney problems rarely affect young children, but if action is not taken in time, then inaction can cause death. Symptoms of renal failure in children are no different from the course of the disease in adult patients. In addition to general malaise, the child feels nausea, his temperature rises, and in some cases swelling is detected. Such children often go to the toilet, but the amount of urine excreted is not normal. Analyzes allow you to diagnose the following picture:

• stones in the kidneys;
• cough;
• increased amount of protein in the urine;
• downgrade muscle tone;
• tremor;
• skin becomes yellow.

Renal failure - diagnosis

The main sign of the presence of a severe pathology in a patient is not only a decrease in the frequency of urination, but also the presence of increased amount potassium or nitrogenous compounds in the blood. Diagnosis of renal failure is carried out in several stages, the condition of the kidneys is assessed according to the diagnosis based on the results of the Zimnitsky test. The main indicators of the effectiveness of treatment are:

• biochemical blood monitoring;
• Biopsy;
• Vascular ultrasound.

Kidney failure - treatment

During therapy, the main cause of pathogenesis is eliminated with the help of modern medications. The recovery process includes replenishment of the missing blood volume and normalization of blood pressure during a shock reaction in a patient. Treatment of kidney failure during the period of nephrotoxin poisoning consists of washing the intestines and stomach from toxins, for these purposes they often use:

• plasmapheresis;
• nephroprotective treatment;
• hemodialysis;
• hemoperfusion;
• peritoneal dialysis;
• hemosorption.

Treatment of kidney failure - drugs

The treatment of such a serious illness must be supported by appropriate medical intervention, such as insulin preparations. Most of the existing diuretics, when taken uncontrolled, can harm human health, so the use of therapeutic substances is possible only under the strict supervision of a specialist. Most effective drugs for the treatment of renal failure can be distinguished into a separate category of drugs:

• Trimetazidine;
• Lisinopril;
• Desferal;
• Sulodexide;
• Eufillin;
• Hypothiazide;
• Digoxide;
• Ramipril;
• Curantyl;
• Glurenorm;
• Enalapril;
• metoprolol;
• Deferoxamine;
• propranolol;
• Dopamine.

Renal failure - treatment with folk remedies

Some people stick to natural therapies, so treating kidney failure folk remedies allows the use of only the gifts of nature. By using medicinal plants, fruits or vegetables, special decoctions are prepared, designed to save a person from this ailment. The most effective folk methods of therapy are the use of burdock, pomegranate juice and corn silk. There are other useful ingredients to treat:

• sea ​​kale;
• echinacea tincture;
• Dill seeds;
• horsetail.

Kidney failure during pregnancy

During the bearing of a child, the body of a pregnant mother is subjected to an additional degree of stress, which is why all its systems are forced to work in an enhanced mode. Sometimes the main cause of kidney failure during pregnancy is malfunction of some organs. These diseases endanger the health of a woman and her unborn child, so childbirth in such circumstances is impossible. The only exceptions are those cases when the disease was promptly eliminated in the early stages of diagnosis.

Prevention of kidney failure

Timely treatment diseases such as chronic pyelonephritis and glomerulonephritis will help prevent further complications, and regular adherence to the doctor's recommendations will ensure that the organs of the genitourinary system remain functional. Prevention of renal failure is applied to any category of patients, at whatever stage of the disease they are. Simple rules, including diet, adjustment water-salt balance and the use of medications will help prevent the development of the disease.

Video: kidney failure symptoms and treatment