Chronic renal failure

First, the cause
Chronic renal failure is extremely extensive, almost all the development of kidney disease can lead to deterioration of chronic renal failure. Acute renal failure without cure, a short period of time without death can also be a direct transition to chronic renal failure. The common reasons are described below:
1. Chronic glomerulonephritis progression to the late stage is the most common cause of chronic renal failure.
2. Interstitial nephritis (Interstitial Nephritis) is a group of mainly involving the renal interstitial and renal tubular disease, also known as tubulointerstitial nephropathy (Tubulo-Interstitia Nephropa-thy). Its complex causes, is a common clinical disease, accounting for Urinary system diseases of 25% to 33%, living in the second place of chronic renal failure.
(1) infection: bacteria, viruses, mold, malaria parasite and other invasion of renal interstitial and renal tubules, which represent diseases such as chronic pyelonephritis. Malignant hernia and so on.
(2) immune damage: common drug allergy such as penicillin, sulfonamides, autoimmune diseases such as systemic lupus erythematosus, scleroderma, dermatomyositis involving the kidney.
(3) Toxic substances such as aminoglycoside antibiotics, contrast agents damage the kidneys, heavy metal salts such as mercury, lead, arsenic, gold and other damage to the kidneys.
(4) renal blood supply disorders: such as renal arteriosclerosis, renal artery stenosis and so on.
(5) metabolic abnormalities: such as hyperuricemia, hypercalcemia, long-term hypokalemia and so on.
(6) physical factors: long-term exposure to X-ray, malignant radiotherapy and other radiotherapy.
(7) urinary tract obstruction: obstruction caused by bladder, ureteral reflux to the renal pelvis, ureteral pressure increased renal interstitial, such as infection is more aggravated condition.
(8) tumor direct infiltration of renal interstitial: such as leukemia, lymphoma, cancer cell metastasis caused by renal interstitial damage.
(9) hereditary diseases: such as polycystic kidney disease, renal cysts.
(10) Balkan nephritis: belong to the cause of unknown renal interstitial disease, mainly in southern Europe.
3. Hypertensive atherosclerosis at this time first damage the renal tubules and then damage the glomerular, and glomerulonephritis first damage the glomerular and then damage the renal tubular different.
4. Secondary to metabolic diseases such as diabetes, gout kidney, amyloidosis and so on.
Second, the mechanism
1. Glomerular hyperfiltration theory when the glomerular destruction of more and more residual kidney units due to compensatory over-filtration, and ultimately lead to glomerular succession and loss of function, such as 85% of nephrectomized animals, 3 months visible residual Glomerular hypertrophy, epithelial cell vacuolization, foot process fusion, 6 months visible mesangial area increased; glomerular basement membrane endothelium, epithelial cells shedding, and finally lead to focal, segmental glomerular sclerosis, Renal filtration rate is further reduced, further deterioration of renal function.
2. In the chronic renal failure, the body of toxic substances increased, the body in order to clear some of the poison and compensation, the results of a new imbalance, such as decreased glomerular filtration rate, reduced urinary phosphorus excretion, high blood Phosphorus, hypocalcemia, stimulation of parathyroid secretion increased, the role of renal tubules, increased urinary phosphorus excretion, so that phosphorus decreased, elevated serum calcium, returned to normal levels. The increase in serum deposition in the various systems including the kidney itself, the glomerular filtration rate further decreased, further deterioration of renal function.
Chronic renal failure, glomerular filtration rate is low, sodium decreased, at this time increased secretion of natriuretic hormone, proximal renal tubular reabsorption of sodium decreased, but the sodium hormone on Na + -K + -ATP enzyme inhibition, so So that many organizations on the steel transport obstacles, resulting in a new imbalance.
3. Toxins theory in the uremia when the body has more than 200 kinds of substances increased, of which there are more than 20 kinds of toxic substances, small molecules (molecular weight <500 molecules (molecular weight 500 ~ 5000) and macromolecules (molecular weight> 5000) three Small molecules are the main cause of clinical symptoms such as urea, guanidine, amines, molecular substances such as peptides, cells and bacteria lysates.Molecular substances can cause peripheral neuropathy, uremia encephalopathy, erythropoiesis Inhibition of insulin activity, inhibition of lipoprotein lipase activity, platelet function damage, low cellular immune function, sexual dysfunction and exocrine glandular atrophy.When chronic renal failure, hyperglycemia hypocalcemia stimulates increased secretion of parathyroid gland Tissue calcium deposition, nerve conduction velocity slowed down, brain cells increased calcium content, while parathyroidism is an important cause of renal anemia, in addition to affect the heart function and myocardial cell metabolism.

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