Chronic renal insufficiency

Chronic renal insufficiency: description

The term “chronic kidney failure” is used by physicians when kidney function has dropped to less than 60 percent. The severity of the disease can be divided into five stages (read more in the article Kidney Failure – Stages). In Western Europe, about 10 out of every 100,000 people develop chronic renal insufficiency each year. It has dangerous effects on the body.

uremia

The main tasks of the kidneys are blood purification and water elimination. Every day, the body produces metabolites that are transported in the blood to the kidneys and excreted in the urine. They are also called urinary substances.

If a chronic renal insufficiency is present, the body can no longer excrete the toxic metabolic products – they accumulate in the blood and cause urine poisoning (uremia). In addition, it comes to water retention in the tissue (edema), as the kidneys can no longer completely eliminate the ingested liquid.

Further consequences for the body

In addition to the excretory function, the kidney has even more tasks. It helps to control blood pressure and regulate bone metabolism. In addition, it produces various hormones that are important, among other things, for the formation of blood. Thus, chronic renal failure also affects other body functions – the blood pressure, hormone and vitamin balance and the blood coagulation system are changing. These changes due to kidney weakness ultimately have consequences for the whole body.

risk of death

Chronic renal insufficiency can lead to renal failure and eventually death if left untreated: patients undergo artificial blood dialysis or undergo kidney transplantation.

Chronic renal insufficiency: symptoms

The symptoms of chronic renal insufficiency can be found in the article Kidney Failure – Symptoms.

Chronic renal insufficiency: stages

Chronic renal failure occurs at various stages. All important information can be found in the article Kidney Failure – Stages.

Chronic renal insufficiency: causes and risk factors

Each kidney consists of more than one million kidney bodies (glomeruli). These small, spherical structures contain a tangle of tiny veins whose walls have a filter structure. Through these filter vessels about 180 liters of primary urine are extracted from the blood per day. Various substances and transport mechanisms are used to recover those substances that the body can still use, for example various salts. About one and a half liters of urine remain.

Chronic renal insufficiency makes adequate filtering and purification of the blood impossible. Various diseases can be responsible for this: They lead to a loss of kidney tissue, that is, a part of the renal corpuscles is destroyed. The remaining kidney bodies then take over the tasks of the diseased part. Usually this works well at first, which is why those affected do not notice anything of the diminishing function of the kidneys. Only when there is no longer enough healthy kidney tissue, the chronic renal insufficiency becomes noticeable.

Chronic renal insufficiency: Most common trigger

The most common causes of chronic renal failure are:

• Diabetes (diabetes mellitus): In about 35 percent of all cases, chronic renal insufficiency is caused by diabetes.
• High blood pressure (hypertension): It may be the cause of chronic kidney failure (due to damage to the renal corpuscles), but it can also be the result (as the renal function decreases, increased blood pressure increasing hormones are formed).
• Renal inflammation: Both inflammation of the renal corpuscles (glomerulonephritis) and inflammation of the urinary canals and the surrounding space (interstitial nephritis) can lead to chronic renal insufficiency.
• Cystic kidney: In this congenital malformation of the kidneys occur numerous fluid-filled cavities in the kidneys, which severely limits their function.
• Medicines: kidneys are harmful to over-the-counter analgesics such as acetaminophen, ibuprofen or diclofenac. Especially with prolonged use, they can cause chronic renal insufficiency.

In some cases, it is not possible to clarify what has caused chronic renal insufficiency.

Chronic renal insufficiency: examinations and diagnosis

In a detailed conversation with the patient, the doctor first raises the medical history (anamnesis). Among other things, he will ask about pre-existing kidney damage, chronic diseases, medication and kidney disease in the family. This is followed by a physical examination with measurement of blood pressure and heart rate.

Blood and urine examination

A blood test is also a routine in suspected chronic renal failure. In the blood, among other things, the concentration of the urine-containing substances creatinine and urea are measured – they accumulate in the red body juice, if there is a chronic kidney failure. More meaningful than the creatinine value is the so-called creatinine clearance. It allows a statement about the functioning of the kidneys, because a chronic renal insufficiency leads to a reduced creatinine clearance.

If the patient excretes protein with the urine, this substantiates the suspicion of a kidney weakness. With the help of another laboratory value (Glomerular Filtration Rate, GFR), the doctor can determine the severity of the disease.

Further investigations

If the diagnosis “chronic kidney failure” is fixed, the search for the causes follows. Depending on the suspected diagnosis, doctors carry out further urine and blood tests as well as imaging examinations such as ultrasound (ultrasonography). Sometimes the removal of a tissue sample from the kidney (kidney biopsy) is necessary. Even after possible sequelae of renal insufficiency, such as anemia (renal anemia), are being investigated in the investigations.

Chronic renal insufficiency: treatment

Chronic renal insufficiency is treated according to its cause and severity. The cause of the kidney weakness is if possible eliminated or treated, so that the chronic renal failure does not progress further. Once destroyed kidney tissue, however, can not be restored.

The following measures are important for renal failure therapy and the treatment of possible sequelae:

• Ample hydration (two to two and a half liters) and administration of diuretics
• Regular control of blood salts (blood electrolytes) and body weight
• Treatment of hypertension with drugs (especially ACE inhibitors and AT1 blockers)
• Medicines that lower the blood lipid content (lipid-lowering drugs)
• Treatment of anemia due to renal insufficiency (renal anemia)
• Treatment of bone disease (vitamin D deficiency due to renal insufficiency)
• Right nutrition

Despite treatment, chronic renal insufficiency continues to increase in many cases, eventually requiring patients to undergo artificial dialysis or kidney transplantation.

Chronic renal insufficiency: prevention

The most common causes of chronic renal failure are diabetes mellitus and high blood pressure. A good adjustment of the blood sugar and blood pressure values ​​can therefore prevent a chronic kidney weakness.

Since many medications can cause chronic renal insufficiency, you should discuss any medication with your family doctor. This also applies to over-the-counter medications. If there is already a kidney weakness, often a dose adjustment of drugs is required. Generally, you should stop taking medicines for kidney dysfunction chronic renal insufficiency Tune closely with the doctor.

Diet in chronic renal failure

The diet also has an influence on the course of chronic renal insufficiency. More in the article Diet in renal failure!

Chronic renal insufficiency: disease course and prognosis

The sooner a chronic renal failure is detected and treated, the better the chances of success. However, complete healing is usually not possible – the loss of functional kidney tissue can not be reversed.

In men and elderly patients, chronic renal insufficiency is usually faster than in women and younger patients. High blood sugar and blood pressure levels as well as obesity and smoking also have a negative effect on the course of the disease.

A chronic renal insufficiency can shorten the life expectancy of those affected. This is particularly the case when diabetes (diabetes mellitus) is the cause of renal insufficiency. Some patients die from the sequelae of the diseased kidneys, for example, diseases of the cardiovascular system.