Renal Insufficiency

Renal Insufficiency 

a syndrome in which all kidney functions are impaired; it results in disturbance of water, electrolyte, and nitrogen metabolism.

Renal insufficiency may be acute or chronic. Acute renal insufficiency may be caused by shock resulting from trauma, burns, blood transfusions, or surgery. It may also be caused by the effect of such poisons as mercury or arsenic on the kidneys; by mushroom poisoning, drugs, infections, and such acute renal diseases as nephritis and pyelonephritis; and by obstruction of the upper urinary tract. The principal symptoms are oliguria or anuria (daily quantity of urine less than 400–500 ml), retention of nitrogenous residues in the body, disturbance of the fluid and acid-base balances, cardiovascular disorders, and anemia. Most of the changes that occur in the kidneys are reversible and diuresis is restored within two weeks, less commonly in one to two months. Treatment is aimed at eliminating such causes as shock and poisoning and at eliminating the metabolic disturbances. Hemodialysis and other means of extrarenal cleansing of blood are used to prevent and control uremia. Recovery with restoration of ability to work takes place within three to 12 months.

Chronic renal insufficiency may result from such kidney diseases as chronic diffuse glomerulonephritis, chronic pyelonephritis, and renal amyloidosis. It may also result from such dynamic or mechanical obstructions of the urinary tract as nephrolithiasis and urethrostenosis, from cardiovascular and collagen diseases, and from such endocrine disorders as diabetes mellitus. Chronicrenal insufficiency is accompanied by general weakness, insomnia, pruritus, dyspepsia, anemia, high and stable hypertension, electrolyte disturbances and, at a later stage, by polyuria giving way to oliguria. It is also accompanied by polyneuritis and by azotemia and uremia.

Treatment in the initial stage consists of a low-protein diet with restricted sodium intake and administration of hypotensive agents in the case of hypertension and of anabolic hormones, cardiac stimulants, and other drugs. At a later stage, when there is an increase in canalicular insufficiency as well, the diet is less restricted and additional measures are taken to maintain the blood’s electrolytic balance. Chronic hemodialysis and kidney transplants are used in the terminal stage of chronic renal insufficiency.

REFERENCE

Osnovy nefrologii, vol. 1. Edited by E. M. Tareev. Moscow, 1972.

N. R. PALEEV and B. D. VERKHOVSKII