Symptoms of chronic renal failure, stages, treatment methods, drugs

Modern medicine manages to cope with most acute kidney diseases and curb the progression of most chronic ones. Unfortunately, until now, about 40% of renal pathologies are complicated by the development of chronic renal failure (CRF).

This term means the death or replacement by connective tissue of part of the structural units of the kidneys (nephrons) and irreversible impairment of the kidneys’ functions to cleanse the blood of nitrogenous wastes, produce erythropoietin, which is responsible for the formation of red blood elements, remove excess water and salts, and reabsorb electrolytes.

The consequence of chronic renal failure is a disorder of water, electrolyte, nitrogen, acid-base balance, which entails irreversible changes in the state of health and often becomes the cause of death in terminal chronic renal failure. The diagnosis is made when disorders are registered for three months or longer.

Today, CKD is also called chronic kidney disease (CKD). This term emphasizes the potential for the development of severe forms of renal failure even in the initial stages of the process, when the glomerular filtration rate (GFR) has not yet been reduced. This allows for more careful attention to patients with asymptomatic forms of renal failure and improves their prognosis.

What it is?

Chronic renal failure (CRF) is an irreversible impairment of the filtration and excretory functions of the kidneys, up to their complete cessation, due to the death of renal tissue. Chronic renal failure has a progressive course, in the early stages it manifests itself as general malaise. As chronic renal failure increases, there are pronounced symptoms of intoxication of the body: weakness, loss of appetite, nausea, vomiting, swelling, the skin is dry and pale yellow. Diuresis decreases sharply, sometimes to zero.

In later stages, heart failure, bleeding tendency, pulmonary edema, encephalopathy, and uremic coma develop. Hemodialysis and kidney transplantation are indicated.

Causes of kidney failure

Acute renal failure (abbreviated as ARF) in 60% of cases is provoked by surgical interventions and injuries. In 2% - pregnancy.

Causes of acute renal failure:

• problematic urination;
• neoplasms;
• liver diseases;
• kidney inflammation;
• lack of water in the body (dehydration);
• rapid decrease in pressure;
• dysfunction of the cardiovascular system;
• autoimmune diseases (lupus, myasthenia gravis, autoimmune thyroiditis, etc.)
• blockage of the ureter;
• massive destruction of blood cells;
• intoxication.

The chronic course of pyelonephritis and glomerulonephritis is most often provoked by chronic renal failure (CRF).

Causes of chronic renal failure:

• kidney disease;
• non-compliance with the dosage of medications;
• diseases that cause blockage of the urinary tract;
• intoxication;
• long-term illnesses that cause kidney damage.

Provoking factors

The most common provoking factors of the syndrome of impairment of all renal functions are:

• addiction;
• diabetes;
• malignant neoplasms;
• obesity;
• alcoholism;
• age-related changes;
• smoking.

Classification

There is a classification of chronic renal failure regarding the stage of symptoms:

1. Latent – ​​signs practically do not appear. The person may feel slightly tired. Very often it is determined during the diagnosis of a completely different problem, for the diagnosis of which blood or urine tests were performed;
2. Compensated - the volume of urine excreted increases (more than two liters per day), slight swelling appears in the morning;
3. Intermittent – ​​severe fatigue bothers a person, as well as dry mouth. Muscle weakness appears;
4. Terminal – a sharp change in the patient’s mood, decreased immunity. There is disruption of the functioning of other internal organs, including the heart and lungs. But the most obvious end-stage of chronic renal failure is characterized by such a sign as the appearance of the smell of urine from the victim’s mouth.

Types and stages of kidney failure

There are 2 forms of kidney failure:

1. acute renal failure (ARF);
2. chronic renal failure (CRF).

AKI is a sudden deterioration in kidney function. The process is associated with sudden inhibition, stopping the removal of metabolic products from the body. The amount of urine excreted decreases sharply or is absent altogether.

CRF is a slow decrease in the number of functioning structural units of an organ. At the initial stage, symptoms may not appear. The syndrome provokes irreparable processes in the body. Kidney tissue is destroyed. Formed as a result of chronic kidney disease. It is established when performing appropriate studies.

Acute renal failure is divided into:

• prerenal; Associated with blood circulation in the kidneys. The process of urine formation worsens. Happens in half of cases of the disease.
• renal; Soreness of the kidney tissue. Blood circulation is not impaired, but urine is poorly formed.
• postrenal; The process of urine formation is not disrupted, but it cannot flow down the urethra.

Acute renal failure can be triggered by both external and internal factors. Most often it occurs in older people. With proper treatment, kidney function is completely restored.

Chronic renal failure is not a disease. This is a syndrome with many signs showing decreased kidney function.

Different classifications of stages of chronic renal failure are used. The most common is related to the patient’s condition.

Stages of progression of chronic renal failure:

• latent;
• compensated;
• intermittent;
• terminal.

1. At stage 1, some nephrons begin to die, and the rest begin to actively work. As a result, they exhaust themselves. Symptoms are rare. There may be some changes in urination.
2. On the 2nd – the remaining nephrons can no longer cope with filtration. The patient's condition worsens. He starts to get tired quickly.
3. On the 3rd – the patient’s well-being noticeably worsens. The skin becomes dry. Urination becomes more frequent.
4. The 4th is the most severe form. The skin turns yellow. The patient constantly wants to sleep. Without appropriate treatment, a person dies.

Reasons for development

The development of chronic kidney failure is preceded by more serious factors than excessive salt intake or simple hypothermia. The main causes are pre-existing urinary tract disease. But in some clinical cases, the infection present in the human body may not be associated with the kidneys, although it ultimately affects this paired organ. Then chronic renal failure is defined as a secondary disease.

Diseases leading to kidney failure:

1. Glomerulonephritis (especially chronic form). The inflammatory process covers the glomerular apparatus of the kidneys.
2. Polycystic. The formation of multiple vesicles - cysts - inside the kidneys.
3. Pyelonephritis. Inflammation of the kidney parenchyma of bacterial origin.
4. The presence of congenital or acquired (post-traumatic) malformations.
5. Nephrolithiasis. The presence inside the kidneys of multiple or single stone-like deposits - calculi.

The disease develops against the background of such infections and conditions:

1. Diabetes mellitus of the insulin-dependent type.
2. Connective tissue damage (vasculitis, polyarthritis).
3. Viral hepatitis B, C.
4. Malaria.
5. Uric acid diathesis.
6. Increased blood pressure (arterial hypertension).

Also, the development of chronic renal failure is predisposed by regular intoxication with medications (for example, uncontrolled, chaotic use of medications), chemicals (work in paint and varnish production).

Forms

There are such forms of acute renal failure, depending on the etiopathogenesis:

• Shock kidney.
• Toxic.
• Acute infectious.
• Vascular obstruction.
• Urological obstruction.
• Arenal state.

Along the flow they distinguish:

• Initial period.
• Stage of uremia.
• Restoration of diuresis.
• Recovery.

According to severity they are distinguished:

• Easy.
• Average.
• Heavy.

According to the reason for the surge arrest:

• Prerenal (hemodynamic). Develops as a result of acute hemodynamic disturbance.
• Renal (parenchymal). The pathogenesis of acute renal failure is toxic or ischemic damage to the parenchyma, acute inflammatory process in the kidneys.
• Postrenal (obstructive). Occurs as a result of obstruction of the urinary tract.

In 70% of cases, prerenal acute renal failure is diagnosed, in 20% - renal, and only in 5% - postrenal.

Symptoms

Symptoms of chronic renal failure are as follows:

1. Appearance of patients. Almost no characteristic external signs will be noticeable until there is a pronounced decrease in the glomerular filtration of organs. The following disturbances can then be visualized:
   Pale skin is caused by anemia, which gradually increases. Violations of water and electrolyte balance lead to increased dryness of the skin. For the same reason, the skin loses elasticity and may acquire a jaundiced color;
2. Subcutaneous hematomas often begin to appear. Bruises appear without previous injury or contusion;
3. There are scratches on the skin of patients, which are caused by severe painful itching;
4. The face becomes very swollen. Swelling spreads to the limbs, to the abdomen;
5. Muscle tone decreases, they become flabby, which affects their functionality. This negatively affects a person’s ability to work. Muscle twitching and cramps against the background of clear consciousness are explained by a drop in calcium levels in the blood;
6. The skin remains dry even when the patient experiences severe anxiety or stress.
7. Nervous system disorders. Patients become apathetic, sleep poorly at night, and feel tired and overwhelmed during the daytime. Cognitive functions suffer, primarily memory and attention. The ability to learn and perceive information deteriorates. Patients often complain of coldness in the extremities, a tingling sensation, and “goosebumps.” It is associated with a disorder of the peripheral nervous system. As the pathological process progresses, movement disorders are observed in the upper and lower extremities.
8. Urinary system. The volume of urine increases in the initial stages of the disease, and the patient goes to the toilet more often at night. As insufficiency develops, the volume of urine excreted becomes less and less, swelling continues to increase, and complete anuria is possible.
9. Disturbances of water-salt balance. The thyroid gland begins to produce parathyroid hormone in large volumes. As a result, phosphorus levels rise and calcium levels fall. This causes frequent spontaneous fractures due to softening of the bone tissue.
   There is constant thirst, the patient’s mouth is dry;
10. When you rise sharply from a place, darkening of the eyes and muscle weakness occur. This is due to the leaching of sodium from the body;
11. Against the background of excess potassium in the blood, muscle paralysis increases;
12. Respiratory dysfunction is possible;
13. Water-salt balance is essential for the functioning of the body as a whole. Failures can lead to serious problems in the functioning of the heart, including cardiac arrest.
14. Nitrogen imbalance. If the glomerular filtration rate falls below 40 ml per minute, the patient's signs of enterocolitis increase. Against the background of an increase in the level of urea and uric acid in the blood, as well as an increase in creatinine, an ammonia odor will emanate from the patient’s mouth, and joint lesions will begin to develop.
15. Manifestations from the cardiovascular system. The hematopoietic function suffers, which is expressed in anemia, lethargy, increased fatigue and weakness.
    Pericarditis and myocarditis develop;
16. Blood pressure rises;
17. Pain in the heart of a dull and aching nature occurs, shortness of breath increases, the heart rhythm is disturbed;
18. Acute heart failure is a complication of renal failure and can cause the death of the patient.

At a late stage in the development of renal failure, “uremic lung” develops. Interstitial edema increases, a bacterial infection occurs, which is associated with a decrease in immunity.

As for the digestive system, its functioning is disrupted. Appetite disappears, nausea and vomiting may occur. Often the salivary glands and the oral mucosa react with inflammation. Sometimes patients reach the stage of anorexia due to aversion to food. Uremia causes stomach and intestinal ulcers, which can be complicated by bleeding. Acute hepatitis also often accompanies uremia.

Causes

The causes of renal failure most often lie in chronic kidney pathology, in which the organ’s own cells are slowly destroyed and replaced with fibrous tissue:

• urolithiasis disease;
• pyelonephritis;
• tumors of the urinary system;
• glomerulonephritis;
• renal vein thrombosis;
• hydronephrosis.

Other pathologies may also be responsible for functional renal failure:

• diabetes;
• high blood pressure;
• infectious diseases;
• frostbite and burns;
• poisoning with toxic substances;
• overdose of medications;
• shock of any origin (traumatic, surgical, cardiogenic, anaphylactic);
• polymetabolic syndrome;
• abnormal fluid loss (through the skin or kidneys);
• obstetric complications (septic abortion);
• dehydration due to uncontrollable vomiting and diarrhea;
• peritonitis;
• massive blood loss;
• blockage of the urinary ducts.

Very rarely, the cause of the disease is hereditary abnormalities.

Signs of renal failure depend on the stage at which the pathological process is located. The initial phase does not manifest itself in anything. During this period, the patient complains only about the symptoms of the leading disease.

The first clear signs of kidney failure appear at the oliguric stage. It is characterized by a decrease in the daily volume of urine and disturbances in the water-salt balance, which is expressed by the following symptoms:

• deterioration of general health, weakness, lethargy, loss of performance;
• low temperature;
• shortness of breath, bradycardia, arrhythmia;
• skin itching;
• anemia;
• increased blood pressure;
• loss of appetite, vomiting, nausea, bloating;
• convulsive muscle twitching.

Pain in renal failure can be localized in the lumbar region, spread across the abdomen or concentrated in one side. It all depends on the cause that provoked the functional impairment of the kidneys and the number of affected organs.

The acute stage of the disease lasts 7–14 days, then the recovery phase begins, during which the patient’s condition gradually improves. During the same period, the amount of urine discharge can significantly exceed the norm.

The final restoration of kidney function lasts 8–12 months. If during the acute course of the disease most of the parenchyma was excluded from work, then complete rehabilitation is impossible.

Among women

Symptoms of kidney failure in women are very specific. Even at the latent stage, emotional imbalance develops, caused by a disorder in progesterone synthesis.

Representatives of the fair sex become extremely quarrelsome, touchy and whiny. Possible disturbance of the monthly cycle, prolonged intermenstrual bleeding, insomnia. Frequent changes in blood pressure cause headaches and fainting, constipation, bloating, and gas. Ladies of thin build often suffer from impaired thermoregulation.

In men

The symptoms of kidney failure in men are not particularly noticeable. At the initial stage, the amount of urine decreases, skin itching, diarrhea occurs, and signs of a central nervous system disorder may appear.

Kidney failure during pregnancy

Even a physiologically occurring pregnancy significantly increases the load on the kidneys. In chronic kidney disease, pregnancy aggravates the course of the pathology and can contribute to its rapid progression. This is due to the fact that:

• during pregnancy, increased renal blood flow stimulates overstrain of the renal glomeruli and the death of some of them,
• deterioration of conditions for reabsorption of salts in the renal tubules leads to losses of high volumes of protein, which is toxic to renal tissue,
• increased functioning of the blood coagulation system contributes to the formation of small blood clots in the capillaries of the kidneys,
• worsening arterial hypertension during pregnancy contributes to glomerular necrosis.

The worse the filtration in the kidneys and the higher the creatinine numbers, the more unfavorable the conditions for pregnancy and its gestation. A pregnant woman with chronic renal failure and her fetus face a number of pregnancy complications:

• Arterial hypertension
• Nephrotic syndrome with edema
• Preeclampsia and eclampsia
• Severe anemia
• Feto-placental insufficiency and fetal hypoxia
• Delays and malformations of the fetus
• Miscarriage and premature birth
• Infectious diseases of the urinary system of a pregnant woman

To resolve the issue of the advisability of pregnancy for each specific patient with chronic renal failure, nephrologists and obstetricians-gynecologists are involved. In this case, it is necessary to assess the risks for the patient and the fetus and correlate them with the risks that the progression of chronic renal failure every year reduces the likelihood of a new pregnancy and its successful resolution.

Consultation with a doctor for kidney failure

Question: How is a kidney biopsy performed? Answer: The procedure is performed in a specialized medical institution (usually in the nephrology department) by a nephrologist. Under local anesthesia, under the control of an ultrasound probe, a tiny column of kidney tissue is taken with a thin disposable needle. In this case, the doctor performing the biopsy sees the kidney and all the movements of the needle on the screen. Contraindications to performing a puncture biopsy of the kidneys are: 1. single kidney; 2. hemorrhagic diathesis; 3. polycystic kidney disease; 4. purulent inflammation of the kidney and perinephric tissue (purulent pyelonephritis, paranephritis); 5. kidney tumors; 6. kidney tuberculosis; 7. refusal of the patient to conduct the study.

Question: Are there age or other restrictions for kidney transplantation? Answer: Age cannot be an obstacle to surgery. The psychological readiness of the transplant candidate is important. It is determined by one's ability to comply with medical recommendations after a kidney transplant, since non-adherence to immunosuppressant treatment is the most common cause of kidney transplant loss. Absolute contraindications for transplantation are: sepsis, AIDS, uncontrolled malignant neoplasms.

General practitioner Vostrenkova I.N.

Damage to organs and systems in chronic renal failure

1. Changes in the gastrointestinal tract. During the first phases, appetite often decreases and the mouth becomes dry. Over time, stomatitis occurs, constant nausea ending in vomiting, and frequent belching. Irritated mucosa leads to manifestations of enterocolitis and atrophic gastritis. As a result, superficial ulcers of the intestines and stomach occur, often causing bleeding.
2. Blood changes. Chronic renal failure causes a decrease in hemoglobin levels. Hematopoiesis is inhibited, and the lifespan of red blood cells decreases. There may also be a deterioration in blood clotting, prothrombin levels decrease, and thrombocytopenia occurs.
3. Reaction from the heart and lungs. In most patients, arterial hypertension, myocarditis, and pericarditis can be observed. Congestive heart failure occurs, and in advanced cases, uremic pneumonitis.
4. Problems with the musculoskeletal system. With chronic renal failure, various forms of osteodystrophy often occur: osteoporosis, osteitis fibrosa, osteosclerosis, osteomalacia. Diseases can manifest themselves in arthritis, compression of the vertebrae, unexpected fractures, skeletal deformities, muscle pain radiating to the bones.
5. Complications from the nervous system. In the early stages, changes in the central nervous system may occur such as sleep disturbances, problems with concentration, then confusion in consciousness, inhibited reactions are possible, in complex cases hallucinations begin, the patient becomes delusional. Peripheral polyneuropathy is also observed.
6. Changes in the immune system. Chronic renal failure is often accompanied by lymphocytopenia. Due to the suppression of the body's defenses, various purulent-septic complications develop.

Treatment

Treatment of acute renal failure is performed in a hospital. The patient, who is in serious condition, is placed in intensive care.

For chronic disease, therapy is prescribed depending on the degree of kidney damage. At an early stage, the underlying disease is stopped. In most cases, this allows you to cope with the functional disorder and avoid complications.

When symptoms of kidney failure appear, specific treatment is carried out: remove blockage of the ureters, replenish the loss of plasma, use antiarrhythmic and cardiac drugs.

Drugs for kidney failure:

• medications that improve blood circulation - Dopamine;
• diuretic tablets - Lasix, Furosemide, Hypothiazide, Diacarb, Trigrim;
• plasma replacement drugs - Reogluman, Sorbilact. Solutions are administered intravenously through droppers or injections;
• sorbents - Filtrum-STI, Enterodes;
• blood pressure pills - Enalapril, Captopril, Adelan.

For autoimmune diseases and glomerulonephritis, glucocorticosteroids are prescribed - Prednisolone. Anemia is combated by subcutaneous administration of Epovitan.

Antibiotics for renal failure are used if the cause of the illness is sepsis, pyelonephritis or another infectious pathological process. The most effective and safe in this case are Cefepime and Cefaclor.

If medications for renal failure do not have the expected effect and symptoms continue to develop, the patient is transferred to hemodialysis or undergoes an organ transplant.

Complications and consequences

Over time, chronic kidney disease damages almost every human organ. Potential complications of chronic renal failure include:

1. Weakness of bone tissue, frequent fractures.
2. Diseases of the heart and blood vessels.
3. Low libido and impotence.
4. Pericarditis, inflammation of the pericardial sac.
5. Complications of pregnancy that involve risks for the mother and fetus.
6. Fluid retention, which leads to swelling in the arms and legs, increased blood pressure, and fluid accumulation in the lungs.
7. A sudden increase in potassium levels in the blood (hyperkalemia), which can interfere with the normal functioning of the heart.
8. Damage to the central nervous system, which is manifested by personality changes, decreased intelligence, and seizures.
9. Deterioration of the immune response, which makes the patient's body more susceptible to infections.
10. Decreased red blood cell count (anemia).
11. Irreversible kidney damage requiring lifelong dialysis or transplantation.

How does chronic renal failure develop?

The process of replacing the affected glomeruli of the kidney with scar tissue is simultaneously accompanied by functional compensatory changes in the remaining ones. Therefore, chronic renal failure develops gradually, passing through several stages in its course. The main reason for pathological changes in the body is a decrease in the rate of blood filtration in the glomerulus. The normal glomerular filtration rate is 100-120 ml per minute. An indirect indicator by which one can judge GFR is blood creatinine.

• The first stage of chronic renal failure is initial

At the same time, the glomerular filtration rate remains at the level of 90 ml per minute (normal variant). There is confirmed kidney damage.

• Second stage

It suggests kidney damage with a slight decrease in GFR in the range of 89-60. For older people, in the absence of structural damage to the kidneys, such indicators are considered normal.

• Third stage

In the third moderate stage, GFR drops to 60-30 ml per minute. At the same time, the process occurring in the kidneys is often hidden from view. There is no bright clinic. There may be an increase in the volume of urine excreted, a moderate decrease in the number of red blood cells and hemoglobin (anemia) and associated weakness, lethargy, decreased performance, pale skin and mucous membranes, brittle nails, hair loss, dry skin, decreased appetite. About half of the patients experience an increase in blood pressure (mainly diastolic, i.e. lower).

• Fourth stage

It is called conservative because it can be controlled by medications and, like the first, does not require blood purification using hardware methods (hemodialysis). At the same time, glomerular filtration is maintained at a level of 15-29 ml per minute. Clinical signs of renal failure appear: severe weakness, decreased ability to work due to anemia. The volume of urine excreted increases, significant urination at night with frequent urges at night (nocturia). Approximately half of patients suffer from high blood pressure.

• Fifth stage

The fifth stage of renal failure is called terminal, i.e. final. When glomerular filtration decreases below 15 ml per minute, the amount of urine excreted drops (oliguria) until it is completely absent in the outcome of the condition (anuria). All signs of poisoning of the body with nitrogenous wastes (uremia) appear against the background of water-electrolyte imbalance, damage to all organs and systems (primarily the nervous system, heart muscle). With this development of events, the patient’s life directly depends on blood dialysis (cleaning it bypassing non-functioning kidneys). Without hemodialysis or kidney transplantation, patients die.

Diagnostics

Diagnosis of chronic renal failure begins with a visit to the office of a nephrologist, who will conduct an examination, draw up an anamnesis and prescribe an examination plan:

• laboratory study of the composition of urine, in case of chronic renal failure, revealing the presence of protein (proteinuria), density below normal, sometimes - traces of red blood cells;
• a urine test to determine the amount of protein lost over 24 hours is carried out in order to assess kidney damage, because the amount of protein released in urine indicates the degree of perforation of the membranes, which normally should retain the protein and return it to the bloodstream;
• a clinical (general) blood test at any stage, with the exception of isolated stage, reveals high ESR, low hemoglobin (anemia);
• biochemistry of blood composition at any stage, with the exception of latent and in some cases compensated, reveals an increase, as a rule, of two indicators: blood urea and creatinine; with proteinuria, protein in the blood decreases;
• Rehberg's test is a study that most accurately determines the main factor in the efficiency of kidney function, namely GFR;
• Ultrasound – with chronic renal failure visualizes a decrease in the size of organs and parenchyma;
• X-rays with contrast injection are used to assess the condition of the renal vessels, but in practice they are used infrequently due to the toxicity of the drugs.

If the study has proven the presence of chronic kidney failure, the nephrologist’s patient should undergo the tests described above regularly, 6-8 times a year, to monitor the dynamics.

Acute PN

Renal failure in women, the symptoms of which are expressed in an acute form, causes a disorder in the functioning of several vital systems of the body, namely:

• hypertensive crisis, attacks of tachycardia, heart rhythm disturbances;
• frequent urination, but the color of the urine is completely colorless, since there is no full filtration;
• the woman refuses to eat;
• the urge to vomit is present all the time (when the stomach is empty, vomit mixed with bile is released);
• the organs of the digestive system stop working, and the body attempts to carry out self-cleaning without renal filtration;
• bowel disorder leads to the fact that a woman is constantly bothered by diarrhea.

General health is unsatisfactory. Loss of consciousness or the body may be in such a weakened state that the patient is unable to independently meet her needs. Extensive intoxication of the blood and tissues of internal organs increases.

The causes of acute renal failure in women are associated with the influence of the following negative factors on the body:

• intoxication of kidney tissue with harmful chemical compounds that entered the female body along with food, drink or air (a similar reaction of the excretory system can be caused by salts of heavy metals, mercury vapor, lead, substances based on glycols of all types);
• ischemia of the papillary covering of the organ, which occurs with the development of a purulent form of pyelonephritis;
• sudden thrombosis of the artery responsible for the blood supply to the kidneys;
• complication of diabetic nephropathy;
• microscopic type polyangiitis;
• chronic alcoholism, which is expressed in the daily consumption of large quantities of strong alcoholic beverages for several months;
• long-term use of potent drugs from the pharmacological group analgesics;
• septic shock caused by blood poisoning.

The further course of treatment aimed at restoring kidney function and quickly eliminating the consequences of intoxication of the body depends on the cause that caused the acute form of renal failure.

Treatment of chronic renal failure

Each stage of kidney failure requires specific actions to be taken.

1. At stage I, the underlying disease is treated. Stopping the exacerbation of the inflammatory process in the kidneys reduces the severity of renal failure.
2. At stage II, along with treatment of the underlying disease, the rate of progression of renal failure is assessed and drugs are used to reduce its rate. These include lespenefril and hofitol - these are herbal preparations, the dose and frequency of administration are prescribed by the attending physician.
3. At stage III, possible complications are identified and treated, and medications are used to slow the rate of progression of renal failure. They correct arterial hypertension, anemia, calcium-phosphate disorders, treat infectious and cardiovascular complications.
4. At stage IV, the patient is prepared for renal replacement therapy
5. and at stage V, renal replacement therapy is performed.

Renal replacement therapy includes hemodialysis and peritoneal dialysis.

Hemodialysis is an extrahepatic method of blood purification, during which toxic substances are removed from the body and disturbances in water and electrolyte balances are normalized. This is done by filtering the blood plasma through the semi-permeable membrane of the artificial kidney apparatus. Treatment with maintenance hemodialysis is carried out at least 3 times a week, with a duration of one session of at least 4 hours.

Peritoneal dialysis. The human abdominal cavity is lined by the peritoneum, which acts as a membrane through which water and substances dissolved in it enter. A special catheter is surgically installed into the abdominal cavity, through which the dialysate solution enters the abdominal cavity. An exchange occurs between the solution and the patient’s blood, resulting in the removal of harmful substances and excess water. The solution sits there for several hours and then is drained. This procedure does not require special installations and can be performed independently by the patient at home or while traveling. Once a month he is examined at the dialysis center for control. Dialysis is used as treatment while waiting for a kidney transplant.

All patients with stage V chronic kidney disease are considered candidates for kidney transplantation.

Acute renal failure - what is it?

Acute renal failure syndrome occurs in one patient in 5000 cases. This is not much, given the spontaneous nature of its occurrence. But, on the other hand, in a large regional or regional center with a population of 1 million people there will already be about 200 patients within a year, and this is a lot.

From the history of the issue, it can be established that in 90% of cases, acute renal failure occurred in the middle of the twentieth century, as a complication of criminal abortion. Currently, acute renal failure occurs in various fields of medicine, and is most often a manifestation of multiple organ failure syndrome. There are:

• Prerenal acute renal failure (i.e. prerenal) – 50%.

Prerenal acute renal failure occurs with completely preserved renal function. But arrhythmias, various shocks, pulmonary embolism and heart failure simply cannot provide “pressure supply” to the kidney system.

Also, acute renal failure develops with vasodilation (with allergic shock, or anaphylaxis, with sepsis). Of course, if a significant amount of fluid has disappeared from the body (bleeding, severe diarrhea), then this will also lead to an elementary lack of filtration volume.

• Renal (acute nephron damage);

According to statistics, almost all renal acute renal failure is caused by either ischemia or intoxication of nephrons. Almost always, with this disorder, acute tubular necrosis occurs, that is, “death” of the urine concentration apparatus. For example, this type of acute renal failure occurs when there is a massive release of muscle breakdown products (myoglobin) into the blood during prolonged crush syndrome, or crash syndrome, shortly after improper removal of compression.

It is also caused by certain medications (antibiotics - aminoglycosides), NSAIDs, X-ray contrast agents, captopril.

In 1998, a case was described in which, after a single administration of cefuroxime (an antibiotic from the cephalosporin group), the patient developed acute bilateral necrosis. As a result, she lived on hemodialysis for 1.5 years, and her condition improved only after a kidney transplant.

• Postrenal (postrenal, urine outflow is disrupted) – 5%.

This type of acute renal failure is rare and can occur in unconscious, elderly and mentally ill patients. Accompanied by anuria (less than 50 ml per day). The reason is stones, adenoma, cancer and other obstacles to the passage of urine leading to obstruction at any level, from the urethra to the pelvis.

Diet and nutrition for chronic renal failure

To reduce the symptoms of the disease, the doctor will prescribe a special nutrition program for the patient. A diet for chronic renal failure involves eating foods containing fats and carbohydrates. Proteins of animal origin are strictly prohibited, and proteins of plant origin are strictly prohibited in very limited quantities. The use of salt is completely contraindicated.

When drawing up a nutrition program for a patient with chronic renal failure, the doctor takes into account the following factors:

• stage of the disease;
• rate of progression;
• daily loss of protein through diuresis;
• the state of phosphorus, calcium, and water-electrolytic metabolism.

In order to reduce the concentration of phosphorus, dairy products, white rice, legumes, mushrooms and baked goods are prohibited. If the primary task is to regulate the balance of potassium, it is recommended to abandon the content of dried fruits, cocoa, chocolate, bananas, buckwheat, and potatoes in the diet.

Signs of kidney failure in a woman

The manifestation of symptoms of acute renal failure is determined by the reasons that caused acute renal failure and the stage of development of the pathological process.

1. Causes of a prerenal nature (independent of renal disorders) cause the development of the disease against the background of heart failure, shock, or cardiovascular collapse, severe arrhythmia or a significant decrease in blood flow to the kidneys (for example, with blood loss).
2. The renal factor (the reason lies in the structural disorders of the kidney itself) is caused by acute necrosis (death) of the renal tubules that filter the blood. What can happen under the influence of toxic substances, various surrogates, medications and lack of blood supply to the kidneys. Sometimes, this may be a consequence of acute inflammatory kidney diseases.
3. The postrenal (obstructive) factor causes the development of acute renal failure against the background of decreased vascular patency (occlusion), for example, acute bilateral blockage of the ureters.

Stages of symptom development

The onset of the disease (stage 1) is manifested by severe migraines, chills, muscle pain and fever, if the cause is due to infectious influence. Signs of functional gastrointestinal disorders in the form of nausea, vomiting and diarrhea appear after an hour. The toxic effect of toxic substances is expressed by yellowing of the skin, signs of anemia and tremors of the extremities.

The development of the disease is manifested by a rapid increase in symptoms:

• Manifestation of confusion, which is replaced by deep fainting;
• Increased sweating is noted (cold sweat covers the forehead);
• Signs of thread-like pulsation;
• A characteristic manifestation of arterial hypertension with an alternating decrease in blood pressure to critical limits.

In case of infectious damage to the organs of the urinary system, pain appears in the lumbar area, problems in the urination process and the presence of bloody inclusions in the urine.

The next stage of development (2nd) is characterized by a decrease in the volume of urine excreted, or a complete cessation of its excretion. Loss of consciousness and development of coma are noted. Edema processes in the subcutaneous tissue significantly increase the patient's weight. Swelling of the brain and lung tissue may occur.

Signs of the terminal stage of acute renal failure appear with inadequate treatment of the disease or its complete absence. Symptoms are expressed:

• The appearance of a large amount of foaming sputum at the mouth;
• Manifestation of subcutaneous and internal hemorrhages;
• Syncope (fainting);
• Frequent cramps in the calf muscles;
• Cardiovascular disorders.

At this stage of the disease, it is no longer possible to help the patient.

Prevention

1. Avoid alcoholic beverages. If you do drink alcohol, keep it in moderation. Western doctors believe that for a healthy woman under 65 years of age the norm should not exceed one drink, and for a healthy man - no more than two drinks a day. Alcohol is generally not recommended for older people, the sick and pregnant women.
2. Follow instructions for medications. When using any medications, including aspirin, ibuprofen, paracetamol, follow the manufacturer's instructions. Taking large doses of medications can cause kidney damage. If you have a history of kidney disease, consult your doctor before taking any medications.
3. Maintain a healthy body weight. If you have problems with excess weight, start exercising and control your diet. Obesity not only increases the risk of kidney problems, but also contributes to diabetes, leads to hypertension, and reduces life expectancy and quality of life.
4. Give up cigarettes. If you smoke, consult your doctor about modern methods of relieving nicotine addiction. Pills, nicotine patches, psychotherapy, and support groups can help you quit.
5. Watch your health. Avoid developing infectious diseases that can affect your kidneys over time.

It is recommended that patients with this disease visit the following resorts: Truskavets, Zheleznovodsk, Evpatoria, Berezovsky Mineral Waters and others.

Kidney functions

excretory

The nephrons (the structural units of the kidneys) filter the blood, resulting in the formation of urine.

Excreted in urine:

• Protein metabolism residues: urea, creatinine, ammonium salts, sulfuric, phosphoric, uric acids.
• Excess water, salts, micro- and macro-elements, glucose.
• Hormones.
• Harmful substances of third-party origin, including medications.

Homeostatic

Homeostasis means the balance of the internal environment of the body. The amount and ratio of vital substances (for example, water, sodium, potassium, etc.) can fluctuate only within limited limits - even a slight imbalance leads to disease.

The kidneys “monitor” that the amount of substances excreted corresponds to the amount of substances received. This maintains water-salt, acid-base, electrolytic, and osmotic homeostasis. This means that a constant volume of blood, external and intracellular fluid is ensured, the uninterrupted flow of metabolic processes is ensured, and a normal level of blood pressure is maintained.

Endocrine

This is the synthesis of some biologically active substances and hormones.

For example, the kidneys produce the hormone erythropoietin, which stimulates the production of red blood cells in the bone marrow. They also complete the formation of active vitamin D3 (calcitriol), which forms bone tissue.

Metabolic

Participation in the breakdown of proteins and the construction of part of cell membranes. Synthesis of glucose from other substances.

Forecast

The prognosis of the disease depends on the quality of the therapy, the stage of the disease, the presence of complications or concomitant diseases.

The further prognosis of the disease depends on the patient himself: how he will lead his future lifestyle and adhere to medical recommendations. After hemodialysis and kidney transplantation began to be widely used, deaths are reported less frequently. Modern treatment methods (nephrology deals with) help relieve these syndromes and continue the life of patients with chronic kidney disease up to 20 years.

Urolithiasis Glomerulonephritis Pyelonephritis Hydronephrosis Hypertension Hypocalcemia

Complications

The severity of the consequences depends on the severity of oliguria. The most common complications:

• changes in blood composition;
• violation of water-salt balance;
• neurological disorders;
• decrease in the body's defenses;
• disruption of the gastrointestinal tract;
• pathologies of the cardiovascular system.

Violation of water-salt balance

This disorder is observed with severe oliguria. At the same time, patients are diagnosed with hyperkalemia. When the level of potassium in the blood exceeds 6-6.5 mmol/l, the following symptoms appear:

• muscle pain;
• heart rhythm disturbance (tachycardia, arrhythmia or barycardia).

In addition to hyperkalemia, hypocalcemia, hypermagnesemia and hyperphosphatemia may occur.

Blood change

As a result of an increase in the content of nitrogenous compounds in the blood plasma, the level of hemoglobin and red blood cells decreases. Anemia develops.

Immune disorders

Acute renal failure is accompanied by suppressed immunity, as a result of which up to 70% of patients suffer from infectious diseases, which cause death. This could be mumps, pneumonia or sepsis.

Neurological disorders

Patients experience the following symptoms:

• drowsiness;
• disorientation in space;
• slow reaction;
• confusion;
• a depressed state that alternates with a period of increased agitation.

Peripheral neuropathy is often diagnosed in older patients.

Complications from the cardiovascular system

ARF is often accompanied by heart failure, arrhythmia, bradycardia, tachycardia, pericarditis and hypertension.

Complications from the gastrointestinal tract

The course of acute renal failure is complemented by symptoms of poisoning. Abdominal pain, loss of appetite, nausea and vomiting appear. The most severe complication is bleeding from the gastrointestinal tract.

Risk factors

There are groups for which the possibility of developing acute renal failure should be especially taken into account. These include people who have the following conditions:

• elderly age;
• high blood pressure;
• vascular diseases;
• episodes of renal failure;
• heart failure;
• diabetes;
• chronic infections with septic complications;
• leukemia;
• studies with X-ray contrast agents;
• oliguria or anuria.

Stages and symptoms

How does acute renal failure develop, or what is the pathogenesis of acute renal failure? The appearance of new symptoms is well consistent with the transition of the pathological process from stage to stage, and the stages of acute renal failure are well known. Let's consider the classic course and clinic of acute renal failure.

Initial period

In the initial period, the effect of the unfavorable factor on the kidney parenchyma continues. The initial period of development of acute renal failure very often occurs with chills and a rapid decrease in blood pressure. The patient may have a fever, pale and cyanotic skin. Jaundice increases rapidly. Before the onset of urine, the urine quickly darkens, the protein concentration in it increases significantly, the content of all cellular elements increases - leukocytes, erythrocytes, many cylinders. Regardless of the cause that caused this syndrome, in the initial period, systemic hemodynamics always change, and the pressure drops sharply.

Oliguric or anuric stage

In the oliguric period, the main symptom of which is a decrease in urine volume (less than 500 ml/day), signs of acute renal failure are caused by the accumulation of toxic metabolic products in the blood that are not excreted by the kidneys. Patients have decreased appetite, headache and weakness, and drowsiness. The concentration of urea, phosphates, creatinine and uric acid quickly increases in the blood. The concentration of potassium, which is not excreted, sharply increases, and at the same time the level of sodium, calcium and chlorine decreases.

Signs of increasing uremia clearly correlate with these laboratory indicators. Neurological disorders occur most frequently. Pathological reflexes appear, the patient experiences an attack of excitement, convulsions and paralysis occur. On examination, there is a difference in the size of the pupils, the so-called anisocoria, and sluggish tendon reflexes are observed. In severe cases, drowsiness gives way to coma, and before falling into a coma, mental disorders and changes in the state of consciousness, such as delirium, amentia or severe stupor, often occur.

Almost always, the clinical picture of acute renal failure in the oliguric stage is accompanied by a disorder of the functions of the cardiovascular system. Attacks of heart failure occur, pain in the heart appears, hyperkalemia can lead to severe variants of cardiac arrhythmia and deterioration of impulse conduction in the tissues of the heart. Breathing quickens, the lungs try to compensate for the developed metabolic acidosis. Therefore, patients in this stage of acute renal failure may have deep and noisy breathing. In some cases, excess fluid that is not excreted by the kidneys sweats through the alveoli and is manifested by the development of pulmonary edema.

Anemia is a constant companion to acute renal failure at this stage. Bone marrow is a tissue that divides very quickly at a high rate, producing various blood cells; it requires especially ultra-clean conditions for production. Therefore, when metabolic products accumulate, the bone marrow is one of the first to be depressed, new cells are not produced, and hemolysis (destruction of blood cells) due to the unfavorable environment in the plasma increases sharply.

The duration of the oligoanuric period determines the severity: the longer it is, the worse the prognosis.

Stage of diuresis restoration

Initially, the patient produces little urine, only about half a liter per day. This is the stage of initial diuresis. At the same time, the previous symptoms do not decrease, or even increase. After 2 or 3 days, polyuria develops. The kidneys suddenly begin to secrete large amounts of urine, and at the same time, patients sharply reduce their weight, dry skin occurs, which peels, dry mouth and thirst appear. Hyperkalemia is replaced by its opposite, the level of nitrogen in the blood plasma sharply decreases, creatinine and urea are normalized. This period lasts about 20 days, and almost all symptoms of acute renal failure gradually disappear.

Recovery stage

Kidney recovery after acute renal failure begins with the normalization of urea and creatinine, and this fact can be considered the beginning of clinical recovery. During this period, glomerular filtration rates are gradually restored, but the restoration of the normal concentrating ability of the kidneys takes a long time - from six months to 2 years.

Thus, in the case of acute tubular necrosis, the kidneys are completely restored within a year in 60% of patients. If glomerulonephritis was the basis of acute renal failure, then the situation is worse. After a year, less than 50% of patients recover, and 25% require chronic hemodialysis.

Prognosis and complications

With uncomplicated kidney failure, the probability of complete recovery is 90%. The chances of recovery of all kidney functions depend on:

• surge arrester phases;
• age;
• timeliness of therapy;
• causes of damage to renal structures.

According to practical data, complete restoration of the excretory system is observed in 40% of cases, partial – in 15% of cases. Ignoring the disease leads to chronic renal failure, which is irreversible.

Possible complications of acute renal failure include:

• hyperkalemia;
• heart failure;
• immunodeficiency states;
• confusion;
• uremia (urinary bleeding);
• anemia;
• pulmonary edema;
• arterial hypertension;
• sepsis.

The outcome of the disease is influenced by the degree of renal dysfunction. In 3% of cases, patients require continuous hemodialysis.

Diagnosis of the disease

Before proceeding with the choice of treatment, it is necessary to correctly establish the diagnosis and extent of kidney damage. First of all, you will need to consult a nephrologist and therapist. When you first visit a doctor’s office, he conducts a thorough examination, collects anamnesis, and establishes possible causes that could provoke the disease. To obtain a complete picture of the patient’s health status, the doctor prescribes the following diagnostic procedures:

• General and biochemical blood test. These laboratory tests will help determine the level of red blood cells and determine the presence of anemia; detect the presence of urea and creatinine.
• A general urine test to determine the presence of urea and creatinine. In addition, the volume of urine excreted per day is monitored.
• An electrocardiogram will help determine the presence of dysfunction of the cardiovascular system.
• Ultrasound examination of the kidneys to determine changes in the structure, size and functioning of the kidneys.
• Arteriography - this study is carried out to identify narrowing of the abdominal aorta and the formation of blood clots in it.
• Carrying out tomography.
• Isotope scan of the kidneys.
• Cavography will help determine the presence of blood clots in the inferior vena cava.

Treatment of acute renal failure

The complex of therapeutic measures depends on the stage at which renal failure is located.

At the first stage, treatment is aimed at eliminating the etiotropic factor that led to acute renal failure. Thus, in a state of shock, blood volume should be replenished and blood pressure should be kept at the proper level.

In case of poisoning with toxic substances, you need to rinse the digestive tract. In severe cases, extracorporeal hemosorption is used as a means of emergency cleansing of the body. If obstruction is present, the structural formation that caused it should be removed.

In the oligoanuric stage, it is necessary to stimulate diuresis. For this purpose, a sick person is prescribed diuretic drugs, for example, furosemide.

If there is severe vasoconstriction of the renal vessels, then vasopressor support should be provided in the form of dopamine administration in a renal dosage. At this stage, it is important to follow a strict diet, where protein-containing foods are completely excluded.

In some cases, acute renal failure requires hemodialysis . This procedure is justified when blood urea values ​​are more than 24 mmol/l, and potassium levels are more than 7 mmol/l.

In parallel with biochemical disorders, the patient should experience symptoms of acidosis, uremia and edematous syndrome. Currently, experts say that early or preventive hemodialysis significantly reduces the risk of complications.

Hemodialysis

Epidemiology

According to the medical article “Acute renal failure: causes, outcomes, methods of renal replacement therapy” from 2012, authored by Svetlana Sergeevna Bunova and colleagues, the epidemiology of the disease has not been fully studied and varies in the general population.
The frequency of prerenal acute renal failure is 46 people per 1,000,000 population, obstructive - 23 people per 1,000,000 population. Death is recorded in 20-30% of cases after the patient is admitted to the intensive care unit. In the textbook on urology B.K. Komyakov presented data that the prevalence of the syndrome is about 150-200 people per 1,000,000 population, and in half of the cases patients require hemodialysis. Acute renal failure is also 5 times more likely to develop in older people.

Kidneys and their role for the body

To find out why these diseases occur, you must first understand the role the kidneys play in the body.

Kidneys are important organs that perform the following functions: through them, metabolic products are removed and water and acid balances are maintained. These functions work due to renal blood flow.

Kidney failure develops as a result of serious weakening of the vital functions of the body. This disorder can lead to disruption of the body's water and acid balance. And the consequences of this may be irreversible. Any unpleasant and painful condition should be paid attention to.

Peculiarities

In women, symptoms of the disease appear much more often. This is due to the fact that the female body has a greater predisposition to kidney diseases due to the anatomical structure of the genitourinary system.

The female urethra, unlike the male one, has a wider and shorter shape. This allows pathogenic microorganisms to freely enter the bladder with the formation of foci of inflammation. The infection then travels through the urinary tract to the kidneys.

Significant damage to the parenchyma, calyces, and pelvis leads to disruption of the filtration and excretion process. Urinary retention causes intoxication of the cells and tissues of the body. As can be seen, both endogenous and exogenous factors influence the formation of the disease.

Acute symptoms

Symptoms and treatment of the disease depend on a number of factors. These include: forms of the disease, causes of occurrence and stages of progression. Signs of kidney failure in women directly depend on what caused the exacerbation.

Depending on the stage of the disease, the symptoms of the disease also change significantly.

Attention! If a significant portion of the kidney tissue has been damaged as a result of the disease, complete restoration of organ function does not occur.

Symptoms of the chronic form

The symptoms of chronic renal failure (CRF) are very similar to those of the acute form. The difference lies in the prolonged form of manifestation.

Attention! If diagnosis is delayed, when the disease has entered its final phase, only forced hemodialysis can save the patient.

Detailed characteristics of acute kidney failure

The kidneys are the main filter of the body, continuously passing blood through itself, cleansing it of toxins and excess fluid and preserving useful components. They are rightfully considered an organ without which human life becomes impossible. But against the background of many diseases and pathological processes, severe disruptions in their functioning often develop, and in order to prevent the development of complications, doctors try to provide maximum assistance to the patient. In the international classification ICD-10, somatic pathology has its own code N-17.

Causes and provoking factors

According to available statistics, acute renal failure develops in approximately 200 people per million of the planet's population.

It is important to know! It is noteworthy that in the countries of the African continent the disease occurs against the background of a viral or parasitic infection, while in European countries the cause of its development is diabetes mellitus or arterial hypertension.

The main causes of acute renal failure are:

• polytrauma;
• surgical intervention on the organs of the cardiovascular system;
• obstetric and gynecological pathologies;
• poisoning with nephrotoxic drugs;
• intoxication with narcotic substances, methyl alcohol, alcohol substitute.

The disease is considered polyetiological, but experts identify three main forms of the disease, each of which develops under the influence of certain causes.

Hemodynamic – prerenal insufficiency. Its development is caused by the following conditions.

1. Decrease in cardiac output:
   pulmonary embolism;
2. cardiogenic shock;
3. heart failure with arrhythmia;
4. bleeding, mainly uterine;
5. hemotamponade of the heart.

1. Vasodilation of systemic vascular origin:
   septic shock;
2. severe forms of anaphylactic reactions;
3. taking vasodilators, a sharp drop in blood pressure.

1. Decreased extracellular fluid levels:
   ascites against the background of liver cirrhosis;
2. burn disease;
3. vomiting and diarrhea;
4. significant blood loss;
5. uncontrolled use of laxatives and diuretics.

The development of acute renal failure can be provoked by severe liver damage with loss of functional ability - cirrhosis, cancer.

Parenchymal - renal failure.

1. Post-ischemic.

It is considered a consequence of the previous form. It develops as a result of the above-described reasons, if adequate therapy was ineffective or completely absent. The leading mechanism of development is tissue ischemia.

1. Exogenous intoxication – poisoning with toxins:
   bites of poisonous insects, reptiles;
2. exposure to a number of medications;
3. household poisons;
4. administration of diagnostic contrast agent, use of antibiotics.

1. Infectious diseases:
   hemorrhagic fever;
2. leptospirosis;
3. viral hepatitis;
4. HIV infection.

1. Massive hemolysis of red blood cells:
   intoxication;
2. gout;
3. multiple myeloma;
4. long-term compartment syndrome;
5. heatstroke;
6. heavy physical activity;
7. coma of alcoholic or drug origin.

1. Acute inflammatory processes in a paired organ:
   glomerulonephritis;
2. damage to the renal vessels;
3. all types of tubulointerstitial nephritis.

The renal form of acute renal failure can develop as a result of injury or removal of the only healthy kidney.

Obstructive – postrenal insufficiency. Diagnosed in no more than 5% of all cases due to the following factors:

• neuropathy as a complication of diabetes;
• kidney tuberculosis, urethritis;
• dystrophic lesions of the retroperitoneal tissue;
• obstruction of the excretory ducts with stones during the development of urolithiasis;
• tumors of the prostate gland, bladder;
• accidental ligation (ligation) of the ureter during surgery.

Sometimes there may be a combination of several factors that provoke the development of acute renal failure. This form is quite rare.

Symptoms of different stages

The acute process has several stages, each of which manifests itself in its own way. It is considered obvious that as the pathology progresses, the symptoms of acute renal failure will also vary.

Initial phase

Has a clinical picture of the underlying disease. The development of the infectious process is characterized by an increase in temperature and signs of general intoxication. The presence of polytrauma is indicated by persistent pain. In case of poisoning, nausea, vomiting, diarrhea, and weakness appear. The patient experiences drowsiness and lack of appetite, which is considered to be symptoms of a common malaise.

Oligoanuric phase

It is characterized by a decrease in diuresis. The amount of urine excreted does not reach 500 ml. Symptoms of poisoning gradually increase: nausea, dizziness, apathy, weakness, adynamia. With pulmonary edema due to dehydration, shortness of breath and moist rales are noted. Protein and increased levels of nitrogen compounds, potassium, sodium, and phosphates appear in the urine. Against the background of weakened immunity, pancreatitis, pneumonia, stomatitis, mumps, and sepsis can develop. Pericarditis and uremic gastroenterocolitis often occur. From the gastrointestinal tract, 30% of patients develop bleeding erosions, abdominal pain, and persistent nausea.

Acute symptoms persist for the first three days. The average duration of the phase is 10-14 days. A prolonged stage can be observed in elderly patients with a history of concomitant vascular pathology. If the oligoanuric phase lasts more than a month, differential diagnosis should be carried out to exclude vasculitis, glomerulonephritis, necrosis of the renal cortex and occlusion of the renal artery.

Diuretic phase

This phase is considered the third and is characterized by the restoration of diuresis. Increased urine output - polyuria occurs due to impaired reabsorption by damaged renal tubules. The amount of liquid reaches 2-5 liters. If infusion therapy is carried out in insufficient volume, the patient develops overhydration, and there is a decrease in potassium, phosphorus, and calcium ions.

Recovery phase

The duration of the final phase ranges from 6 months to 1 year. Ideally, lost renal functions are completely restored during this period. But with irreversible damage to the nephrons, a return to the original level is not possible, and then the functionality of the organ is partially restored.

Types of pathology and their symptoms

Depending on the degree of exposure to the damaging factor leading to pathology, the following stages of acute renal failure are distinguished:

Hemodynamic or prerenal. Occurs as a result of acute disruption of the renal blood supply, accounting for more than 50% of cases.

Parenchymal or renal. The main reason lies in damage to the functional structures of the kidneys and kidney tissue.

Obstructive or postrenal. The main reason is considered to be narrowing of the ureters with cessation of the ability to excrete urine.

Transition to chronic form and other complications

Complications of acute renal failure are most often caused by the development of uremia, that is, the process of poisoning the body with decay products that are not able to be excreted by the kidneys in the case of oliguria or low glomerular filtration rate. Pathology can lead to conditions such as:

• anemia;
• cardiac dysfunction;
• dyspeptic disorders;
• increased risk of infections;
• neurological disorders;
• uremic coma.

It is important to know! A gradual increase in the concentration of toxins and poisons in the blood plasma, the inability of the kidneys to cope with their elimination, leads to their complete failure. In this case, doctors do not exclude the development of chronic renal failure with all the ensuing consequences dangerous to the health and life of the patient.

Symptoms and stages

It all depends on what stage the disease is at, then the symptoms are more pronounced, but this does not allow us to say with confidence that the diagnosis will be carried out with high accuracy. Symptoms are often veiled and coincide with concomitant diseases, especially in trauma, so renal failure requires special attention. Nausea and weakness can be manifestations of both kidney problems and many other diseases. Observed in the latent stage:

• weakness, nausea, drowsiness, shortness of breath;
• high blood pressure.

In the compensated stage:

• acute uremia;
• swelling;
• copious urine output.

The intermittent stage has symptoms and signs such as:

• yellowish skin tone;
• tremor;
• joint pain;
• Colds become more severe.

In this case, the diagnosis of renal failure may be correct, and even the treatment may be correct, but therapy without surgery brings a temporary improvement. Even with a small load, or with mental stress, kidney function can be even more impaired, and the symptoms will be more pronounced.

The terminal stage is the most severe, with a number of disorders occurring, and general health seriously deteriorates.

Causes of the disease

Acute kidney failure develops under the influence of a variety of reasons: from disruption of the functioning of internal organs, to damage by poisons or mechanical damage to kidney tissue. The most common and common factors that provoke the disease include:

• The presence of diseases of the cardiac system in a person, as a result of which the blood volume is significantly reduced: Cardiac tamponade - accumulation of a large amount of fluid in the pericardial sac.
• Arrhythmia is a significant acceleration of the heart rate.
• Heart failure is a dysfunction of the heart, resulting in a decrease in the supply of blood and oxygen to organs and tissues.

Depending on the prerequisites that provoke the development of the disease, acute renal failure can be divided into three types:

• Prerenal acute renal failure - the main development factor is impaired blood circulation in the kidneys or a decrease in filtration rate, which results in a significant increase in cretinin levels and impaired renal function. With timely assistance, the disease responds well to treatment, but in the case of its advanced form, necrosis or ischemic disease is possible.
• Obstructive acute renal failure – the development of this type of disease is facilitated by impaired urine patency in the urinary tract. That is, the kidneys perform their functions fully, but due to damage to the ureters, urine is not excreted, which is most often caused by the presence of tumor diseases, hematomas or stones.
• Parenchymal acute renal failure is kidney damage caused by mechanical, toxic, chemical, and ischemic effects.

Drug treatment

Treatment of acute renal failure is initially aimed at eliminating the causes that provoked the syndrome. In chronic cases, the main goal of therapy is to slow the progression of the disease.

At the same time, based on the severity of the pathological process and the individual characteristics of the body, such drugs for renal failure as diuretics, antibiotics, plasma substitutes, sorbents, drugs for parenteral nutrition, herbal products, vitamin complexes and others are used in treatment.

Diuretics (diuretics)

The first sign of kidney failure is the appearance of edema. This is due to the fact that salts and liquid cannot be completely eliminated from the body. Therefore, the patient is prescribed diuretics to compensate the body’s excretory abilities. The choice of diuretic will depend on the severity of edema, the patient’s age and the general condition of his body. The most popular and effective drugs include:

• Furosemide. It is a powerful loop diuretic that is prescribed for various stages of kidney failure. The drug is presented in the form of tablets and injections. After taking the tablet, the diuretic effect occurs after 60 minutes, with intramuscular administration - 5 minutes. Each dose of the drug lasts from 3 to 6 hours. The disadvantage is that when urinating, the body loses useful elements - calcium and magnesium, which is fraught with a number of side effects. Therefore, treatment with Furosemide is mainly carried out in a hospital, under the supervision of medical professionals. Contraindications include prerenal renal failure, in which urine is not produced, pregnancy, lactation and individual intolerance to the drug.

• Uregit. It is a fast-acting diuretic against edema of various origins, available in tablets. The diuretic effect occurs after 30 minutes and lasts 6-8 hours. Contraindicated for children, pregnant women, and patients with renal coma.

• Hypothiazide. Promotes the rapid removal of excess fluid along with sodium salts and chlorine, without affecting the level of calcium and other useful elements. The product quickly relieves swelling and lowers blood pressure. It should not be taken by patients with an allergic reaction to any component of the drug, in conditions with a complete absence of urine, diabetes mellitus and gout.

• Trigrim. The diuretic is excellent for renal failure and edema syndrome. Initially, the drug is taken in an amount of 20 mg once a day. If there is no diuretic effect, the dose is doubled. Contraindications include childhood, pregnancy and lactation, anuria, renal coma, hypersensitivity to the components of the drug.

Plasma replacement drugs

Plasma replacement drugs are presented in the form of solutions that replenish the deficiency of blood plasma or its individual components. Among the plasma-substituting solutions, the following can be distinguished:

• Reogluman. Representations as a plasma-substituting, hypertonic, colloidal solution. It thins the blood and restores blood flow in small capillaries. Dextran, which is contained in the medicine, promotes the absorption of 20-25 ml of fluid from tissues into the bloodstream. The medicine is administered intravenously by drip. There are practically no side effects. The exception is patients who have allergic reactions to the components of the drug.

• Sorbilact. Improves blood microcirculation, has anti-shock, detoxification, diuretic, and energetic effects. The drug is presented in the form of a solution, the active ingredients of which are sorbitol and sodium lactate. It is administered intravenously by stream or drip, at a rate of 60-80 drops per minute. Contraindications are conditions that limit fluid administration (stroke, thromboembolism, heart failure).

Medicines for parenteral nutrition

Parenteral nutrition solutions include all the substances necessary for the body in quantities appropriate to the needs and in the correct ratio to each other. The dosage of medications is determined based on the patient’s age, daily requirement and energy consumption level. In case of renal failure, you need to use specialized solutions prepared for the needs of the individual organism. However, the following widely used means are also used:

• Aminosteril KE Nefro. It is a complex drug that is administered by infusion. The preparation contains replaceable and essential amino acids and ions of basic electrolytes (potassium, sodium, magnesium, chlorine). The dosage of the drug and the period of its administration are determined by the doctor. The recommended dose is 1.3 ml/kg body weight.

• Nephrotect. The drug is a solution of amino acids necessary for protein synthesis during parenteral nutrition during renal failure. The recommended rate of administration is 1 ml per 1 kg of body weight per hour. The medication has no side effects.

Antibacterial drugs

Antibacterial drugs for renal failure are prescribed if the cause of the syndrome is an infectious pathology, or it occurs after the development of renal failure. Before choosing an antibiotic, the doctor should weigh everything carefully. In patients with renal failure, the elimination rate of some drugs may be reduced. That is, a person can take the next dose, while the previous one still circulates through the vessels. In this case, intoxication of the body may develop.

Also, some antibacterial agents negatively affect the renal parenchyma, and if there are diseases of this organ, the risk increases significantly.

The safest in this case are penicillin antibiotics and cephalosporins. However, the dose of the drug should be slightly less than that of a healthy person.

Aminoglocoside antibacterial drugs (Gentamicin, Amikacin) are highly not recommended for renal failure. Because they are excreted by the kidneys in their pure form and have a nephrotic effect. You can also take modern macrolide and fluorolinolone drugs with a reduced dosage.

Such widespread antibiotics as biseptol, tetracycline, and doxycycline are strictly contraindicated in patients with renal failure.

Sorbents for renal failure

Thanks to the kidneys, all toxins and harmful substances are removed from the body.

In case of acute or chronic failure, the organ is unable to function fully, which is why all the harmful elements accumulate in the body.

Sorbents absorb them and promote further excretion.

Drugs in this group that are recommended to be taken for renal failure:

• Filtrum-STI. The active ingredients of the medicine bind and remove bacteria, poisons, heavy metals, drugs, allergens, and alcohol from the body. The drug is presented in the form of tablets, which need to be crushed and washed down with plenty of water. Contraindications include digestive diseases, pregnancy and lactation.

• Enterodesis. Has strong sorbent properties. It is sold in powder form, which is diluted with water and taken orally. Contraindications include individual intolerance to individual components of the drug.

• Enterosgel. It can be sold in the form of a paste or gel, which is diluted with water and drunk. The drug relieves intoxication of any nature. Appointed from the age of 1 year. During pregnancy and breastfeeding, take the baby only under the supervision of a doctor and with extreme caution.

Herbal preparations

When prescribing herbal remedies, doctors are guided by the fact that there are practically no restrictions on their use, and they do not cause side effects. The most commonly used means are:

• Polyphepan. This is a drug of plant origin, where the active substance is hydrolytic lignin. It has an antidote, detoxification and enterosorbent effect. The drug is available in the form of granules and paste intended for making a suspension.

• Hofitol. The main active component of the drug is a dry aqueous extract from field artichoke. It has diuretic, choleretic and hepatoprotective properties. Hophytol comes in the form of tablets, syrup, intravenous or intramuscular injections. The drug should be taken under the supervision of a physician.

• Lespefril. The composition of the herbal preparation includes the biologically active substance shoots of Lespedeza bicolor. Thanks to the properties of the plant, the product regulates metabolism at the cellular level and helps cleanse the body of toxins. The drug is available in the form of solutions for oral administration. When taking the medicine, you must strictly adhere to the doctor's instructions, since it has many contraindications.

In addition to drug treatment prescribed by a doctor for renal failure, the patient must follow a certain diet. It is necessary to increase products that have a diuretic effect, as well as those containing as many useful elements as possible.

Before using medications, let's look at nutrition

Only certain potassium-containing foods are excluded from the diet:

• milk;
• fish;
• meat;
• dried fruits;
• bananas;
• potato.

Limit consumption of foods high in phosphorus and magnesium. In addition, it is important to observe a gentle work regime, avoid great physical stress and rest often.

During treatment, a specialist may prescribe a combination drug - cardonate. It can be classified as a drug with an anabolic effect. It is synthesized in the nervous system, liver and kidneys. In the blood plasma it is found in the free sphere and as an acylcarnitine ester.

Carnitine contained in this drug is the most important regulator of acid metabolism throughout the body. Thanks to carnitine, toxic substances are removed from the cytoplasm and metabolic processes are improved.

Over time, performance begins to increase, muscle mass increases and fat cells decrease. The basal metabolism in hyperthyroidism is completely normalized.

In addition, the drug contains lysine. This is one of the most important acids, which takes part in all processes of assimilation and growth. At the same time, the body also receives the necessary vitamins: B12, B1, B6.

Establishing diagnosis

Since the primary signs of acute renal failure can easily be confused with symptoms of other diseases of the urinary system, an examination is a necessary step. Acute renal failure can be detected with proper diagnosis. But, first of all, the patient is interviewed and examined, and an anamnesis of his life and illness is compiled.

Laboratory diagnostics

1. Clinical blood test. It is performed to determine the parameters of hemoglobin, leukocytes, and ESR.
2. Biochemical blood test. Increased creatinine, urea, and potassium are determined.
3. Zimnitsky's test. Daily diuresis is monitored.
4. General and bacteriological urine analysis. The amount of protein, leukocytes, and cylinders is determined.

Instrumental research.

1. Ultrasound, MRI, CT is prescribed for suspected urinary tract obstruction, anomalies and gross hematuria. Additionally, ascending pyelography can be performed.
2. X-ray contrast angiography and Doppler ultrasound are prescribed if stenosis of the renal artery is suspected.
3. Cavography is performed for thrombosis of the inferior vena cava.

Also considered additional methods are:

1. X-ray of the lungs.
2. Radioisotope dynamic scintigraphy.
3. Chromocystoscopy.
4. Electrocardiography of the heart.
5. Kidney biopsy.

Excretory urography is not prescribed because the level of creatinine and urea exceeds normal limits, and the excretory function of the kidneys is impaired. The introduction of a contrast agent can cause additional intoxication, which will only aggravate the pathological process.

Drug therapy

Treatment of renal failure in women using medications is symptomatic and depends on the clinical picture of the disease, as well as the results of a diagnostic examination.

Depending on the situation, the following medications may be used:

• Sorbitol;
• Calcium gluconate;
• Aluminum hydroxide;
• Furosemide;
• Cephaloredin;
• Neomycin;
• Methicillin;
• Polymyxin;
• Monomycin;
• preparations based on iron oxide;
• Ampicillin.

The formation of a course of drug therapy is greatly influenced by the causative factor that caused the development of renal failure, as well as the severity of the current illness.

Prognosis and prevention

Prevention of acute renal failure consists, first of all, in controlling the underlying disease. So, if a patient has cancer, then before starting chemotherapy it is necessary to prescribe Allopurinol in fairly high doses, due to the potentially predictable breakdown of protein. In the event of a high or prerenal form of acute renal failure, it is necessary to ensure high levels of renal blood flow, correct hypovolemia, or a decrease in circulating blood volume as planned. And for those patients who are prescribed nephrotoxic drugs, if necessary, it is necessary to carefully select dosages and take into account the glomerular filtration rate.

Of course, there is no point in talking about a complete ban on alcohol substitutes, and in the event of a risk of occupational intoxication at work, the task of protecting the health of workers in hazardous professions lies with the labor protection department.

Primary and secondary prevention

Acute renal failure is a serious but reversible process of dysfunction of a paired organ. To prevent the formation of pathology, you need to monitor the condition and function of the kidneys.

Individual or primary prevention includes the following tasks:

1. Preserving kidney health in childhood and adolescence.
2. Fight against bad habits - smoking, drinking alcohol.
3. Proper and balanced nutrition.
4. Protection from drafts, colds and hypothermia.
5. Avoid taking nephrotoxic drugs.
6. Changing difficult working conditions to more comfortable and gentle ones.

Secondary prevention is aimed at preventing exacerbation of the disease and the occurrence of a second attack. It contains a list of other recommendations:

• follow the diet prescribed by your doctor, limit your salt and protein intake;
• control body weight;
• reduce the risk of infectious agents entering the body;
• take all prescribed medications;
• undergo preventive examinations;
• treat emerging diseases in a timely manner.

Your attitude towards your health should be conscious, and giving up bad habits, behavioral attitudes and compliance with other rules of prevention should be voluntary.

Basic principles of treating the disease

There are many causes of kidney failure. It can be called:

• poisoning;
• medications;
• infectious diseases;
• inflammatory processes;
• urinary tract obstruction;
• hemodynamic disturbance;
• urological pathology and much more.

Treatment of this disease is a very complex process. This procedure should only be carried out under the supervision of a specialist.

The specialist first discovers the cause of the disease and then eliminates it. If the condition is already advanced and conventional medications do not help, then hemodialysis is performed - with the help of an artificial kidney, the blood is cleansed.

With this procedure, blockage of the kidney arteries may occur. In this case, bypass surgery, prosthetics, and an additional procedure are performed - balloon angioplasty.

If blood circulation is poor, it should also be restored. Metabolic substances are removed from the blood and then antibacterial drugs are prescribed.

For preventive purposes, the patient is prescribed a certain diet: the necessary diet is prescribed, which includes restrictions on the consumption of proteins and excess liquid.

Stages

Acute kidney failure has four stages:

1. Death of kidney tissue due to any reason.
2. Reducing the volume of urine excreted to 0.5 liters per day (oliguria) or up to 50 ml per day (anuria).
3. Normalization of diuresis in 2 stages: the initial diuresis phase (more than 0.5 l) and the polyuria phase (2-3 l of urine per day).
4. Recovery. It begins with the disappearance of azotemia.

There is a non-oliguric option, when, with normal diuresis, blood parameters in a biochemical analysis change.