Chronic renal failure

Chronic renal failure (chronic uremia, renal shrinkage) is a symptom complex caused by progressive sclerosis of the renal parenchyma with the death of nephrons due to primary or secondary chronic kidney disease.

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Epidemiology

The incidence of chronic renal failure varies in different countries within the range of 100-600 per 1 million adult population, with 50-100 new cases of chronic renal failure registered annually.

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Causes chronic renal failure

The main causes of chronic renal failure are endocrine and vascular diseases. The percentage of patients with diabetic nephropathy, atherosclerotic and hypertensive nephroangiosclerosis among all patients on chronic dialysis is constantly growing.

The causes of chronic renal failure are as follows:

• Inflammatory: chronic glomerulonephritis, chronic pyelonephritis, kidney damage in systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma, necrotizing vasculitis, hemorrhagic vasculitis), tuberculosis, HIV nephropathy, HCV nephritis, HBV nephritis, malarial nephropathy, schistosomal nephropathy.
• Metabolic and endocrine: diabetes mellitus type 1 and 2, gout, amyloidosis (AA, AL), idiopathic hypercalciuria, oxalosis, cystinosis.
• Vascular diseases: malignant hypertension, ischemic kidney disease, hypertension.
• Hereditary and congenital diseases: polycystic disease, segmental hypoplasia, Alport syndrome, reflux nephropathy, Fanconi nephronophthisis, hereditary onychoarthrosis, Fabry disease.

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Symptoms chronic renal failure

The first symptoms of chronic renal failure are non-specific “masks”: anemic, hypertensive, asthenic, gouty, osteopathic, as well as complications caused by a decrease in renal elimination of drugs, for example, an increase in the frequency of hypoglycemic conditions in stable diabetes with a selected dosage of insulin.

The initial stage of chronic renal failure is characterized by a latent course with polyuria, nocturia, and moderate anemia. In 40-50% of cases, arterial hypertension is detected. A decrease in appetite is often noted.

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Diagnostics chronic renal failure

The terminal stage of chronic renal failure is characterized by lethargy and apathy of patients. The skin of patients is pale, dry, icteric, with a gray tint (anemia and staining with urochromes), with hemorrhages, bruises and traces of scratching. Pericarditis is accompanied by pericardial friction rub.

Early diagnosis of chronic renal failure is based on laboratory methods.

Polyuria with nocturia, persistent arterial hypertension combined with anemia, symptoms of gastroenteritis and secondary gout, hyperphosphatemia with hypocalcemia indicate chronic renal failure.

The most informative and reliable methods are the determination of the maximum relative density or osmolarity of urine, the value of the CF and the level of creatinine in the blood. Depression of the maximum relative density of urine below 1018 in the Zimnitsky test with a decrease in the CF below 60-70 ml/min indicates the initial stage of chronic renal failure. The method of calculating the CF using the Cockroft-Gault formula is more accurate, since it takes into account the age, body weight and sex of the patient.

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Treatment chronic renal failure

Conservative treatment of chronic renal failure is divided into symptomatic and pathogenetic. Its tasks include:

• inhibition of the progression of chronic renal failure (nephroprotective effect);
• slowing down the formation of left ventricular hypertrophy (cardioprotective effect);
• elimination of uremic intoxication, hormonal and metabolic disorders;
• elimination of infectious complications of chronic renal failure.

The drug is optimal for monotherapy of chronic renal failure; it has a nephroprotective and cardioprotective effect, is metabolically neutral, and has no side effects.

The main directions of conservative treatment of chronic renal failure are correction of nitrogen and water-electrolyte homeostasis, treatment of arterial hypertension and anemia.