Renal Failure
Introduction
Introduction to renal failure Pathological condition in which some or all of the kidney function is lost. According to the rapid onset of the attack, it is divided into acute and chronic. Acute renal failure is caused by a variety of diseases, causing the two kidneys to lose excretory function in a short time, referred to as acute renal failure. Chronic renal failure is a syndrome that consists of a group of clinical symptoms that arise from the development of chronic kidney disease caused by various causes to the advanced stage. Chronic renal failure was divided into 4 stages according to the degree of renal dysfunction: 1 renal reserve function decreased, and the patient was asymptomatic. 2 renal insufficiency compensation period. 3 renal decompensation (nitrogenemia), patients with fatigue, loss of appetite and anemia. 4 uremia stage, there are symptoms of uremia. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: hypertension, anemia, heart failure, pericarditis, cardiomyopathy, renal osteodystrophy, fracture
Cause
Cause of renal failure
Insufficient blood volume (25%):
Renal ischemia and renal poisoning, various factors causing pre-renal azotemia continue to cause renal ischemia and hypoxia; various nephrotoxic substances such as drugs, bacterial endotoxin, heavy metal poisons and biological poisons act on Kidney can cause disease.
Hemolysis (20%):
In addition, mistype of blood transfusion and drugs can cause acute intravascular hemolysis, crush injury, burns and severe myopathy, which can cause acute tubular necrosis and acute renal failure due to hemoglobin and myoglobin occluding the renal tubules.
Certain diseases (26%):
The main causes of chronic renal failure include diabetic nephropathy, hypertension, renal arteriosclerosis, primary and secondary glomerulonephritis, tubulointerstitial lesions (chronic pyelonephritis, chronic uric acid nephropathy, obstructive nephropathy, drugs) Nephropathy, etc., renal vascular disease, hereditary nephropathy (such as polycystic kidney disease, hereditary nephritis).
Prevention
Renal failure prevention
Nursed the five internal organs
It is easy to live and eat, pay attention to hygiene, and avoid foreign invasion. Especially in the seasons and areas where infectious diseases are prevalent, preventive measures should be strengthened. However, the food is spicy and savory, so as not to breed damp heat; to adjust emotions and maintain a happy spirit. To make the blood flow smooth and avoid qi stagnation and blood stasis; strengthen physical exercise and improve the body's defense ability.
Prevent poisoning
Relevant information indicates that 20% to 50% of acute renal failure is caused by drugs, and some are caused by exposure to harmful substances. Therefore, the use and exposure of drugs or poisons that are toxic to the kidneys should be avoided. In case of accidental taking or contact, it should be discovered and treated early.
Timely prevention
Once the primary disease of acute renal failure occurs, it should be treated early, pay attention to expand blood volume, correct water and electrolyte imbalance and acid-base imbalance, and restore circulation function. If the disease is about to occur, measures should be taken early to supplement blood volume, increase cardiac output, restore renal perfusion flow and glomerular filtration rate, exclude renal tubular obstruction, prevent infection, prevent DIC, renal ischemia Caused damage to the renal parenchyma. At the same time, the application of blood-activating and stasis-removing drugs as soon as possible has a positive effect on preventing the occurrence of this disease.
Complication
Renal failure complications Complications, hypertension, anemia, heart failure, pericarditis, cardiomyopathy, renal osteodystrophy
Often complicated by hypertension, anemia, heart failure, pericarditis, cardiomyopathy, hydroelectric disorders and acid-base imbalance, renal osteodystrophy, fractures, infections, etc.
In addition to the above systemic complications, long-term dialysis patients with chronic renal failure can also have the following complications:
Aluminum poisoning
Patients with end-stage renal disease treated with conventional dialysis are prone to aluminum toxicity.
2. Dialysis-related amyloidosis
Dialysis-related amyloidosis (DRA) is an osteoarthrosis found in long-term dialysis patients. The clinical symptoms and incidence are closely related to the length of dialysis.
3. Trace element changes
Renal failure and dialysis have a great influence on the metabolism of trace elements, and they accumulate in various parts of the body to cause toxicity.
(1) Aluminum: See aluminum poisoning.
(2) Copper: Plasma copper levels in patients with chronic renal failure who are not dialysis are often normal, but can be slightly lower.
(3) Zinc: Chronic renal failure eating low-protein diet and nephrotic syndrome, a large number of urine protein loss in patients with plasma zinc is often extremely low.
Symptom
Symptoms of Renal Failure Common Symptoms Nail dystrophy Hyperkalemia Myoglobin High Urine Proteinuria Nail Slim Dehydrated Urine Nitrogenemia Hematuria
1 oliguria. Reduced urine volume causes hyperkalemia, water intoxication (severe edema, elevated blood pressure, pulmonary edema or cerebral edema), metabolic acidosis, and acute uremia symptoms. Hyperkalemia and water poisoning are the main causes of death.
2 more urine period. After the regeneration of renal tubular epithelial cells, the amount of urine gradually increases, which causes blood potassium and blood sodium to decrease. Patients with persistent polyuria can die from dehydration and electrolyte imbalance.
3 recovery period. After the polyuria period, the urine volume decreased to normal, and blood Bun, creatinine (Scr) and electrolytes all returned to normal levels, but it took 3 to 6 months for the renal tubular function and structure to return to normal. Those who failed to recover were converted to chronic renal failure. Although there is a lot of urine in non-oliguric type, blood Bun and Scr increase day by day and symptoms of poisoning appear. Because the kidney damage is light, the prognosis is good.
Examine
Examination of renal failure
I. Laboratory inspection
Urine check
The urine routine protein is generally >2.0g/L, and the urine protein is reduced when the renal function damage is obvious. The morning urine specific gravity is reduced to below 1.018, or fixed at around 1.010.
Because of anemia in CRF, blood routine examination has an important role in CRF. Other tests include plasma total protein, albumin, globulin and their ratio determination; blood electrolytes (HCO3--, K, Na, Ca, Mg2, P3, etc.) levels.
Serum creatinine (Scr), urea nitrogen (BUN) increased, urine concentration-dilution function measurement showed a decrease in endogenous creatinine clearance (Ccr).
4. Liver function and hepatitis B two-and-a-half check
5. Serum immunological examination
Including serum IgA, IgM, IgG, complement C3, complement C4, T lymphocyte subsets, B lymphocyte population CD4 / CD8 ratio and so on.
6. Malnutrition index detection
Serum total protein, serum albumin, serum transferrin white and low molecular weight proteins were determined. Very low levels of cholesterol are also considered indicators of malnutrition.
Second, imaging examination
Kidney B ultrasound
The thickness of the renal cortex is <1.5 cm, and the CRF is judged to be superior to the size of the kidney. Such as kidney atrophy, support end-stage diagnosis.
2. Other
Conventional electrocardiogram, X-ray, bone and gastroscopy, as well as some special examinations such as X-ray, radionuclide kidney scan, CT and magnetic resonance to determine the shape and size of the kidney and the presence or absence of urinary tract obstruction, Water, stones, cysts and tumors are helpful.
Diagnosis
Diagnosis and diagnosis of renal failure
The identification of CRF (chronic renal failure) and prerenal azotemia is not difficult. The renal function of patients with pre-renal azotemia can be restored after 48-72 hours of effective blood volume supplementation, while the renal function of CRF is difficult. restore.
The identification of CRF and acute renal failure is not difficult in most cases, and it is often possible to make a differential diagnosis based on the patient's medical history. When the patient's medical history is not detailed, it can be analyzed by means of imaging examination (such as B-ultrasound, CT, etc.) or renal graph examination results, such as the obvious reduction of the kidneys, or the kidney map suggesting chronic lesions, then support the diagnosis of CRF.
