Kidney Failure

Kidney failure

Renal failure is a violation of the filtration and detoxification functions of the kidney. There are acute and chronic renal failure.

Acute renal failure

Acute renal failure is a severe impairment of kidney function due to massive damage to its tissue. Based on the causes of occurrence, acute renal failure is divided into prerenal, renal and postrenal.

Prerenal insufficiency is associated with impaired blood supply to the kidney and occurs with massive bleeding, injury to the renal vessels, and a sharp decrease in blood pressure below 80 mmHg. Art. Renal failure is associated with direct damage to the nephrons in certain diseases (lupus, glomerulonephritis, vasculitis, high arterial hypertension) and poisoning with toxic substances (mercury, cadmium, copper salts, acetic acid, poisonous mushrooms).

Postrenal insufficiency is a consequence of impaired urine outflow.

During the course of the disease, renal failure is divided into the initial, oligoanuric, diuretic stages and the recovery stage. The initial stage of renal failure is caused by the action of a damaging factor and lasts no more than a day; already during this period there is a tendency towards a decrease in diuresis. The duration of the initial and oligoanuric stages depends on the strength of the damaging factor.

The oligoanuric stage, the most dangerous period of the disease, lasts 2-11 days. Its main manifestation is a decrease in the daily amount of urine to less than 300-500 ml; it is dark in color and contains a large amount of protein. The patient's consciousness is disturbed: he is drowsy, inhibited, and the development of convulsions and coma is possible. Disorders from the gastrointestinal tract are varied: nausea, vomiting, bloating, diarrhea, which is replaced by constipation, ulcers of the gastric and intestinal mucosa are often formed, which is accompanied by bleeding. The electrolyte balance of the blood is disrupted, sodium ions and water accumulate in the body, resulting in increased blood pressure and possible pulmonary edema.

If the patient survives with timely treatment, the disease enters the diuretic stage, which lasts 9-11 days. At this time, there is a gradual increase in the daily amount of urine, on the 4-5th day it reaches 2-4 liters. Electrolyte balance and nitrogen concentration in the blood are restored.

The recovery stage takes from 6 to 12 months, its duration depends on the severity of the disease. During this period, the functional abilities of the kidney are completely restored.

Chronic renal failure

Chronic renal failure is a decrease in the filtration capacity of the kidneys due to their gradual progressive damage. The causes of chronic renal failure are chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, systemic connective tissue diseases, and prolonged exposure to heavy metals at work.

The main factor determining the severity of the disease is minute filtration. In a healthy person, it is 100-120 ml/min; when it decreases to 20-30 ml/min, a detailed clinical picture appears, and when it decreases below 15 ml/min, a life-threatening condition develops.

The patient's skin is dry, pale yellow; renal failure is characterized by swelling of the face in the morning, which disappears in the evening; in severe cases, pulmonary edema may develop. The functioning of the gastrointestinal tract is disrupted: dry mouth, nausea, vomiting, a yellow-gray tongue, and a swollen stomach.

Blood pressure increases, toxic damage to the myocardium develops and, as a result, heart failure. Nervous system disorders occur: hiccups, convulsions, decreased body temperature, coma. In the blood, a decrease in the amount of hemoglobin to 4-6 g/l is determined.