Renal failure

Disease description

Renal failure is a condition characterized by the reduction or complete loss of all kidney functions (filtration, secretion, and excretion). It leads to dysfunction of other organs, potentially resulting in irreversible consequences.

Renal failure is classified as either acute (rapid onset) or chronic (slow progression). Acute renal failure typically affects the elderly, with 50% of cases requiring hemodialysis (“artificial kidney”).

The causes of acute renal failure include critical conditions such as: poisoning by toxins, injuries, obstruction by kidney stones, severe blood loss, burns, and acute heart failure.

Chronic renal failure (CRF) develops due to the following kidney diseases:

• Pyelonephritis (inflammation of the renal pelvis and calyces): more common in women and children, it spreads through an ascending infection. It poses a risk of developing emphysematous pyelonephritis, with a mortality rate exceeding 40%.
• Amyloidosis (protein metabolism disorder): accumulation of insoluble fibrillar glycoprotein leads to sclerosis and subsequent necrosis.
• Polycystic kidney disease (multiple cysts): a genetically determined condition.
• Glomerulonephritis (damage to glomeruli and tubules): an autoimmune disease with a progressive course, resulting in the destruction of glomeruli where urine filtration occurs.
• Nephroangiosclerosis (damage to the kidney’s blood vessels): develops against the background of hypertension and leads to kidney atrophy.

Symptoms indicating the need for diagnosis and treatment

In the early stages, symptoms of renal failure are non-specific and include: weakness, fatigue, nausea, loss of appetite.

As the disease progresses, distinct symptoms of renal failure appear:

• Dry mouth and excessive thirst
• Pale and itchy skin
• Decreased urine output (less than 0.5 liters per day)
• Tremors and seizures
• Muscle weakness and brittle bones
• Ammonia odor on the breath

Diagnostic and treatment methods

Diagnosis

The assessment of kidney function in renal failure is conducted using:

• Urine tests: Rehberg and Zimnitsky tests
• Blood biochemistry: levels of urea, creatinine, and electrolytes
• Ultrasound of the kidneys and bladder including Doppler ultrasonography
• Pelvic catheterization

Treatment

The treatment of renal failure involves a comprehensive approach, focusing primarily on addressing the underlying condition that caused the renal failure.

In cases of severe intoxication, device-based detoxification methods are used, including plasmapheresis and hemosorption. For advanced renal failure, hemodialysis is employed. If a patient chooses to receive treatment abroad, transportation is possible with a portable “artificial kidney” machine.

Surgical intervention is indicated in acute renal failure, such as in cases of urinary tract obstruction by stones.

If the progression of renal failure cannot be slowed, the patient may require a kidney transplant.

Innovations in global clinics

Researchers from a university hospital in Israel propose replacing kidney transplantation in children with kidney tissue transplantation derived from stem cells. The results of their studies have been published in the prestigious medical journal EMBO Molecular Medicine.