Renal failure: signs, stages, tests, diet
Renal insufficiency is called gradualdecrease in renal function, which is due to the death of nephrons, provoked by chronic diseases. Gradual fading of functions can lead, as a rule, to disruption of the whole organism, as well as to the appearance of various complications on the part of certain systems and organs.
There are several forms of this pathology: latent, intermittent, compensated and terminal. Diagnostic measures to determine this disease involve special clinical and biochemical tests, Reberg and Zimnitsky samples, ultrasound, ultrasound of kidney vessels, etc. Treatment of this pathology is based on the fight against the underlying disease, as well as on symptomatic treatment and extracorporal hemocorrection.
Chronic renal failure is consideredirreversible violation of excretory and filtration functions, up to the complete destruction of the renal tissue. The pathological process has a progressive course. With the development of the disease, there is an increase in his symptoms, which are weakness, loss of appetite, vomiting, swelling, nausea, dry skin, etc. The diuresis drastically decreases, in some cases - until its complete cessation. In later stages, heart failure, pulmonary edema, a tendency to bleed, encephalopathy, uremic coma may develop. In this case, the patient is shown hemodialysis and kidney removal.
Causes of Renal Failure
What are the reasons? Depending on them, acute renal failure is divided into:
- Prerenalnuyu. Has arisen because of disturbance of a renal blood flow.
- Renal. The reason is the pathology of the kidney tissue.
- Posteralnuyu. The outflow of urine is impaired due to an obstruction in the urethra.
The chronic form arises because of:
- Congenital and hereditary kidney diseases.
- Renal lesions in chronic pathologies. These include gout, urolithiasis, diabetes mellitus, metabolic syndrome, scleroderma, cirrhosis, obesity, systemic lupus erythematosus, etc.
- Various pathologies of the urinary system, when urinary tracts gradually overlap: tumors, urolithiasis.
- Kidney diseases: chronic glomerulonephritis, chronic pyelonephritis.
- Incorrect use, overdose of medicines.
- Chronic poisoning with toxic substances.
Renal failure may resultglomerulonephritis, hereditary nephritis, kidney inflammation in systemic diseases of chronic pyelonephritis, amyloidosis or polycystosis, glomerulosclerosis in diabetes mellitus, nephroangiosclerosis and a number of other diseases that affect either one kidney at once.
The main characteristic of this pathologicalprocess is the progression of nephron death. At an early stage of the disease, kidney functions become more relaxed, after which a significant decrease in their functions is observed. Histological studies confirm the death of the kidney parenchyma, which is gradually replaced by cells of connective tissue.
What precedes this?
Development of a patient with renal insufficiency, asthe rule precedes the emergence of chronic diseases in the period from 3 to 10 years, and sometimes more. The development of the pathology of the kidneys before the onset of chronic insufficiency is conditionally divided into certain stages, and the choice of tactics for the treatment of this disease depends directly on them.
Classification of the disease
The following stages of this pathological process are distinguished:
- Latent stage. At this period, the disease occurs without a particularly severe symptomatology. As a rule, it is revealed only after the results of an in-depth clinical study. The glomerular filtration of the kidneys in this one is reduced to 60-70 ml / min. There is also some proteinuria.
- Compensated stage of renal failure. At this stage, the patient is concerned about fatigue and a feeling of dryness in the mouth. Increases the volume of urine with a decrease in its density. Reduction of the level of glomerular filtration is up to 50-40 ml / min. The levels of creatinine and urea are also rising.
- Intermittent stage of chronic renal diseaseinsufficiency. Observed pronounced clinical symptoms of the disease. There are specific complications, which are caused by the increase in kidney failure. The condition of the patient can change wavy. Glomerular filtration during this period is reduced to 25-15 ml / min., Acidosis and persistence of a high level of creatinine are observed.
- Terminal renal failure. It, in turn, is divided into four stages:
- I. Diuresis is more than 1 liter a day. Filtration - 15-10 ml / min.
- II-a. The volume of urine is reduced to 500 ml, hypernatremia and hypercalcemia are observed and the symptoms of fluid retention and decompensated acidosis increase.
- IIb. The signs become even more pronounced, heart failure develops, stagnant phenomena in the lungs and liver are noted.
- III. Develops strong uremic intoxication, hyponatremia, hypermagnesia, liver dystrophy, hyperkalemia, hypochloraemia, polyserositis.
Defeat the body
Changes that occur in the patient's blood: anemia, which is due to the oppression of hematopoiesis and a reduction in the life span of red blood cells. There are also violations of coagulability: thrombocytopenia, lengthening of the bleeding period, decrease in the amount of prothrombin.
Complications that develop in the lungs and heart: arterial hypertension (almost half of patients), heart failure, myocarditis, pericarditis, uremic pneumonitis (in later stages).
Changes from the nervous system: in the early stages - sleep disturbance and absent-mindedness, on later - inhibition of reactions, confusion, delirium, hallucinations, peripheral polyneuropathy.
Disorders in the work of the digestive organs: in the early stages - loss of appetite, dryness of the mucous membrane of the mouth, belching, nausea, stomatitis. Due to irritation of the mucous membrane, enterocolitis and gastritis of atrophic form may develop. Ulcerative lesions of the stomach and intestines are formed, which often become sources of bleeding.
Pathology of the musculoskeletal system: for men and women, renal failure is characterized by various forms of osteodystrophy - osteosclerosis, osteoporosis, osteitis of a fibrous nature, etc. Clinical manifestations of osteodystrophy are spontaneous fractures, compression of the vertebrae, skeletal deformity, arthritis, muscle and bone pain.
From the side of immunity, development of lymphocytopenia is often observed. Decrease in immune defense causes an increase in the frequency of development of purulent-septic formations.
Consider how renal failure manifests itself in women and men.
Symptoms of pathology
In the period preceding the development of thispathological process, the renal functions are preserved in full. Glomerular filtration levels are not violated. At subsequent stages, glomerular filtration begins to decline, and the kidneys lose their ability to concentrate urine, which affects the kidney processes. Homeostasis at these stages is not yet broken. However, later on, the number of workable nephrons decreases sharply, and the first signs of renal failure begin to appear in the patient.
Symptoms depending on the stage
Patients with the latent stage of this diseasecomplaints, as a rule, do not show. In some cases, they may notice mild weakness and weakness. Patients with renal insufficiency of the compensated stage may be disturbed by increased fatigue. With the development of the intermittent stage, more pronounced symptoms of the disease are observed. Weakness increases, patients may complain of constant thirst and loss of appetite. Their skin is pale and dry. At the terminal stage, patients tend to lose weight, their skin becomes grayish-yellow, becomes flabby. Also for this stage of the pathology are characterized: itchy skin, decreased muscle tone, hand tremor, muscle twitching, increased thirst and dry mouth. The occurrence of apathy, drowsiness, absent-mindedness may also be noted.
When strengthening the process of intoxication beginsappear characteristic breath, nausea. Periods of apathy, as a rule, are replaced by excitement, inadequacy. Also in this case, manifestations of dystrophy, hoarseness, hypothermia, and aphthous stomatitis are characteristic. The abdomen of the patient is swollen, there is frequent vomiting and liquid stools of dark color. Patients may also complain of the painful itching of the skin and muscle twitching. The degree of anemia is increasing, hemorrhagic syndromes are developing, as well as renal osteodystrophy. Typical manifestations of renal failure in women of this stage are: ascites, myocarditis, encephalopathy, pericarditis, uremic coma, pulmonary edema.
Diagnosis of pathology
If you suspect the development of this pathology is necessary to conduct certain laboratory studies:
- biochemical blood examination;
- Reberg samples;
- determination of creatinine and urea levels;
- Zimnitsky test.
Renal failure tests are prescribed by a doctor.
In addition, an ultrasound scan is necessary fordetermine the size of the thickness of the parenchyma and the total size of the kidneys. UZDG of vessels will allow to reveal intraorgan and main blood flows. In addition, a study such as radiopaque urography is also used, but this should be used with caution, since many contrast agents are highly toxic to renal cells.
What is timely therapy aimed at slowing the development of renal failure and reducing the clinical symptoms of the disease?
The main aspect here is the treatment of the maina disease that triggered the development of this pathology. The patient needs special dietary food. If necessary, he may be prescribed antibacterial drugs and antihypertensive drugs. Also shown spa and resort treatment. In addition, careful monitoring of the glomerular filtration rate, renal blood flow, kidney concentration, urea and creatinine levels is required.
When homeostasis changescorrection of acid-base composition, water and salt balance of blood. It should be noted that symptomatic therapy consists, as a rule, in the treatment of anemic, hemorrhagic and hypertensive syndromes, as well as in the maintenance of cardiac functions.
Diet for renal failure
Patients who have thispathology, appointed low-protein diet with a large amount of calories, which includes a large number of essential amino acids. It is necessary to minimize the amount of salt consumed, and with the development of hypertension - to completely eliminate salt intake.
The protein content in the patient's diet shoulddepend on the degree of damage to the renal functions: with glomerular filtration below 60 ml / min, the amount of protein should be reduced to 40 grams per day, and if this figure is below 30 ml / min, to 25 grams per day.
In case of renal osteodystrophy in patientsVitamin D is prescribed, high calcium supplements, but it should be remembered that organ calcification is a very dangerous morphological process caused by high doses of vitamin D. Sorbitol and aluminum hydroxide are prescribed to reduce hyperphosphatemia. And a prerequisite here is the control during the treatment of calcium levels in the blood and phosphorus.
When anemia is prescribed, as a rule, drugs withhigh iron content, folic acid, androgens. With a decrease in hematocrit, red blood cell transfusions are performed. The use of chemotherapeutic drugs and antibacterial drugs is determined depending on how they will be displayed. The dose of sulfanilamide, ampicillin, cefaloridin, penicillin and methicillin is reduced several times in this case, and while taking polymyxin, monomitsin, neomycin and streptomycin, certain complications can occur in the form of, for example, acoustic neuritis, etc. Nitrofurans are contraindicated in patients with renal insufficiency.
The use of glycosides in the treatment of suchthe consequences of this pathology as heart failure should occur strictly under the supervision of a specialist and laboratory parameters. The dosage of such drugs decreases with the development of hypokalemia. Patients with an intermittent stage of renal failure, especially during periods of exacerbations, are prescribed hemodialysis.