Hospital pediatrics. Treatment of chronic renal failure (most important)

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Hospital pediatrics. Treatment of chronic renal failure (most important)

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23. Treatment of chronic renal failure

Treatment. Treatment of chronic renal failure in conjunction with treatment of the underlying kidney disease, which leads to renal failure.

In the initial stage, when there is no impairment of renal processes, etiotropic and pathogenetic therapy is prescribed, which will cure the patient and prevent the development of renal failure or lead to remission and a slow course of the disease. In the stage of impaired renal processes, pathogenetic therapy is carried out with symptomatic treatment methods (hypotensive drugs, antibacterial treatment, protein restriction in the daily diet, spa treatment, etc.).

Conservative treatment of CRF is aimed at restoring homeostasis, reducing azotemia, and reducing symptoms of uremia.

The glomerular filtration rate is below 50 ml / min, the level of creatinine in the blood is above 0,02 g / l - it is necessary to reduce the amount of protein consumed to 30-40 g / day. The diet should be high in calories and contain essential amino acids (potato-egg diet without meat and fish). Food is prepared with a limited (up to 2-3 g) amount of table salt. To reduce the level of phosphates in the blood, use almagel 1-2 tsp. 4 times a day. During treatment, it is necessary to control the level of calcium and phosphorus in the blood. With acidosis, depending on the degree, 100-200 ml of a 5% sodium bicarbonate solution is injected intravenously.

With a decrease in diuresis, lasix is prescribed in doses (up to 1 g / day) that provide polyuria. Antihypertensive drugs are prescribed to lower blood pressure.

Anemia is treated with iron supplements. With a hematocrit of 25% and below, transfusions of erythrocyte mass by fractional administration are indicated. Antibiotics and their chemotherapeutic drugs in chronic renal failure are used carefully: doses are reduced by 2-3 times. Derivatives of nitrofurans in chronic renal failure are contraindicated. In heart failure and chronic renal failure, cardiac glycosides are used carefully in reduced doses, especially with hypokalemia. Hemodialysis may be indicated for exacerbation of renal failure, after the exacerbation subsides.

When the patient's condition improves, conservative therapy is carried out. Plasmapheresis courses give a good effect in chronic renal failure.

In the terminal stage, the patient is transferred to hemodialysis.

Regular hemodialysis is used when creatinine clearance is below 10 ml/min and plasma levels are above 0,1 g/l. CRF must be differentiated from acute renal failure, which is distinguished by a sudden onset with an oligoanuric stage and reverse development, from neurohypophyseal diabetes insipidus, the difference is that there is no hyperazotemia and other signs of chronic renal failure, from anemic syndrome and other diseases (hypoplastic anemia, etc.), in which there are no symptoms of CRF.

Forecast. Hemodialysis and kidney transplantation change the fate of patients with chronic renal failure, allowing them to prolong life and achieve rehabilitation. The selection of patients for these types of treatment is carried out by specialists from hemodialysis and organ transplantation centers.

Author: Pavlova N.V.

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