Symptoms of chronic renal failure

In the initial stage of chronic renal failure, patients' complaints and clinical symptoms may be largely associated with the underlying disease. Unlike acute renal failure, chronic renal failure develops gradually. The clinical picture often develops with a SCF of less than 25 ml/min. Complications, damage to other organs and systems in chronic renal failure in children occur earlier than in adults and are more pronounced.

Clinical signs of the initial stage of chronic renal failure (SCF = 40-60 ml/min):

• often absent;
• polyuria and moderate anemia are possible;
• In 40-50% of cases, arterial hypertension develops.

Clinical and laboratory signs of the conservative stage of chronic renal failure (SCF = 15-40 ml/min):

• weakness, decreased ability to work, anorexia;
• polyuria, nocturia;
• arterial hypertension, anemia, osteoporosis (in most patients);
• compensated acidosis;
• osteodystrophy (including that accompanied by growth retardation);
• delayed mental development and sexual maturation;
• increased concentration of creatinine, urea nitrogen, parathyroid hormone;
• hypocalcemia, hyperphosphatemia, decreased content of 1,25(OH) ₂ vitamin D3 ₍ calcitriol).

Clinical and laboratory signs of terminal stage chronic renal failure (SCF <15-20 ml/min):

• oliguria (instead of polyuria in the conservative stage of chronic renal failure);
• severe peripheral edema (up to anasarca), ascites, fluid in the pericardium, pleural cavity;
• severe disturbances of water-electrolyte metabolism (hyperkalemia, hyperphosphatemia, hypocalcemia);
• Acid-base balance disorders (decompensated metabolic acidosis);
• lesions of the peripheral and central nervous system (impaired consciousness, convulsive syndrome, polyneuropathy);
• gastrointestinal tract damage (uremic gastropathy);
• refractory anemia;
• cardiovascular disorders: pericarditis, myocarditis, left ventricular hypertrophy, arrhythmia, arterial hypertension, heart failure (up to the development of pulmonary edema);
• immunological disorders (including immunological areactivity - lack of antibody production after vaccination against hepatitis B, etc.);
• severe osteodystrophy.

Symptoms of renal osteodystrophy in a growing child's body are more pronounced than in adults. Renal osteodystrophy includes all skeletal disorders: fibrous osteitis, osteomalacia, osteosclerosis and growth retardation. Skeletal changes in children are similar to those in rickets and include "rosary", Garrison's groove, thickening of the wrists, ankles and osteochondral joints, muscle hypotonia. Deformation of the limbs most often occurs in the metaphyseal zones, while curvature of the diaphyseal sections of long bones is usually absent.

Features of the clinical picture of chronic renal failure in children of the first year of life

Chronic renal failure is accompanied by pronounced metabolic disorders, since the metabolism of newborns and infants is 5 times higher than that of adolescents. Clinical signs: anorexia, vomiting, metabolic acidosis, rapid development of renal osteodystrophy, mental retardation. In severe congenital chronic renal failure, these symptoms are observed from the first months of life. This is why newborns with renal hypoplasia and obstructive uropathy often require intensive care already in the neonatal period. In the 3rd-4th week of life, the kidneys gradually adapt, the concentration of creatinine usually decreases to 90-270 μmol/l and, as a rule, polyuria with loss of salts develops. During this period, careful monitoring of fluid and electrolyte balance is necessary, but this is a very difficult task, since against the background of severe metabolic acidosis, children develop anorexia, and they do not retain the food they eat well.

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