Chronic renal failure

Introduction Chronic renal failure (CRF) is not an independent disease. It is the end-stage manifestation of deterioration of renal damage caused by various causes. When the renal function is close to 10% of normal people, a series of syndromes appear. Generally, there is a relatively long course of disease. According to the degree of renal dysfunction, the renal insufficiency is compensated. The decompensation period of renal insufficiency is also called azotemia, renal failure, and the end stage is also called uremia.

Cause

Chronic renal failure is caused by a wide range of causes, and almost all kidney disease progression can lead to chronic kidney failure. Acute renal failure is not cured, and no death in a short period of time can directly lead to chronic renal failure. The common reasons are now described as follows:

1. Chronic glomerulonephritis: The progression of the disease to the advanced stage is the most common cause of chronic renal failure.

2. Interstitial Nephritis: is a group of diseases mainly involving the renal interstitial and renal tubules. Therefore, it is also known as Tubulo-Interstitia Nephropa-thy. Its etiology is complex and is a common clinical disease. 25% to 33% of urinary system diseases, ranking second in chronic renal failure.

(1) Infection: Bacteria, viruses, molds, malaria parasites, etc. invade the renal interstitial and renal tubules, which represent diseases such as chronic pyelonephritis. Malignant dysentery and so on.

(2) immune damage: common drug allergies such as penicillin, sulfonamide, autoimmune diseases such as systemic lupus erythematosus, scleroderma, dermatomyositis involving the kidneys.

(3) Toxic substance damage: such as aminoglycoside antibiotics, contrast agents damage the kidneys, heavy metal salts such as mercury, lead, arsenic, gold and other damage to the kidneys.

(4) renal blood supply disorders: such as renal arteriosclerosis, renal artery stenosis.

(5) Metabolic abnormalities: such as hyperuricemia, hypercalcemia, and long-term hypokalemia.

(6) Physical factors: long-term exposure to X-ray, X-ray radiotherapy for malignant tumors, etc.

(7) urinary tract obstruction: obstruction caused by bladder, ureteral urine reflux, renal pelvis, ureteral pressure increased damage to the renal interstitial, such as combined infection is more serious.

(8) Tumor directly infiltrating the renal interstitial: such as leukemia, lymphoma, cancer cell metastasis caused by renal interstitial damage.

(9) hereditary diseases: such as polycystic kidney disease, renal cysts.

(10) Balkan nephritis: a renal interstitial disease of unknown cause, mainly occurring in southern Europe.

3. Hypertensive arteriosclerosis: At this time, the renal tubule is damaged first and then the glomerulus is damaged. The glomerular nephritis first damages the glomerulus and then damages the renal tubule.

4. Secondary to metabolic diseases: such as diabetes, gout kidney, amyloidosis.

an examination

Related inspection

Renal MRI examination, renal ultrasound, protein electrophoresis, urinary aldosterone urea

1. Common laboratory tests

The program includes urine routine, renal function, 24-hour urine protein quantitation, blood glucose, blood uric acid, blood lipids, and blood electrolytes (K, Na, Cl, Ca, P, Mg, etc.), arterial blood gas analysis, and renal imaging examination.

The main methods for examining glomerular filtration function include: detection of serum creatinine (Scr), creatinine clearance (Ccr), and radionuclide measurement of GFR. The normal value of Ccr in China is 90±10ml/min. For different populations, there may be significant differences in Scr and Ccr values, and clinicians need to make correct judgments.

2. Imaging examination

Generally, only B-mode ultrasound is needed to exclude stones, kidney tuberculosis, and renal cystic diseases. In some special cases, radionuclide renal maps, intravenous pyelography, renal CT, and magnetic resonance imaging (MRI) may be required. Renal examination is helpful for the differential diagnosis of acute and chronic renal failure. If the results of the kidney diagram show that the renal vascular segment, secretory segment, and excretory function are very poor, it generally indicates the presence of CRF. For example, the renal map shows that the renal vascular segment is better, and the excretion function is poor, showing an "obstructive type" ( Parabolic), generally suggesting that there may be acute renal failure. It is helpful to have urinary tract obstruction, stagnant water, stones, cysts and tumors.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Renal failure: a pathological condition in which part or all of kidney function is lost. According to the rapid onset of the attack, it is divided into acute and chronic.

Acute renal failure: The two kidneys lose their excretory function in a short period of time due to various diseases. Referred to as acute renal failure. It is characterized by oliguria (urinary volume without urine (urinary uremia, also non-oliguric type (nitrogen volume >1000mL / d). Timely and appropriate treatment, renal function can be restored. Complex condition, critically ill patients or treatment It can be converted to chronic renal insufficiency or death.

Acute renal failure includes the following three conditions:

1 prerenal azotemia: due to insufficient blood volume or cardiac insufficiency caused by insufficient renal blood perfusion, resulting in decreased glomerular filtration rate.

2 post-renal azotemia: due to stones, tumors or prostatic fertilizers, the acute obstruction of the urinary tract is caused, leading to oliguria and elevated blood urea nitrogen (Bun).

3 renal acute renal failure: due to renal parenchymal disease, seen in severe acute glomerular disease, acute interstitial-tubular disease, acute tubular necrosis, acute renal vascular disease and chronic kidney disease, under certain incentives Acute renal tubular necrosis is most common in patients with a sharp deterioration of both kidney functions.

2. Renal failure: Renal failure can be divided into acute and chronic. The condition of acute renal failure progresses rapidly, usually due to insufficient blood supply to the kidney (such as trauma or burn), impaired function of the kidney due to some factors, or The damage of poisons causes the production of acute kidney failure. The main cause of chronic renal failure is long-term renal disease. As time and disease progress, the function of the kidney gradually declines, causing renal failure.

There is a history of chronic kidney disease, dysfunction of various organs other than the kidney, laboratory tests show that metabolites accumulate in the blood, a series of electrolyte disorders, acid-base balance disorders, endocrine disorders, generally can establish a diagnosis. After the diagnosis of uremia is established, the cause of uremia, the diagnosis of primary disease, should be further clarified. In the near future, there are no incentives for the deterioration of renal function such as urinary tract obstruction, infection, dehydration, heart failure, use of kidney drugs, surgery, anesthesia, shock, and recent reactivation of the primary disease. B-ultrasound and CT examination should show double kidney atrophy.

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