L’insuffisance rénale chronique est une pathologie au cours de laquelle le rein perd progressivement ses capacités de filtration. Quelles sont les causes de cette pathologie ? Quels sont les premiers symptômes ? Comment la prendre en charge ?
Le rein remplit plusieurs fonctions essentielles : filtrer et réguler la composition du sang et sécréter des hormones. Lorsqu’une personne est atteinte d’insuffisance rénale chronique, cela signifie que son rein n’est plus en capacité de les assumer pleinement, de façon irréversible. Environ 2 millions de Français sont concernés par cette pathologie.
Quelles sont les causes de l’insuffisance rénale chronique ?
Cette pathologie est souvent secondaire à une autre, c’est-à-dire qu’elle est la conséquence ou la complication d’une autre maladie comme le diabète, l’hypertension artérielle ou une maladie auto-immune (lupus, polyarthrite rhumatoïde, maladie de Crohn, purpura rhumatoïde). Certains facteurs favorisent la survenue d’une insuffisance rénale chronique : le surpoids et de surcroît l’obésité, le tabagisme, l’excès de cholestérol.
Quels sont les symptômes de l’insuffisance rénale chronique ?
La maladie est silencieuse pendant de nombreuses années. Lorsque des symptômes apparaissent, c’est que l’insuffisance rénale est déjà bien avancée. Un suivi médical régulier est le seul moyen de diagnostiquer la pathologie à un stade précoce.
En cas d’insuffisance rénale, le sang n’est plus correctement filtré et des déchets du métabolisme (acide urique, urée, créatinine) s’y accumulent. Les conséquences sont des nausées, des vomissements, une perte d’appétit. De l’eau s’accumule dans les tissus provoquant des gonflements ou œdèmes.
Par ailleurs, le rein est aussi le lieu de fabrication d’une hormone, l’érythropoïétine, responsable de la stimulation de production de globules rouges par la moelle osseuse.
En cas d’insuffisance, celle-ci fait défaut et une anémie s’installe, responsable d’un essoufflement et d’une fatigue chez le patient.
AU STADE TERMINAL, LA DIALYSE EST INDISPENSABLE
Quels sont les traitements de l’insuffisance rénale chronique ?
Dans un premier temps, il s’agit d’identifier la maladie sous-jacente pour la prendre en charge, si ce n’est pas déjà le cas.
Des conseils hygiéno-diététiques sont donnés au patient pour alléger le travail des reins. Un régime pauvre en protéines et sans alcool est conseillé, voire pauvre en sel en cas d’hypertension et pauvre en matières grasses en cas de surpoids. Le patient est accompagné vers l’arrêt du tabac s’il est fumeur.
Une activité physique adaptée est recommandée.
Les traitements dépendent du niveau d’avancement de la maladie. Des médicaments peuvent être prescrits pour diminuer le volume d’urines ou réduire la production d’acide urique. Lorsque le rein passe en dessous de 15 % de ses capacités habituelles, la dialyse devient indispensable dans l’attente d’une greffe, qui demeure le traitement de choix de l’insuffisance rénale chronique au stade terminal.
Le rein peut être donné par une personne décédée ou par une personne vivante de la famille du patient. Même si une greffe s’accompagne d’un traitement immunosuppresseur à vie, elle augmente beaucoup la qualité de vie des patients.
futura
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