Diagnosis of chronic renal failure

Stages of diagnosis of chronic renal failure.

• Anamnesis of the disease: the presence and duration of proteinuria, arterial hypertension, delay in physical development, recurrent infection of the urinary system,
• Family history: indications of polycystosis, Alport syndrome, systemic connective tissue diseases, etc.
• Objective examination: stunted growth, lack of body weight, deformations of the skeleton, signs of anemia and hypogonadism, increased blood pressure, ocular fundus abnormalities, decreased acuity of hearing,
• Instrumental methods of examination allow us to establish the etiology of the underlying disease, leading to chronic renal failure. They include ultrasound (ultrasound) of the urinary system with assessment of renal blood flow, mictorial cystourethrography, excretory urography, nephroscintigraphy, nephrobiopsy, densitometry, etc.
• Clinical, laboratory and instrumental studies to clarify the severity of chronic renal failure: the determination of the concentration of creatinine, urea nitrogen, GFR.
• Diagnosis of complications of chronic renal failure: the determination of the total protein, albumin, potassium, sodium, calcium, phosphorus, iron, ferritin and transferrin, paratha-hormone, hemoglobin, alkaline phosphatase activity, absolute lymphocyte count, daily protein excretion, electrolytes, ammonia and titrated acids, the concentration ability of the kidneys; CBS assessment; electrocardiography, echocardiography, monitoring of arterial pressure, roentgenologic confirmation of osteodystrophy, etc.

Depending on the disease that caused the irreversible death of nephrons, chronic renal failure is diagnosed both in the early stages of development, and in the stage of decompensation. For example, with pronounced glomerulonephritis (hematuria, proteinuria, arterial hypertension, edema), chronic renal failure is diagnosed earlier. In the case of a latent course of hereditary and congenital nephropathies, chronic renal failure is determined only in the terminal stage.

The presence of a thirst in the child, subfebrile temperature, polyuria, delay in physical development (more than 1/3 of the age norm) should serve as an excuse for the exclusion of chronic renal failure. When confirmed by laboratory studies of polyuria, nocturia, hypoisostenuria, anemia, azotemia and electrolyte disorders, the diagnosis of chronic renal failure leaves no doubt. The concentration of urea does not always accurately reflect the severity of impaired renal function and the mass of functioning nephrons. Urea in a number of diseases is not only filtered, but partially reabsorbed and secreted. The creatinine content in the blood is considered a more stable indicator. The amount of its secretion and reabsorption is negligible, so its concentration in the blood is used to determine the glomerular filtration.

Differential diagnosis of chronic renal failure

In the initial stages of chronic renal failure, polyuria is often mistakenly interpreted as:

• hypophyseal diabetes insipidus, but the absence of the effect of adiurecrin, a negative test with pituitrin and hyperazotemia allow suspected chronic renal failure;
• acute renal insufficiency; in contrast to chronic renal failure, it is characterized by a sudden onset, an inverse sequence in the development of the oligoanuric and polyuric phase, as well as a better prognosis.

Expressed anemia in chronic renal failure is often mistakenly interpreted as an anemia of unclear etiology. Resistance to anti-anemia, polyuria, hyposthenuria and the development of hyperaemia in the future indicate chronic renal failure.

In the terminal stage of chronic renal failure, an erroneous diagnosis is virtually excluded, which is associated with the severity of the characteristic clinical symptoms.

[1], [2], [3], [4], [5], [6], [7], [8]