Management of Chronic Kidney Disease

Chronic kidney disease
Chronic kidney disease (CKD), or uremia or Bright's disease or chronic nephritis, is achieving gradual, significant, and final renal function, and thus the glomerular filtration.

All chronic renal disease and acute renal diseases incurable lead inevitably to chronic renal failure in a period varies from a few weeks to several decades. We can define chronic renal failure as the irreversible reduction in glomerular filtration.

Any renal failure, whatever the cause, is the result of a reduction in the number of active nephrons. The nephrons are excluded affected or destroyed, the remaining nephrons behave like healthy nephrons. They provide their own control of renal homeostasis (balance within the body).

The kidney can perform its excretory capacity for very long because it just 20% of nephrons to function. When lesions involve more than 80% of nephrons, the troubles begin to emerge.

From the destruction of 80% of its capacity, chronic renal failure begins.

All kidney disease may progress to chronic renal failure:

* Polycystic family;
* Diabetes mellitus;
* Hypertension;
* Chronic glomerulopathy;
* Chronic interstitial nephritis;
* Dilated urinary excretory by obstacles;
* Multiple myeloma, systemic lupus erythematosus;
* Alport syndrome.

For some diseases, renal disease is usually transient:

* Rhabdomyolysis complicated by acute renal failure.

Chronic renal failure does long asymptomatic.

When they occur, are:

* Asthenia with anemia and weight loss;
* Anuria-oliguria: that is to say less than 300ml/24h urine;
* Digestive disorders: anorexia, nausea, vomiting, diarrhea, gastrointestinal bleeding;
* Neurological disorders: Mononeuropathy forward leg, calf fatigue, paresthesias (tingling in the legs), weakness of the lower limbs;
* In very severe cases, there are problems with mental confusion, disorientation, stupor ... ;
* Signs of heart: pericarditis, congestive heart failure, hypertension;
* Bone disorders: renal osteodystrophy: bone pain, secondary hyperparathyroidism, osteomalacia;
* Gout attacks;
* Skin disorders: skin infections, pruritus;
* Urinary tract infections.

At a later stage, anemia causes a yellowish pallor, tachycardia, poor exercise tolerance, fatigue and other problems still...

The severity of chronic kidney disease is estimated by creatinine clearance.

It is estimated by the Cockcroft (patients under 80 years):
CrCL coef = x ((140-age) x weight) / creatinine

With a weight in kg, age in years, creatinine in micromoles / L;
The coefficient is 1.25 for men and 1.04 for women.

Interpretation and classification
Renal failure is:

* Starting between 60 and 90 ml / min;
* Moderate when creatinine clearance is between 30 and 60 ml / min;
* Severe between 10 and 30 ml / min, between 15 and 30 in the diabetic;
* Severe or terminal below 10 ml / min and below 15 in the diabetic;
* Requires dialysis below 10 ml / min.

The blood urea rises rapidly. Creatinine blood also increases while decreasing its clearance. Hyperuricemia is common.

Anemia is constant during chronic renal failure (except in cases of polycystic). Because the kidney can synthesize more of EPO.

Hyperkalemia can be fatal.

Metabolic acidosis, the hydro-electrolytic imbalances, calcium phosphate disorders (hypocalcemia, hyperphosphatemia) are important.

The lower speed motor nerve conduction and sensory neuropathy device detects sensory-motor.

Initially, when chronic renal failure is not very advanced, treatment and lifestyle advice is sufficient.

In very advanced stages, patients' lives are threatened. Some said alternative treatments such as periodic hemodialysis by artificial kidney, peritoneal dialysis or kidney transplantation becomes necessary.

However, dialysis does not replace all functions of the kidney failure and complications are possible and require close monitoring. Only the kidney transplant can find an almost normal life, with regular intake without interruption of immunosuppressive therapy.

In 2003, according to a survey by the National Health Insurance, 33 000 patients in France were treated by dialysis, 25 000 were holders of a functioning kidney transplant.

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