Chronic renal failure (CPN) MKB 10 is a disease in which irreversible changes in the kidney structure occur. This leads to disorders inside the body, which is distinguished by the work of other organs. Before switching to chronic form The disease can manifest itself with sharp attacks.

Doctors allocate four pronounced diseases of the disease:

1. Latent usually proceeds asymptomatic and is usually detected only when clinical studies. It is characterized by a stage is characterized by the fact that periodic proteinuria appears.
2. Compensated is characterized by a decrease in glomerular filtration. During this period, weakness is noted, dry mouth, polyuria, as well as fast fatigue. Analysis reveals increased urea content and such a substance as creatinine, in the blood.
3. The intermittent stage of the disease is associated with even greater decrease in filtration rate, an increase in creatinine and the development of acidosis. The patient's condition is seriously deteriorating, symptoms of diseases can appear - complications.
4. The terminal stage is most serious, and therefore there are several of its stages:

• at the first stage, the water release function is preserved, and the filtering of kidney glomers is reduced to 10 ml / min. Change water balance can still be adjusted by conservative therapy;
• at the second, decompensated acidosis occurs, the fluid delay in the body comes, symptoms of hyperkathemia appear. In the cardiovascular system and the lungs there are reversible disorders;
• in the third stage, which is characterized by the same symptoms as on the second, only disorders in the lungs and the vascular system are irreversible;
• the last stage is accompanied by the liver dystrophy. Treatment at such a stage is limited, and modern methods ineffective.

The main causes of renal failure

Call chronic renal failure (CPN) Code of ICD 10 may series of factors:

1. which are striking the clusters: acute and chronic glomerulonephritis, nephrosclerosis, endocarditis, malaria.
2. Secondary lesions of the tissue of the organ due to vascular disorders: hypertension, stenosis of the arteries or hypertonic disease Oncological character.
3. Diseases of urinary organs, which are characterized by urine outflows, toxins poisoning.
4. Heredity. Vices for the development of the pair of organ and ureters: various cysts, hypoplasia, neuromuscular dysplasia.

Regardless of the cause of the occurrence, all changes in the kidneys are reduced to a significant decrease in the functioning tissues of the kidneys. Increased content Azotist substances makes the work of the kidneys. Since the kidneys do not cope with the load, the body begins to "self-diverge". The attacks of nausea and vomiting, muscle cramps and bone pain can appear. The skin acquires a jaundice shade, the smell of ammonia appears from the mouth.

Other causes of the disease can be:

• unbearable skin itching, most acutely manifested at night;
• increasing sweating;
• heart failure;
• arterial hypertension.

For the diagnosis of pathological disorders, a number of studies are applied:

• general I. biochemical analysis blood;
• urine study;
• Ultrasound kidneys and urinary bodies;
• cT scan;
• arteriography;
• pyelography;
• radioisotope renography.

They provide an opportunity to assess the degree of damage to the body, changing the structure, as well as identify education in the urinary system.

Most effective methods Treatment of the disease is considered:

1. Hemodialysis. This is the most effective method Treatment that cleans the body from toxins using blood run through a special machine.
2. Peritoneal dialysis is prescribed by patients suffering from severe diseases that have the intolerance to heparin. The mechanism is to introduce a solution in the peritoneum and bringing it through the catheter.
3. The most cardinal is the kidney transplantation.

As preventive treatment Applied conservative therapy With several types of preparations:

• corticosteroids (methylprednisolone);
• antilimphocytic globulin;
• cytostatic (Imuran, Azatioprin);
• anticoagulants (heparin);
• antiagregants (Kuraltil, Trental);
• vasodialators;
• antibacterial drugs (neomycin, streptomycin, kanamycin).

Before applying any drugs, it is necessary to undergo a full examination, as it is possible to choose a better treatment scheme can only professional specialist.

Treatment of the disease with the help of popular recipes and prevention

How to spend? Lots of medicinal plants Can take symptoms. The most common recipes:

• collected from the following ingredients:

1. Brusnel sheets.
2. Violet.
3. Flax seeds.
4. Linden blossom.
5. Corn silk.
6. Motherwort.
7. Truck.
8. Blueberry.
9. Rephetka.

• collecting from the fruits of a hawthorn, nettle, laurel, chamomile, rosehip, dill and currants;
• collection made from birch leaf, calendula, hunter, viburnum, dyeing, mint, sage and apples peel;
• each of them has a beneficial effect on the state of the urinary system, support the function of the kidneys.

For people prone to the development of kidney disease, it is important to comply with some prevention measures:

• refusal of cigarettes and alcohol;
• development and compliance with low cholesterol and fats diet;
• physical exertion, beneficially affecting the patient's condition;
• control over cholesterol and blood sugar levels;
• regulation of fluid consumed;
• limitation of salt and protein in the diet;
• providing a full sleep.

All this will help support functionality. internal organs and improve general state patient.

HBS Code on the ICD 10: N18) - a compensation concept that combines all patients with signs of damage to the kidneys and / or a decrease in the function assessed by magnitude speed \u200b\u200bof glomerular filtration (SCF)which are preserved within 3 or more months.

Concept " Chronic illness kidney "(HBP) is more versatile (covers all the stages of kidney diseases, including the initial) and more consistent with the tasks of prevention and nephroprotection than the old term " Chronic renal failure "(CPN).

Examples of diagnosis wording:

Chronic glomerulonephritis of mixed type (nephrotic syndrome, arterial hypertension), morphologically - focal-segmental glomerosclerosis, with a moderate decrease in function, HBP-3: A (CPN I).

Sugar diabetes type 2. Diabetic nephropathy. Proteinuria. HBP-3: a

Chronic interstitial nephritis (analgesic nephropathy), terminal renal failure. Hemodialysis treatment since 2007. HBP-5: D.

Chronic gematuric type glomerulonephritis (IGA nephropathy, kidney biopsy in 01/1996) in the terminal renal failure. Hemodialysis treatment from 02/2004. His kidney allotransplantation at 04/2006. Chronic transplant nephropathy. HBP-4: T.

Chronic kidney disease and arterial hypertension

Chronic kidney disease is an independent risk factor for cardiovascular complications. Between kidney damage, arterial hypertension And the remodeling of the cardiovascular system exists a close relationship. The violation of the kidney function is celebrated at each fourth patient with cardiovascular diseases.

Only every fifth patient level systolic blood pressure Below 140 mm Hg, while safe for kidney level is the level below 130. That is, 80% control arterial pressure At the idiosal stage it is conducted unsatisfactory.

To date, it has been established that the risk of cardiovascular complications increases sharply compared with the proper leveling level already at the stage of moderate reducing the kidney function. As a result, most patients with chronic kidney disease do not live to dialysis, dilding at earlier stages. Special danger of chronic kidney disease, as well as other, more well-known, "quiet killers" - sugar diabetes and arterial hypertension - It is that it can not cause any complaints for a long time that would wonder the patient to appeal to the doctor and begin treatment.

Symptoms of chronic kidney disease

There are the following complaints, allowing to suspect kidney disease and urinary tract and violation of their functions:

• pain and discomfort in the lumbar region;
• a change in the type of urine (red, brown, turbid, foam, containing "flakes" and precipitate);
• students of urination, imperative urges (hard to endure the urge, you need to immediately run to the toilet), difficult to urinate (sluggish jet);
• reduction of daily urine (less than 500 ml);
• polyuria, violation of the process of concentrating urine by the kidney at night (regular urge on urination at night);
• constant feeling of thirst;
• bad appetite, disgust for meat food;
• general weakness, malaise;
• shortness of breath, reducing load portability;
• an increase in blood pressure, often accompanied by headaches, dizziness;
• pain behind sternum, heartbeat or heart interruptions;
• skin itch.

According to Nhanes research (National Health and Nutrition Examination Survey)At a minimum, each tenth resident of the Earth has signs of damage to the kidneys or reduce their functions. Large studies allowing to assess the prevalence of chronic kidney disease in the Russian population has not been conducted.

According to studies in individual groups of the population with an increased risk of kidney damage, signs of chronic kidney disease are marked more than 1/3 patients with chronic heart failure, the decrease in the kidney function is observed in 36% of persons over the age of 60.

A study conducted with the participation of specialists of the First Moscow State Medical University. Sechenov, which included more than 1000 patients of working age (30-55 years) who were not previously observed by a nephron and who had not previously been diagnosed with kidney disease, revealed a decrease in the speed of glomerular filtration to a level of less than 60 ml / min / 1.73 m 2 for each sixth patient without Diseases of the cardiovascular system and each fourth patient with cardiovascular diseases. Another major screening study conducted on the basis of the health centers of the Moscow region, that is, among the conditionally healthy population, revealed a high and very high excretion of albumin (more than 30 mg / l) in 34% of the surveyed.

Today, data indicate a predominance in the population of secondary nephropathies. IN different countries "Palm Championship" divide kidney lesions during diabetes and cardiovascular diseases (diabetic and hypertensive nephropathy as well ischemic disease kidney).

Given the steady growth in the population of the number of patients diabetes It can be expected that the proportion of secondary nephropathies in the structure of the HBC will increase even more.

A significant part of patients with HBA constitute patients chronic glomerulonephritis , chronic interstitial jade (Analgesic nephropathy occupies a special place), chronic pyelonephritis , Polycystic kidney disease. Other nosologies are significantly less common.

Very important factor in the risk of kidney defeat, the fight against which due attention is not paid in Russia, is the abuse of analgesics and non-steroids by anti-inflammatory drugs, "Hobby" food additives (Means to reduce weight in women, protein cocktails for building muscle mass in men).

In countries that are poorly provided with dialysis, such as Russia, substitution therapy, in the first place, are selected by patients of young age, which have tolerability of dialysis and the forecast is better compared to the elderly suffering diabetes, severe cardiovascular diseases.

It is important to emphasize that at the beginning of the development of HBS, the kidney function can remain preserved for a long time, despite the presence of pronounced signs of damage. With a normal or increased SCF, as well as in patients with its initial decline (60 ≤ SCF<90 мл/мин/1,73 м 2 ) наличие признаков повреждения почек является обязательным условием для диагностики ХБП.

SCF more than 120 ml / min / 1.73 m 2 is also considered to be a deviation from the norm, since in persons suffering from diabetes mellitus and obesity can reflect the phenomenon of hyperfiltration, that is, a breakdown of the glomeruli, caused by the increased perfusion with the development of glomerular hypertension, which leads To their functional overload, damage with further sclerization. However, today, increased glomeric filtering is not included in the number of independent diagnostic CRT criteria, and is considered a risk factor for its development. On the presence of a HBE in diabetes and obesity, they speak only if there are renal damage markers, first of all, increased albuminuria.

The level of SCF within 60-89 ml / min / 1.73 m2 in the absence of signs of renal damage is indicated as "initial decrease in the SCF", but the diagnosis of the HBE is not put. For persons 65 years and older, it is regarded as an option of age norm. Persons younger than this age recommend monitoring the condition of the kidneys at least once a year and the active prevention of HBS.

Stages of development of chronic kidney disease

At the same time, the decrease in the SCF to the level of less than 60 ml / min / 1.73 m 2 even with the complete absence of signs of renal damage and regardless of age not only indicates the presence of HBS, but also corresponds to its advanced stages (3-5). For example, a patient with SCF 55 ml / min / 1.73 m 2 with absolutely normal analyzes of urine and ultra-sound pattern of the kidney will be diagnosed with HBP 3A stage.

Depending on the level of the SCF, 5 stages of HBS are distinguished. Patients with 3 Stages of HBC Most of all in the population, at the same time, this group is inhomogeneous at risk of cardiovascular complications, which increases as the SCF decreases. Therefore, 3 Stage HBS was asked to divide into two substards - A and B.

The classification of HBS is distributed on patients receiving renal renal therapy - dialysis or kidney transplantation. Considering that standard dialysis provides moderate blood purification ratio from nitrogen slags (at a level corresponding to SCF less than 15 l / min), all dialysis patients relate to 5 HBS stages.

Criteria for the diagnosis of chronic kidney disease

1) the presence of any kidney damage markers:

• a) clinical laboratory (primarily elevated albuminuria / proteinuria), confirmed during repeated studies and remaining for at least 3 months;
• b) irreversible structural changes of the kidneys identified during radiation studies (for example, with an ultrasound) or morphological study of the renal biopsy

2) Reducing the speed of glomerular filtration (SCF) to the level< 60 мл/мин/1,73 м 2 , сохраняющееся в течение трех и более месяцев.

Thus, the concept of the HBE consists of two components: signs of damage to the kidneys and reduction of the SCF.

Risk factors of chronic kidney disease

The main risk factors of the HBC include diabetes and other metabolic disorders, the presence of cardiovascular diseases, a number of autoimmune and infectious diseases, neoplasms, smoking and other bad habits, elderly age and male floor, the presence of HBA in direct relatives and others. Of particular importance have factors leading to the development of the oligrony, i.e. The inconsistency of the number of operating nephrons needs of the body: kidney operations, aplasia and kidney hypoplasia - on the one hand, and obesity - on the other.

In most cases, the kidney disease flows for a long time, without causing any complaints, changes in well-being, which would be forced to consult a doctor. Early clinical laboratory signs of kidney lesions often have a non-market picture, and do not cause a doctor's caution, especially if we are talking about the patient of elderly and old age. The initial symptoms of the renal disease are considered as an "age norm".

The most common kidney disease in the population - secondary nephropathy when arterial hypertension, diabetes and other systemic diseases. At the same time, patients are observed with therapists, cardiologists, endocrinologists without the attraction of the nephrologist - to the latest stages, when the possibilities of nephroprotective treatment are minimal.

• 1. Do not abuse salt and meat food. As much as possible to limit the use of canned food, food concentrates, fastest products.
• 2. Control the weight: not allow overweight and not drop it sharply. More use vegetables and fruits, limit high-calorie products.
• 3. Drink more fluid, 2-3 liters, especially in the hot season: fresh water, green tea, renal films, natural fruit, compotes.
• 4. Do not smoke, do not abuse alcohol.
• 5. Regularly engage in physical education (for kidney it is no less important than for the heart) - if possible, 15-30 minutes per day or 1 hour 3 times a week. Move more (walking on foot, if possible, do not use the elevator, etc.).
• 6. Do not abuse painkillers (if it is impossible to abandon them completely from them, limit the reception to 1-2 tablets per month), not to take on their own, without appointing a diuretic doctor, do not engage in self-treatment, do not get involved in food additives, do not experiment on oneself, using " Thai herbs "with an unknown composition," fat burners ", allowing" to lose weight and forever without any effort on your part ".
• 7. Protect itself from contacts with organic solvents and heavy metals, insecticides and fungicides at work and in everyday life (during repair, maintenance of the machine, work on the household plot, etc.), use protective equipment.
• 8. Do not abuse the stay in the sun, prevent the subcooling of the lumbar region and the pelvis organs, legs.
• 9. Control blood pressure, blood glucose and blood cholesterol.
• 10. Regularly undergo medical examinations to estimate the state of the kidneys (general urine analysis, albuminuria, biochemical blood test, including blood creatinine, ultrasound - 1 time per year).

Mandatory testimony to regular surveys to exclude HBS are:

• diabetes;
• arterial hypertension;
• other cardiovascular diseases (CHD, chronic heart failure, damage to peripheral arteries and brain vessels);
• obstructive urinary tract diseases (stones, urinary tract abnormalities, prostate diseases, neurogenic bladder);
• autoimmune and infectious systemic diseases (systemic red lupus, vasculitis, rheumatoid arthritis, subacute infectious endocarditis, HBV-, HCV-, HIV infection);
• diseases nervous system and joints requiring regular intake of analgesics and NSAIDs;
• cases of terminal renal failure or hereditary diseases of the kidneys in a family history;
• random detection of hematuria or proteinuria in the past.

Kidney damage markers This is any changes that are detected in clinical and laboratory surveys, which are associated with the presence of a pathological process in renal tissue (Table 1).

Table 1. Basic kidney damage markers that allow assume the presence of HBS

HBS - Non-forensic concept, and at the same time is not a formal association of chronic damage to the kidneys of various nature.

The reasons for the allocation of this concept are based on the unity of the main pathogenetic mechanisms for the progression of the pathological process in the kidneys, the community of many risk factors for the development and progression of the disease during the damage to the organ of different etiology and the methods of primary and secondary prophylaxis flowing.

The diagnosis of HBS should be established on the basis of the following criteria:

1. The presence of any clinical markers of damage to the kidneys, confirmed with an interval of at least 3 months;
2. Any markers of irreversible structural changes of the body identified once in a plundered morphological examination of the body or with its visualization;
3. Reducing the speed of glomerular filtration (SCF)< 60 мл/мин/1,73 кв.м в течение трех и более месяцев, вне зависимости от наличия других признаков повреждения почек.

In 2007, the World Health Organization (WHO) significantly clarified the heading N18 (earlier this under the code was "chronic renal failure") of the international classifier of diseases (ICD-10). In order to preserve the generally accepted diagnosis structure, the diagnosis of "chronic kidney disease" is recommended to indicate after the main disease and then the encoding of the disease is established in accordance with the ICD on the main disease.

If the etiology of the renal function is unknown, "chronic kidney disease" can be exhibited the main diagnosis, which is encoded by refricted N18 (where N18.1 is chronic kidney disease, stage 1; N18.2 - chronic kidney disease, stage 2, etc. ).

* - To refer to the etiology, the CBS should use the appropriate disease codes

** - code N18.9 Indicates cases of HBP with unspecified stage

The need to detect HBS on early stage in children

Children have their own list of diseases that lead to the development of HBS:

1. Polycystic kidney or other genetic diseases of the kidneys in a family history.
2. Small weight at birth.
3. Acute renal failure as a result of perinatal hypoxemia or other sharp kidney damage.
4. Renal dysplasia or hypoplasia.
5. Urological anomalies, especially obstructive uropathy.
6. Bubble-ureteral reflux associated with re-infections of urinary tract and kidney scarring.
7. Acute nephrite or nephrotic syndrome in anamnesis.
8. Hemolytic-uremic syndrome in history.
9. SHENLEYNA DISEASE - Genoch in anamnesis.
10. Sugar diabetes.
11. System red lupus.
12. Hypertension in history, in particular as a result of renal artery thrombosis or renal veins in the perinatal period.

Children with a lag in physical development (growth delay, low body weight), ricket-like skeletal deformations, metabolic acidosis, early emerging anemia, polyuria, polydipsey, proteinuria, hypertension, a violation of the concentration kidney function represent a risk group for the development of HBS, which requires a thorough examination of these patients, the appointment of corrective and substitution therapy in order to prevent or slow down the progression of HBS.

Congenital, hereditary and acquired kidney disease in children potentially carry the likelihood of adverse outcomes - the formation of chronic kidney disease (HBP) and CPN.

The need to identify HBS in children at an early stage is a socially significant task - the earlier we will begin the prevention of identifying the risk of risk of HBS in children, more people It will remain healthy and able-bodied, while significantly reduced the risk of developing concomitant diseases.

The symptoms of chronic renal failure is largely determined by the course of the underlying disease, but independently of the nosology that caused the development of Glomerulosclerosis, for chronic renal failure, changes in organs and systems caused by the effects of toxic metabolic products are characterized. At the moment, along with uremic toxins, more than 200 substances are known, the accumulation of which causes the progression of chronic renal failure.
Appearance It does not suffer before the stage, when glomerular filtration is significantly reduced.
Due to the anemia, pallor appears, due to water-electrolyte disorders, dry skin dry.
As The progression of the process appears the jaggility of the skin and mucous membranes, reduce their elasticity.
Spontaneous hemorrhages and bruises may appear.
Due to the skin of the skin arise rasche.
Characterized so-called renal edema with the endlessness of the face up to the extended anasarki.
The muscles also lose tone, become flabby, which is increasing fatigue and falls the ability of patients.
Defeat nervous system.
This is manifested by apaticity, night sleep disorders and drowsiness during the day. Reduced memory, learning ability. As CPN is increasing, pronounced inhibition and disorder of ability to memorize and thinking.
Violations in the peripheral part of the nervous system are affected by the zyabacity of the limbs, the sensations of tingling, crawling goosebumps. In the future, motor disorders are joined in their hands and legs.
Urinary function.
It first suffers from the type of polyuria (increasing urine volume) with the predominance of night urinary. Further, CPN develops along the way to reduce urine volumes and the development of edema syndrome, until the complete absence of selection.
Water salt balance.
Salt imbalance is manifested by increased thirst, dry mouth.
Weakness, darkness in the eyes with a sharp rise (due to sodium losses).
Absorbent potassium explains muscle paralysis.
Breath disorders.
Defend of heartbeat, arrhythmias, intracardiac blockades up to a heart stop.
On the background increasing the development of parathyroid glands of the parathgamon appears high level Phosphorus I. low level Calcium in the blood. This leads to the softening of bones, spontaneous fractures, skin toide.
Violations of nitrogen balance.
They determine the growth of creatinine blood, uric acid and urea, as a result:
At the SCF less than 40 ml in a minute, enterocolite develops (lesion of thin and colon with pains, swelling, frequent liquid chair).
Ammonia smell of mouth.
Secondary articular lesions according to the type of gout.
The cardiovascular system.
First, responds with an increase in blood pressure.
Secondly, the lesions of the heart (muscles - myocarditis, a nearby bag - pericarditis).
There are blunt pain in the heart, violations heart Rhythm, shortness of breath, swelling on the legs, the increase in the liver.
With an unfavorable course of myocarditis, the patient may die against the background of acute heart failure.
Pericarditis can proceed with the accumulation of fluid in a windowless bag or losing in it of uric acid crystals, which in addition to pain and expansion of the heart boundaries, while listening chest It gives the characteristic ("funeral") noise of fridge friction.
Blealing.
Against the background of the development of erythropoietin kidneys, hematopoia slows down. The result becomes anemia, manifested very early weakness, lethargy, reduced performance.
Pulmonary complications.
Characteristic for later stages of CPN. This is a uremic light - interstitial swelling and bacterial inflammation of light Against the background of falling immune protection.
Digestive system.
It reacts with a decrease in appetite, nausea, vomiting, inflammation of the mucous membrane and salivary glands. Under Urema, erosive and ulcerative defects of the stomach and intestines, fraught with bleeding (black feces appears). A sharp hepatitis is also becoming a spicy hepatitis.