Chronic Renal Failure

Chronic renal failure (chronic uraemia, pimple of the kidney) is a symptom complex due to the progressive sclerosing of the renal parenchyma with the death of nephrons due to primary or secondary chronic kidney disease.

[1], [2], [3], [4], [5],

Epidemiology

The frequency of chronic renal failure varies in different countries in the range of 100-600 per 1 million adults, with 50-100 new cases of chronic renal failure recorded annually. 

[6], [7], [8], [9], [10], [11], [12],

Causes of the 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 is constantly growing among all patients on chronic dialysis.

The causes of chronic kidney 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 type 2, gout, amyloidosis (AA, AL), idiopathic hypercalciuria, oxalose, cystinosis.
• Vascular diseases: malignant hypertension, ischemic kidney disease, hypertension.
• Hereditary and congenital diseases: polycystic disease, segmental hypoplasia, Alport syndrome, reflux-nephropathy, Fanconi nephronophytosis, hereditary onyarthrosis, Fabry's disease.

[13], [14], [15], [16], [17], [18]

Symptoms of the chronic renal failure

The first symptoms of chronic renal failure are nonspecific "masks": anemic, hypertonic, asthenic, gouty, osteopathic, as well as complications caused by a decrease in renal elimination of drugs, for example, the increase in hypoglycemic states with stable diabetes on a selected dosage of insulin.

The initial stage of chronic renal failure is characterized by latent flow with polyuria,  nicturia, moderately severe anemia. In 40-50% of cases, there is an arterial hypertension. Often noted decrease in appetite.

[19], [20], [21], [22]

Diagnostics of the chronic renal failure

The terminal stage of chronic renal failure is characterized by lethargy, apathy of patients. Patients' skin is pale, dry, icteric, with a gray tinge (anemia and staining with urochromes), with hemorrhages, bruises and traces of scrapes. With pericarditis listen to the noise of friction of the pericardium.

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

In favor of chronic renal failure are polyuria with nicturia, persistent arterial hypertension in combination with anemia, symptoms of gastroenteritis and secondary gout, hyperphosphataemia with hypocalcemia.

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

[23], [24], [25], [26], [27], [28], [29], [30]

Treatment of the chronic renal failure

Conservative treatment of chronic renal failure is divided into symptomatic and pathogenetic. His 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.

Optimal for monotherapy of chronic renal failure is a drug with a nephroprotective and cardioprotective effect, metabolically neutral, without any side effects.

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