Chronic renal failure

Description:

Chronic renal failure - the symptom complex developing as a result of the progressing death of nephrons as result practically of any chronic disease of kidneys. This state is characterized by gradual deterioration in functional capacities of kidneys and life activity disturbances connected with it.

Now the chronic renal failure is in the 11th place among the lethality reasons.

Symptoms of the Chronic renal failure:

The symptomatology of a chronic renal failure substantially is defined by a current of a basic disease, however irrespective of the nosology which caused development of a glomerulosclerosis, the changes in bodies and systems caused by influence of toxic products of metabolism are characteristic of a chronic renal failure. At the moment along with uraemic toxins more than 200 substances which accumulation causes progressing of a chronic renal failure are known.

The patient's skin with a chronic renal failure usually dry, yellow color owing to accumulation of an urochrome, an atrophy of sweat glands causes sharp reduction of sweating. The patient is disturbed by a severe skin itch, especially at night.

The liquid delay in an organism causes congestive heart failure which can be shown by formation of so-called water easy (fluid lung), accumulation of liquid in a pericardium and a pleural cavity can be noted further. These phenomena are aggravated with existence of arterial hypertension which occurs at 50% of patients with a chronic renal failure.

As a result of chronic uraemia ventilating ability decreases and the compensatory role of lungs in regulation of a metabolic acidosis is lost. Thereof oxygenation of blood goes down and the fabric hypoxia develops.

The liver and kidneys - bodies, functionally connected among themselves, both anti-toxic function of a liver and secretory function of kidneys are considered as two physiological processes supplementing each other. At a chronic renal failure barrier function of a liver, protein, fatty and carbohydrate metabolism is quite often broken.

Cardiovascular disturbances take an important place in a clinical picture of chronic uraemia. The condition of cardiovascular system at a chronic renal failure in many respects defines the forecast of treatment as a cause of death of the patients who are on a program hemodialysis in 30% of cases is heart failure. A hypocalcemia with a hyperpotassemia at a chronic renal failure aggravate disturbances of cordial activity as calcium ions are antagonists of potassium ions. The cardiac muscle is very sensitive to deficit of oxygen which takes place at chronic uraemia. The leading role in a pathogeny and a clinical picture of heart failure, especially in an end-stage is assigned to a hypertensive syndrome at patients with a chronic renal failure. Disturbance of a heart rhythm at patients with chronic uraemia is quite frequent symptom of a cardiac disturbance. Disturbances of water and electrolytic balance and acid-base state - a hyperpotassemia, a hyponatremia, a hypocalcemia, a metabolic acidosis, and also a hypertensive syndrome are the main reasons for disturbances of a cordial rhythm. Frequency of arrhythmia increases at bystry correction of a hyperpotassemia and hypernatremia, and also in connection with difficult controlled falling of arterial pressure during the hemodialysis sessions.

Perikardita treat a classical picture of a chronic renal failure. Till an era of a hemodialysis and renal transplantation the pericardis was considered as an adverse predictive sign.

Parallel to increase of level of nitrogenous metabolites of blood frustration central and peripheral nervous systems develop. One of the main reasons promoting progressing of polyneuropathy at patients with chronic uraemia is the inadequate hemodialysis, and also a malignant hypertension and a viral hepatitis.

The chronic renal failure is followed by a hypocalcemia as a result of disturbance of absorption of calcium in intestines, osteomalacy and an osteofibrosis turn out to be consequence of what.

Anemia is observed at the vast majority of patients with a chronic renal failure. The terminal chronic renal failure is followed by anemia in 100% of cases. Anemia origins at a chronic renal failure are: decrease in level of the erythropoetin produced by kidneys, dysfunction of marrow against the background of an azotemia, thrombocytopenia and the raised bleeding (that is aggravated with a constant geparinization against the background of a hemodialysis at a terminal chronic renal failure), and also hemolysis as a result of a hemodialysis and change of erythrocytes against the background of an azotemia.

Reduction in the rate of glomerular filtering causes a giperfosfagemiya that in turn causes decrease in level of the ionized blood serum calcium. It leads to a hyper parathyroidism that increases a calcium resorption from a bone tissue, causing an osteodystrophy and formation of metastatic calcificats.

As the compensatory mechanism at a chronic renal failure secretory function of digestive tract early enough joins. Constant release of urea, ammonia, creatinine causes emergence of unpleasant taste in a mouth, nausea, appetite loss. Active allocation of metabolites leads to destruction of a mucous membrane and causes development of stomatitis, a gastroenterocolitis, is frequent with formation of erosion and ulcers.

Reasons of the Chronic renal failure:

The main reasons causing a chronic renal failure are:

  1. The diseases which are followed by preferential defeat of balls: acute and chronic glomerulonephritis, diabetic nephrosclerosis, amyloidosis, lupoid nephrite, gout, long septic endocarditis, multiple myeloma, malaria.
  2. The diseases which are characterized by primary defeat of the canalicular device: the majority of the urological diseases which are followed by urine outflow disturbance, the inborn and acquired tubulopatiya (a renal not diabetes mellitus, canalicular acidosis of Albright, Fankoni's syndrome, poisonings medicinal and toxics).
  3. Secondary defeats of a parenchyma of kidneys owing to vascular diseases: stenosis of renal arteries, essential hypertensia, idiopathic hypertensia of a malignant current.
  4. Hereditary malformations of kidneys and ureters: polycystosis, cysts of kidneys, hypoplasia of kidneys, neuromuscular dysplasia of ureters.

Treatment of the Chronic renal failure:

Treatment of a chronic renal failure in many respects is defined by its stage and rate of development, existence of the leading syndromes in a clinical current and features of the basic disease which led to development of chronic uraemia. An initial stage of a chronic renal failure at a high-quality current of a basic disease (a chronic glomerulonephritis, chronic pyelonephritis, a polycystosis, etc.) can stretch for many years, significantly without affecting overall health and without demanding active medical actions. In this situation paramount value gets treatment of a basic disease that allows to slow down progressing of a chronic renal failure. Other treatment is necessary for patients with the developed clinical picture of the chronic renal failure which is characterized by a hyperazotemia, a metabolic acidosis, disturbance of water and electrolytic balance it is difficult the managed hypertensia and a circulatory unefficiency. In such cases it is necessary to carry out correction of water-salt balance, an azotemia, alignment of an acid-base state, treatment of hypertensive, hemorrhagic and anemic syndromes, maintenance of cordial activity. Low proteinaceous diet (20-60 g of protein a day), restriction of physical activity, control of intake of sodium with food, adequate consumption of liquid under control of a daily urine become important components of therapy. The good effect is reached by use of the drugs improving a renal blood stream (trental, Troxevasinum) and also furosemide with selection of a dosage taking into account renal function. It is not necessary to appoint drug treatment, without having specified a functional condition of kidneys.

Treatment of a chronic renal failure can have replaceable character: program hemodialysis, peritoneal dialysis and renal transplantation.