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Acute renal failure: symptoms and treatment

Acute renal failure is sudden severe violation of, or completely stop the functioning of the kidneys. This disease process is potentially reversible, although it affects all functions of the kidney excretory, filtration and secretion.

According to available statistics, out of every million of the population of Europe acute renal failure develops in about two hundred people. More than 50% of cases pathology is due to operations on the heart or large vessels, as well as multiple injuries. 15 to 20% of cases of acute renal failure has on obstetric practice. In addition, over the past 10 years has increased the number of cases of acute disorders of renal function in patients receiving drugs. It is noteworthy that in the African countries renal failure develops mainly on the background of a viral or parasitic infection. While in European countries the cause is often hypertension and diabetes.

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Causes of renal failure.

The causes of renal failure are multiple, but they are all United in three large groups, which also represent the forms of disease.

Causes of prerenal renal failure (hemodynamic):

  • The decrease in cardiac output, which is observed in heart failure, arrhythmias, cardiogenic shock, pulmonary embolism, cardiac tamponade;
  • A marked reduction in the level of extracellular fluid, which may be due to diarrhoea, prolonged vomiting, severe blood loss, dehydration, burns, ascites in cirrhosis;
  • Intestinal obstruction, peritonitis, acute pancreatitis, as the condition, leading to sequestration of fluid in the tissues;
  • Vasodilation systemicGenesis on the background of sepsis, anaphylaxis, shock endodonticheskogo or receiving vasodilators.

Causes of renal insufficiency renal (parenchymatous form):

  • Toxic effect on the renal parenchyma poisons, fertilizers, cadmium, mercury, uranium, salts of copper. Perhaps the development of the pathological state on the background of the bites of poisonous snakes and insects;
  • Uncontrolled intake of drugs, which have toxic effects on the kidneys. Among them sulfonamides and some other antibiotics, antitumor agents. If a person already has issues with kidneys, the introduction of contrast media to perform radiographic studies, as well as all of these drugs can cause development of acute failure, even if observed, the dosage;
  • The increase in blood levels of hemoglobin and myoglobin with coma alcoholic or drug origin, transfusion of the wrong blood, if macrohematuria on the background of prolonged compression of the tissues;
  • Inflammation of the kidneys, although rarely, but it can also lead to kidney failure. This glomerulonephritis, tubulointerstitial nephritis;
  • Infectious disease – hemorrhagic fever with severe renal syndrome, viral hepatitis, leptospirosis, HIV infection, etc.;
  • Remove one kidney or injury.

Causes of postrenal renal failure (obstructive form):

  • Urolithiasis obstruction of the urinary tract stones, which leads to disruption of the passage of urine;
  • Tumors of the prostate gland, ureters, bladder;
  • Dystrophic lesions of retroperitoneal fat;
  • Urethritis, periurethral;
  • Tuberculosis of the kidneys;
  • Accidental ligation of the ureter during surgery.

Sometimes the combination of several factors causing renal failure.


Stages and symptoms of renal failure

The symptoms of kidney failure will vary depending on the stage of the disease:

  1. Symptoms early stages of the disease. The patient's condition will determine the disease that caused renal failure. Therefore, to determine the manifestation of the person isn't able, pathogenesisveiled symptoms etiological factor. Although circulatory collapse and there, but a short time and therefore go unnoticed. Such symptoms of impaired functioning of the kidneys as loss of appetite, nausea and weakness, the patient is referred to the injury, poisoning, or other condition that led to the manifestation of the process of kidney failure.

  2. Symptoms oligoanalgesia phase of the disease. Complete absence of urine is rare, but its volume is significantly reduced (up to 500 ml or less per day).

    In addition, manifest violations such as:

    • Proteinuria in the urine revealed a large protein;
    • Azotemia – increase in the content of nitrogenous metabolic products in the blood;
    • Giperfosfatemia – increasing levels of phosphates in the blood;
    • Metabolic acidosis with nausea and vomiting, drowsiness, increasing weakness, shortness of breath and shortness of breath;
    • Hypertension is diagnosed in 20-30% of patients;
    • Hypernatremia – increased sodium in the interstitial space;
    • Hyperphosphatemia – increased phosphate levels in the blood;
    • Acute uremia triggers liver (increase in size) and other organs of the gastrointestinal tract. May develop gastrointestinal bleeding due to ulcers that is found in 10-30% of cases.

    Against the background of possible fluid overload pulmonary edema, resulting in the appearance of moist rales, the appearance of shortness of breath. In addition, the patient becomes lethargic, there is a danger of entering a coma.

    Another common symptom of this stage of the disease is pericarditis , and uremic gastroenterocolitis. Often these conditions are complicated by bleeding.

    The weakening of immune forces of the accession of infection. It is possible the development of sepsis, pancreatitis, stomatitis and pneumonia. Acute infections in high risk patients.

    This stage develops within the first three days after the body is exposed to one or another etiological factor leading to renal failure. Oligoanalgesia stage lasts from 10 days to 2 weeks, but can be reduced to a few hours or stretch out for 2 months. If oligoanalgesia stage lasts more than 4 weeks, it is necessary to exclude renal vasculitis, glomerulonephritis, necrosis of the renal cortex.

  3. Symptoms of stages of recovery of diuresis. Prominent symptom of this phaseis polyuria that develops on the background of the fact that the destruction of renal tubules lost their ability of reabsorption. Daily diuresis increases gradually, and can range from 2 to 5 liters. Fluid and electrolyte balance gradually returns to normal. However, there is a risk of developing hypokalemia because of leaching of potassium in the urine. This phase lasts an average of two weeks. If the patient receives inadequate therapy situation, you may develop dehydration, hypophosphatemia, hypocalcemia.

  4. The symptoms of the stage of full recovery. At this time there is recovery of renal function to baseline. This period can take from six months to a year. However, it is possible that acute renal failure will develop into chronic. This occurs in the case that affected a large part of the kidney tissue.


Complications of renal failure

Complications of renal failure depend on how pronounced the dysfunction of organs, and the presence of oliguria. It is on the background of bright oliguria there is a drop in the level of glomerular filtration, which reduces the intake of electrolytes, products of nitrogen metabolism and water. In the end, severely affected the composition of the blood.

  • Failures in water-salt exchange. Most dangerous in this respect hyperkalemia as its background, patients begin to show complaints of muscular weakness, occasionally formed tetraparesis, bradycardia. The higher the concentration of potassium in the blood, the higher the risk of heart failure.

  • Violations of the blood. Since it increases the level of nitrogen, it causes rapid breakdown of red blood cells. As a result of developing this complication, as normalitatea normochromic anemia.
  • Disturbances in the functioning of the immune system. This leads to the fact that patients develop a variety of infections that occurs in 30-70% of cases. Complications in the form of immune disorders are very dangerous, as it joined the infection is often fatal. Suffer oral cavity, postoperative wounds heal slowly, may infect the respiratory and urinary system. Sepsis as the most threatening complication of failure, usually triggered by gram-negative and gram-positive bacteria.
  • Violations of the nervous system are manifested in the fact that a person is observed confusion, confusion, which gives way to excitement. Maybe some disorientation. In old age often develop neuropathy.
  • From the cardiovascular system are possiblecomplications like arrhythmia, heart failure stagnant, hypertension.
  • From the work of the digestive system possible complications such as nausea, vomiting, abdominal pain, lack of appetite, bleeding on the background of gastroenterocolitis.

Diagnosis of renal failure

Diagnosis of renal failure includes the delivery of a variety of tests, including:

  • Blood to determine the level of potassium, nitrogenous compounds;
  • Urine sample of General;
  • Biochemical analysis of blood determination of urea, electrolytes, creatine;
  • Urine is also sent for General bacteriological analysis.

Detect the failure, examining the bladder. Urine in it. It is important to distinguish between anuria and acute urinary retention, which can accompany failure. Overflow on urine anuria does not develop.

With regard to instrumental methods of examination, it is necessary to perform ultrasound of the bladder and kidneys to determine the form of failure. It will be possible to judge the presence or absence of obstruction of the urinary tract.

Doppler ultrasound of renal vessels is performed to assess blood flow in the organs. A kidney biopsy is performed with the purpose of differential diagnosis.

It is possible to perform chest x-ray to exclude pulmonary-renal syndrome and pulmonary edema. Chromatotherapy shown if there is a suspicion that the mouth of the ureter was subjected to obstruction.

Electrocardiogram relieve every patient with renal insufficiency, in order to detect the arrhythmia.


How to treat acute renal failure?

Treatment of renal failure is mainly determined by what stage the disease is, as well as the factor that provoked the development of pathological process. The success of the therapy also depends on the tight interaction of the patient with physicians, nephrologists, and urologists.

The primary goal – the elimination of the etiological factor that caused failure of the kidneys. In parallel, activities have been undertaken aimed at eliminating the existing shock, normalization of the heart for replenishment of blood loss. It is important that the vessels were in good shape, and blood flow to the kidneys is restored.

Detoxification activities to be pursued in the case when the patient is poisoned by salts of heavy metals, resulting in development failure. It is measures such as the reception of enterosorbents, gastric lavage, hemoperfusion.

To rid the patient of postrenal failure is necessary to remove obstruction of the urinary tract. For this purpose, the ureters can be installed catheters, nephrostomy is performed and pyelostomy.

Thus, the initial stage of failure requires a reduction of the action of nephrotoxins on the body, elimination of circulatory disorders. If acute insufficiency not yet manifested, but only threatens to develop, perhaps as a preventive measure intravenous drug Mannitol, contributing to better filtration and working on the type of osmotic diuretic. In the oliguric stage to use it makes no sense.

It is important to understand that therapy aimed at eliminating the causes that triggered the failure, will be effective only if it is in the initial stages of pathology development. In addition to therapeutic interventions, essential care of the oral cavity, mucous membranes and skin. Antibiotics can be prescribed, in that case, if the selected bacterial flora. Although often these drugs are prescribed to treat or prevent bacterial infection. However, it is desirable to abandon Streptomycin, and Neomycin Monomitsina, as they have high nephrotoxicity.

When oligoanalgesia form of the disease the patient is administered a hardware extracorporeal dialysis, as well as conduct a powerful detoxification therapy.

In order not to provoke gipergidratace, water intoxication, you need special care to assigned patient control the volume of fluid in oliguric and euricase period.

As for the nutrition of patients in the first three phases of development of the pathology of protein from the diet should eliminate completely. Maybe eating cream, cream, syrups. If dyspepsia are persistent in nature, then the patient is transferred to the parenteral method of feeding.

For leaching of nitrogenous wastes that trigger severe nausea and vomiting, it is necessary to conduct prolonged gastric lavage. On the background of seizures are introduced calcium salts parenteral method.

All forms of failure of the kidneys require placement of a person in a hospital. According to the testimony of him hemodialysis. Sometimes it is performed before operation – before nephrostomies or before pelotonia. Surgery performed on the kidney that functions better. Evaluation criterion in this case are the clinical signs. The pain will always be intensewhere the kidney works better. After anuria resolved, the patient is prescribed drugs aimed at the normalization of renal blood flow and to improve rheological properties of blood.

Should take into account that hemodialysis allows you to save the life of even the most difficult patients, so to abandon it should not be. It is effective even when arenaline form of the disease, when the patient's condition is very heavy. After hemodialysis, it is possible to perform kidney transplantation.

Puncture nephrostomy performed in the presence of tumor malignancy in the pelvis or in the retroperitoneal space, in that case, if the patient has obstruction of the ureters.

Unitiol administered with the development of the failure formed by mercury poisoning.

To normalize the condition of the patient help of osmotic diuretics orientation, the combination of Dopamine with Furosemide. To correct salt and water balance allows the combination of two methods – hemodialysis and hemosorption extrarenal blood method.

Indications for hemodialysis artificial kidney:

  1. The absence of effect of conservative treatment.

  2. The rate of creatine in the blood more than 114 mmol/L.

  3. Residual nitrogen exceed 113 mmol/L.

  4. Urea above the level of 49 mmol/L.

You cannot perform dialysis in sepsis, on a background of myocardial infarction, in hemorrhage of the gastrointestinal tract, while liver and heart failure, with thromboembolism during acute.

Spa with the purpose of prevention of pathology it is advisable not earlier than six months after the patient was discharged from the hospital.

As for the forecast for recovery, it depends entirely on the severity of the disease, the age of the patient and how successful treatment reason that caused to the acute kidney failure. With adequate therapy, full recovery is observed in 35-40% of cases, partial – in 10-15%. In continuous hemodialysis will need to 3% of patients. Especially unfavorable in this respect is considered to be the renal form of the disease. After her more than 40% of patients are transferred for permanent hemodialysis.

The death of patients is due to uremic coma, sepsis and hemodynamic disorders. Oliguria worsens the prognosis. Uncomplicated course of disease, developed primarily allows us to forecast a full recovery in 90% of cases. However, an importantthe condition is a timely appeal to the doctor.


What treatment can be arranged at home?

About what treatment of acute kidney failure can be done at home, the answer may be straightforward – you should immediately call an ambulance. Acute renal failure is a serious condition that threatens the life of the patient and requires emergency hospitalization. House to cure the person will not succeed.

Than later will have qualified help, the worse the prognosis. In addition, with early treatment remain the chances that the person will regain the ability to work in the next few years.


What drugs treat acute renal failure?

  • For relieving symptoms of intoxication, shows the introduction of a solution of Sodium bicarbonate (2-3%) + insulin, and glucose.
  • To prevent the development of pathology is introduced Mannitol (20%) in a volume of 300 ml. Apply the medication as soon as possible.
  • Acts as an osmotic diuretic glucose (10-20%) + insulin. Administered intravenously in the first hours of the manifestation of renal insufficiency in a volume of 0.5 L.
  • Dopamine + Furosemide for 6-24 hours. Dose of Dopamine from 3 to 5 µg per kg per minute, of Furosemide from 30 to 50 mcg per kg per hour.
  • Venoruton in the form of injections or orally three times in 24 hours.
  • Intramuscularly or under the skin Unitiol, if an abnormal condition occurs on the background of mercury poisoning. Dose 1 ml per 10 kg of body weight of the patient.
  • Trental intravenously or orally. Intravenous administration of 100 mg, orally take 1-2 tablets three times in 24 hours.
  • Intravenous Furosemide 200 mg + Mannitol.

    • What kind of doctor treats kidney failure?

    Urologist and nephrologist treat kidney failure, however, if you suspect the demonstration is to call an ambulance and not wait for your next appointment.