CKD ICD Code 10: N18) - a nadnosological concept that combines all patients with signs of kidney damage and / or a decrease in function, estimated by the value glomerular filtration rate (GFR)that persist for 3 months or more.

The concept of " Chronic Kidney Disease "(CKD) is more universal (covers all stages of kidney disease, including the initial) and is more consistent with the goals of prevention and nephroprotection than the old term " Chronic renal failure "(CRF).

Examples of diagnosis:

Mixed chronic glomerulonephritis (nephrotic syndrome, arterial hypertension), morphologically - focal segmental glomerulosclerosis, with a moderate decrease in function, CKD-3: A (CRF I).

Type 2 diabetes. Diabetic nephropathy. Proteinuria CKB-3: A

Chronic interstitial nephritis (analgesic nephropathy), terminal renal failure. Hemodialysis treatment since 2007. CKB-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 allograft in 04/2006. Chronic transplantation nephropathy. CKB-4: T.

Chronic kidney disease and arterial 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 disease.

Only one in five patients has a level systolic blood pressure below 140 mm Hg, despite the fact that a level lower than 130 is safe for the kidneys. That is, 80% of the blood pressure control in the pre-dialysis stage is unsatisfactory.

To date, it has been established that the risk of cardiovascular complications increases sharply compared with the general population level already at the stage of a moderate decrease in renal function. As a result, most patients with chronic kidney disease do not live up to dialysis, dying in the earlier stages. A particular danger of chronic kidney disease, as well as other, more famous, "silent killers" - diabetes mellitus and arterial hypertension - is that she can long time Do not cause any complaints that would prompt the patient to consult a doctor and begin treatment.

Symptoms of Chronic Kidney Disease

The following complaints are available to help suspect kidney and urinary tract diseases and impaired function:

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

Prevalence of Chronic Kidney Disease

According to NHANES research (National Health and Nutrition Examination Survey)at least every tenth inhabitant of the Earth has signs of kidney damage or decreased function. Major studies to assess the prevalence of chronic kidney disease in the Russian population have not been conducted.

According to studies in selected 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, decreased 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, who included more than 1000 patients of working age (30-55 years), who were not previously observed by a nephrologist and who were previously not diagnosed with kidney disease, revealed a decrease in glomerular filtration rate to a level of less than 60 ml / min / 1.73 m 2 in every six patients without diseases of the cardiovascular system and in every fourth patient with cardiovascular diseases. Another large screening study conducted at the Health Centers of the Moscow Region, that is, among a conditionally healthy population, revealed high and very high albumin excretion (more than 30 mg / l) in 34% of the examined.

Currently available data indicate a predominance of secondary nephropathies in the population. IN different countries "Palm" is divided among the kidney damage in diabetes and cardiovascular diseases (diabetic and hypertensive nephropathies, as well as coronary artery disease kidney).

Given the steady increase in the number of patients in the population diabetes , it can be expected 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, the “addiction” to nutritional supplements (drugs for weight loss in women, protein shakes for building muscle mass in men).

In countries poorly endowed with dialysis, such as Russia, substitution therapy is primarily used to select young patients whose dialysis tolerance and prognosis are better than elderly patients with diabetes mellitus and severe cardiovascular diseases.

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

GFR of more than 120 ml / min / 1.73 m 2 is also considered a deviation from the norm, as in patients with diabetes mellitus and obesity, it can 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 to their functional overload, damage with further sclerosis. However, to date, increased glomerular filtration is not included in the number of independent diagnostic criteria for CKD, but is considered a risk factor for its development. The presence of CKD in diabetes and obesity is only indicated if there are markers of renal damage, primarily increased albuminuria.

The level of GFR in the range of 60-89 ml / min / 1.73 m2 in the absence of signs of renal damage is indicated as the "initial decrease in GFR", however, the diagnosis of CKD is not made. For persons 65 years and older, this is regarded as a variant of the age norm. Persons younger than this age are advised to monitor the condition of the kidneys at least 1 time per year and actively prevent CKD.

Stages of Chronic Kidney Disease

At the same time, a decrease in GFR to a level of less than 60 ml / min / 1.73 m 2 even with 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, in a patient with GFR 55 ml / min / 1.73 m 2 with absolutely normal urinalysis and an ultrasound picture of the kidneys, stage 3A CKD will be diagnosed.

5 stages of CKD are distinguished depending on the level of GFR. Patients with stage 3 CKD are the largest 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, it was proposed to divide stage 3 of CKD into two sub-stages - A and B.

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

Diagnostic Criteria for Chronic Kidney Disease

1) the presence of any markers of kidney damage:

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

2) a decrease in glomerular filtration rate (GFR) to a 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 a decrease in 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 are the factors leading to the development of oligonephronia, i.e. the mismatch of the number of active nephrons with 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 diseases occur for a long time without causing any complaints, changes in well-being that would force you to see a doctor. Early clinical and laboratory signs of kidney damage often have a dull picture, and do not cause a doctor’s alertness, especially when it comes to an elderly patient. The initial symptoms of kidney disease are considered as the "age norm."

The most common kidney diseases in the population are secondary nephropathies in case of arterial hypertension, diabetes mellitus and other systemic diseases. At the same time, 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 abuse salt and meat food. Limit the use of canned food, food concentrates, instant foods as much as possible.
• 2. Control weight: avoid overweight and do not drop it sharply. Eat more fruits and vegetables, limit high-calorie foods.
• 3. Drink more liquid, 2-3 liters, especially in the hot season: fresh water, green tea, kidney herbal teas, natural fruit drinks, compotes.
• 4. Do not smoke, do not abuse alcohol.
• 5. Exercise regularly (for the kidneys it is no less important 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 abandon them, limit the intake to 1-2 tablets per month), do not take them yourself, without the appointment of a diuretic, do not self-medicate, do not get carried away with food additives, do not experiment with yourself, consuming Thai herbs "with an unknown composition," fat burners ", allowing" to lose weight once and for all without any efforts on your part. "
• 7. Protect yourself from contact with organic solvents and heavy metals, insecticides and fungicides in the workplace and at home (when repairing, maintaining the machine, working on a personal plot, etc.), and use protective equipment.
• 8. Do not abuse sun exposure, 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 urinalysis, albuminuria, blood chemistry, including blood creatinine, ultrasound - 1 time per year).

Mandatory indications for regular examinations to exclude CKD are:

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

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

Table 1. Key markers of kidney damage suggesting CKD

Marker	Remarks
Albuminuria / proteinuria	Persistent increase in urinary albumin excretion over 10 mg / day (10 mg albumin / g creatinine) - see recommendation
Persistent changes in urine sediment	Erythrocyturia (hematuria), cylindruria, leukocyturia (pyuria),
Renal changes in imaging studies	Anomalies in the development of kidneys, cysts, hydronephrosis, changes in kidney size, etc.
Changes in the composition of blood and urine	Changes in serum and urinary concentration 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 detected during intravital nephrobiopsy	Should be taken into account, changes that undoubtedly indicate a “chronicity” of the process (sclerotic changes in the kidneys, changes in membranes, etc.)

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

The reasons for highlighting this concept are based on the unity of the main pathogenetic mechanisms of the progression of the pathological process in the kidneys, the commonality of many risk factors for the development and progression of the disease with damage to an organ of different etiologies and the resulting primary and secondary prevention methods.

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

1. The presence of any clinical markers of kidney damage confirmed with an interval of at least 3 months;
2. Any markers of irreversible structural changes in the organ identified once during intravital morphological examination of the organ or during its visualization;
3. 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) substantially clarified section N18 (earlier this code was “Chronic renal failure”) of the international classifier of diseases (ICD-10). In order to maintain the generally accepted structure of the diagnosis, it is recommended that the diagnosis of "Chronic kidney disease" be indicated after the underlying disease and then the coding of the disease is set in accordance with the ICD for the underlying disease.

If the etiology of renal dysfunction is unknown, the main diagnosis may be Chronic Kidney Disease, which is coded under rubric N18 (where N18.1 is Chronic Kidney Disease, stage 1; N18.2 is Chronic Kidney Disease, stage 2, etc. )

CKD stages	ICD-10 code (as amended by october 2007) **	Description of ICD-10
		CKD stage 1, kidney damage with normal or elevated GFR (\u003e 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)
		Stage 5 CKD, chronic uremia, end-stage kidney disease (including cases of PST (dialysis and transplantation)

* - the 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 for early detection of CKD in children

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

1. Polycystic kidney disease or other genetic kidney disease in a family history.
2. Low birth weight.
3. Acute renal failure due to perinatal hypoxemia or other acute kidney damage.
4. Renal dysplasia or hypoplasia.
5. Urological abnormalities, especially obstructive uropathies.
6. Bladder-ureteral reflux associated with repeated urinary tract infections and kidney scarring.
7. A history of acute nephritis or nephrotic syndrome.
8. A history of hemolytic-uremic syndrome.
9. Shenlein's disease - Genoches in the anamnesis.
10. Diabetes mellitus.
11. Systemic lupus erythematosus.
12. History of hypertension, in particular as a result of renal artery or renal vein thrombosis in the perinatal period.

Children with retarded physical development (growth retardation, low body weight), rickets-like skeletal deformities, metabolic acidosis, early 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 the progression of CKD.

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

The need to detect CKD in children at an early stage is a socially significant task - the sooner we start the prevention of identifying risk factors for CKD in children, the more people will remain healthy and able-bodied, while the risk of developing concomitant diseases will be significantly reduced.

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

Doctors distinguish four pronounced stages of the development of the disease:

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

• at the first stage, the function of water secretion is preserved, and filtration by the renal glomeruli decreases to 10 ml / min. Changes in water balance can still be corrected using conservative therapy;
• on the second, decompensated acidosis occurs, fluid retention in the body occurs, and symptoms of hyperkatemia appear. IN cardiovascular system and lungs, reversible disorders occur;
• 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;
• last stage accompanied by dystrophy of the liver. Treatment at this stage is limited, and modern methods are ineffective.

The main causes of renal failure

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

1. that affect the glomeruli: acute and chronic glomerulonephritis, nephrosclerosis, endocarditis, malaria.
2. Secondary lesions of organ tissues due to vascular disorders: hypertension, arterial stenosis or hypertension of oncological nature.
3. Urinary diseases, which are characterized by outflow of urine, poisoning by toxins.
4. Heredity. Malformations of the paired organ and ureters: various cysts, hypoplasia, neuromuscular dysplasia.

Regardless of the cause, all changes in the kidney are reduced to a significant decrease in the functioning of the kidney tissue. The increased content of nitrogenous substances complicates the work of the kidneys. 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 acquires a icteric hue, the smell of ammonia appears from the mouth.

Other causes of the disease may include:

• intolerable 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 analysis;
• urinalysis;
• Ultrasound of the kidneys and urinary organs;
• cT scan;
• arteriography;
• pyelography;
• radioisotope renography.

They make it possible to assess the degree of organ damage, structural changes, as well as to identify the formation in the urinary system.

The most effective methods of treating the disease are:

1. Hemodialysis. This is the most effective treatment method that cleanses the body of toxins by passing blood through a special apparatus.
2. Peritoneal dialysis is prescribed for patients suffering from serious illnesses who have heparin intolerance. The mechanism is the introduction of the solution into the peritoneum and its removal through the catheter.
3. The most cardinal is kidney transplantation.

As preventative treatment conservative therapy is used with the use of several types of drugs:

• corticosteroids (methylprednisolone);
• antilymphocytic globulin;
• cytostatics (Imuran, Azathioprine);
• anticoagulants (heparin);
• antiplatelet agents (Curantil, Trental);
• vasodilators;
• antibacterial drugs (Neomycin, Streptomycin, Kanamycin).

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

Treatment of the disease with the help of folk recipes and prevention

How to spend? Many medicinal plants can relieve symptoms. The most common recipes:

• collection made from the following ingredients:

1. Lingonberry leaves.
2. Violet.
3. Flax seeds.
4. Linden blossom.
5. Corn silk.
6. Motherwort.
7. A series of.
8. Blueberries
9. Repeshka.

• collection from the fruits of hawthorn, nettle, laurel, chamomile, rose hip, dill and currant;
• collection made from birch leaf, calendula, St. John's wort, viburnum, motherwort, mint, sage and peel of apples;
• each of them has a beneficial effect on the state of the urinary system, support kidney function.

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

• refusal of cigarettes and alcohol;
• developing and maintaining a diet low in cholesterol and fat;
• physical exercisebeneficial effects on the patient's condition;
• control of cholesterol and blood sugar;
• regulation of the volume of fluid intake;
• restriction of salt and protein in the diet;
• ensuring full sleep.

All this will help maintain functionality. internal organs and improve general state the patient.

Acute renal failure (ARF) is a rapid but reversible inhibition of renal function, sometimes to the point of complete failure of one or both organs. Pathology is deservedly characterized as a critical condition that requires immediate medical attention. Otherwise, the risk of an adverse outcome in the form of loss of organ performance increases significantly.

Acute renal failure

The kidneys are the main “filters” of the human body, the nephrons of which continuously pass blood through their membranes, removing excess fluid and toxins with urine, sending the necessary substances back into the bloodstream.

Kidneys are organs without which human activity is impossible. Therefore, in a situation where, under the influence of provoking factors, they cease to fulfill their functional task, doctors render an emergency to a person medical care, diagnosing him - acute renal failure. The ICD-10 somatic pathology code is N17.

Today, statistical information makes it clear that the number of people encountering this pathology is growing every year.

Etiology

The causes of djpybryjdtybz acute renal failure are as follows:

1. Pathologies of the cardiovascular system that disrupt the blood supply to all organs, including the kidneys:
   • arrhythmia;
   • atherosclerosis;
   • heart failure.
2. Dehydration on the background of the following ailments, which is the cause of the change in blood counts, or rather, an increase in its prothrombin index, and, as a result, the difficult work of the glomeruli:
   • dyspeptic syndrome;
   • extensive burns;
   • blood loss.
3. Anaphylactic shock, which is accompanied by a sharp decrease in blood pressure, which negatively affects the work of the kidneys.
4. Acute inflammatory events in the kidneys, which lead to damage to the tissues of organs:
   • pyelonephritis.
5. Physical obstruction to urine outflow during urolithiasis, which first leads to hydronephrosis, and then, due to pressure on the kidney tissue, to damage their tissues.
6. Reception of nephrotoxic drugs, which include a contrast composition for x-rays, causes poisoning of the body, which the kidneys can not cope with.

Classification of arrester

The process of acute kidney failure is divided into three types:

1. Prerenal ARF - the cause of the disease is not directly related to the kidneys. The most popular example of the prerenal type of acute renal failure is a violation in the work of the heart, because pathology is often called hemodynamic. Less commonly, it occurs against a background of dehydration.
2. Renal acute renal failure - the root cause of the pathology can be found precisely in the kidneys themselves, in connection with which the second name of the category is parenchymal. Renal functional failure in most cases results from acute glomerulonephritis.
3. Postrenal acute renal failure (obstructive) is a form that occurs when the pathways of urine output are blocked by calculi and subsequent violation of the outflow of urine.

Classification of acute renal failure

Pathogenesis

ARF develops over four periods, which always follow in this order:

• initial stage;
• oliguric stage;
• polyuric stage;
• recovery.

The duration of the first stage can last from several hours to several days, depending on what is the root cause of the disease.

Oliguria is the term by which they briefly indicate a decrease in urine volume. Normally, a person should allocate approximately the amount of fluid that he consumed, minus the part "spent" by the body on sweating and breathing. With oliguria, the volume of urine becomes less than half a liter, out of direct relation to the amount of fluid drunk, which entails an increase in body fluids and decay products.

The complete disappearance of diuresis - occurs only in extremely severe cases. And statistically rarely happens.

The duration of the first stage depends on how quickly adequate treatment was started.

Polyuria, on the contrary, means an increase in urine output, in other words, the amount of urine can reach five liters, although 2 liters of urine per day is already an occasion for the diagnosis of polyuric syndrome. This stage lasts about 10 days, and its main danger is the loss by the body of the substances it needs along with urine, as well as dehydration.

After the completion of the polyuric stage, a person, with a favorable development of the situation, recovers. However, it is important to know that this period may be one year, during which deviations in the analysis of the analyzes will be revealed.

Stages of arrester

Clinical picture

The initial stage of acute renal failure does not have specific symptoms, according to which it was possible to accurately recognize the ailment, the main complaints during this period are:

• loss of strength;
• headache.

The symptomatic picture is supplemented by signs of the pathology that caused the acute renal failure:

1. With oliguric syndrome against the background of acute renal failure, the symptoms become specific, easily recognizable and fit into the overall picture of the pathology:
   • decreased urine output;
   • dark foamy urine;
   • dyspepsia;
   • lethargy;
   • wheezing in the chest due to fluid in the lungs;
   • susceptibility to infections due to reduced immunity.
2. The polyuric (diuretic) stage is characterized by an increase in the amount of urine excreted, therefore all patient complaints follow from this fact, and that the body loses a large amount of potassium and sodium with urine:
   • disturbances in the work of the heart are recorded;
   • hypotension.
3. The recovery period, which takes from 6 months to one year, is characterized by fatigue, changes in the results of laboratory tests of urine (specific gravity, red blood cells, protein), blood (total protein, hemoglobin, ESR, urea,).

Diagnostics

Diagnosis of acute renal failure is carried out using:

• interrogation and examination of the patient, is his anamnesis;
• a clinical blood test showing reduced hemoglobin;
• biochemical blood test, with the help of which increased creatinine, potassium, urea is detected;
• monitoring diuresis, that is, control over how much fluid (including soups, fruits) a person consumes in 24 hours, and how much it excretes;
• ultrasound method, with ARF more often showing the physiological dimensions of the kidneys, a decrease in size is a bad sign, indicating tissue damage, which may be irreversible;
• nephrobiopsim - taking a piece of an organ with a long needle for microscopic examination; carried out infrequently due to the high degree of trauma.

Treatment

Therapy for acute renal failure occurs in the intensive care unit of the hospital, less often in the nephrological department of the hospital.

All medical manipulations performed by a doctor and medical staff can be divided into two stages:

1. Identification of the root cause of the pathological condition - is carried out using diagnostic methods, the study of symptoms, specific complaints of the patient.
2. Elimination of the cause of acute renal failure is the most important stage of treatment, because without treatment of the root cause of the disease, any treatment measures will be ineffective:
   • when revealing the negative effect of nephrotoxins on the kidneys, extracorporeal hemocorrection is used;
   • upon detection of an autoimmune factor, glucocorticosteroids (Prednisone, Metipred, Prenizole) and plasmapheresis are prescribed.
   • with urolithiasis, drug litholysis or surgery is performed to remove calculi;
   • with infection, antibiotics are prescribed.

At each stage, the doctor adjusts the appointment based on the symptomatic picture at the moment.

During oliguria, it is necessary to prescribe diuretics, a strict diet with a minimum amount of protein and potassium, if necessary, hemodialysis.

Hemodialysis - a procedure for cleansing the blood of decay products and removing excess fluid from the body, has an ambiguous attitude of nephrologists. Some doctors argue that preventive hemodialysis for acute renal failure is necessary to reduce the risk of complications. Other experts warn of a tendency for the kidneys to completely lose function from the moment the artificial blood purification was started.

During the period of polyuria, it is important to replenish the patient’s missing blood volume, restore the electrolyte balance in the body, continue diet No. 4, and beware of any infection, especially when taking hormonal drugs.

General principles for the treatment of acute renal failure

Forecasts and Complications

ARF on the background of proper treatment has a favorable prognosis: after an illness, only 2% of patients need lifelong hemodialysis.

Complications from acute kidney failure are associated with, that is, with the process of poisoning the body with its own decay products. As a result, the latter are not excreted by the kidneys with oliguria or at a low rate of blood filtration with glomeruli.

Pathology leads to:

• impaired cardiovascular activity;
• anemia
• increased risk of infections;
• neurological disorders;
• dyspeptic disorders;
• uremic coma.

It is important to note that in acute nephrological failure, unlike chronic, complications rarely occur.

Prevention

Prevention of acute renal failure is as follows:

1. Avoid taking nephrotoxic drugs.
2. Timely treat chronic ailments of the urinary and vascular system.
3. Monitor blood pressure, if signs of chronic hypertension are identified, consult a specialist immediately.

In the video about the causes, symptoms and treatment of acute renal failure:

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Chronic kidney disease ICD code 10

Chronic renal failure

Diagnostic criteria

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

Physical examination: itching, calculations, urinary odor from the mouth, dry skin, pallor, nocturia and polyuria, AH.

Laboratory studies: anemia, hyperphosphatemia, hyperparathyroidism, increased levels of urea and creatinine, OAM - isostenuria, GFR less than 60 ml / min.

Instrumental research:

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

Dopplerography of the vessels of the kidneys - depletion of blood flow;

Cystography - vesicoureteral reflux or a condition after antireflux surgery;

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

Indications for expert advice:

ENT doctor; - dentist;

Gynecologist - for the sanation of infection of the nasopharynx, oral cavity and external genital organs;

Oculist - to assess changes in microvessels;

Severe arterial hypertension, disturbances from the ECG, etc. are an indication for a cardiologist's consultation;

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

The list of the main diagnostic measures:

General analysis blood (6 parameters);

General urine analysis;

Urinalysis according to Zimnitsky;

Reberg test;

Determination of residual nitrogen;

Determination of creatinine, urea, intact Parath-hormone, KHS;

Determination of potassium / sodium.

Determination of calcium;

Determination of chlorides;

Determination of magnesium; - determination of phosphorus;

The level of serum ferritin and serum iron, the coefficient of transferrin saturation with iron;

Ultrasound of the abdominal cavity;

Ultrasound of vessels.

The list of additional diagnostic measures:

Determination of glucose, free iron, the 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 of VG;

Determination of total lipids, cholesterol and lipid fractions;

CT scan;

Consultation with an ophthalmologist.

diseases.medelement.com

CRF (chronic renal failure) - ICD code 10

Emergency conditions

CRF ICD 10 - what does this code mean and how to deal with it?

Chronic renal failure (CRF) ICD 10 is a disease in which irreversible changes in the structure of the kidneys occur. This leads to disorders within the body, as a result of which the work of other organs is disrupted. Before going into a chronic form, the disease can manifest itself with acute attacks.

Medications

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Doctors distinguish four pronounced stages of the development of the disease:

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

• at the first stage, the function of water secretion is preserved, and filtration by the renal glomeruli decreases to 10 ml / min. Changes in water balance can still be corrected using conservative therapy;
• on the second, decompensated acidosis occurs, fluid retention in the body occurs, and symptoms of hyperkatemia appear. In the cardiovascular system and lungs, reversible disorders occur;
• 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.

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

• Expert opinion: Today it is one of the most effective means in the treatment of kidney disease. I have been using German drops in my practice for a long time ...

1. Kidney diseases that affect the glomeruli: acute and chronic glomerulonephritis, nephrosclerosis, endocarditis, malaria.
2. Secondary lesions of organ tissues due to vascular disorders: hypertension, arterial stenosis or hypertension of oncological nature.
3. Urinary diseases, which are characterized by outflow of urine, poisoning by toxins.
4. Heredity. Malformations of the paired organ and ureters: various cysts, hypoplasia, neuromuscular dysplasia.

Regardless of the cause, all changes in the kidney are reduced to a significant decrease in the functioning of the kidney tissue. The increased content of nitrogenous substances complicates the work of the kidneys. 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 acquires a icteric hue, the smell of ammonia appears from the mouth.

Other causes of the disease may include:

• intolerable 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 analysis;
• urinalysis;
• Ultrasound of the kidneys and urinary organs;
• cT scan;
• arteriography;
• pyelography;
• radioisotope renography.

They make it possible to assess the degree of organ damage, structural changes, as well as to identify the formation in the urinary system.

The most effective methods of treating the disease are:

1. Hemodialysis. This is the most effective treatment method that cleanses the body of toxins by passing blood through a special apparatus.
2. Peritoneal dialysis is prescribed for patients suffering from serious illnesses who have heparin intolerance. The mechanism is the introduction of the solution into the peritoneum and its removal through the catheter.
3. The most cardinal is kidney transplantation.

As a preventive treatment, conservative therapy using several types of drugs is used:

• corticosteroids (methylprednisolone);
• antilymphocytic globulin;
• cytostatics (Imuran, Azathioprine);
• anticoagulants (heparin);
• antiplatelet agents (Curantil, Trental);
• vasodilators;
• antibacterial drugs (Neomycin, Streptomycin, Kanamycin).

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

How to treat kidneys at home folk remedies? Many medicinal plants can relieve symptoms. The most common recipes:

• collection made from the following ingredients:

1. Lingonberry leaves.
2. Violet.
3. Flax seeds.
4. Linden blossom.
5. Corn silk.
6. Motherwort.
7. A series of.
8. Blueberries
9. Repeshka.

• collection from the fruits of hawthorn, nettle, laurel, chamomile, rose hip, dill and currant;
• collection made from birch leaf, calendula, St. John's wort, viburnum, motherwort, mint, sage and peel of apples;
• each of them has a beneficial effect on the state of the urinary system, support kidney function.

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

• refusal of cigarettes and alcohol;
• developing and maintaining a diet low in cholesterol and fat;
• physical activities that have a beneficial effect on the patient's condition;
• control of cholesterol and blood sugar;
• regulation of the volume of fluid intake;
• restriction of salt and protein in the diet;
• ensuring full sleep.

All this will help maintain the functionality of the internal organs and improve the general condition of the patient.

• IMPORTANT TO KNOW! Kidneys will clear instantly if in the morning on an empty stomach ... A unique recipe for health from Germany!

Emergency conditions

What is an urethral fistula

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The emergence and significance of the formulation of CKD

Chronic kidney disease is a modern classification that determines the presence of various pathological changes that exist in the human body for 3 months.

Changes may occur in studies of urine and blood, with a kidney biopsy or instrumental examination of the body.

The concept of a chronic disease in itself cannot be attributed to an accurate diagnosis of the condition of the kidneys. Rather, it is a medical-social formulation. An unambiguous criterion showing a deviation in the functioning of the kidney is the glomerular filtration rate (GFR).

Previously, the diagnosis of "Chronic renal failure" was made to the patient at the initial stage of chronic kidney disease. Moreover, the first stages of chronic renal failure were ignored and did not fall under the concept of any pathology. Changes of this nature can lead to the terminal stage with all the ensuing consequences.

Thus, a diagnosis of CKD was introduced for the early diagnosis of kidney damage, by identifying initial stages diseases using the GFR criterion. This prevents the development of potential complications to increase the efficiency of the kidneys.

Common CKD Classification

To determine kidney disease, several indicators are used to assess the functionality of the organ:

1. Abnormalities in blood tests (creatinine, urea, electrolyte deficiencies).
2. Change in urine analysis (hematuria, leukocyturia, proteinuria).
3. Glomerular filtration rate.
4. Kidney structural abnormalities (ultrasound, X-ray examination).

One accurate measure for determining kidney function is glomerular filtration rate. GFR determines the mass of active nephrons and takes into account body weight, gender, age limits.

Several classifications have been adopted for chronic kidney disease. But common and relevant is the KDOQI classification, it has been used since 2002 and takes into account the GFR indicator. The classification of chronic kidney disease, taking into account the GFR score, represents five stages.

Chronic kidney disease stage:

When the patient has GFR acceptable, but there are injuries at other indicators, for example, in urine or blood tests, then the first stage takes place. Various kidney ailments at a certain point acquire a similar degree of damage. In chronic kidney disease, stage 3. At this stage, no matter what pathology of the kidneys arises, the mechanisms of disease progression work the same way in people.

At this stage, nephrologist intervention is necessary to prescribe protective therapy to prevent the progression of the disease. Therefore, the first 3 stages in terms of GFR are a measure for the patient, followed by a significant deterioration in his health and lifestyle.

A GFR score of less than 60 means the death of about half of the nephrons. In the framework of Russian terminology, the last three stages of chronic kidney disease are classified as chronic renal failure.

Manifestations and clinical consequences

Chronic kidney diseases are mainly characterized by the course of the underlying disease that caused the development of pathology. With kidney disease, changes occur in the organs of the body under the influence of toxic products. About 200 substances are known to cause aggravation of the disease during their accumulation.

The first stages of the disease can be accompanied by very mild symptoms or with its complete absence. Only after increased exposure to the kidneys: excessive use of salt, low-alcohol drinks, can manifest itself in the form of swelling on the face, fatigue and weakness.

The strengthening of the underlying disease leads to a general deterioration of the patient's condition, and in disruption of the work of many organs. Nocturia, polyuria, dry mouth appears. The skin of patients with CKD becomes yellowish, it becomes drier. There is a significant decrease in the intensity of sweating due to atrophy of sweat glands. The patient develops nausea, vomiting, generalized and itchy skin with intense intensity, a feeling of vague taste in oral cavity.

In the patient's body, an accumulation of fluid occurs, which can cause congestive heart failure. Stagnant fluid is aggravated when hypertension occurs. The vast majority of patients with advanced kidney disease face this disease.

Renal failure leads to chronic uremia, which occurs due to intoxication of the body. One of the symptoms with this pathology is lethargy, apathy, drowsiness. Tissue hypoxia is the result of chronic uremia. It manifests itself as a result of the release of urea with sweat on the patient’s skin, as a result, the ventilation ability of the lungs decreases and the metabolic acidosis process is disrupted.

Violation of the functional features of the kidneys leads to a decrease in the antitoxic function of the liver. The close interconnection of organs in chronic kidney disease entails a failure in protein and carbohydrate metabolism.

Disorders in the field of CVS play a significant role in CKD. Cardiovascular dysfunction for a third of patients acts as a causative factor in the death of patients with the thermal stage of the disease.

The degree of cardiac pathology determines the course of treatment in the later stages of chronic kidney disease. The lack of oxygen during the delay of toxic substances in kidney disease (uremia) greatly affects the functioning of the heart muscle. Failure of acid-base balance, violation of water balance, acidosis - factors provoke various disturbances in the heart rhythm. Hemodialysis causes a significant decrease in blood pressure, which further increases the frequency of arrhythmias.

Chronic kidney disease leads to malfunctioning of the digestive tract. This causes a constant release of urea, ammonia, creatinine, and this entails the manifestation of symptoms such as: metallic aftertaste in the oral cavity, vomiting, stomatitis develops.

Most patients with renal disease have anemia. At the last, terminal stage, anemia is already present in 100% of cases. The source of anemia in chronic kidney disease is: deterioration in bone marrow activity, increased bleeding during hemodialysis, and the amount of erythropoietin produced by the kidneys decreases.

What diseases cause CKD?

As described above, the designation "chronic disease" in itself is not a separate diagnosis that determines a pathological change in the kidneys. This term in modern medicine introduced to determine the degree of progression of the underlying disease directly affecting the kidneys.

Common primary diseases include:

1. Diabetes. Each person has friends or acquaintances with a blood sugar deficiency. This is one of the most common diseases on the planet.
2. Nephrolithiasis is a disease in which the presence of kidney stones is determined.
3. Glomerulonephritis - with this pathology, the glomeruli of the kidneys and other tissue structure are affected.
4. Pyelonephritis - inflammatory diseasedamaging tissues in the kidneys due to the penetration of pathogenic microflora.
5. Vascular pathology - hypertension, stenosis.
6. Hypoplasia is a kidney defect expressed by its decrease.

The late stages of kidney disease progress are accompanied by pulmonary diseases:

• tracheitis;
• pleurisy;
• bronchopneumonia.

Pulmonary and cardiovascular pathologies cause pneumonia and pulmonary edema.

Risk factors

Risk factors for renal failure include not only diseases that accompany the disease, but also phenomena that adversely affect the course of the disease. These factors enhance the course of the pathology and increase the risk of further deterioration of the patient's health. Therefore, when confronted with them, the elimination of these phenomena comes first in order to reduce the progress of renal pathology.

But not all risks can be eliminated or prevented.

These include:

Considering these factors, it can be noted that patients with age are more at risk of the disease, and a genetic predisposition - well, then God himself ordered. The gender of the patient may play a role when a causative factor appears, for example, women are more susceptible to diseases of the lower urinary tract.

Risk factors of "artificial" origin include banal smoking and alcoholism. Quitting smoking may well become the key to reducing progress in the development of renal failure, it is also proved that smokers have an increased risk of kidney pathologies.

The close relationship of changes in the kidneys with vascular diseases leads to a dangerous increase in the concentration of low density lipoproteins in the human body. Such a complication entails the development of atherosclerosis.

It is impossible to get rid of clogged vessels without surgical intervention. The cause of cholesterol increase will be overweight. Therefore, the normalization of cholesterol is an important component in renal pathology.

CKD in children

A distinctive feature of chronic kidney diseases in children are congenital pathologies. There is the concept of chronic renal failure in children. A baby may not have kidneys from birth. A child with a pathology undergoes replacement therapy from birth. It includes types of dialysis or kidney transplantation.

Chronic kidney disease in children does not always occur with a pronounced clinic and depends on the primary disease. If the cause is congenital disease, then there may be a lag in physical development and rickets-like bone changes.

The main guarantee of successful treatment will depend on the close cooperation of parents with the doctor. All the recommendations of the attending physician on taking medication and passing tests are required. Drugs will be prescribed depending on the disease that caused renal failure. Therefore, it is necessary to comply with all recommendations for the correction of disorders identified at different stages of renal disease.

CKD Treatment

When it comes to treating renal pathologies, the motivation of American nephrologists who have introduced the concept of "chronic kidney disease" becomes clear. Before prescribing therapy, the main role is played by the diagnosis of deviations according to the GFR criterion.

The first stage means that this indicator does not have deviations from the norm, but there are deviations in the diagnosis of other markers (urinalysis or blood test). Treatment in this case is aimed at eliminating the associated pathology.

The second stage is characterized by a slight decrease in glomerular filtration rate. For this stage, the main thing is to assess the reduction of nephrons, to assess the risks of further complications. It is the first stages that signal the nephrologists that the patient needs to be registered, in order to prevent complications.

The third stage according to the generally accepted Russian classification means the beginning of chronic renal failure. The causative factor enhances the frequency of metabolic disorders and requires specialist-controlled treatment.

The fourth and fifth stages require immediate intervention by a nephrologist and renal therapy or hemodialysis are performed, respectively.

Chronic kidney disease and its treatment will be to eliminate the causes of decreased nephrons. This will require a reduction in the load on existing nephrons. Drug treatment allows you to restore the mineral and electrolyte imbalance. The drug Polyphepan allows for the correction of imbalance in renal pathology. To remove potassium from the body, enemas and laxatives are prescribed. To correct homeostasis, drug therapy is prescribed: glucose solution, diuretics, vitamins B, C.

Hemodialysis is performed to replace kidney function. This is the most effective, but at the same time quite costly method.

The next step after hemodialysis is a kidney transplant. This method is the most radical and is carried out in specialized clinics.

In polyclinics, a nephrologist is very rare. Most patients go to therapists or urologists. Diagnosis and therapy carried out in the early stages allows avoiding complications and huge expenses associated with them in the future.

wmedik.ru

Correspondence of the stages of chronic kidney disease to the microcoding мк 10

CKD stages	ICD-10 code
Stage not specified

The introduction of key approaches to the diagnosis of CKD in real clinical practice had important consequences. Over the ten years since the adoption of the concept of CKD, the awareness and alertness of doctors of various specialties regarding CKD as a significant public health problem has significantly increased. The introduction of automatic calculation of GFR in laboratories and the inclusion of its value in the results of a laboratory study in addition to the serum creatinine level contributed to an increase in the initial nephrology of patients with CKD by 68.4%.

Using the categories of GFR and albuminuria allows stratification of CKD patients by the risk of renal outcomes (decreased GFR, progression of albuminuria, AKI, ESRD) and other complications (cardiovascular morbidity and mortality, endocrine and metabolic disorders, drug toxicity) (Table 5).

Table 5.

The combined risk of progression of CKD and the development of cardiovascular complications, depending on the degree of decrease in SCF and the severity of albuminuria

	Albuminuria**
Optimal or slightly increased		Very high
30 mg / mol
		High or optimal			Moderate
	Slightly reduced			Moderate
	Moderately reduced		Moderate		Very tall
	Significantly reduced			Very tall	Very tall
	Sharply reduced		Very tall	Very tall	Very tall
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