What Is Chronic Renal Failure?

Chronic renal failure (CRF), also known as chronic renal insufficiency, refers to chronic progressive renal parenchymal damage caused by various causes, which causes the kidney to shrink significantly and fail to maintain its basic functions. Clinical manifestations of metabolite retention, water, electrolytes, Acid-base imbalance, which is the clinical manifestation of systemic system involvement, is also called uremia. The interval from the onset of the primary disease to the onset of renal insufficiency can range from several years to more than ten years. Chronic renal failure is a severe stage of renal insufficiency.

Chronic renal failure (CRF), also known as chronic renal insufficiency, refers to chronic progressive renal parenchymal damage caused by various causes, which causes the kidney to shrink significantly and fail to maintain its basic functions. Clinical manifestations of metabolite retention, water, electrolytes, Acid-base imbalance, which is the clinical manifestation of systemic system involvement, is also called uremia. The interval from the onset of the primary disease to the onset of renal insufficiency can range from several years to more than ten years. Chronic renal failure is a severe stage of renal insufficiency.

Causes of chronic renal failure

The etiology of chronic renal failure is dominated by various primary and secondary glomerulonephritis, followed by congenital malformations of the urinary system (such as renal dysplasia, congenital polycystic kidney, bladder ureteral reflux, etc.), hereditary Diseases (such as hereditary nephritis, renal medullary cystic disease, Fanconi syndrome, etc.) are common in systemic diseases such as renal arteriosclerosis, hypertension, and connective tissue disease. In recent years, the primary pathogenesis of CRF has changed. CRF caused by renal interstitial tubule damage has gradually received people's attention. Diabetic nephropathy, autoimmune and connective tissue disease renal damage, CRF caused by it has also increased.

Clinical manifestations of chronic renal failure

Chronic renal failure affects various systems and organs, and can cause a variety of clinical manifestations. However, before 80% of the nephrons are lost, or when GFP drops to 25ml / min, there can be no symptoms or only few Biochemical changes, in chronic progressive diseases such as polycystic kidney disease, even if the GFR is less than 10ml / min, there can be no symptoms, which is due to the huge adaptive effect of the remaining nephrons. The late stages of chronic renal failure mainly cause the following clinical lesions:

1. Water, electrolyte, acid-base balance disorders

The basic function of the kidney is to regulate water, electrolytes, acid-base balance, and renal insufficiency, due to its excretion or metabolic dysfunction, it will inevitably cause different degrees of water, electrolyte, acid-base balance disorders. However, unlike ARF, CRF Due to various compensatory mechanisms of the body during their long course of disease, these metabolic disorders sometimes do not appear very obvious. In fact, during mild to moderate CRF, the kidneys that have lost some functions still completely discharge various exogenous radiographs. When the normal kidney function is lost by about 70%, only some water, electrolytes, and acid-base balance disorders will occur. Only when the kidney function is further reduced, and ingestion or the body produces too much Water, electrolytes, acidic or alkaline substances will have obvious clinical manifestations.

2. Disorders of sugar, fat, protein and amino acid metabolism.

3. Dysfunction of each system

Digestive system; Cardiovascular system; Respiratory system; Nervous system; Blood system; Motor system; Skin changes; Immune system; Endocrine system.

Chronic renal failure examination

Urine test

Urinary protein is reduced when the renal function is significantly advanced in the later stage. Microscopic examination of urinary sediment has different degrees of hematuria, cast urine, and large and wide waxy casts, which are of diagnostic value for chronic renal failure.

Blood test

Because anemia is present at CRF, routine blood tests have important implications for CRF.

3. Renal function test

Serum creatinine (Scr) and urea nitrogen (BUN) increased, and urine concentration-dilution assays showed a decrease in endogenous creatinine clearance (Ccr).

4. Two and a half tests of liver function and hepatitis B.

5. Serum immunological examination

Including serum IgA, IgM, IgG, complement C3, complement C4, T lymphocyte subsets, CD4 / CD8 ratio of B lymphocytes, etc.

6. Detection of malnutrition indicators

The serum total protein, serum albumin, serum transferrin white, and low molecular weight protein were measured, and the measured value decreased as an indicator of protein-calorie malnutrition. Decreased plasma albumin level was an advanced indicator of malnutrition.

7. Kidney B-ultrasound

Renal cortex thickness is less than 1.5cm. CRF is better than kidney size standard, such as atrophy of kidneys, which supports end-stage diagnosis.

8. Other inspections

Routinely do ECG, chest X-ray, bone radiograph, and gastroscopy, as well as some special examinations such as radiography, radionuclide kidney scan, CT and magnetic resonance to determine the shape, size, and presence of urinary tract obstruction. Hydrocephalus, stones, cysts, and tumors are helpful, and kidney shrinkage in advanced stages of chronic renal failure (polycystic kidney disease, except for renal tumors) is a characteristic change.

Diagnosis of chronic renal failure

Diagnosis is based on etiology, clinical manifestations, and laboratory and imaging examinations.

Treatment of chronic renal failure

Treatments for chronic renal failure include medical therapies, dialysis, and kidney transplants. Dialysis therapy and kidney transplantation are undoubtedly the best treatment options for patients with end-stage renal failure, but because these therapies are expensive and the source of donor kidneys is limited, they are often not accepted by most patients. Some patients with kidney disease can delay the progression of their disease course through reasonable medical treatment before they progress to end-stage renal failure, and a few can be completely reversed. Therefore, conservative medical treatment of chronic renal failure should be emphasized.

1. Primary disease and inducement treatment

For patients with CRF diagnosed for the first time, we must pay attention to the diagnosis of the primary disease. For chronic nephritis, lupus nephritis, purpuric nephritis, IgA nephropathy, diabetic nephropathy, etc., it is necessary to maintain long-term treatment. At the same time, we should also actively look for CRF This kind of inducing factors, and reasonable correction of these inducements may make the lesions lessened or tend to stabilize and improve renal function to a large extent.

2. Diet Therapy

The diet therapy for chronic renal failure has been considered as its basic treatment for many years. It has been admired by scholars from various countries. In the past, diet therapy was generally limited to the use of low-protein diets, but long-term low-protein diets will affect the nutritional status of patients. Studies show that chronic The incidence of malnutrition in renal failure is as high as 20% to 50%. Severe malnutrition is now considered to be an independent risk factor for CRF, which is directly related to morbidity and mortality. Therefore, the current diet therapy is more inclined to formulate patients more rationally. Nutritional treatment options.

3. Alternative therapy

Including hemodialysis, peritoneal dialysis, and kidney transplantation, each has its advantages and disadvantages, and can complement each other in clinical applications.

(1) Hemodialysis should be performed arterio-venous fistula (vascular access) in advance (several weeks before hemodialysis); dialysis time is 12 hours per week, usually 3 times a week, 4-6 hours each time; adhere to full and reasonable Dialysis can effectively improve the quality of life of patients, and many patients can survive more than 20 years.

(2) Peritoneal dialysis Continuous ambulatory peritoneal dialysis (CAPD) has the same effect on uremia as hemodialysis. CAPD is particularly suitable for patients with cardiovascular and cerebrovascular complications, diabetes, elderly, pediatric patients or arteriovenous For patients with internal fistula, CAPD is continuous dialysis, uremic toxins are continuously cleared, hemodynamic changes are small, and residual renal function is better than hemodialysis. It is safer for patients with cardiovascular and cerebrovascular diseases than hemodialysis. The incidence of complications such as dual systems, peritonitis, etc. has been significantly reduced.

(3) Kidney transplantation Successful kidney transplantation can restore normal renal function (including endocrine and metabolic functions). The kidney can be donated by a cadaver or relative (donated by siblings or parents). Based on the appropriate ABO blood type and HLA matching, the kidney donor should be selected. The HLA matching is better. The survival time of the transplanted kidney is longer. long.