Chronic kidney disease urinary syndrome presentation. Chronic kidney disease (CKD)

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Chronic illness kidneys. Chronic renal failure. 1 Definition 2 ICD-10 diagnosis formulation 3 Clinical picture 4 Risk factors 5 CKD classification 6 CKD diagnostic criteria 7 Treatment 8 Prevention 9 Summary. Plan:.

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Chronic kidney disease. Chronic renal failure

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The filtration function of the kidneys The formula is simple, but it is also desirable to standardize the obtained value to the surface of the patient's body. The Cockcroft-Gault formula has been widely used successfully for many years - not only in nephrology, but also in clinical pharmacology and other areas of medicine. In patients with a decrease in GFR less than 30 ml/min, this formula may give inaccurate results.

It is detected in polyclinics and hospitals by doctors of therapeutic specialties (therapists, cardiologists, endocrinologists). Patients with CKD are treated by a general practitioner. Specialized nephrology care is provided by a nephrologist as well as substitution therapy specialists. Consultation with a nephrologist is advisable in the following cases: GFR<30 мл/мин (ХБП 4–5 стадий). СКФ 30–60 мл/мин (ХБП 3 стадии) с быстрым снижением функции почек или с риском быстрого снижения функции почек: прогрессирующее снижение СКФ (более 15% за 3 месяца), протеинурия более 1 г/сут, выраженная и неконтролируемая артериальная гипертония, анемия (гемоглобин менее 110 г/л). При впервые выявленной сниженной скорости клубочковой фильтрации (СКФ) до 30–60 мл/мин следует оценить стабильность нарушения функции почек. Повторное обследование проводится через 2–4 недели и далее через 3–6 месяцев. Тактика ведения пациентов с ХБП

Measurement of blood pressure, examination of the fundus, GFR and creatinine, lipidogram, glucose, complete blood count (hemoglobin), complete urinalysis, daily microalbuminuria (proteinuria). The frequency is annually. At stage 3: Plus additionally: potassium, sodium, calcium, phosphorus, uric acid. Frequency - every six months, with a stable course (decrease in GFR less than 2 ml / min for 6 months) - annually At stages 4-5: Plus additionally: parathyroid hormone, bicarbonate. Frequency - once a quarter, with a stable course (decrease in GFR less than 2 ml / min for 6 months) - once every six months Diagnostic measures for CKD (K / DOQI, 2006)

ACE inhibitor or ARB treatment Diuretic or non-DHP ant. Ca ACE inhibitor + ARB Diuretic or Non-DHP ant. Ca Accession of drugs of central action Replacement of non-DHP ant. Sa on DGP ant. Ca + betta AB Joining alpha AB

Renoprotective therapy consists of drugs that block the RAS - ACE inhibitors and angiotensin receptor blockers, which is associated with its key role in the progression of nephrosclerosis.

A heterogeneous group of drugs that differ in their effects on central and renal hemodynamics Pronounced antihypertensive effect that persists for drugs with prolonged action during the day Additional organo- and vasoprotective effect Does not cause metabolic disorders Non-hydropyridine drugs reduce intraglomerular pressure and proteinuria Nefidipine may increase intraglomerular pressure and proteinuria, cause activation of the sympathoadrenal system Non-hydropyridines cannot be combined with beta-blockers, which limits the possibility of combined treatment of severe renal hypertension

Forms of CKD and diabetes mellitus are the drugs of choice are non-dihydropyridine calcium antagonists, which, unlike dihydropyridines, do not increase glomerular pressure and do not increase proteinuria.

A heterogeneous group of drugs that have different effects on electrolyte metabolism Have a pronounced antihypertensive effect and reduce the risk of cardiovascular complications Correction of hypertension usually requires small doses Effectiveness of diuretic combinations with different mechanisms of action: Saluretic + potassium-sparing Thiazide + loop Intermittent diuretics are ineffective In CKD 3B- 5 thiazides are ineffective. The drugs of choice are loop diuretics. Sensitivity to them decreases as kidney function decreases. Risk of exacerbation of hyperuricemia, urate crisis when using thiazides and loop diuretics Aldosterone antagonists (aldactone, eplerenone) inhibit the processes of myocardial remodeling and nephrosclerosis. Risk of hyperkalemia and breast cancer in men (aldactone)

Suppress hyperreactivity of the sympathetic-adrenal system that develops in CKD Make an additional contribution to the suppression of the renin-angiotensin system Reduce the risk of cardiovascular complications "-" Frequent side effects: Bronchial obstruction Bradycardia Vasoconstriction Erectile dysfunction Depression, insomnia Metabolic disorders (rarely occur when using therapeutic doses) Not their combination with non-hydropyridine calcium antagonists is recommended. They do not have proven nephroprotective properties. Beta-blockers.

It consists in identifying and eliminating relevant risk factors. The fight against them remains important at the stage of secondary prevention, allowing, along with a decrease in the rate of deterioration of kidney function, also to reduce the risk of cardiovascular complications. prevention

Food. Limit the use of canned food, food concentrates, fast food products as much as possible. Control weight: do not allow excess weight and do not drop it abruptly. Eat more vegetables and fruits, limit high-calorie foods and exclude canned food. Drink more fluids, 2-3 liters, especially in the hot season: fresh water, green tea, kidney herbal teas, natural fruit drinks, compotes. Do not smoke, do not abuse alcohol. Exercise regularly (this is no less important for the kidneys than for the heart!) - if possible, 15-30 minutes a day or 1 hour 3 times a week. TEN GOLDEN RULES to keep your kidneys healthy

Painkillers (if it is impossible to completely refuse them, limit the intake to 1-2 tablets per month), do not take diuretics on your own, without a doctor's prescription, do not self-medicate, do not get carried away with food supplements, do not experiment on yourself by using "Thai herbs" with unknown composition, "fat burners" that allow you to "lose weight once and for all without any effort on your part." Protect yourself from contact with organic solvents and heavy metals, insecticides and fungicides at work and at home (when repairing, servicing a machine, working on a personal plot, etc.), use protective equipment. Do not abuse exposure to the sun, do not allow hypothermia of the lumbar region and pelvic organs, legs. Control blood pressure, blood glucose and cholesterol levels. Regularly undergo medical examinations to assess the condition of the kidneys (general urinalysis, blood creatinine, ultrasound - 1 time per year).

Disability in patients with CKD cannot be assessed, since they depend on the etiology and characteristics of the course of nephropathy, the response to pathogenetic and nephroprotective therapy. The vast majority of patients with CKD stages 4-5, regardless of the therapy, have varying degrees of persistent disability. EVN

Highly specialized, “nephrological”, but general medical problem: the cost of renal replacement therapy is a significant part of the national health budgets; the main causes of terminal renal failure are not primary kidney diseases (glomerulonephritis, hereditary kidney diseases), but secondary nephropathy (diabetic, hypertensive, ischemic); the main cause of death in patients with chronic kidney disease is not uremia, but cardiovascular complications that occur in patients with impaired renal function ten times more often than in the general population and have their own characteristics; summary

Chronic kidney disease at an early stage is not possessed by nephrologists, but by representatives of other specialties (endocrinologists, cardiologists), therapists and general practitioners, who, first of all, are contacted and under the supervision of patients who are at risk of developing chronic kidney disease; the presence of chronic kidney disease limits many methods of treatment and diagnostics widely used in the population (certain antibiotics and antihypertensive drugs, non-steroidal anti-inflammatory drugs and analgesics, radiopaque agents, other potentially nephrotoxic drugs, any drugs excreted by the kidneys) the task of monitoring patients with chronic kidney disease, ensuring effective nephroprotective therapy, achieving the recommended target clinical and laboratory parameters can be solved only with the joint efforts of the entire medical community

"renal failure" is used when referring to the end stage of chronic kidney disease. The diagnosis of "Chronic kidney disease" (even in the absence of a decrease in GFR) implies the inevitable further progression of the process and is intended to attract the attention of a doctor. It is the potential for loss of kidney function that is the most important point in understanding the term "chronic kidney disease".

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"Infectious diseases"- Classification of infectious diseases. Ways of spread of infections. Cholera. 1. Incubation (hidden) from the moment of infection until the first symptoms appear. An organism that does not show signs of disease. Disinfection of clothes, shoes, care items, etc.; Prevention: vaccination. Oars. What are infectious diseases characterized by?

"Kidney disease"- Restricted intake of spicy foods and spices. Treatment of pyelonephritis. Pyelonephritis occurs in a variety of circumstances: the postoperative period, pregnancy. What is diuresis? A dairy-vegetarian diet is recommended, meat, boiled fish are allowed. The main symptoms of kidney disease. Inflammation of the kidneys Pyelonephritis.

"Let's talk about diseases"- Angina flu indigestion. Influenza cold appendicitis. 7. Find the wrong advice for a person with the flu. Infection epidemic quarantine. Draw on your checklist. Therapist surgeon dentist. 3. Signs of what disease are high fever and severe muscle pain? 9. Which doctor corrects bad eyesight?

"Peptic ulcer"- Perforation. Photograph of a stomach ulcer caused by smoking on an empty stomach. Examination of the duodenum. Uriasis tests for Helicobacter pylori. Clinic of gastric ulcer. reactive pancreatitis. Types of ulcers: Acute. 2. Scarring. 3. Not scarring. 4. Chronic. Malignancy. Types of ulcers. Pathogenesis.

"Myeloma"- X-ray of the skull. Myeloma, myeloma G, multiple, diffuse nodular form. The diagnosis can be considered reliable when the first two signs are identified. 2. Paraprotein in myeloma: polyclonal monoclonal. Multiple ulcers of the esophagus. A 30-year-old patient complained of pronounced facial edema.

"Urolithiasis disease"- Endoscopic techniques continue to play an important role in the treatment of ureteral stones. Ureteral stones were diagnosed using laboratory, X-ray and ultrasound methods. In the examined patients, stones were determined at the intersection of the ureters with the iliac vessels (in 10 patients), as well as in the juxtavesical part of the ureter (in 8 patients).