Chronic renal failure
"It is a pathology caused by different diseases, including diabetes".
DR. NURIA GARCÍA FERNÁNDEZ
DIRECTOR. NEPHROLOGY DEPARTMENT
Chronic renal failure is the progressive and irreversible deterioration of kidney function.
When the glomerular filtrate - blood filtering in the kidney - falls below 25 to 35%, urea and creatinine begin to increase. Patients may be relatively asymptomatic or may present anemia, high blood pressure, polyuria and nocturia.
When the glomerular filtrate falls below approximately 15%, the signs of uremic syndrome begin to appear.
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What are the symptoms of chronic kidney failure?
Electrolyte alterations: anomalies are produced in the levels of different electrolytes such as potassium and bicarbonate.
Cardiovascular manifestations: high blood pressure, which is found in up to 80% of patients with chronic end-stage renal failure.
Gastrointestinal disorders: anorexia, nausea and vomiting. A characteristic sign is the uremic factor, ammonia odor produced by nitrogen metabolites in saliva.
Hematological alterations: an early sign in the evolution of chronic renal failure is anemia.
Neurological alterations: the appearance of uremic encephalopathy is typical, which manifests itself as a cognitive alteration ranging from difficulty in concentrating to deep coma. A polyneuropathy can also appear, which at first is sensitive but, if it progresses, becomes also motor.
Osteomuscular alterations (renal osteodystrophy): it is manifested by bone pain, deformities (reabsorption of distal phalanges in fingers), fractures and growth retardation in children.
Dermatological alterations: the characteristic sign is the straw color of the skin, produced by the anemia and by the accumulation of urochromes. Pruritus (itching) is also very frequent and very annoying.
Hormonal alterations: in man it mainly causes impotence and oligospermia (decreased sperm production). In women it causes alterations in the menstrual cycle and frequently amenorrhea (lack of menstruation).
The most common symptoms are:
- Alterations in potassium and bicarbonate.
- High blood pressure.
- Anorexia, nausea and vomiting.
Do you have any of these symptoms?
You may have chronic kidney failure
What are the causes of chronic kidney failure?
Acute renal failure may occur because some or all of the mechanisms involved in glomerular filtration fail.
A decrease in filtration may occur when the filtration pressure decreases due to a reduction in blood pressure or significant hypovolemia (absolute due to hemorrhage or dehydration, or relative due to poor distribution of vascular volume as occurs in septic conditions, ascites, intestinal occlusions).
Such acute renal failure may occur due to loss of functional units, as in glomerulonephritis, or due to the action of toxins such as some drugs (including intravenous contrast).
Other causes of acute renal failure are those that occur when there is an obstructive condition that does not allow the elimination of the filtrate, as occurs when there is a prostatic obstruction or by ureteral compression by masses or nodes.
What are the risk factors?
There are several factors that can predispose to the appearance of this disease, such as advanced age, chronic infection, diabetes, high blood pressure, immune disorders, kidney and liver problems, prostatic hypertrophy and bladder obstruction.
The signs and symptoms presented by these patients are:
- Decreased urine production.
- Lack of elimination of waste products through urine.
- Fluid retention, causing edema (swelling) in the legs, ankles or feet.
- Sleepiness, breathing difficulty, fatigue, confusion and even coma in very serious cases and normally associated with other diseases.
How is chronic kidney failure diagnosed?
The diagnosis of chronic renal insufficiency is based on the clinical manifestations that the patient presents, as well as on the alterations that the anal'litica can be appreciated.
When this disease is suspected, a blood and urine test should be performed. The alterations that can appear are: decrease in the volume of urine (less than 500 milliliters), increase in blood urea and creatinine and elevated electrolytes such as potassium.
The ultrasound shows that the kidney has decreased in size and presents an alteration in its normal structure.
How is chronic kidney failure treated?
It is important to start treatment of kidney failure early in order to avoid complications, anticipate long-term sequelae and slow disease progression as much as possible (protecting residual kidney function).
Restriction of salt, protein, phosphorus and potassium rich foods.
- Protectors of renal function: Angiotensin conversion enzyme inhibitors.
- Phosphorus chelators.
Potassium chelators used in very terminal phases of chronic renal insufficiency.
- Vitamin D: helps control the increase in parathyroid hormone and promotes calcium absorption and bone mineralization.
- Erythropoietin: stimulates the production of red blood cells.
In hemodialysis, the elimination of toxins and excess liquid is carried out through an artificial filter. It requires an extracorporeal circuit with the need for vascular access (arteriovenous fistula or hemodialysis catheter). It consists of intermittent sessions (three a week) of variable duration (3 to 4 hours).
In peritoneal dialysis the elimination of toxins and fluid is produced through the peritoneal membrane. It requires an entire peritoneal cavity with the need for the implantation of a peritoneal dialysis catheter to introduce dialysis fluid into the abdomen. It is a continuous dialysis, requiring the exchange of peritoneal dialysis fluid three or four times a day.
The Clinica Universidad de Navarra has more than 50 years of experience in kidney transplantation.
With survival rates above the European average, the Clinic and the Hospital Complex of Navarra have been collaborating for years to improve the quality of life of renal patients.
Donation in type III asystole
This type of donation has increased the availability of kidneys for transplantation.
Incompatible ABO transplants
It allows the donation of a kidney between two people with blood group incompatibility.
Find another donor-recipient pair with similar characteristics, with which there is no problem of blood compatibility or other type of antibodies.
Where do we treat it?
IN NAVARRE AND MADRID
The Nephrology Service
of the Clínica Universidad de Navarra
The Nephrology Service of the Clínica Universidad de Navarra has more than five decades of experience, both in the diagnosis and treatment of all kidney pathologies and in the transplant of this organ.
Our specialists have completed their training in centers of national and international reference.
We have the best facilities in the Dialysis Unit in order to offer the highest quality care to our patients.
Why at the Clinica?
- National reference in kidney transplantation, pioneer in living donor kidney transplantation.
- Specialized nursing for the care and follow-up of our patients.
- Cardiovascular and renal damage prevention program.
Our team of professionals
A new approach to cardiovascular risk
The only checkup that incorporates the latest diagnostic imaging technology to accurately quantify your risk of stroke and myocardial infarction.
Thanks to the exclusive dedication of our professionals, we are able to perform the ICAP checkup in less than 48 hours with a highly accurate diagnosis.