Chronic kidney disease - classification, stages, causes and treatment of the disease. Everything about chronic kidney failure: from symptoms to prevention Chronic kidney disease code

Markers of kidney damage are any changes revealed during clinical and laboratory examination that are associated with the presence of a pathological process in the renal tissue (Table 1).

Table 1. Main markers of kidney damage that suggest the presence of CKD

Marker	Notes
Albuminuria/proteinuria	Persistent increase in urinary albumin excretion of more than 10 mg/day (10 mg albumin/g creatinine) - see recommendation
Persistent changes in urine sediment	Erythrocyturia (hematuria), cylindruria, leukocyturia (pyuria),
Changes in the kidneys on imaging studies	Anomalies of kidney development, cysts, hydronephrosis, changes in kidney size, etc.
Changes in blood and urine composition	Changes in serum and urinary concentrations of electrolytes, disorders of CBS, etc. (including those characteristic of “tubular dysfunction syndrome” (Fanconi syndrome, renal tubular acidosis, Bartter and Gitelman syndromes, nephrogenic diabetes insipidus, etc.)
Persistent decrease in glomerular filtration rate less than 60 ml/min/1.73 sq.m	In the absence of other markers of kidney damage (see recommendation)
Pathomorphological changes in kidney tissue identified during intravital nephrobiopsy	Changes that undoubtedly indicate “chronization” of the process (sclerotic changes in the kidneys, changes in membranes, etc.) should be taken into account.

CKD is a supranosological concept, and at the same time is not a formal association of chronic kidney damage of various natures.

The reasons for identifying this concept are based on the unity of the main pathogenetic mechanisms of progression of the pathological process in the kidneys, the commonality of many risk factors for the development and progression of the disease in case of organ damage of various etiologies and the ensuing methods of primary and secondary prevention.

The diagnosis of CKD should be based on the following criteria:

The presence of any clinical markers of kidney damage, confirmed at intervals of at least 3 months;
Any markers of irreversible structural changes in the organ, identified once during a lifetime morphological study of the organ or during its visualization;
Decreased glomerular filtration rate (GFR)< 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 N18 category (previously this code meant “Chronic renal failure”) of the International Classification of Diseases (ICD-10). In order to preserve the generally accepted structure of the diagnosis, it is recommended that the diagnosis “Chronic kidney disease” be indicated after the main disease, and then the coding of the disease is established in accordance with the ICD for the main disease.

If the etiology of renal dysfunction is unknown, then the main diagnosis can be “Chronic kidney disease”, which is coded under N18 (where N18.1 - Chronic kidney disease, stage 1; N18.2 - Chronic kidney disease, stage 2, etc. ).

Stages of CKD	ICD-10 code (as amended by October 2007)**	Description of ICD-10
		CKD stage 1, kidney damage with normal or increased GFR (>90 ml/min)
		CKD stage 2, kidney damage with slightly reduced GFR (60-89 ml/min)
		CKD stage 3, kidney damage with moderately reduced GFR (30-59 ml/min)

		CKD stage 4, kidney damage with a pronounced decrease in GFR (15-29 ml/min)
		CKD stage 5, chronic uremia, end-stage kidney disease (including cases of RRT (dialysis and transplantation)

* - appropriate disease codes should be used to indicate the etiology of CKD

** - code N18.9 indicates cases of CKD with an unspecified stage

The need to identify CKD at an early stage in children

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

1. Family history of polycystic kidney disease or other genetic kidney diseases.
2. Low birth weight.
3. Acute renal failure as a result of perinatal hypoxemia or other acute kidney injury.
4. Renal dysplasia or hypoplasia.
5. Urological abnormalities, especially obstructive uropathy.
6. Vesicoureteral reflux associated with recurrent urinary tract infections and kidney scarring.
7. History of acute nephritis or nephrotic syndrome.
8. History of hemolytic-uremic syndrome.
9. History of Schonlein-Henoch disease.
10. Diabetes mellitus.
11. Systemic lupus erythematosus.
12. History of hypertension, in particular as a result of thrombosis of the renal artery or renal vein in the perinatal period.

Children with retarded physical development (growth retardation, low body weight), rickets-like skeletal deformities, metabolic acidosis, early-onset anemia, polyuria, polydipsia, proteinuria, hypertension, impaired renal concentration function represent a risk group for the development of CKD, which requires a thorough examination of these patients, prescribing corrective and replacement therapy to prevent or slow down the progression of CKD.

Congenital, hereditary and acquired kidney diseases in children potentially carry the risk of developing unfavorable outcomes - the formation of chronic kidney disease (CKD) and chronic renal failure.

The need to identify CKD in children at an early stage is a socially significant task - the sooner we begin to prevent the identification of risk factors for the development of CKD in children, the more people will remain healthy and able to work, while the risk of developing concomitant diseases in them will be significantly reduced.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Chronic renal failure, unspecified (N18.9)

general information

Short description

Chronic renal failure (CRF)- persistent irreversible progressive impairment of the homeostatic functions of the kidneys (filtration, concentration and endocrine) due to the gradual death of nephrons.

Protocol code: H-T-028 "Chronic renal failure"
For therapeutic hospitals
ICD-10 code(s):
N18 Chronic renal failure

Classification

NKF K-DOQI (National Kidney Foundation - Kidney Disease Outcomes Quality Initiative)
There are 5 stages of chronic kidney disease (CKD); Stages 3-5 of CKD, when GFR is less than 60 ml/min, are classified as CKD.

Stage 3 CKD- GFR 59-30 ml/min.

Stage 4 CKD- GFR 29-15 ml/min. (pre-dialysis period of chronic renal failure).

Stage 5 CKD- GFR less than 15 ml/min. (end-stage chronic renal failure).

Diagnostics

Diagnostic criteria

Complaints and anamnesis: symptoms of chronic kidney disease or characteristic syndromes of chronic renal failure (hematuria, edema, hypertension, dysuria, pain in the lower back, bones, nocturia, retardation in physical development, bone deformation).

Physical examination: itching, swelling, urinary breath, dry skin, pallor, nocturia and polyuria, hypertension.

Laboratory research: anemia, hyperphosphatemia, hyperparathyroidism, increased levels of urea and creatinine, TAM - isosthenuria, GFR less than 60 ml/min.

Instrumental studies:

Ultrasound of the kidneys: absence, reduction in size, change in the shape of the kidneys, uneven contours, expansion of the collecting systems of the kidneys, ureters, increased echogenicity of the parenchyma;

Dopplerography of kidney vessels - depletion of blood flow;

Cystography - vesicoureteral reflux or condition after antireflux surgery;

Nephroscintigraphy - foci of renal sclerosis, decreased excretory-evacuation function of the kidneys.

Indications for consultation with specialists:

ENT doctor;
- dentist;
- gynecologist - for the treatment of infections of the nasopharynx, oral cavity and external genitalia;

Oculist - to assess changes in microvessels;

Severe arterial hypertension, ECG abnormalities, etc. are indications for consultation with a cardiologist;

In the presence of viral hepatitis, zoonotic and intrauterine and other infections - an infectious disease specialist.

List of main diagnostic measures:

General blood test (6 parameters);

General urine analysis;

Urinalysis according to Zimnitsky;

Rehberg's test;

Determination of residual nitrogen;

Determination of creatinine, urea, intact parathyroid hormone, acid-base balance;

Determination of potassium/sodium.

Determination of calcium;

Determination of chlorides;

Determination of magnesium;
- determination of phosphorus;

Level of serum ferritin and serum iron, transferrin saturation coefficient with iron;

Ultrasound of the abdominal organs;

Doppler ultrasound of blood vessels.

List of additional diagnostic measures:

Determination of glucose, free iron, number of hypochromic red blood cells;

Coagulogram 1 (prothrombin time, fibrinogen, thrombin time, APTT, plasma fibrinolytic activity, hematocrit);

Determination of ALT, AST, bilirubin, thymol test;

ELISA markers for VH;

Determination of total lipids, cholesterol and lipid fractions;

CT scan;

Consultation with an ophthalmologist.

Differential diagnosis

Sign	surge arrester	chronic renal failure
Subsequence Stages	Oliguria - polyuria	Polyuria - oliguria
Start	Acute	Gradual
Arterial pressure	+	+
Retarded physical development, osteopathy	-	-/+
Kidney ultrasound	Enlarged more often	Reduced, increased Echogenicity
Dopplerography of renal vessels	Decreased blood flow	Decreased blood flow in combined with an increase resistance index Vessels

Treatment abroad

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Treatment

Treatment goals:
- stage 3 of CKD - slowing down the rate of progression of chronic kidney disease;
- Stage 4 - preparation for dialysis therapy, kidney transplantation;
- Stage 5 - renal replacement therapy (peritoneal dialysis, hemodialysis, kidney transplantation).

Non-drug treatment

Diet, table No. 7 (No. 7a or No. 7b - for severe chronic renal failure, No. 7d - for patients on hemodialysis). Reducing protein intake to 0.6 g/kg/day; in stage 5, protein intake is increased to 1.2 g/kg/day.

For hyperkalemia (oliguria, anuria) - limit foods containing potassium salts. Reducing phosphorus and magnesium intake. The volume of fluid consumed is 500 ml higher than the daily diuresis. Limiting table salt, with the exception of salt-wasting syndrome.

Drug treatment

1. Correction of arterial hypertension:
- ACE inhibitors;
- angiotensin II receptor blockers;
- dihydroperidine (amlodipine) and non-dihydropyridine calcium channel blockers (verapamil, diltiazem groups);
- beta-blockers;
- loop diuretics (furosemide).

2. Correction of hyperphosphatemia and hyperparathyroidism: calcium gluconate or carbonate, lanthanum carbonate, sevelamer hydrochloride, calcitriol.

3. Correction of hyperlipidemia: statins. Statin doses are reduced when GFR is less than 30 ml/min.

4. Correction of anemia: epoetin beta, iron-III preparations (for intravenous administration, low molecular weight dextran), red blood cell transfusion for health reasons when the hemoglobin level is less than 60 g/l.

5. Correction of water and electrolyte balance. In the predialysis period, adequate fluid replacement through diuresis.
In the presence of edema, diuretic therapy: loop diuretics in combination with hydrochlorothiazide.
If the creatinine level is more than 180-200 µmol/l, hydrochlorothiazide preparations are not indicated.
In the terminal stage, in the presence of diuresis, diuretic therapy with large doses of furosemide (up to 120-200 mg once) is indicated on interdialysis days to preserve residual urine volume for a long time. Limit sodium to 3-5 g/day.
Correction of acidosis: necessary if the concentration of bicarbonates in the blood serum is less than 18 mmol/l (in the later stages, at least 15 mmol/l). Prescribe calcium carbonate 2-6 g/day, sometimes sodium carbonate 1-6 g/day.

Further management:

Monitoring of filtration and concentration functions of the kidneys, urine tests, blood pressure, ultrasound of the kidneys, nephroscintigraphy of the kidneys, vaccination against viral hepatitis B;
- with GFR 30 ml/min. - formation of an arteriovenous fistula or solution to the issue of preventive kidney transplantation;
- when the GFR level is less than 15 ml/min. - renal replacement therapy (peritoneal dialysis, hemodialysis, related/living donor/cadaveric kidney transplantation).

List of essential medications:

1. ACE inhibitor (fosinopril)

2. Angiotensin II receptor blockers

3. *Atenolol 50 mg, tablet, Dilatrend, Concor

4. *Verapamil hydrochloride 40 mg, tablet, diltiazem

5. *Furosemide 20 mg/2 ml, amp.

6. *Epoetin beta, 1000 IU and 10,000 IU, syringe tubes

7. *Calcium gluconate 10 ml, amp., calcium carbonate, lanthanum carbonate, celelamer hydrochloride, alfacalcidol, rocaltrol, calcitriol

8. *Iron-III preparations for intravenous administration, low molecular weight iron dextran, 2 ml/100 mg, amp.

9. Hemodialysis with GFR less than 15 ml/min.

10. *Iron sulfate monohydrate 325 mg, table.

11. Amlodipine

List of additional medications:

1. Clinical recommendations. Formulary. Vol. 1. Publishing house "GEOTAR-MED", 2004. 2. Jukka Mustonen, Treatment of chronic renal failure. EBM Guidelines 11.6.2005. www.ebmguidelines.com 3. Evidence-based medicine. Clinical recommendations for practitioners based on evidence-based medicine. 2nd ed. GEOTAR, 2002.

Information

List of developers

Kanatbaeva A.B., Professor, KazNMU, Department of Childhood Diseases, Faculty of Medicine

Kabulbaev K.A., consultant, City Clinical Hospital No. 7, Department of Nephrology and Hemodialysis

Attached files

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CKD, ICD 10 code: N18)– a supernosological concept that unites all patients with signs of kidney damage and/or decreased function, assessed by the value Glomerular filtration rate (GFR), which persist for 3 months or more.

Concept " Chronic kidney disease (CKD) is more universal (covers all stages of kidney disease, including initial ones) and is more consistent with the tasks of prevention and nephroprotection than the old term " Chronic renal failure (CRF).

Examples of diagnosis formulation:

Chronic glomerulonephritis of mixed type (nephrotic syndrome, arterial hypertension), morphologically – focal segmental glomerulosclerosis, with moderate decrease in function, CKD-3: A (CKD I).

Diabetes mellitus type 2. Diabetic nephropathy. Proteinuria. CKD-3: A

Chronic interstitial nephritis (analgesic nephropathy), end-stage renal failure. Hemodialysis treatment since 2007. CKD-5: D.

Chronic glomerulonephritis of the hematuric type (IgA nephropathy, kidney biopsy in 01/1996) in the stage of terminal renal failure. Hemodialysis treatment since 02/2004. Kidney allotransplantation in 04/2006. Chronic transplantation nephropathy. CKD-4: T.

Chronic kidney disease and hypertension

Chronic kidney disease is an independent risk factor for cardiovascular complications. Between kidney damage arterial hypertension and remodeling of the cardiovascular system there is a close relationship. Impaired renal function is observed in every fourth patient with cardiovascular diseases.

Only every fifth patient has a level systolic blood pressure below 140 mm Hg, despite the fact that a safe level for the kidneys is a level below 130. That is, in 80%, blood pressure control at the pre-dialysis stage is unsatisfactory.

To date, it has been established that the risk of cardiovascular complications increases sharply compared to the general population level already at the stage of moderate decline in renal function. As a result, most patients with chronic kidney disease do not survive to dialysis, dying at earlier stages. The particular danger of chronic kidney disease, as well as other, more well-known, “silent killers” is diabetes mellitus And arterial hypertension – is that it may not cause any complaints for a long time that would prompt the patient to see a doctor and begin treatment.

Symptoms of chronic kidney disease

There are the following complaints that allow one to suspect diseases of the kidneys and urinary tract and impairment of their functions:

pain and discomfort in the lumbar region;
change in the appearance of urine (red, brown, cloudy, foamy, containing “flakes” and sediment);
frequent urge to urinate, imperative urge (it is difficult to endure the urge, you must immediately run to the toilet), difficulty urinating (sluggish stream);
decrease in the daily amount of urine (less than 500 ml);
polyuria, disruption of the process of urine concentration by the kidneys at night (regular urge to urinate at night);
constant feeling of thirst;
poor appetite, aversion to meat foods;
general weakness, malaise;
shortness of breath, decreased exercise tolerance;
increased blood pressure, often accompanied by headaches and dizziness;
chest pain, palpitations or heart failure;
skin itching.

Prevalence of Chronic Kidney Disease

According to NHANES studies (National Health and Nutrition Examination Survey), at least every tenth inhabitant of the Earth has signs of kidney damage or a decrease in their functions. There have been no large studies to assess the prevalence of chronic kidney disease in the Russian population.

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

A study conducted with the participation of specialists from the First Moscow State Medical University. Sechenov, which included more than 1000 patients of working age (30-55 years), who had not previously been observed by a nephrologist and who had not previously been diagnosed with kidney disease, revealed a decrease in glomerular filtration rate to a level of less than 60 ml/min/1.73 m2 in every sixth patient without diseases of the cardiovascular system and every fourth patient with cardiovascular diseases. Another large screening study conducted at the Health Centers of the Moscow Region, that is, among a relatively healthy population, revealed high and very high albumin excretion (more than 30 mg/l) in 34% of those examined.

The data available today indicate the predominance of secondary nephropathies in the population. In different countries, the “palm” is shared between kidney damage due to diabetes and cardiovascular diseases (diabetic and hypertensive nephropathies, as well as ischemic kidney disease).

Considering the steady increase in the number of patients in the population diabetes mellitus , we can expect that the proportion of secondary nephropathies in the structure of CKD will increase even more in the future.

A significant proportion of patients with CKD are patients chronic glomerulonephritis , chronic interstitial nephritis (analgesic nephropathy occupies a special place), chronic pyelonephritis , polycystic kidney disease. Other nosologies are much less common.

A very important risk factor for kidney damage, the fight against which is not given due attention in Russia, is the abuse of analgesics and non-steroidal anti-inflammatory drugs, “hobby” with nutritional supplements (weight loss products in women, protein shakes for building muscle mass in men).

In countries poorly provided with dialysis, such as Russia, replacement therapy is primarily selected for young patients who have better dialysis tolerance and prognosis compared to older people suffering from diabetes mellitus and severe cardiovascular diseases.

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

GFR more than 120 ml/min/1.73 m2 is also considered a deviation from the norm, since in people suffering from diabetes and obesity, it may reflect the phenomenon of hyperfiltration, that is, disruption of the glomeruli caused by their increased perfusion with the development of glomerular hypertension, which leads to their functional overload, damage with further sclerosis. However, to date, increased glomerular filtration is not included in the independent diagnostic criteria for CKD, but is considered a risk factor for its development. The presence of CKD in diabetes mellitus and obesity is only indicated if there are markers of renal damage, primarily increased albuminuria.

A GFR level of 60-89 ml/min/1.73 m2 in the absence of signs of kidney damage is designated as “initial decline in GFR”, but the diagnosis of CKD is not made. For persons 65 years of age and older, this is regarded as a variant of the age norm. People younger than this age are recommended to monitor their kidney condition at least once a year and actively prevent CKD.

Stages of development of Chronic kidney disease

At the same time, a decrease in GFR to a level of less than 60 ml/min/1.73 m2, even in the complete absence of signs of renal damage and regardless of age, not only indicates the presence of CKD, but also corresponds to its advanced stages (3-5). For example, a patient with a GFR of 55 ml/min/1.73 m2 with absolutely normal urine tests and an ultrasound picture of the kidneys will be diagnosed with stage 3A CKD.

Depending on the level of GFR, 5 stages of CKD are distinguished. Patients with stage 3 CKD are the most common in the population; at the same time, this group is heterogeneous in terms of the risk of cardiovascular complications, which increases as GFR decreases. Therefore, stage 3 CKD was proposed to be divided into two substages - A and B.

The classification of CKD applies to patients receiving renal replacement therapy - dialysis or kidney transplantation. Considering that standard dialysis provides a moderate degree of blood purification from nitrogenous wastes compared to healthy kidneys (at a level corresponding to a GFR of less than 15 l/min), all dialysis patients belong to stage 5 CKD.

Criteria for diagnosing chronic kidney disease

1) presence of any markers of kidney damage:

a) clinical and laboratory (primarily increased albuminuria/proteinuria), confirmed by repeated studies and persisting for at least 3 months;
b) irreversible structural changes in the kidney identified by radiation examination (for example, ultrasound) or morphological examination of a renal biopsy;

2) reduction in glomerular filtration rate (GFR) to the level< 60 мл/мин/1,73 м 2 , сохраняющееся в течение трех и более месяцев.

Thus, the concept of CKD consists of two components: signs of kidney damage and decreased GFR.

Risk factors for chronic kidney disease

The main risk factors for CKD include diabetes mellitus and other metabolic disorders, the presence of cardiovascular diseases, a number of autoimmune and infectious diseases, neoplasms, smoking and other bad habits, old age and male gender, the presence of CKD in direct relatives, etc. Of particular importance have factors leading to the development of oligonephronia, i.e. discrepancy between the number of active nephrons and the needs of the body: kidney surgery, aplasia and hypoplasia of the kidney - on the one hand, and obesity - on the other.

In most cases, kidney disease occurs for a long time without causing any complaints or changes in well-being that would force you to see a doctor. Early clinical and laboratory signs of kidney damage often have a vague picture and do not cause the doctor’s alertness, especially if we are talking about an elderly and senile patient. The initial symptoms of kidney disease are considered as “age-related norms”.

The most common kidney diseases in the population are secondary nephropathy due to arterial hypertension, diabetes mellitus and other systemic diseases. In this case, patients are observed by therapists, cardiologists, endocrinologists without the involvement of a nephrologist - until the very late stages, when the possibilities of nephroprotective treatment are already minimal.

1. Do not overuse salt and meat foods. Limit the consumption of canned food, food concentrates, and instant foods as much as possible.
2. Control weight: avoid excess weight and do not lose it suddenly. Eat more vegetables and fruits, limit high-calorie foods.
3. Drink more liquid, 2-3 liters, especially in the hot season: fresh water, green tea, herbal teas, natural fruit drinks, compotes.
4. Do not smoke, do not abuse alcohol.
5. 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. Move more (walk, if possible - do not use the elevator, etc.).
6. Do not abuse painkillers (if it is impossible to completely give them up, limit your 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 nutritional supplements, do not experiment on yourself by using “ Thai herbs" with an unknown composition, "fat burners" that allow you to "lose weight once and for all without any effort on your part."
7. 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.
8. Do not overexpose yourself to the sun, do not allow hypothermia of the lumbar region and pelvic organs, legs.
9. Monitor blood pressure, blood glucose and cholesterol levels.
10. Regularly undergo medical examinations to assess the condition of the kidneys (general urine test, albuminuria, biochemical blood test, including blood creatinine, ultrasound - once a year).

Mandatory indications for regular examinations to exclude CKD are:

diabetes;
arterial hypertension;
other cardiovascular diseases (coronary artery disease, chronic heart failure, damage to peripheral arteries and cerebral vessels);
obstructive urinary tract diseases (stones, urinary tract abnormalities, prostate diseases, neurogenic bladder);
autoimmune and infectious systemic diseases (systemic lupus erythematosus, vasculitis, rheumatoid arthritis, subacute infective endocarditis, HBV-, HCV-, HIV infection);
diseases of the nervous system and joints that require regular use of analgesics and NSAIDs;
cases of end-stage renal failure or hereditary kidney disease in the family history;
Incidental detection of hematuria or proteinuria in the past.

The term “chronic kidney disease” (CKD) is a new concept, previously known as chronic kidney failure.

It is not a separate disease, but a syndrome, that is, a complex of disorders that are observed in the patient for three months.

According to statistics, the disease occurs in approximately 10% of people, and both women and men are susceptible to it.

There are many factors that cause kidney dysfunction; the most likely causes include:

arterial hypertension. Persistently elevated blood pressure and the disorders that accompany hypertension cause chronic failure;
diabetes. The development of diabetes mellitus provokes diabetic kidney damage, which leads to chronic disease;
age-related changes in the body. Most people develop CKD after age 75, but if there are no associated diseases, the syndrome does not lead to serious consequences.

In addition, CKD can provoke conditions that are associated with kidney dysfunction (renal artery stenosis, urinary outflow disorders, polycystic disease, infectious diseases), poisoning accompanied by kidney damage, autoimmune diseases, obesity.

Hypertension and kidney function are directly related - in people diagnosed with CKD, it ultimately causes problems with blood pressure.

Symptoms

At the first and second stages of the disease, it does not manifest itself in any way, which greatly complicates the diagnosis.

As the disease progresses, other signs appear, including:

rapid and unexplained weight loss, loss of appetite, anemia;
decreased performance, weakness;
pale skin, dryness and irritation;
the appearance of edema (extremities, face);
, decreased amount of urine;
dry tongue, ulceration of mucous membranes.

Most of these symptoms are perceived by patients as signs of other ailments or ordinary fatigue, but if they continue for several months, they should consult a doctor as soon as possible.

Characteristic signs of CKD are persistent with associated symptoms and impaired urine flow.

Classification

The pathological process develops gradually, sometimes over several years. passing through several stages.

With a pathology such as chronic kidney disease, the stages are as follows:

initial. The patient’s tests at this stage may not show serious changes, but dysfunction is already present. As a rule, there are also no complaints - there may be a slight decrease in performance and an increased urge to urinate (usually at night);
compensated. The patient often gets tired, feels drowsy and generally unwell, begins to drink more fluids and go to the toilet more often. Most test parameters may also be within normal limits, but dysfunction progresses;
intermittent. Signs of the disease increase and become pronounced. The patient's appetite worsens, the skin becomes pale and dry, and sometimes blood pressure rises. In a blood test at this stage, the level of urea and creatinine increases;
terminal. The person becomes lethargic, feels constant drowsiness, and the skin becomes yellow and flabby. The water and electrolyte balance in the body is disrupted, the functioning of organs and systems is disrupted, which can lead to early death.

Chronic kidney disease according to ICD-10 is classified as N18.

Diagnostics

The diagnosis of CKD is made on the basis of a set of studies, which include (general, biochemical, Zimnitsky test) and blood, CT, and isotope scintigraphy.

Isotope scintigraphy

The presence of the disease may be indicated by protein in the urine (proteinuria), an increase in the size of the kidneys, tumors in the tissues, and dysfunction.

One of the most informative studies to identify CKD and its stage is to determine the glomerular filtration rate (GFR). A significant decrease in this indicator can indicate CKD, and the lower the rate, the more severely the kidneys are affected. According to the GFR level, chronic kidney disease has 5 stages.

A decrease in GFR to 15-29 units or lower indicates the last stages of the disease, which poses a direct threat to human life.

Why is kidney failure dangerous?

In addition to the risk of the disease progressing to the terminal stage, which carries with it the risk of death, CKD can cause a number of serious complications:

disorders of the cardiovascular system (myocarditis, pericarditis, congestive heart failure);
anemia, blood clotting disorder;
gastrointestinal diseases, including duodenal and gastric ulcers, gastritis;
osteoporosis, arthritis, bone deformities.

Treatment

Treatment of CKD includes treatment of the primary disease that causes the syndrome, as well as maintaining normal kidney function and protecting it. In Russia, there are National Recommendations regarding chronic kidney disease created by experts from the Scientific Society of Nephrologists of the Russian Federation.

Chronic kidney disease treatment involves the following:

reducing the load on healthy kidney tissue;
correction of electrolyte imbalance and metabolic processes;
cleansing the blood of toxins and breakdown products (,);
replacement therapy, organ transplantation.

If the disease is detected at a compensated stage, the patient is prescribed surgical treatment, which restores the normal outflow of urine and returns the disease to the latent (initial) stage.

At the third (intermittent) stage of CKD, surgical intervention is not performed, since it is associated with a high risk for the patient. Most often, in this case, palliative treatment methods are used, which alleviate the patient’s condition, and detoxification of the body is also carried out. Surgery is possible only if kidney function is restored.

Approximately 4 times a year, all patients with CKD are recommended to receive infusion treatment in a hospital setting: administration of glucose, diuretics, anabolic steroids, and vitamins.

For stage 5 chronic kidney disease, hemodialysis is performed every few days, and for people with severe concomitant pathologies and heparin intolerance, peritoneal dialysis is performed.

The most radical method of treating CKD is organ transplantation, which is performed in specialized centers. This is a complex operation that requires tissue compatibility between the donor and recipient, as well as the absence of contraindications to the intervention.

Prevention

To reduce the risk of developing CKD, you must adhere to the following rules:

balance your diet, avoid fatty, smoked and spicy foods, reduce your consumption of animal protein and salt;
treat infectious diseases in a timely manner, especially diseases of the genitourinary system;
reduce physical activity, avoid psycho-emotional stress if possible;

Chronic renal failure (CRF) ICD 10 is a disease in which irreversible changes occur in the structure of the kidneys. This leads to disturbances within the body, as a result of which the functioning of other organs is disrupted. Before becoming chronic, the disease may manifest itself in acute attacks.

Doctors distinguish four distinct stages of disease development:

Latent is usually asymptomatic and is usually detected only during clinical studies. The stage is characterized by the appearance of periodic proteinuria.
Compensated is characterized by a decrease in the level of glomerular filtration. During this period, weakness, dry mouth, polyuria, and fatigue are noted. The analysis reveals increased levels of urea and a substance such as creatinine in the blood.
The intermittent stage of the disease is associated with an even greater decrease in filtration rate, an increase in creatinine and the development of acidosis. The patient's condition seriously deteriorates, and symptoms of diseases and complications may appear.
The terminal stage is the most serious, and therefore there are several stages:

at the first stage, the function of water excretion is preserved, and filtration by the renal glomeruli is reduced to 10 ml/min. Changes in water balance can still be corrected with conservative therapy;
in the second, decompensated acidosis occurs, fluid retention occurs in the body, and symptoms of hyperkatemia appear. Reversible disorders occur in the cardiovascular system and lungs;
in the third stage, which is characterized by the same symptoms as in the second, only disorders in the lungs and vascular system are irreversible;
the last stage is accompanied by liver dystrophy. Treatment at this stage is limited, and modern methods are ineffective.

The main causes of kidney failure

A number of factors can cause chronic renal failure (CRF) code according to ICD 10:

that affect the glomeruli: acute and chronic glomerulonephritis, nephrosclerosis, endocarditis, malaria.
Secondary damage to organ tissue due to vascular disorders: hypertension, arterial stenosis or hypertensive disease of an oncological nature.
Diseases of the urinary organs, which are characterized by the outflow of urine, poisoning with toxins.
Heredity. Malformations of the paired organ and ureters: various cysts, hypoplasia, neuromuscular dysplasia.

Regardless of the cause, all changes in the kidneys boil down to a significant decrease in functioning kidney tissue. The increased content of nitrogenous substances makes it difficult for the kidneys to function. Since the kidneys cannot cope with the load, the body begins to “self-poison”. Attacks of nausea and vomiting, muscle cramps and bone pain may occur. The skin becomes jaundiced and the smell of ammonia appears from the mouth.

Other causes of the disease may be:

unbearable skin itching, most acute at night;
increased sweating;
heart failure;
arterial hypertension.

A number of studies are used to diagnose pathological disorders:

general and biochemical blood test;
urine test;
Ultrasound of the kidneys and urinary organs;
CT scan;
arteriography;
pyelography;
radioisotope renography.

They make it possible to assess the degree of organ damage, changes in structure, and also identify formations in the urinary system.

The most effective methods of treating the disease are:

Hemodialysis. This is the most effective method of treatment, which cleanses the body of toxins by running blood through a special apparatus.
Peritoneal dialysis is prescribed for patients suffering from severe illnesses who are intolerant to heparin. The mechanism consists of introducing a solution into the peritoneum and removing it through a catheter.
The most drastic is kidney transplantation.

Conservative therapy using several types of drugs is used as preventive treatment:

corticosteroids (Methylprednisolone);
antilymphocyte globulin;
cytostatics (Imuran, Azathioprine);
anticoagulants (Heparin);
antiplatelet agents (Curantil, Trental);
vasodilators;
antibacterial drugs (Neomycin, Streptomycin, Kanamycin).

Before using any medications, it is necessary to undergo a full examination, since only a professional specialist can choose the best treatment regimen.

Treatment of the disease using traditional recipes and prevention

How is it carried out? Many medicinal plants can relieve symptoms. The most common recipes:

a mixture prepared from the following ingredients:

Lingonberry leaves.
Violet.
Flax seeds.
Linden blossom.
Corn silk.
Motherwort.
A series.
Blueberry.
Agrimony.

a collection of the fruits of hawthorn, nettle, laurel, chamomile, rose hips, dill and currants;
a collection prepared from birch leaves, calendula, St. John's wort, viburnum, motherwort, mint, sage and apple peels;
each of them has a beneficial effect on the condition of the urinary system and supports kidney function.

For people prone to developing kidney disease, it is important to follow some preventive measures: