End Stage Renal Disease

Chronic kidney disease (CKD) is damage to the kidneys or a decrease in their function for 3 months or more. The disease is classified into several stages, which differ in tactics of patient management and the risk of developing terminal renal failure and cardiovascular complications.

Causes of disease

Causes of kidney disease:

• (Acute renal hemodynamics (shock, collapse);
• Intoxications of various genesis (insect bites, snakes, drugs, household poisons);
• Infectious diseases (hemorrhagic fever, leptospirosis, etc.);
• Acute kidney disease (acute pyelonephritis, glomerulonephritis);
• Urinary tract obstruction and impaired urine outflow (urolithiasis, urinary tract tumors, etc.);
• Kidney removal;
• Injury.

Causes of chronic renal failure:

• Kidney disease (chronic pyelonephritis, glomerulonephritis);
• Metabolic disorders (gout, amyloidosis, diabetes mellitus);
• Congenital renal pathology (narrowing of the renal arteries, polycystosis, underdevelopment of the kidneys);
• Rheumatic diseases (scleroderma, hemorrhagic vasculitis, systemic lupus erythematosus);
• Vascular disease (arterial hypertension).

The most common causes of chronic renal failure are glomerulonephritis, congenital malformations of the kidneys, diabetes mellitus, pyelonephritis.

Diagnostics

Diagnostic methods include analysis of daily urine, protein in the urine, biochemical blood analysis, urine biochemistry, clinical blood analysis, general urine analysis.

The greatest attention is given to maximum relative density (osmolarity) of urine, glomerular filtration (CF), serum creatinine level.

Symptoms of kidney failure

The chronic form of the disease develops as a result of the progression of acute renal failure. The condition is characterized by the destruction and death of the kidneys (glomeruli, nephrons, parenchyma), as a result, the organ cannot perform its functions – this entails disturbances in the work of other vital organs.

Depending on the degree of damage to the kidney tissue and the severity of the patient’s condition, they distinguish several stages of chronic renal failure with various symptoms:

• Latent stage – there are no clinical manifestations of the disease, so the patient is not aware of his or her condition – however, with an increase in physical exertion, weakness, dry mouth, drowsiness, lethargy, fatigue, urine output in increased quantities occur;
• Clinical stage – clinical symptoms of intoxication occur: nausea, vomiting, pallor of the skin, lethargy, drowsiness, lethargy, a sharp decrease in the volume of urine, diarrhea, bad breath, tachycardia, cardiac arrhythmia, headaches;
• Stage of decompensation – complications in the form of frequent respiratory diseases, inflammatory infections of the urinary organs are added to the signs of general intoxication of the body;
• Compensation stage (terminal or end-stage) – the extinction of the functions of vital organs, a fatal outcome. Clinically, this stage is manifested by symptoms of severe intoxication of the body, impaired functioning of all organs, halitosis, yellowness of the skin, neurological disorders.

If you notice such signs, you should immediately consult a urologist.

The sooner renal failure is identified and treated, the higher the chances of the patient’s recovery.

The acute form of the disease is a reversible condition. To treat it, it is important to determine the causes of the organ malfunction.

If renal failure is not treated, the patient will quickly die.

Treatment

Treatment for kidney diseases consists of specific treatment for a particular disease and nephroprotective treatment, universal for all kidney pathologies.

Treatment is prescribed depending on the specific disease. With glomerulonephritis, kidney damage with systemic diseases of the connective tissue, doctors prescribe steroids, BIARL (disease-changing antirheumatic drugs). With infectious lesions of the kidneys and urinary tract, antibiotics are used. In diabetic nephropathy, the correction of blood glucose is indicated.

Physical activity, maintaining normal body weight, low protein diet are very important. All patients are required to control diet for the prevention of protein-energy malnutrition.

The main nephroprotective treatment is the blockade of the renin-angiotensin-aldosterone system due to several groups of drugs: angiotensin-converting enzyme blockers, angiotensin receptor blockers, aldosterone antagonists, direct renin inhibitors, etc. The most important is treatment that reduces the level of proteinuria through normalization of intraocular hypertension (RAAS blockade) and protection of the proximal epithelium from toxic protein endocytosis (antioxidants).

Non-specific but important treatment is antihypertensive therapy with concomitant arterial hypertension).

In the treatment of hypertension in combination with CKD, a combination of two drugs is used: an RAAS blocker (ACE inhibitor, ARB) + calcium antagonist or diuretic. For GFR <30, loop diuretics must be used since thiazide and thiazide-like diuretics are significantly less effective or ineffective when GFR is reduced to these values. With inefficiency, a combination of three drugs is used: an apf inhibitor or sconce + bcc + diuretic. If ineffective, doctors prescribed spironolactone (contraindicated in patients with GFR <30) or a beta-blocker or an antagonist of imidazoline receptors.

If end-stage renal failure develops, dialysis (hemodialysis or peritoneal dialysis) or kidney transplantation is indicated.

Complications

Renal failure causes disruption of the cardiovascular system (arrhythmia, ischemia, myocardial infarction, etc.), the nervous system (dialysis dementia, disequilibrium syndrome, delirium, seizures, etc.). When using program hemodialysis, thrombosis, infection of fistulas, arteriovenous shunts, tissues may occur. One of the most serious complications is renal cortical necrosis.

In the absence of treatment for kidney failure, a coma and death occur.

Prevention

Prevention of chronic renal failure includes the timely and adequate treatment of chronic kidney diseases (glomerulonephritis, pyelonephritis, urolithiasis).

About Network 13

The 13Network is a service hosted by Bankruptcy Software Specialists, LLC. BSS is the nation’s leading provider of Bankruptcy Software and Services to Chapter 13 Trustees.

The End-Stage Renal Disease Network Program consists of a national network of 18 ESRD Networks. Each of them is responsible for each U.S. state, territory, and the District of Columbia.

Network 13  is serving Arkansas, Louisiana, and Oklahoma. For comparison, Florida is served by Network 7; Arizona, Colorado, Nevada, New Mexico, Utah, and Wyoming are served by Network 15; American Samoa, Guam, Hawaii, the Mariana Islands, and Northern California are served by Network 17.

The goal of Network 13 is to effectively increase the quality of care and quality of life for patients with end-stage renal disease.