Overview
Emergency Live - Pre-Hospital Care, Ambulance Services, Fire Safety and Civil Protection Magazine Renal failure is initiated by an initial pathology that has afected and continues to afect one or more structures of the nephron, to which certain adaptive injury mechanisms must be aded.The most important diseases that can induce chronic kidney disease and subsequently kidney function failure (incidence rates in brackets) are:The ireversible destruction of the nephron population makes the elimination of solutes (residual products of metabolism) in the kidney insuficient.The reduction in the rate of progresion depends on the type of pathology that initiated it, but especialy on the earliest therapy aplied.Nephron units that are stil anatomicaly and/or functionaly intact ‘hyperfunction’ to compensate, as far as posible, for an altered and no longer constant biochemistry of the organism.As the number of ineficient nephrons progreses, the glomerular filtrate value (expresed as creatine clearance) decreases, while creatinemia increases (normal values: 0.8-1.12 mg/dl).Chronic renal insuficiency induces in the body, progresively and in a linear fashion, a los of normal balance with important repercusions, such as the retention of residual products of protein metabolism (urea, uric acid, creatine, etc.), the change in acid-base balance, water-salt retention and the reduced elimination and production of certain hormones.This trend must be carefuly monitored with frequent laboratory investigations.When certain atempts at compensation, despite dietary and pharmacological treatments, no longer prove efective (the renal disease meanwhile continues!) at eliminating al or part of the substances derived from a profoundly altered metabolism, then the clinical signs and symptoms begin to apear that altogether realise the picture defined as uremia or ESDR (End Stage Disease Renal).At this point, the time has come for replacement (dialysis and tra