Symptoms of chronic kidney failure

In the initial stage of chronic renal failure, patients' complaints and clinical symptoms can to a large extent be related to the underlying disease. Unlike acute renal failure, chronic renal failure develops gradually. The clinical picture is more often formed with GFR less than 25 ml / min. Complications, lesions of other organs and systems in chronic kidney failure in children occur earlier than in adults, and are more pronounced.

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

• often absent;
• possible polyuria, moderate anemia;
• in 40-50% of cases, hypertension develops.

Clinico-laboratory signs of the conservative stage of chronic renal failure (GFR = 15-40 ml / min):

• weakness, disability, anorexia;
• polyuria, nocturia;
• Arterial hypertension, anemia, osteoporosis (in most patients);
• compensated acidosis;
• osteodystrophy (including those accompanied by a lag in growth);
• retardation of mental development and puberty;
• increasing the concentration of creatinine, urea nitrogen, parathyroid hormone;
• hypocalcemia, hyperphosphatemia, a decrease in the content of 1,25 (OH) ₂ vitamin D ₃ (calcitriol).

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

• oliguria (instead of polyuria with a conservative stage of chronic renal failure);
• expressed peripheral edema (up to the anasarca), ascites, fluid in the pericardium, pleural cavity;
• pronounced disturbances of water-electrolyte metabolism (hyperkalemia, hyperphosphataemia, hypocalcemia);
• violations of CBS (decompensated metabolic acidosis);
• lesions of the peripheral and central nervous system (impaired consciousness, convulsive syndrome, polyneuropathy);
• defeat of the digestive tract (uremic gastropathy);
• refractory anemia;
• cardiovascular disorders: pericarditis, myocarditis, left ventricular hypertrophy, arrhythmias, arterial hypertension, heart failure (up to the development of pulmonary edema);
• Immunological abnormalities (including immunological non-reactivity - absence 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. Changes in the skeleton in children are similar to those in rickets and include "rosary", Harisson's furrow, thickening of wrists, ankles and bone-cartilaginous joints, muscle hypotension. Deformity of the limbs often occurs in the metaphyseal zones, while at the same time the curvatures of the diaphyseal sections of the long bones are 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 severe metabolic disorders, as the metabolism in newborns and infants is 5 times higher than in adolescents. Clinical signs: anorexia, vomiting, metabolic acidosis, rapid development of renal osteodystrophy, mental retardation. With a severe degree of congenital chronic renal failure, these symptoms have been observed since the first months of life. That's why newborns with kidney hypoplasia and obstructive uropathy often need intensive care already in the neonatal period. On the 3-4th week of life, the kidneys gradually adapt, the concentration of creatinine usually decreases to 90-270 μmol / l and, as a rule, polyuria develops with the loss of salts. This period requires careful monitoring of the balance of fluid and electrolytes, but this is a very difficult task, because against the background of pronounced metabolic acidosis, children develop anorexia, and eaten food they keep poorly.

[1], [2], [3], [4], [5], [6]