Chronic renal failure

Chronic renal failure

Definition:

A gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.

Alternative Names:

Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; CRF; Chronic kidney failure

Causes, incidence, and risk factors:

Unlike acute renal failure with its sudden reversible failure of kidney function, chronic renal failure is slowly progressive. It most often results from any disease that causes gradual loss of kidney function. It can range from mild dysfunction to severe kidney failure. Progression may continue to end-stage renal disease. Chronic renal failure usually occurs over a number of years as the internal structures of the kidney are slowly damaged. In the early stages, there may be no symptoms. In fact, progression may be so gradual that symptoms do not occur until kidney function is less than one-tenth of normal.

Chronic renal failure and end stage renal disease (ESRD) affect more than 2 out of 1000 people in the United States. Diabetes and hypertension are the two commonest causes and account for approximately two thirds of the cases of chronic renal failure and ESRD. Other major causes include glomerulonephritis of any type (one of the most common causes), polycystic kidney disease, Alport syndrome, reflux nephropathy, obstructive uropathy, kidney stones and infection, and analgesic nephropathy.

Chronic renal failure results in the accumulation of fluid and waste products in the body, causing azotemia and uremia. Azotemia is the build-up of nitrogen waste products in the blood. It may occur without symptoms. Uremia is the state of ill health resulting from renal failure. Most body systems are affected by chronic renal failure. Fluid retention and uremia can cause many complications (see Complications).

Symptoms:

INITIAL SYMPTOMS (may be nonspecific)

LATER SYMPTOMS

increased or decreased urine output
need to urinate at night
easy bruising or bleeding;
may have blood in the vomit or in stools
decreased alertness
- drowsiness, somnolence, lethargy
- confusion, delirium
- coma
muscle twitching or cramps
seizures
uremic frost--deposits of white crystals in and on the skin
decreased sensation in the hands, feet, or other areas

Additional symptoms that may be associated with this disease:

Signs and tests:

Blood pressure may be high, with mild to severe hypertension. A neurologic examination may show polyneuropathy. Abnormal heart or lung sounds may be heard with a stethoscope.

A urinalysis may show protein or other abnormalities. An abnormal urinalysis may occur 6 months to 10 or more years before symptoms appear.

Creatinine levels progressively increase.
BUN is progressively increased.
Creatinine clearance progressively decreases.
Potassium test may show elevated levels.
Arterial blood gas and blood chemistry analysis may show metabolic acidosis.

Changes that indicate chronic renal failure, including both kidneys being smaller than normal, may be seen on:

This disease may also alter the results of the following tests:

Treatment:

Treatment focuses on controlling the symptoms, minimizing complications, and slowing the progression of the disease.

Associated diseases that cause or result from chronic renal failure must be controlled. Hypertension, congestive heart failure, urinary tract infections, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated as appropriate.

Blood transfusions or medications such as iron and erythropoietin supplements may be needed to control anemia.

Fluid intake may be restricted, often to an amount equal to the volume of urine produced. Dietary protein restriction may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting. Salt, potassium, phosphorus, and other electrolytes may be restricted.

Dialysis or kidney transplant may be required eventually.

Support Groups:

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See kidney disease - support group.

Expectations (prognosis):

There is no cure for chronic renal failure. Untreated, it usually progresses to end-stage renal disease. Lifelong treatment may control the symptoms of chronic renal failure.

Complications:

end-stage renal disease
pericarditis
cardiac tamponade
congestive heart failure
hypertension
platelet dysfunction
loss of blood from the gastrointestinal tract
ulcers
hemorrhage
anemia
Hepatitis B, Hepatitis C, liver failure
decreased functioning of white blood cells
decreased immune response
increased incidence of infection
peripheral neuropathy
seizures
encephalopathy, nerve damage, dementia
weakening of the bones
fractures
joint disorders
changes in glucose metabolism
electrolyte abnormalities including hyperkalemia
decreased libido, impotence
miscarriage, menstrual irregularities, infertility
skin dryness, itching/scratching with resultant skin infection

Calling your health care provider:

Call your health care provider if nausea or vomiting persists for more than 2 weeks.

Call your health care provider if decreased urine output or other symptoms of chronic renal failure occur.

Prevention:

Treatment of the underlying disorders may help prevent or delay development of chronic renal failure. Diabetics should control blood sugar and blood pressure closely and should refrain from smoking.

Review Date: 11/30/2001
Reviewed By: Andrew Koren, M.D., Department of Nephrology, NYU-Mount Sinai Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.

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