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Renal failure

Synonyms: renal dysfunction, kidney malfunction
German: Niereninsuffizienz

1 Definition

Renal failure is defined as the hypofunction of one or both kidneys. In the course of renal failure, the concentration of urophanic substances (creatinin, urea, uric acid, and orthers) in the blood increases.

2 Classification

2.1 ...according to disease progression

Clinically, renal failure is divided into:

ICD10 code N19 is the classification for the unspecified renal failure.

2.2 ...according to glomerular filtration rate

By means of the glomerular filtration rate (GFR), you can differentiate between five stages of renal failure:

Stage GFR ICD10 code Renal disorder...
1 > 89 N18.1 ...with normal renal function
2 60-89 N18.2 ...with mild dysfunction
3 30-59 N18.3 ...with moderate dysfunction
4 15-29 N18.4 ...with severe dysfunction
5 < 15 N18.5 Chronic renal failure

At stage 1 and 2, the diagnosis of a renal failure always requires proof of a proteinuria, or a pathological finding in an imaging technique procedure. Patients with mild renal failure (GFR 60-89 ml/min/1,73m²) in whom you cannot detect proteinuria or other pathological alterations in the kidneys are not suffering from kidney problems.

2.3 ...according to retention values

Another possibility for the differentiation is the classification depending on the retention values. There, renal failure is divided into 4 stages.

2.3.1 Stage 1 - Functional renal impairment

In stage 1 renal failure, you can find a functional renal impairment. Creatinine values lie between 1,2 mg/dl - 2 mg/dl. However, not every functional renal impairment leads to an increase in serum creatinine at this stage. Just from a decrease in GFR by 50%, the serum creatinine level increases.

Therefore, a renal failure can be diagnosed despite creatinine values within the reference range. For the detection of such masked cases of renal failure, you need to determine the clearance, eg. the creatinine clearance.

Especially in elderly patients, you need to consider a low-stage renal failure by adapting the dosage of medicinal drugs that are eliminated renally.

2.3.2 Stage 2 - Compensated retention

At stage 2, you also call it a compensated retention, or azotemia. Creatinine values lie between 2-6 mg/dl. At this stage, urophanic substances can still be sufficiently eliminated.

2.3.3 Stage 3 - Decompensated retention

Stage 3 is the stage of decompensated retention. Urophanic substances are not eliminated sufficiently from the blood anymore - this results in pre-uremia. Creatinine values lie between 6-12 mg/dl. At the stage of decompensated retention, dietetic protein restriction still allows a return to compensated retention.

2.3.4 Stage 4 - Uremia

Stage 4 represents terminal renal failure where dialysis and or a kidney transplant are indicated. Retention values lie above 12 mg/dl. The patientís appearance is characterized by the clinical symptoms of uremia.

3 Symptoms and secondary diseases

Renal failure leads to a number of characteristic symptoms and secondary diseases, which can be diagnostically indicative alongside the lab values.

These include:

4 Diagnostics

5 Therapy

The therapy of renal failure is based on the grade of functional loss and on the underlying cause of the disease. In mild to moderate functional impairments, the main focus of therapy lies on preventing further deterioration of renal function and eliminating the corresponding risk factors (eg. hypertension, hyperglycemia, hyperlipidemia, smoking, abuse of analgetics). This approach is complemented by dietetic measures (protein-reduced nutrition, salt restraint, high liquid intake).

An advanced renal failure that leads to the retention of urophanic substances requires a renal replacement therapy (peritoneal dialysis, hemofiltration, hemolysis). Additional measures are the administration of erytropoietin and phosphate binders. An alternative limited by the lack of donor organs is the kidney transplant.

A causal therapy in terms of a reparation of the damaged tissue is not possible at the moment (2015). Latest research approaches aim to the reconstruction of entire kidneys by 3D-tissue printing. However, it still is at the stage of fundamental research.[1]

6 References

  1. Engineering a Kidney. Wake Forst, School of medicine

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