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Chronic renal failure (CRF)

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

It is diagnosed in children with diseases of the urinary system while keeping them for 3-6 months and reducing glomerular filtration to less than 20 ml / min, increasing serum creatinine and urea levels. Over 50 diseases manifest 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 with systemic diseases, nephroangiosclerosis, polycystic kidney disease, diabetic glomerulonephrosis, amyloidosis of the kidneys, urological diseases. The pathogenetic mechanism of CRF is a progressive decrease in the number of active nephrons, which leads to a decrease in the effectiveness of renal processes and impaired renal functions. Before chronic renal failure develops, chronic kidney disease can last from 2 years or more. They go through several stages, when glomerular filtration and tubular reabsorption at a normal level, the underlying disease is in a stage that is not accompanied by impaired renal processes. Over time, glomerular filtration becomes below normal, the ability of the kidneys to concentrate urine decreases, and the disease enters a stage of impaired renal processes. At this stage, homeostasis is preserved and there is no renal failure yet. If the number of active nephrons and the glomerular filtration rate is below 50 ml / min, the level of creatinine in the blood plasma 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 increase and a terminal stage of chronic renal failure occurs, at which dialysis is necessary. The cause of development are 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 are sclerosed. Morphological changes appear in the form of sclerotic glomeruli and tubules with hypertrophied glomeruli and dilated tubules, with areas of fibrosis of 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 hardening 75–80% of nephrons, others lose the ability for further hypertrophy, which leads to minimal reserve capabilities, clinically manifested by a decrease in tolerance to potassium, sodium, decompensated CRF.

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

Clinic. Complaints of fatigue, decreased performance, headache, loss of appetite. CKD is characterized by the gradual development of weakness, pallor of the skin, anorexia. Sometimes there is an unpleasant taste in the mouth, nausea and vomiting. Pale skin, skin dry, flabby.

Muscle tone is reduced, there are small twitching of muscles, tremor of fingers and hands. There are pains in the bones and joints. Anemia develops, leukocytosis and bleeding appear. Arterial hypertension develops in primary kidney disease. The borders of the heart are enlarged, during auscultation the heart sounds are muffled, characteristic ECG changes (sometimes they are associated with dysplexia). Conservative therapy regulates homeostasis, the patient's general condition is satisfactory, but physical exertion, mental stress, errors in diet, infection, surgery can lead to a deterioration of renal function and the appearance of uremic symptoms. Arterial pressure is normal in the initial and polyuric stages, arterial hypertension appears in the oligoanuric and uremic stages. In the polyuric stage of chronic kidney disease (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 nephropathy (proteinuria up to 1 g / day) proteinuria, hematuria, leukocyturia appear. In the oligoanuric stage, the condition of the patient is sharply worsened, which is caused by the addition of the hemorrhagic syndrome, cardiovascular insufficiency.
When glomerular filtration below 10 ml / min, conservative therapy is performed, homeostasis is impossible. For the terminal stage of chronic kidney disease, emotional lability is characteristic (apathy is replaced by agitation), disturbed sleep, inhibition, inadequate behavior. Puffy face, gray-yellow color, skin itch, scratching on skin, hair dull, brittle, dystrophy, hypothermia is characteristic. Decreased appetite. The voice is hoarse. Ammoniac odor appears from the mouth, aphthous stomatitis develops. The tongue is coated with bloom, vomiting, regurgitation. Sometimes diarrhea, fetid stool, dark color. Appears anemia, hemorrhagic syndrome, muscle twitching. With prolonged uremia, pain in the arms and legs, broken bones, which can be explained by uremic nephropathy and renal osteodystrophy. Uremic intoxication may be complicated by pericarditis, pleurisy, ascites, encephalopathy and uremic coma. Children with chronic renal failure have symptoms of rickets (pain in bones and muscles, bone deformities, growth retardation), which is associated with insufficient production of the biologically active metabolite of vitamin D.

During this period, anemia, hyperkalemia, and impaired renal function due to osmotic dilution are increasing, which leads to the development of hypovolemia with inadequate fluid intake.

Treatment. Treatment of chronic kidney disease in conjunction with the treatment of the underlying kidney disease, which leads to renal failure. In the initial stage, when there is no violation of the 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 a 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, restriction of protein in the daily diet, sanatorium-resort treatment, etc.).

Conservative treatment of chronic kidney disease is aimed at restoring homeostasis, reducing azotemia, reducing the symptoms of uremia. The glomerular filtration rate is below 50 ml / min, the level of creatinine in the blood is 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 salt. To reduce the level of phosphate in the blood using Almagel 1-2 tsp. 4 times a day. During treatment, it is necessary to control the level of calcium and phosphorus in the blood. When acidosis, depending on the degree of injected into / in 100-200 ml of 5% aqueous solution of sodium bicarbonate. With a decrease in diuresis, lasix is ​​prescribed in doses (up to 1 g / day) providing polyuria. To lower blood pressure, antihypertensive drugs are prescribed. When anemia is prescribed iron supplements. With a hematocrit of 25% and below, red blood cell transfusions are shown by fractional administration. Antibiotics and their chemotherapeutic drugs for chronic renal failure are used with caution: the dose is reduced by 2-3 times. Nitrofuran derivatives with CKD are contraindicated. In heart failure and chronic renal failure, cardiac glycosides are used cautiously in reduced doses, especially with hypokalemia. Hemodialysis may be indicated in case of exacerbation of renal failure, after the exacerbation subsides. With the improvement of the condition of the patient spend conservative therapy. Plasmapheresis courses give a good effect in chronic renal failure. 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 distinguishes a sudden onset with oligoanuric stage and reverse development, from neurohypophysial non-sugar diabetes, 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 kidney disease.

The treatment is aimed at reducing hyperazotemia and correction of water and electrolyte metabolic disorders. Basic principles as in the treatment of acute renal failure. The “dialysis — kidney transplant” program remains the most promising in the treatment of children with chronic kidney disease, which helps patients return to normal life. Indications for the implementation of the program are the lack of effect from 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. 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. Kidney biopsy
  2. Chronic renal failure
    DEFINITION OF CRF is a gradually developing irreversible renal failure caused by slowly increasing kidney changes with abnormalities of their development, metabolic diseases, chronic inflammation, etc. This is a nonspecific syndrome, which is an irreversible violation of the homeostatic functions of the kidneys, associated with severe progressive disease. The term "uremia" is identified
  3. Chronic renal failure
    The prognosis of nephropathy different in its genesis is determined by the degree of impaired renal functions and the possibility of their recovery. 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 designate the final stage of CRF, when a complex of biochemical and pathophysiological disorders is determined and clinical signs are particularly pronounced.
  5. Chronic renal failure
    CHRONIC KIDNEY INSUFFICIENCY (CRF) is a snn-core that develops due to a decrease in the number and change of functionally remaining nephrons, which leads to a violation of the excretory and secretory functions of the kidneys, which can no longer maintain the normal internal environment of the body. Sometimes a decrease in the rate of Kluoochkov STATE (GFR) for a long time is asymptomatic and the patient
    Chronic renal failure (CRF), a very common pathology in older cats. This is a non-specific diagnosis, which is understood to mean a progressively manifested progressive incurable clinical syndrome, due to the limited ability of the kidneys to excrete certain substances with urine, regulate acid-base balance, and perform renal endocrine functions.
  7. Chronic renal failure
    (Table 21) Table 21. Stages of chronic renal failure (with some modification according to Wetzels) - the norm; I downgrade; f elevation. Surgical interventions for hidden and overt chronic renal diseases often impair renal function up to a full picture of renal failure. It was repeatedly emphasized that patients suffering from chronic kidney disease, with
    CKD develops as a result of a significant decrease in the number of actively functioning nephrons, which leads to impaired excretory and endocrine function of the kidney. With CRF, the maintenance of homeostasis of the internal environment is disturbed, which is manifested by a change in all metabolic processes: water-electrolyte, protein, carbohydrate and lipid. As a result, pathological processes in
    CRF is a pathological condition of the body, characterized by permanent progressive renal dysfunction. Etiology 1) Chronic glomerulonephritis. 2) Chronic pyelonephritis (it is believed 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
    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 preceding chapter, damage of a more resistant nature is often irreversible. The function of the organ is not restored, moreover, there is a progressive
  11. Chronic renal failure
    • The morphological substrate is nephrosclerosis - wrinkling of the kidneys in the outcome of chronic diseases with bilateral kidney damage. • At the end 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,
    - a syndrome that develops as a result of a gradual decrease in the number and changes in the function of the remaining nephrons, leading to impaired renal blood flow, glomerular filtration, tubular reabsorption and secretion, as well as kidney concentration ability and characterized by azotemia, impaired water and electrolyte balance, acid-base balance . Major Clinical
  13. Food in chronic renal failure
    Chronic renal failure can be caused by various long-lasting kidney diseases that impair their function. If the work of the kidneys is weakened, they are poorly removed from the body of substances that are formed as a result of protein metabolism. These substances accumulate in the blood and have a toxic effect on the body. To reduce their concentration in the blood, it is necessary to sharply
  14. Chronic renal failure
    -detective sm: edema of varying severity, rapid mass increase, oliguria, anuria, pallor of the skin -metabolic disorders: acidosis, azotemia, hyperkalemia, hypernatremia -hypertonic sm expressed-urea sm: impaired renal function - concentration, filtration, nitrogenous, electrolyte, regulation of water and electrolyte
  16. Sample weekly menu for chronic renal failure (diet 76)
    MONDAY First breakfast: cottage cheese - apple pudding, apple puree with whipped whites, fruit juice. The second breakfast: grated carrots with sugar. Lunch: vegetarian vegetable soup, boiled meat with tomato sauce. Lunch: decoction of wild rose. Dinner: omelette protein, tea with sugar. For the night: fruit juice. TUESDAY First breakfast: cereal “Hercules” cereal with milk, vegetable salad on
    The main functions of the kidneys (excretion of metabolic products, maintaining the constancy of the water-electrolyte composition and acid-base state) are carried out by the following processes: renal blood flow, glomerular filtration and tubules (reabsorption, secretion, concentration). Not every change in these renal processes leads to severe renal dysfunction and may be called
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