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What are the symptoms of renal failure?

2017-06-18 15:20

Renal failure can be divided into acute and chronic, acute renal failure disease progress rapidly, usually due to insufficient supply of renal blood flow (such as trauma or burn), renal obstruction caused by dysfunction due to certain factors or by poison damage caused by acute renal failure. Chronic renal failure is the main cause of chronic renal disease. As time goes on and the disease develops, the function of the kidney decreases gradually, resulting in the occurrence of renal failure.

Initial stage

Patients with this disease often experience some known causes of ATN, such as hypotension, ischemia, sepsis, and nephrotoxicity. But no obvious renal parenchymal damage has been observed. Acute renal failure is preventable at this stage. However, with the obvious damage of renal tubular epithelium, GFR suddenly declined. The clinical manifestations of acute renal failure syndrome became obvious, but entered the maintenance period.

holding phase

Oliguria phase. Typical for 7-14 days, but can also be as short as a few days, up to 4-6 weeks. Glomerular rate remained low. Many patients suffer from oliguria (<40Oml/d). But some patients do not have oliguria or urine volume above 400ml/d, which is called non oliguria acute renal failure. The condition is mild and the prognosis is better. However, no matter whether the urine volume decreases or not, with the decline of renal function, a series of uremia manifestations can occur.

Infection is another common and serious complication of acute renal failure. In the course of acute renal failure or in the course of disease development, multiple organ failure can be combined, and the mortality rate can be as high as 70%.

Convalescence

Renal tubular cell regeneration, repair, recovery of renal tubule integrity. The glomerular filtration rate gradually returns to normal or near normal range. Oliguria type begins to appear diuresis, can have polyuria performance, daily amount of urine can amount to 3000-5000ml, or more. Usually last 1-3 weeks and then back to normal. Compared with glomerular filtration rate, the recovery of glomerular epithelial cell function (solute and water reabsorption) is relatively delayed and usually takes months to recover. A small number of patients may eventually leave varying degrees of structural and functional defects in the kidney.

Chronic renal failure clinical stage 1: renal function compensation period: the renal function compensation period, glomerular filtration rate decreased to 30-60 ml / min. the normal human glomerular filtration rate was 120 ml per minute. The nephron reduction about 20%-25%. renal reserve capacity has been lost, but for the excretion of metabolites, regulation of water electrolyte and acid-base balance ability is good, so no special clinical manifestations, serum muscle enzymes and blood urea nitrogen is usually normal or sometimes slightly increased.

The two stage is the period of nitrogen and blood stasis:

Azotemia reduced glomerular filtration rate to 25 ml / min, nephron reduction 50%-70%, concentration of renal dysfunction, appeared nocturia or polyuria, often have varying degrees of anemia, azotemia, serum creatinine, blood urea nitrogen levels. Clinical can have fatigue, anorexia, nausea and mild discomfort all over the body. This stage, such as neglecting the protection of renal function or the extra load of the body, can cause severe vomiting, diarrhea, insufficient blood volume, and if the infection or use of nephrotoxic drugs can cause the rapid decline of renal function and failure.

Three stage: stage of renal failure (early stage of uremia):

During the renal failure stage, the glomerular filtration rate is reduced to 10-15 ml per minute, the renal unit reduces by about 70%-90%, the renal function is seriously damaged, and the metabolism, water, electrolyte and acid-base balance of the organism can not be maintained. It is impossible to keep the environment in the body stable, resulting in significant increase in serum creatinine and urea nitrogen, urinary concentration, dilution, dysfunction, acidosis, retention of water and sodium, low calcium, high phosphorus, high potassium and other imbalance manifestations. Can have obvious anemia and gastrointestinal symptoms, such as nausea, vomiting, loss of appetite. Also can have the neuropsychiatric symptoms, such as fatigue, inattention, depression etc..

Four stage: Uremia period

Glomerular filtration rate decreased to 10 ml per minute -15 ml, renal unit is reduced by more than 90%, this is the late period of chronic renal failure, clinical symptoms of the renal failure more obvious manifestations of systemic multiple organ failure, such as gastrointestinal tract, nervous system, cardiovascular system, respiratory system, hematopoietic system, skin and metabolic imbalance. The clinical manifestations of nausea and vomiting, irritability, increased blood pressure, palpitation, chest tightness, not supine, dyspnea, severe anemia, severe convulsions, coma, often with hyperkalemia, hyponatremia, hypocalcemia and hyperphosphatemia. This phase relies on dialysis to support life. Often due to hyperkalemia, cerebral edema, pulmonary edema, heart failure and sudden death.

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