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Chronic renal failure (CRF)



Chronic renal failure gradually develops as a result of the progressive irreversible loss of a functioning parenchyma.

It is diagnosed in children with diseases of the urinary system while maintaining them for 3-6 months and a decrease in glomerular filtration of less than 20 ml / min, an increase in the level of serum creatinine, urea. Over 50 diseases are manifested by kidney damage and lead to chronic renal failure, which is characterized by progression and irreversibility.

Etiology. Causes of chronic renal failure: chronic pyelonephritis, chronic glomerulonephritis, hereditary nephritis, nephritis for systemic diseases, nephroangiosclerosis, polycystic kidney disease, diabetic glomerulonephrosis, renal amyloidosis, urological diseases. The pathogenetic mechanism of chronic renal failure is a progressive decrease in the number of active nephrons, which leads to a decrease in the effectiveness of renal processes and to impaired renal function. Before chronic kidney failure develops, chronic kidney disease can last from 2 years or more. They go through several stages, when glomerular filtration and tubular reabsorption are at a normal level, the main disease is in a stage that is not accompanied by impaired renal processes. Over time, glomerular filtration becomes lower than normal, the ability of the kidneys to concentrate urine decreases, and the disease passes into the stage of impaired renal processes. At this stage, homeostasis is preserved and there is still no renal failure. If the number of active nephrons and the glomerular filtration rate is lower than 50 ml / min, the plasma level of creatinine is more than 0.02 g / l and urea is more than 0.5 / g / l, conservative treatment of chronic renal failure is required at this stage. When filtering below 10 ml / min, azotemia and other disorders of homeostasis grow and the terminal stage of chronic renal failure occurs, which requires the use of dialysis. The cause of development is acquired and hereditary diseases of the urinary system, factors leading to the development of acute renal failure and chronic renal failure. With progressive kidney diseases, they gradually decrease in size and sclerosize. Morphological changes appear in the form of sclerotic glomeruli and tubules with hypertrophied glomeruli and enlarged tubules, with areas of fibrosis of the interstitial tissue. In infants, chronic renal failure progresses against the background of structural, functional immaturity of the kidneys, with urolithiasis, with destruction of the kidneys, hydronephrosis, pyelonephritis.

1. When sclerotizing 75-80% of nephrons, others lose their ability to further hypertrophy, which leads to minimal reserve possibilities that are clinically manifested by a decrease in tolerance to potassium, sodium, decompensation of chronic renal failure.

2. Clinical signs of chronic renal failure: decreased excretory and other renal functions, activation of secondary factors aimed at compensating for primary disorders (removal of calcium from bones to compensate for acidosis), as well as damage to other organs (pericarditis, etc.), under conditions of change homeostatic constants (acidosis, hyperazotemia, etc.).

Clinic. Complaints of fatigue, decreased performance, headache, decreased appetite. CRF is characterized by the gradual development of weakness, pallor of the skin, anorexia. Sometimes an unpleasant taste in the mouth is noted, nausea and vomiting appear. The skin is pale, the skin is dry, flabby.

Muscle tone is reduced, minor twitching of muscles, tremors of fingers and hands are observed. There are pains in the bones and joints. Anemia develops, leukocytosis and bleeding appear. Arterial hypertension develops with underlying kidney disease. The borders of the heart are widened, with auscultation, heart sounds are muffled, characteristic changes on the ECG (sometimes they are associated with dyskalemia). Conservative therapy regulates homeostasis, the general condition of the patient is satisfactory, but physical activity, mental stress, errors in the diet, infection, surgery can lead to impaired renal function and the appearance of uremic symptoms. Blood pressure is normal in the initial and polyuric stages, in the oligoanuric and uremic stages arterial hypertension appears. In the polyuric stage of chronic renal failure (diuresis reaches

2-3 l / day), which can last for years, hyperazotemia is moderate, glomerular filtration is 20-30 ml / min, the relative density of urine is lower than the relative density of blood plasma (1010-1012). With congenital nephropathies (proteinuria up to 1 g / day) appears proteinuria, hematuria, leukocyturia. In the oligoanuric stage, the patient's condition deteriorates sharply, which is due to the addition of hemorrhagic syndrome, cardiovascular failure.
With glomerular filtration below 10 ml / min, conservative therapy is performed, homeostasis is impossible. The terminal stage of chronic renal failure is characterized by emotional lability (apathy gives way to excitement), disturbed night sleep, lethargy, and inappropriate behavior. Puffy face, gray-yellow in color, skin itching, scratching on the skin, dull, brittle hair, dystrophy, hypothermia is characteristic. Decreased appetite. The voice is hoarse. An ammonia odor appears from the mouth, aphthous stomatitis develops. Tongue coated with plaque, vomiting, regurgitation. Sometimes diarrhea, fetid stool, dark color. Anemia, hemorrhagic syndrome, muscle twitching appears. With prolonged uremia, pain in the arms and legs, brittle bones appear, which can be explained by uremic nephropathy and renal osteodystrophy. Uremic intoxication can be complicated by pericarditis, pleurisy, ascites, encephalopathy and uremic coma. Children with chronic renal failure have symptoms of rickets (bone and muscle pain, bone deformities, stunting), which is associated with insufficient production of a biologically active metabolite of vitamin D.

During this period, anemia, hyperkalemia, impaired renal function by osmotic dilution increase, which leads to the development of hypovolemia with inadequate fluid intake.

Treatment. Treatment of chronic renal failure along with the treatment of underlying kidney disease, which leads to renal failure. In the initial stage, when there is no impaired renal processes, etiotropic and pathogenetic therapy is prescribed, which will cure the patient and prevent the development of renal failure or lead to remission and the slow course of the disease. In the stage of impaired renal processes, pathogenetic therapy is carried out with symptomatic treatment methods (antihypertensive drugs, antibacterial treatment, protein restriction in the daily diet, spa treatment, etc.).

Conservative treatment of chronic renal failure is aimed at restoring homeostasis, reducing azotemia, and reducing symptoms of uremia. Glomerular filtration rate below 50 ml / min, blood creatinine level above 0.02 g / l - it is necessary to reduce the amount of protein consumed to 30-40 g / day. The diet should be high-calorie and contain essential amino acids (potato-egg diet without meat and fish). Food is prepared with a limited (up to 2-3 g) amount of table salt. To reduce the level of phosphates in the blood, use almagel for 1-2 tsp. 4 times a day. During treatment, it is necessary to control the level of calcium and phosphorus in the blood. In case of acidosis, depending on the degree, 100-200 ml of 5% sodium bicarbonate solution is administered iv. With a decrease in diuresis, lasix is ​​prescribed in doses (up to 1 g / day) that provide polyuria. To reduce blood pressure, antihypertensive drugs are prescribed. With anemia, iron preparations are prescribed. With a hematocrit of 25% and below, erythrocyte mass transfusions are shown by fractional administration. Antibiotics and their chemotherapeutic drugs for chronic renal failure are used carefully: doses are reduced by 2-3 times. Derivatives of nitrofurans in chronic renal failure are contraindicated. In heart failure and chronic renal failure, cardiac glycosides are used carefully in reduced doses, especially with hypokalemia. Hemodialysis can be indicated for exacerbation of renal failure, after the exacerbation subsides. When the patient's condition improves, conservative therapy is performed. A good effect in chronic renal failure is given by plasmapheresis courses. In the terminal stage, the patient is transferred to hemodialysis. Regular hemodialysis is used when creatinine clearance is below 10 ml / min, and its plasma level is above 0.1 g / l. CRF must be differentiated from acute renal failure, which is distinguished by a sudden onset with an oligoanuric stage and reverse development, from neurohypophysial diabetes insipidus, the difference is that there is no hyperazotemia and other signs of chronic renal failure, from anemic syndrome and other diseases (hypoplastic anemia, etc.), in which there are no symptoms of chronic renal failure.

Treatment is aimed at reducing hyperazotemia and correction of water-electrolyte metabolic disorders. Basic principles, as in the treatment of acute renal failure. The program “dialysis - kidney transplantation” remains the most promising in the treatment of children with chronic renal failure, which helps patients return to normal life. Indications for the implementation of the program are the absence of the effect of conservative therapy, an increase in serum creatinine to 0.6 mmol / L (6 mg%) and potassium in the blood above 7 mmol / L.

Forecast. Hemodialysis and kidney transplantation change the fate of patients with chronic renal failure, allows you to extend life and achieve rehabilitation. The selection of patients for these types of treatment is carried out by specialists from hemodialysis and organ transplantation centers.

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Chronic renal failure (CRF)

  1. Chronic glomerulonephritis in children. Acute and chronic renal failure
    Questions for repetition: 1. Samples used to study the functional state of the kidneys. Test questions: 1. Definition, etiopathogenesis of chronic glomerulonephritis. 2. Classification of chronic glomerulonephritis. 3. The clinical picture and laboratory diagnosis of various forms of chronic glomerulonephritis. 4. Differential diagnosis of chronic glomerulonephritis. 5. A kidney biopsy,
  2. Chronic renal failure
    DEFINITION of CRF is a gradually developing irreversible renal failure caused by slowly increasing changes in the kidneys with abnormalities of their development, metabolic diseases, chronic inflammation, etc. This is a nonspecific syndrome, which is an irreversible violation of homeostatic functions of the kidneys associated with severe progressive disease. The term "uremia" is equated
  3. Chronic renal failure
    The prognosis of nephropathies of various genesis is determined by the degree of renal function impairment and the possibility of their recovery. The detection of early signs of chronic renal failure (CRF) in children is necessary not only for timely conservative therapy, but also for the timely use of extracorporeal treatment methods, which include peritoneal dialysis, hemodialysis,
  4. Chronic renal failure
    Chronic renal failure (CRF) is a syndrome that develops as a result of a gradual decrease in renal function due to progressive nephron death. CRF is in most cases an irreversible process. The term "uremia" is usually used to refer to the final stage of chronic renal failure, when a complex of biochemical and pathophysiological disorders is determined and clinical
  5. Chronic renal failure
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  6. CHRONIC KIDNEY FAILURE
    Chronic renal failure (CRF), a very common pathology in older cats. This is a non-specific diagnosis, which is understood as a gradually appearing progressive incurable clinical syndrome, due to the limited ability of the kidneys to excrete certain substances in the urine, regulate the acid-base balance and perform renal endocrine functions.
  7. Chronic renal failure
    (tab. 21) Table 21. Stages of chronic renal failure (with some modification according to Wetzels) - normal; I lowering; f increase Surgical interventions for latent and overt chronic kidney diseases often worsen renal function up to a detailed picture of renal failure. It has been repeatedly emphasized that patients suffering from chronic kidney diseases with
  8. CHRONIC KIDNEY FAILURE
    CRF develops as a result of a significant decrease in the number of actively functioning nephrons, which leads to impaired excretory and incretory kidney function. With CRF, the maintenance of homeostasis of the internal environment is disrupted, which is manifested by a change in all metabolic processes: water-electrolyte, protein, carbohydrate and lipid. As a result, pathological processes develop in
  9. CHRONIC KIDNEY FAILURE
    CRF is a pathological condition of the body, characterized by a constant progressive impaired renal function. Etiology 1) Chronic glomerulonephritis. 2) Chronic pyelonephritis (there is an opinion that the main reason). 3) Polycystic kidney disease. 4) Malignant hypertension with outcome in nephrosclerosis. 5) Amyloidosis of the kidneys. 6) A variety of urological pathology
  10. CHRONIC KIDNEY FAILURE: PATHOPHYSIOLOGICAL AND CLINICAL FEATURES
    Barry M. Brenner, J. Michael Lazarus (Barry M. Brenner, J. Michael Lazarus) In contrast to the ability of the kidneys to restore their function after suffering various types of acute renal failure, discussed in the previous chapter, damage of a more persistent nature is often irreversible. The function of the organ is not restored, moreover, progressive
  11. Chronic renal failure
    • Nephrosclerosis is a morphological substrate - wrinkling of the kidneys in the outcome of chronic diseases with bilateral damage to the kidneys. • In the final of chronic renal failure, uremia develops, which is characterized by: ° hyperazotemia; ° metabolic acidosis (due to the accumulation of sulfates, phosphates and organic acids); ° electrolyte imbalance (hyperkalemia,
  12. CHRONIC KIDNEY FAILURE
    - a syndrome that develops as a result of a gradual decrease in the number and function of the remaining nephrons, leading to impaired renal blood flow, glomerular filtration, tubular re-absorption and secretion, as well as the concentration ability of the kidneys and is characterized by azotemia, impaired water and electrolyte balance, acid-base balance . Major clinical
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  14. Chronic renal failure
    - edematous cm: edema of varying severity, rapid weight gain, oliguria, anuria, pallor of the skin - metabolic disorders: acidosis, azotemia, hyperkalemia, hypernatremia - hypertensive cm expressed - urinary cm: impaired renal function - concentration, filtration, nitrogen separation, electrolyte, regulation of water-electrolyte
  15. ACUTE AND CHRONIC KIDNEY FAILURE, FORCED DIURESIS
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    MONDAY First breakfast: cottage cheese - apple pudding, apple puree with whipped proteins, fruit juice. Second breakfast: grated carrots with sugar. Lunch: vegetarian vegetable soup, boiled meat with tomato sauce. Snack: broth of wild rose. Dinner: protein omelette, tea with sugar. At night: fruit juice. TUESDAY First breakfast: porridge from Hercules groats in milk, salad from vegetables on
  17. KIDNEY FAILURE
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