Symptoms of end-stage chronic renal failure. Modern methods of diagnosis and treatment of chronic renal failure

To identify kidney problems and choose treatment tactics for chronic renal failure, the doctor will conduct a whole range of diagnostic tests. Among all examination methods, one of the most important is the determination of the level of nitrogen compounds in the blood. By the amount of nitrogen-containing waste that must be excreted from the body through the urinary tract, one can reliably determine the degree of renal dysfunction. Determining the stages of chronic renal failure by creatinine concentration is very indicative and highly informative, therefore it is widely used in the complex diagnosis of renal failure.

Variants of nitrogenous slags

The urinary function of the kidneys ensures the constant removal from the human body of harmful substances and toxic compounds that are formed in the process of life. If this does not happen, then gradual poisoning occurs with disruption of the functioning of all organs and systems. Some unnecessary substances are very difficult to identify, while others are quite simple. One of the main diagnostic criteria for identifying chronic renal failure are nitrogen-containing wastes, which include:

• residual nitrogen;
• urea;
• uric acid;
• creatinine

Of these biochemical compounds, the last one is most indicative for the diagnosis of chronic renal failure: based on the concentration of creatinine, one can confidently determine the stage of the disease. The levels of other nitrogenous wastes are ineffective and do not affect the determination of the stage of chronic renal failure. However, urea and residual nitrogen concentrations can help diagnose renal failure.

Azotemia

When treating chronic renal failure, the doctor will dynamically determine the level of azotemia, a significant increase in which occurs when the condition worsens or in the absence of effect from treatment measures. Blood creatinine concentration is the most specific finding, but it is advisable to consider urea and uric acid levels. Sometimes determining the cause of the disease depends on this.

If blood urea levels are high and creatinine values ​​are normal, the doctor will look for conditions that are not associated with renal pathology:

• excessive consumption of protein foods;
• severe malnutrition and hunger;
• severe loss of fluid from the body;
• excess metabolic processes.

If all nitrogen-containing compounds increase simultaneously, then we can confidently speak of chronic renal failure.

Classifications of chronic renal failure

Quite a few types of classification of chronic renal failure have been proposed, in which different indicators are taken into account. Among laboratory classifications, doctors widely and actively use the following 2 options:

1. According to the degree of reduction in glomerular filtration.

• Initial. The reduction in the cleansing capacity of the kidneys reaches almost 50% of normal values.
• Conservative. Renal cleansing deteriorates significantly and is only 20-50% of what is required.
• Terminal. The filtration capacity of the kidney parenchyma drops to less than 20%, reaching extremely low levels in the worst case.

1. Based on the concentration of blood creatinine (at a norm of 0.13 mmol/l).

• latent or reversible stage (nitrogen compound level ranges from 0.14 to 0.71);
• azotemic or stable (creatinine level from 0.72 to 1.24);
• uremic or progressive stage (if the value exceeds 1.25 mmol/l).

In each classification, all stages are divided into phases, which are used to select the most effective methods of therapy. Both for diagnosis and for monitoring the treatment of chronic renal failure, it is best to use biochemical studies to identify the characteristics of nitrogen metabolism.

Treatment of chronic renal failure based on creatinine levels

One of the most important areas of treatment for chronic renal failure is the correction of azotemia: it is necessary to improve the filtration capacity of the renal parenchyma so that wastes and harmful substances are removed from the body. In addition, reducing the level of nitrogen compounds in the blood can be achieved using the following treatment methods:

1. Diet therapy.

With minimal creatinine concentrations in the latent stage of chronic renal failure, it is necessary to use a diet with a moderate protein content. It is advisable to consume vegetable protein, giving preference to soy and avoiding meat and fish. It is necessary to maintain normal calorie content of food to maintain energy expenditure.

In the azotemic and uremic stages of chronic renal failure, a significant reduction in protein foods and dietary restrictions on phosphorus and potassium are shown. To maintain the level of vital amino acids, the doctor will prescribe special medications. Be sure to exclude the following products:

• mushrooms;
• legumes and nuts;
• White bread;
• milk;
• chocolate and cocoa.

1. Detoxification.

Purification of the blood from nitrogenous compounds is achieved through intravenous administration of solutions that help bind and remove harmful substances that accumulate in the vascular bed. Typically, sorbent solutions and preparations of calcium salts (carbonate) are used. However, if therapy for chronic renal failure does not bring the desired effect (which will be evident from the level of azotemia), then replacement methods of treatment must be used.

1. Hemodialysis.

An important criterion for starting blood purification by dialysis is the concentration of nitrogen compounds. Against the background of concomitant severe diseases (diabetes mellitus, arterial hypertension), hemodialysis can be started at stage 2, when the creatinine level exceeds 0.71 mmol/l. However, the typical indication for dialysis is stage 3 with severe azotemia.

After each blood purification session, diagnostic studies are required to determine indicators such as:

• general clinical urine and blood tests;
• assessment of the level of azotemia by creatinine and urea 1 hour after the end of the hemodialysis session;
• determination of minerals (calcium, sodium, phosphorus) in the blood after hardware purification.

1. Treatment of concomitant diseases.

Improving the general condition of the body with the correction of pathological changes will help restore the processes of removing nitrogenous compounds. Sometimes it is the harmful substances that accumulate in the blood during chronic renal failure that contribute to the following problems:

• anemia;
• erosive gastritis;
• diseases of joints and bones;
• accumulation of phosphate compounds with an increased risk of urolithiasis.

All variants of pathologies detected in chronic renal failure require a course of therapy taking into account the capabilities of the kidneys. Do not use drugs that have even minimal nephrotoxic effects. Treatment should be carried out in a hospital setting under the constant supervision of a physician with regular monitoring of laboratory parameters. An important factor in therapy will be the correction of sugar and blood pressure in people with diabetes, obesity and hypertension.

Among all the classifications used for the diagnosis and treatment of chronic renal failure, one of the optimal, quite simple and informative ones is determining the stage of the disease by the level of azotemia. In a biochemical blood test, the concentration of creatinine and urea are most indicative for assessing the urinary function of the kidneys and for monitoring during course treatment of chronic renal failure. Assessing azotemia is almost always used for any replacement therapy provided in a hemodialysis unit. The best option for predicting future complications is dynamic monitoring of the concentration of nitrogen-containing compounds in the blood. That is why the doctor at all stages of examination and treatment of renal failure will use laboratory tests with the mandatory determination of creatinine concentration.

What is chronic renal failure (CRF), and what stages of CRF are known based on creatinine? Chronic renal failure is an irreversible impairment of kidney function. The kidneys are responsible for removing many harmful metabolic products, regulating blood pressure and acid-base balance in the body.

The development of chronic renal failure occurs gradually. At the onset of the disease there may be no clinical symptoms or they may be uncharacteristic of the disease (for example, arterial hypertension). To determine the stage of the disease, classification by glomerular filtration rate (GFR) is used.

Factors provoking chronic renal failure

Impaired kidney function can occur either as a result of a sudden triggering of a damaging factor or as a result of a long-term pathological process. In the first case, acute renal failure is diagnosed, which can result in complete impairment of health within several months, complete destruction of the structures of this organ.

If the kidney is damaged gradually due to the effects of a long-term pathological process lasting at least 3 months, then chronic kidney disease develops with the most severe consequences: severe chronic renal failure and advanced stage of renal failure, requiring therapy with hemodialysis.

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Among the main factors affecting the functioning of the kidneys, first of all, we can highlight: circulatory disorders, specific and nonspecific inflammatory processes and immunological factors that are toxic to the kidneys, urinary tract diseases, as well as chronic diseases such as diabetes and arterial hypertension.

Diagnostic methods

The main criteria for laboratory assessment of kidney function are: the amount of filtered plasma per unit time, the level of creatinine and urea in the blood serum, diuresis, that is, the amount of urine produced.

In addition, during chronic renal failure, the patient deals with anemia and thrombocytopenia, hyperphosphatemia, hypocalcemia and hypercalcemia, impaired blood volume regulation, most often with the development of arterial hypertension and acidosis. Loss of protein leads to numerous disorders associated with its deficiency - endocrine disruption or immunodeficiency.

Symptoms of the disease

The main symptoms of chronic renal failure include:

• weakness, fatigue, malnutrition;
• low body temperature;
• impaired hydration of the body;
• change in the amount of urine excreted;
• decreased immunity.

Initially, the renal glomeruli undergo hypertrophy. This means that the kidney increases in size. However, end-stage chronic renal failure (uremia) is characterized by small kidney size.

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As the disease progresses, toxins accumulate in the blood - products of protein metabolism, resulting in an increase in the concentration of creatinine, urea and uric acid in the blood serum, which poison the entire body.

Stages of the chronic form

Classification of chronic renal failure:

1. Kidney diseases with normal GFR – latent stage (GFR 90 and > 90 ml/min).
2. Early stage (GFR 60-89 ml/min).
3. Middle stage (GFR 30-59 ml/min).
4. Severe stage (GFR 15-29 ml/min).
5. End stage (uremia) – GFR below 15 ml/min.

The development of chronic renal failure occurs gradually, and when the glomerular filtration rate is below 15 ml/min, renal replacement therapy is required. As GFR decreases, symptoms and complications appear in various organs and systems.

Each classification has its own clinical picture.

Stage I – clinical manifestations depend on the underlying disease (eg, diabetes, hypertension). Blood pressure often increases. At this stage, the cause should be determined and risk factors for kidney disease should be addressed.

At stage II, susceptibility to dehydration and urinary tract infections increases. Often coexists with vitamin D deficiency, which stimulates the parathyroid glands to secrete parathyroid hormone and develop secondary parathyroid hyperfunction. Some patients experience anemia, mainly caused by decreased production of erythropoietin in the kidneys.

At stage III, polyuria and nocturia occur, that is, night urination and increased thirst. Half of the patients develop arterial hypertension. Many patients have anemia, which can cause weakness, decreased physical activity, and easy fatigue.

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Stage IV chronic renal failure is characterized by symptoms of severe severity. There is discomfort from the gastrointestinal tract: loss of appetite, nausea and vomiting. Arterial hypertension occurs in more than 80% of patients. Many suffer from left ventricular hypertrophy and heart failure.

At stage V of end-stage renal failure, the symptoms that arise affect almost all organs and systems. Patients require renal replacement therapy (dialysis therapy or kidney transplantation), which causes regression of most symptoms of uremia.

Therapeutic measures

In the event of a sudden loss of kidney function, the main goal is to eliminate its cause, for example, replenishing fluid loss in a state of dehydration, treating heart failure, restoring patency of the urinary tract and blood vessels. Strict monitoring of mineral balance, especially serum potassium concentration, is required. It is very important to consider the degree of kidney failure when taking medications, especially those taken chronically. To avoid serious complications and ensure regeneration of damaged organ parenchyma, renal replacement therapy is used.

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Chronic renal failure is an irreversible process, depending largely on the type of underlying disease, the coexistence of other diseases, and the age and gender of the patient. Unfavorable factors are: male gender, smoking, hyperlipidemia and the amount of proteinuria. Treatment is aimed primarily at the underlying disease, the main goals being:

• normalization of blood pressure;
• equalization of glycemic levels in diabetes mellitus;
• treatment of hyperlipidemia;
• equalization of water-electrolyte imbalances;
• stopping taking drugs and substances with neurotoxic effects;
• treatment of concomitant diseases;
• prevention and treatment of complications, in particular anemia.

In addition, it is necessary to strive to reduce protein loss in the urine to an optimal value below 0.3 g/day, for this purpose drugs from the group of inhibitors and receptor blockers are used. To reduce blood cholesterol levels, the patient must take statins, fibrates and lifestyle changes. Ultimately, if chronic renal failure has reached stage 5 of the disease, the patient is treated with hemodialysis.

Carrying out a hemodialysis procedure

When the GFR level decreases to a value of 15-20 ml/min/1.73 m2, the patient undergoes hemodialysis. Indications for the use of dialysis are the following life-threatening conditions:

• uremic pericarditis;
• severe phase of arterial hypertension;
• chronic symptoms of nausea and vomiting;
• serum creatinine concentration >12 mg/dl or urea >300 mg/dl.

Hemodialysis is carried out using a special device, popularly called an “artificial kidney”, it provides a simultaneous flow of blood and fluid, dialysate, separated by a semi-permeable membrane, through which, according to the principle of diffusion (concentration difference) and ultrafiltration (pressure difference), metabolism is possible. Thus, the blood is cleansed of harmful metabolites and toxic compounds. The process lasts about 4-5 hours and is carried out mainly 3 times a week.

During a hemodialysis procedure, the patient receives heparin to prevent blood clotting.

Doctors' opinions on the question of how long hemodialysis patients live are always different, however, the average life expectancy is 20 years. It is not uncommon in medical practice for patients to live for more than 35 years.

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Kidney transplant

A kidney transplant is the only way to completely cure chronic renal failure. The operation entails a significant improvement in the quality of life in persons previously treated with dialysis. Unfortunately, kidney transplantation requires tissue compatibility from a living or deceased donor. Therefore, there is often a long waiting time for surgery. Individuals whose serum creatinine concentration exceeds 6 mg/dL require an organ transplant. After surgery, patients must take immunosuppressive drugs and steroids to prevent organ rejection. Contraindications for surgery are serious organ diseases such as cancer, as well as age and atherosclerosis.

It is necessary to constantly monitor kidney function after surgery. According to the latest research data, after 5 years after surgery, about 80% of transplanted organs perform their functions. Unfortunately, the number of transactions performed is 3 times less than the number of people on the waiting list.

Kidneys are an organ of the human body, one of the components of the urinary system. The process of filtration and secretion takes place here.

In addition to the formation of primary and secondary urine, the kidneys are involved in hematopoiesis. Disruption of at least one of them leads to serious problems of homeostasis and significantly affects a person’s quality of life, causing severe pain.

Chronic renal failure (CRF) is a condition of extreme severity in which kidney function partially stops. In rare cases, the paired organ fails completely.

Negligence in the treatment of renal pathologies leads to the appearance of the disease. CRF develops as a consequence of poorly treated disease of the genitourinary system. This pathology of the urinary system develops slowly and goes through several stages:

• hidden;
• early;
• average;
• heavy;
• terminal.

This complication can be identified by conducting appropriate laboratory or instrumental studies. In all cases, tests are prescribed to make a specific diagnosis and diagnostic accuracy.

The first, most important analysis is to determine the amount of nitrogen compounds in the body. Their content clearly shows the presence of a lesion and its degree. The stages of chronic renal failure are usually determined by the element creatinine.

Creatinine is a component found in plasma. It takes part in metabolic processes and is then excreted in the urine as a toxin. An increased level in the blood is a sign of chronic renal failure, and the stage is determined by the quantitative indicator. This is an effective method, widely used in practice.

Classification can occur not only by stages, but also by the degree of damage to the nephrons:

• partial;
• total;
• terminal.

The types of injuries can be different, the doctor’s task is to correctly diagnose and prescribe productive treatment. Having characterized the patient’s condition as fully as possible, the attending physician draws up a further plan of action.

Detection of the disease in the early stages is the key to high-quality and productive treatment. If you do not pay proper attention to the symptoms of kidney disease, over time the situation becomes critical. The most common complications: anemia, metabolic and excretory disorders, uncontrolled urination, arterial hypertension, heart failure.

In addition to creatinine, uric acid is a waste product, which is normally excreted in the urine. In addition to chronic renal failure, an increased level of its content indicates diseases such as diabetes, gout, and problems of the cardiovascular system.

Classification of chronic renal failure according to Ryabov

For better treatment of chronic renal failure, it is customary to distinguish its types and degrees and classify it. The classification according to S.I. Ryabov is most widespread in the post-Soviet space. The system he developed is based on GFR (glomerular filtration rate) and creatinine levels.

For comparison, the classification of A. Yu. Nikolaev and Yu. S. Milovanov takes into account only the creatinine content and identifies the initial, conservative, terminal stage of chronic renal failure.

Determining the stage of renal failure using creatinine is possible; this method has been used in medical practice for several decades.

The Ryabov classification is more accurate, because it includes several indicators and gives a more complete picture of the course of the disease.

The modern method for determining chronic renal failure is based on the detection of several substances in the blood, the determination of the level of which excludes medical error. Nitrogen compounds must be eliminated during kidney function.

Their presence, combination and high concentration are a 100% sign of damage to the organs of the urinary system and the development of necrosis of kidney tissue. All these problems lead to the development of chronic renal failure.

Stages depending on the degree of GFR

CRF is a long process that develops slowly, passing through stages, each of which has its own characteristics and specific characteristics. Based on the level of GFR, four stages of the disease are distinguished.

The first is the latent stage. This is a reversible process when tissue damage has just begun to develop. Detection of the disease at this stage would have a beneficial effect on the course of treatment. However, due to vaguely expressed symptoms, patients often do not pay attention to them and do not go to the doctor for help.

Kidney function is not impaired, the person is not bothered by pain or discomfort, and there are no specific signs. Considering that chronic renal failure develops against the background of existing pathology, all symptoms can be attributed to an already identified disease.

The test results do not show significant deviations from the norm, but even exceeding the norm by 0.1% can alert the doctor, and he will prescribe additional examinations.

The second is the compensated stage. This stage of the disease has clearly defined symptoms. Tests show a specific excess of the norm, the doctor is able to accurately determine the diagnosis and tell the stage.

The lack of kidney function is partially compensated by the work of other organs and systems. Basic functions are performed, so the patient may not experience specific disruptions.

The doctor will notice a characteristic decrease in the filtration rate, which clearly indicates the presence of pathology.

Diagnosis at this stage will help stop the development and prevent the worsening of the pathology. Obvious symptoms are disruption of homeostasis (changes in body temperature and blood pressure), constant thirst and frequent urge to urinate.

The third is the intermittent stage. It is characterized by a more pronounced deviation of test results from the norm. There is increased urine production and a constant urge to go to the toilet. Nocturnal diuresis predominates, the patient has to constantly interrupt sleep to urinate. Cases of incontinence may occur.

In addition to the kidneys, other organs of the genitourinary system also suffer, for example, damage to the tubules appears. Due to weakened immunity, the patient becomes more susceptible to viruses and infections.

The general condition worsens, weakness and fatigue appear. Impaired kidney function has external manifestations: the skin becomes pale and acquires a yellowish tint.

The fourth is end-stage renal failure. The most complex and difficult stage, which is practically impossible to treat.

There is no need to talk about assessing the condition of the kidneys, because at the terminal stage in most cases they fail completely. There are significant deviations in GFR indicators,<15 мл/мин. Этот критический показатель сопровождается четкими симптомами, постоянно беспокоящими пациента.

The functioning of most organs is disrupted. Changes in metabolism reach a critical level. The risk of death is enormous; urgent medical intervention is required. An increased level of creatinine and a decrease in GFR lead to severe intoxication of the body.

Treatment of chronic renal failure

Determining the course of treatment is always based on the results of tests and studies. In each individual case, the attending doctor prescribes specific treatment to stop the development of the disease, completely restore the functionality of vital organs, and normalize metabolism.

The primary task is to restore normal blood supply to the affected kidney (or two) and correct azotemia. The increased content of nitrogenous compounds and waste in the blood must be quickly eliminated, then the natural filtration rate in the kidneys must be restored so that harmful substances are quickly eliminated from the body.

Treatment methods primarily depend on the stages of the disease. Different levels of creatinine require appropriate therapy. All symptoms must be carefully checked, and taking them into account, treatment for chronic renal failure is prescribed. All efforts are directed towards eliminating the cause of chronic insufficiency.

Traditionally, several methods have been used to treat chronic renal failure.

Diet

Diet for illness is mandatory. Correction of nutrition is the most important point on the path to recovery. A balanced diet will promote the correct action of medications.

Reduce your consumption of protein-containing foods to a minimum. The more serious the degree of pathology, the less animal proteins should enter the body. Preference is given to vegetable proteins.

If you have chronic renal failure, you are not allowed to eat foods that contain phosphorus. Beans, mushrooms, milk, nuts, rice, cocoa should be completely excluded. It is necessary to completely exclude bread from the diet. You will have to give up both white and black bread.

Due to problems with urination, a personal water consumption regimen is introduced. It is recommended to keep a diary in which you note your diet. This is necessary for the correct accounting of all elements entering the body. The egg-potato diet is often used. But its use is possible only with the permission of the doctor.

Keep in mind that all methods are purely individual, prescribed by a doctor for each patient, and diet is no exception.

Detoxification

The patient is injected intravenously with a special solution that promotes detoxification. Harmful substances are bound and excreted from the body along with urine, as this should happen normally.

In this way, the blood is cleansed, the content of nitrogenous compounds and wastes is reduced, which is reflected in the test results. The solution is selected individually, most often it is preparations of calcium salts.

The introduction of the solution is not used as an independent method, only in combination with others. Depending on the degree of damage, the method that will be effective at this stage of the disease is selected. If there is no desired effect, replacement therapy and other methods are used.

Hemodialysis

Hemodialysis is the purification of blood without the participation of the kidneys. This extrarenal cleansing is carried out with a special device to eliminate excess toxic elements that poison the body. It is necessarily prescribed at stages 3 and 4 of chronic renal failure, at stages 2 and 1 - if necessary, at the discretion of the doctor. If the situation is not critical, then hemodialysis is not used.

Since the kidneys do not perform their direct function of filtering and purifying the blood, and a person does not have another organ that could perform this task, one has to turn to devices.

The principle of operation is that blood is passed through the artificial kidney apparatus. Passing through a special membrane, the blood gives excess water and waste products to the dialyzer.

After each procedure, tests are taken to confirm a positive result: the level of electrolytes, urea, and creatinine decreases. Dialysis is carried out periodically, so the results can only be considered intermediate.

However, the patient feels better after getting rid of the toxic elements in his blood. The doctor will prescribe a further course based on the patient’s general condition and recovery progress.

Treatment of existing concomitant diseases

Considering that chronic renal failure does not exist on its own, but is a consequence of other kidney diseases, the doctor’s actions should not be aimed solely at eliminating chronic renal failure.

An important stage of treatment is the fight against the underlying disease. In addition, chronic renal failure affects not only the urinary system, but also the entire body as a whole. Other organs also suffer during the development of the disease, so it is necessary to increase immunity and restore the balance of substances in the blood.

Kidney transplant

An extreme measure and extremely expensive, which only a few resort to. This is a radical solution that turns out to be truly effective. There is a risk that the new organ will not take root and will be rejected, so it is rarely transplanted.

Don't forget about preventative measures as well. Give up bad habits that adversely affect the condition of the body in general and the kidneys in particular, adjust your diet once and for all so that there is no relapse and no complications arise. Be regularly examined by a urologist so that in case of an exacerbation, you can react in time and take appropriate measures.

Forecast

When such a serious illness is discovered, the question naturally arises of how long people live with it. The answer is simple: it all depends on at what stage of development of the disease it is detected. If it was possible to stop the disorders in the early stages, then the patient will live happily ever after.

But in cases where the patient ignores obvious symptoms and seeks help only in the later stages, there is less chance of further life. The fourth stage in most cases ends with immediate death.

The transition from stage to stage is quite slow, but the specific period depends on the characteristics of the human body. It takes approximately 3 months from the onset of the first chronic renal failure to death.

All cases are considered individually, and forecasts are made individually for each. Every little detail plays a role: age, health status, the presence of other pathologies. The worst-case scenario is a person’s gradual decline, disability, and then death.

For a faster recovery and a longer life, it is important to follow all the doctor’s recommendations.

Self-discipline and following the established course are 90% of success in treatment. From time to time, the doctor checks the dynamics of recovery, and if the patient fulfills all the instructions, then he manages to win the battle with the disease.

A decrease in kidney function until the complete cessation of their filtration capabilities and the ability to remove toxins from the body is chronic renal failure. The etiology of this disease is a consequence of previous diseases or the presence of chronic processes in the body. This kidney damage is especially often diagnosed in older people. Chronic renal failure is a fairly common kidney disease and the number of patients is growing every year.

Pathogenesis and causes of chronic renal failure

• chronic kidney disease - pyelo- or glomerulonephritis;
• systemic metabolic disorders - vasculitis, gout, rheumatoid arthritis;
• the presence of cameos or other factors (mucus, pus, blood) blocking the ureter;
• malignant neoplasms of the kidneys;
• neoplasms of the pelvic organs, in which compression of the ureter occurs;
• disorders in the development of the urinary system;
• endocrine diseases (diabetes mellitus);
• vascular diseases (hypertension);
• complications of other diseases (shock, poisoning with toxic drugs);
• alcohol and drug use.

The pathogenesis of this disease is a consequence of the above reasons, in which chronic damage and structural disorders of the renal tissue develop. The process of parenchyma restoration is disrupted, which leads to a decrease in the level of functioning kidney cells. At the same time, the kidney decreases in size and wrinkles.

Symptoms and signs of the disease

Signs of chronic renal failure occur against the background of removing toxins, as well as maintaining metabolic processes, which leads to a malfunction of all systems and organs of the body. Symptoms of chronic renal failure are mild at first, but as the disease progresses, patients experience malaise, fatigue, dry mucous membranes, changes in laboratory tests, insomnia, nervous twitching of the limbs, tremor, numbness of the fingertips. As the disease progresses, the symptoms worsen. Persistent (morning and around the eyes), dry skin, loss of appetite, nausea, and hypertension develop. Forms of chronic renal failure are divided into five stages depending on the severity of the course.

Classification by stages

• Stage 1 CKD is latent. Passes without significant symptoms. Patients do not complain of anything except increased fatigue. In laboratory tests there is a small amount of protein.
• CKD stage 2 - compensated. Patients have the same complaints, but they appear more often. There are changes in laboratory parameters in urine and blood. There is an increase in the daily amount of urine excretion (2.5 l).
• CKD stage 3 - intermittent. There is a further decrease in kidney function. Blood tests show elevated levels of creatinine and urea. There is a deterioration in the condition.
• CKD stage 4 - decompensated. A severe and irreversible change occurs in the functioning of this internal organ.
• CKD stage 5 - end-stage chronic renal failure is characterized by the fact that kidney function almost completely stops. There is a high content of urea and creatinine in the blood. Electrolyte metabolism in the kidneys changes, uremia occurs.

The stages of chronic renal failure are classified depending on the degree of damage to the parenchyma of the organ, its excretory functions and have five degrees. The stages of chronic kidney disease are distinguished according to two criteria - glomerular filtration rate, creatinine and protein level in the urine.

Classification of chronic kidney disease by GFR

Indexation of CKD by albuminuria level

Kidney damage in children

Chronic kidney disease in children is uncommon, but isolated cases do occur. This is a very dangerous disease because it is in childhood that such disorders cause kidney failure, which leads to death. Therefore, identifying chronic renal failure and CKD at the earliest stages is an important task in pediatric nephrology. The causes of CKD in children are:

• low birth weight;
• prematurity;
• abnormalities of intrauterine development;
• renal vein thrombosis in newborns;
• past infectious diseases;
• heredity.

The classification of chronic disease in adults and CKD in children is the same. But the main sign that a child has this disease is that it occurs in school-age children. The main manifestation of the syndrome is a sharp disruption of the kidneys and, as a result, severe intoxication of the body. Urgent hospitalization is required.

Complications of the disease

This is a very dangerous disease, the 1st stage of which occurs with hidden symptoms, and the 2nd stage with mild signs of the disease. Chronic renal failure should be treated as early as possible. Chronic renal failure in the initial stage is not characterized by profound changes in the renal tissue. With CKD stage 5, irreversible processes develop that lead to poisoning of the body and deterioration of the patient’s condition. Patients experience arrhythmia, albuminuria, persistent hypertension, anemia, confusion up to coma, nephrogenic hypertension, angiopathy, heart failure and pulmonary edema may develop. Exacerbation of CKD and chronic renal failure leads to uremia. In this case, urine entering the blood leads to uremic shock, which often leads to death.

Diagnosis of the disease

Diagnosis of CKD involves consulting doctors:

• therapist;
• urologist;
• cardiologist;
• endocrinologist;
• ophthalmologist;
• neurologist;
• nephrologist.

The doctor will collect an anamnesis (all symptoms of the disease, concomitant diseases, in children - the presence of physical developmental delay, as well as features of the family history). An objective examination includes percussion and palpation of the kidneys. In children - examination of the ridge, the presence of weight deficiency, stunted growth, the presence of high blood pressure, signs of anemia, etc. Chronic renal failure is determined by tests:

• Urinalysis - a small amount of protein, decreased density, the presence of red blood cells, casts and an increased number of leukocytes.
• A blood test reveals an increase in leukocytes and ESR, a decreased amount of hemoglobin and red blood cells.
• Biochemical analysis - increased creatinine, urea, nitrogen, potassium and cholesterol in the blood. Decreased protein and calcium.
• Determination of glomerular filtration rate - calculated based on a blood test for creatinine, age, race, gender and other factors.
• An ultrasound of the kidneys and urinary system will help to see the condition of the kidney.
• MRI visualizes the structure of the kidney, its components, ureter and bladder.
• Doppler ultrasound evaluates the condition of the kidney vessels.
• Zimnitsky test - shows the state of kidney function, and you can also see the volume of urine excreted in the morning and afternoon.

Treatment of kidney failure

Initially, treatment of chronic kidney disease is aimed at reducing blood pressure, improving urine formation, lowering the pH of the stomach, and normalizing microelements in the blood. Later, depending on the patient’s condition, hemodialysis, peritoneal dialysis or kidney transplantation are prescribed. With this disease, you should not overcool, lift heavy objects, or succumb to stressful situations. It is very important to adhere to proper nutrition. Patients are prescribed diet No. 7. Its main principles are: limited protein intake, reducing the amount of salt and phosphorus in food, reducing and monitoring the amount of potassium, controlling fluid intake (no more than 2 liters), controlling the energy value of food. Nutrition for CKD is not similar to the usual fasting during illness; the menu should include enough fruits and vegetables in the form of soups and compotes.

Limiting protein intake is already recommended at the beginning of the disease - up to 1 g/kg, then - 0.8 g/kg, and at other stages - 0.6 g/kg. Controlling salt intake is a very important point in the diet, since an excess of sodium in the blood leads to hypertension and edema, so it is recommended to consume no more than two grams per day. They also limit the intake of phosphorus to 1 g per day (limit the consumption of foods high in phosphorus). To reduce potassium in the body, which can lead to cardiac arrest, dried fruits, bananas, avocados, potatoes, greens, nuts, chocolate, and legumes are excluded from the diet. The energy value of food should be 2.5-3 thousand calories. The patients' diet is divided (5-6 times, in small portions). The menu should be rich in fruits and vegetables in the form of compotes, soups, etc. Take food boiled or baked.

The diet should include the following products:

• cereals;
• whole grain bread;
• dietary soups;
• meat and fish products from low-fat varieties;
• vegetables and fruits;
• eggs;
• milk, cottage cheese;
• jellies and mousses;
• diluted juice and weak tea, rosehip decoction;
• spices.

Contraindicated:

• salty and spicy foods;
• alcoholic drinks, strong teas, coffee.
• mushrooms;
• greenery;
• legumes and pasta;
• smoked and preserved;
• bananas and dried fruits;
• seasonings: mustard and horseradish;
• garlic and radish.

Chronic renal failure never occurs “by itself” - this pathology is a complication of many kidney diseases. But if we talk about the symptoms of chronic renal failure, they will be absolutely the same, regardless of what caused the development of the pathology.

Causes of development of chronic renal failure

It is believed that the disease in question most often occurs against the background of inflammatory and/or infectious kidney pathologies. But there are also diseases of other organs and systems that can also lead to chronic renal failure.

Doctors have identified a list of pathologies that contribute to the development of the disease in question:

• persistent high blood pressure - ;
• amyloidosis;

It is not at all necessary that when diagnosing the above diseases, the patient will experience chronic renal failure - this pathology is a complication and for its development several factors must come together.

Renal failure in the latent stage - symptoms

The clinical picture of renal failure in the latent stage will depend on what disease led to the development of the pathology. Symptoms can be very different - swelling that occurs during the day and is independent of the amount of fluid consumed, increased blood pressure for no apparent reason, pain concentrated in the lumbar region. Doctors often note that the first symptoms of chronic renal failure in the latent stage are completely ignored - this happens with progressive glomerulonephritis and/or polycystic kidney disease.

In the latent stage of the disease in question, the patient will complain of increased fatigue and decreased appetite, up to complete refusal of food. These complaints are absolutely not specific, therefore, the doctor will be able to make a correct diagnosis and associate such changes in the patient’s well-being with problems with kidney function only after a thorough examination of the patient.

Both the patient and the attending physician should be alerted during the night hours, which occur even with a minimal amount of fluid consumed in the evening. This condition may indicate that the kidneys are unable to concentrate urine.

In kidney diseases, some of the glomeruli die, and the remaining ones cannot cope with the function of this organ - the liquid is absolutely not absorbed in the tubules, the density of urine decreases so much that in some cases the indicators approach those of the blood plasma. To clarify this point, doctors prescribe the patient according to Zimnitsky - if a density of 1018 is not present in any portion of urine, then we can talk about the progression of renal failure. A urine density of 1010 is considered critical - this means that fluid reabsorption has completely stopped, and the disturbances in kidney function have gone too far.

The latent stage of development of chronic renal failure acquires more and more pronounced symptoms over time - for example, the patient begins to complain of increased thirst, but there is no high blood pressure (unless it was the cause of the development of the complication in question), a blood test does not show a decrease in the level of hemoglobin and electrolytes shifts. If a doctor examines a patient at this stage of development of the disease in question, a reduced amount of vitamin D and parathyroid hormone will be detected, although there will be no signs of progression of osteoporosis.

Note:at the latent stage of development of chronic renal failure, symptoms are reversible - with timely diagnosis and professional medical care, progression can be prevented.

Azotemic stage of renal failure - signs

If the latent stage of development of the disease in question was diagnosed in a timely manner, but treatment does not produce any results, then the progression of the pathology will occur at a rapid pace - the irreversible stage of chronic renal failure begins. In this case, the patient will complain about very specific symptoms:

1. Blood pressure rises, constant headaches occur and this is associated with a decrease in the synthesis of renin and renal prostaglandins in the kidneys.
2. Muscle mass becomes smaller, the patient loses weight sharply, intestinal upset appears, appetite decreases, and he is often worried - these symptoms are due to the fact that the intestines partially take over the function of removing toxins.
3. Erythropoietin in the kidneys begins to be produced in too small quantities, which leads to the development of persistent anemia.
4. There are complaints of numbness in the upper and lower extremities (feet and hands), corners of the mouth, pronounced muscle weakness - the cause of this condition is a lack of active calcium in the body and a decrease in calcium levels. For the same reason, the patient may experience disturbances in the psycho-emotional background - agitation or.

As chronic renal failure progresses, a more severe stage 4 of the disease occurs. It will have the following symptoms:

Manifestations of end-stage renal failure

At this stage of development of the disease in question, the patient receives only replacement treatment - he regularly undergoes hemodialysis and/or peritoneal dialysis.

The main signs of chronic renal failure in the terminal stage will be the following manifestations:

Note:The life of patients with chronic renal failure at stage 4 of development is not even calculated in days - in hours! Therefore, it is highly advisable to seek professional medical help much earlier, when the first symptoms of the disease in question appear.

Specific symptoms of chronic renal failure develop in later stages of pathology, when irreversible processes in the kidneys occur. And in order to identify the development of the disease in question at stages 1-2, you need to regularly take blood and urine tests - this is especially true for those patients who are at risk.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category