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Renal Failure

What is renal failure?

Renal failure - a pathological condition in which partially or completely lost the ability to form buds and / or release urine, and as a consequence, develop serious violations of water-salt, acid-base and osmotic homeostasis, which lead to secondary damage to all body systems. The clinical course distinguish between acute and chronic renal failure.

Acute renal failure

Acute renal failure develops suddenly as a result of acute (but usually reversible) renal tissue damage, and is characterized by a sharp fall in the number of urine (oliguria) to its complete absence (anuria).

Causes of acute renal failure

1) impaired renal hemodynamics (shock, collapse, etc.);
2) exogenous toxicity (poisons used in the national economy and way of life, the bites of poisonous snakes and insects, drugs);
3) infectious disease (hemorrhagic fever with renal syndrome and leptospirosis);
4) severe kidney disease (acute glomerulonephritis and acute pyelonephritis);
5) The obstruction of the urinary tract (acute impairment of urine outflow);
6) arenalnoe condition (injury or removal of a single kidney).

Symptoms of acute renal failure

- A small amount of urine (oliguria);
- Complete absence (anuria).

The patient's condition worsens, it is accompanied by nausea, vomiting, diarrhea, lack of appetite, edema of limbs, increases in the volume of the liver. The patient may be inhibited, or vice versa comes excitement.

In the clinical course of acute renal failure there are several stages:

Stage I - initial (symptoms caused by the direct influence of the cause of the acute renal failure), lasts from the moment of impact of the main reasons before the first symptoms of the kidney has a different duration (from several hours to several days). Intoxication may appear (pallor, nausea, abdominal pain);

Stage II - oligoanuric (the main symptom - oliguria or complete anuria, as characterized by severe general condition of the patient, the emergence and rapid accumulation of urea in the blood and other end products of metabolism of proteins, causing self-poisoning organism, manifesting lethargy, weakness, drowsiness, diarrhea, hypertension, , tachycardia, edema of the body, anemia, liver failure, and one of the characteristic features are progressively increasing azotemia - increased blood levels of nitrogen (protein) products of metabolism and severe intoxication);

Stage III - replacement:

- Early phase of diuresis - clinic is the same as in stage II;
- The phase of polyuria (increased urine formation) and the recovery of the concentration ability of the kidneys - the renal function normalized, restored the respiratory function and cardiovascular system, digestive tract, locomotor apparatus, nervous; stage lasts about two weeks;

Stage IV - recovery - anatomical and functional recovery of the kidney to the original settings. May take many months, sometimes takes up to one year.

Chronic renal failure

Chronic renal failure - a gradual decline in renal function prior to its extinction, caused by the progressive loss of renal tissue due to chronic kidney disease, the gradual replacement of renal tissue by connective tissue and shrink the kidney.

Chronic renal failure occurs in one out of 200-500 million people. Currently, the number of patients with chronic renal failure increases annually by 10-12%.

Causes of chronic renal failure

The causes of chronic renal failure may be a variety of diseases that lead to the defeat of the renal glomeruli. They are:

- Kidney disease, chronic glomerulonephritis, chronic pyelonephritis;
- Metabolic disease diabetes, gout, amyloidosis;
- Congenital polycystic kidney disease, renal hypoplasia, a congenital narrowing of the renal arteries;
- Rheumatic disease systemic lupus erythematosus, scleroderma, vasculitis hemorrhagic;
- Vascular disease hypertension, diseases that lead to a breach of renal blood flow;
- Diseases that lead to a breach of the outflow of urine from the kidneys of urolithiasis, hydronephrosis, tumors, leading to a gradual compression of the urinary tract.

The most common causes of chronic renal failure are chronic glomerulonephritis, chronic pyelonephritis, diabetes and congenital anomalies of the kidneys.

Symptoms of chronic renal failure

There are four stages of chronic renal failure.

1) the latent stage. At this stage the patient may not complain or appear during physical exertion fatigue, weakness, appearing in the evening, dry mouth. For biochemical analysis of blood reveals a small violation of the electrolyte composition of blood and sometimes protein in the urine.

2) compensated stage. At this stage, patients' complaints are the same, but they occur more frequently. Is accompanied by an increase in urine output to 2.5 liters per day. Detected changes in the biochemical indices of blood and urine.

3) Intermittent stage. The work of the kidneys is reduced even further. There is a persistent increase in blood products of nitrogen metabolism (exchange protein) increased urea, creatinine. The patient has there weakness, fatigue, thirst, dry mouth, appetite decreased dramatically, noted an unpleasant taste in the mouth, nausea and vomiting. The skin takes on a yellowish tint, it becomes dry and loose. Muscles lose their tone, there are minor twitching of muscles, tremor of fingers and hands. Sometimes there are pains in the bones and joints. The patient may be much heavier than usual flow respiratory diseases, tonsillitis, pharyngitis. In this stage can be expressed in periods of improvement and deterioration in the patient's condition. Conservative (non-surgical) therapy makes it possible to regulate the homeostasis, and the general condition of the patient often allows him to still work, but increasing physical activity, mental stress, errors in diet, limiting drinking, infection, surgery may lead to a deterioration of renal function and worsening of symptoms.

4) The terminal (final) stage. For this stage is characterized by emotional lability (lethargy followed by excitation), the violation of a night's sleep, daytime sleepiness, confusion and inadequate behavior. His face puffy, gray-yellow, itchy skin, the skin is scratching, hair dull, brittle. Increases dystrophy, characterized by hypothermia (low body temperature). There was no appetite. The voice hoarse. Mouth feel the smell of ammonia. There is a thrush. Tongue coated, stomach swollen, often repeated vomiting, regurgitation. Not infrequently - diarrhea, foul-smelling stools, dark in color. The filtration ability of the kidneys decreases to a minimum. The patient may feel satisfactorily for several years, but at this stage in the blood is constantly increased the amount of urea, creatinine, uric acid, disturbed electrolyte composition of blood. All this causes uremic toxicity or uremia (uremia urine in the blood). Number of urine per day is reduced to its complete absence. Affected other organs. There is a degeneration of the heart muscle, pericarditis, circulatory failure, pulmonary edema. Disorders of the nervous system are manifested symptoms of encephalopathy (sleep disturbance, memory, mood, the emergence of depressive states). Disrupted hormone production, changes occur in the coagulation of blood, impaired immunity. All these changes are irreversible. Nitrogenous waste products are excreted in sweat, and the patient's urine smell ever.

Prevention of renal failure

Prevention of acute renal failure is reduced to prevent the causes of it.

Prevention of chronic renal failure is reduced to the treatment of chronic diseases such as pyelonephritis, glomerulonephritis, urolithiasis.

Forecast

With timely and proper application of appropriate methods of treatment, most patients with acute renal failure recover and return to normal life.

Acute renal failure is reversible: the kidneys, in contrast to most organs are able to fully restore the lost function. However, acute renal failure - this is an extremely serious complication of many diseases, often presages death.

However, some patients reduced glomerular filtration and renal concentrating ability remains, and some kidney failure takes a chronic course, an important role is played by joined pyelonephritis.

In advanced cases of death in acute renal failure often comes from uremic coma, hemodynamic disorders, and sepsis.

Chronic renal failure should be monitored and to begin treatment at the early stages of the disease, otherwise it can lead to complete loss of kidney function and require a kidney transplant.

What can you do?

The main task of the patient to notice the changes that occur to him as part of overall health, and by the amount of urine, and seek medical advice. Patients with confirmed diagnosis of pyelonephritis, glomerulonephritis, congenital anomalies of the kidneys, systemic disease, should be observed regularly for the nephrologist.

And, of course, need to adhere strictly to a doctor's prescription.

What can a doctor do?

Your doctor will determine the first cause of a renal failure and the stage of the disease. You will be taken all necessary measures to treat and care for the sick.

Treatment of acute renal failure is aimed primarily at eliminating the causes that causes this condition. Suitable measures to combat shock, dehydration, hemolysis, intoxication, etc. Patients with acute renal failure was transferred to intensive care unit, where they are provided with the necessary assistance.

Treatment of chronic renal failure is inseparable from the treatment of kidney disease, which led to kidney failure.