Chronic Renal Failure

Chronic Renal Failure

Alternate Names

  • CRF
  • chronic kidney failure
  • Kidneys and adrenal glands

Definition

Chronic renal failure, called CKD for chronic kidney disease, is a process in which progressive damage to the kidneys gradually leads to their failure. Usually, this takes place over years. If it happens suddenly, it is called acute rather than chronic.

What is going on in the body?

In a healthy body, the kidneys filter wastes and regulate fluid and salt balance. The wastes are then excreted from the body in the urine. In people with CKD, toxins that the kidneys fail to get rid of build up slowly in the body.
Two of the most common wastes that are measured are urea, a nitrogen or protein waste product, and creatinine. The amount of toxins that remain in the blood is a measure of how well the kidneys are working at any given time (see kidney function tests).

Risks

What are the causes and risks of the disease?

Any kidney disease can cause CKD. More common causes include diabetes or high blood pressure. Others are:
  • glomerulonephritis, damage to the glomerulus which filters blood to make urine
  • interstitial disease called interstitial nephritis
  • multiple myeloma, which is also known as a cancer of the bone marrow
  • obstructive uropathy, a condition in which the flow of urine is blocked
  • polycystic kidneys, a condition in which the kidneys become enlarged and grow cysts
  • systemic lupus erythematosus (SLE) or other autoimmune diseases, that affect many parts of the body, including the kidneys
Everyone is at risk for chronic renal failure, especially as they age. But some people are at greater risk, such as:
  • African Americans (high blood pressure, diabetes, a disease called focal glomerulosclerosis)
  • Latinos (because of Diabetes type 2)
  • those who have a family history of inherited diseases like high blood pressure or polycystic kidney disease
  • Native Americans (because of their increased incidence of type 2 diabetes)
  • family members of people who have any type of CKD.

Prevention

What can be done to prevent the disease?

Weight control to prevent or improve diabetes type 2 and strict control of blood pressure can prevent this disease or slow its progression.
The best ways to slow the progression of this disease are:
  • to control blood pressure using an ACE inhibitor medication that not only lowers blood pressure, but also reduces the protein in urine
  • Adding a medication, called an ARB, to an ACE inhibitor to further reduce protein excretion and blood pressure
  • At certain stages of CKD diet is helpful.
  • to keep blood glucose in a healthy range if a person has diabetes
  • Smoking cessation
CKD is associated with a significantly higher risk of heart disease. The measures directed at heart disease (aspirin, medication therapy to lower cholesterol, etc.) are also used in CKD patients before and during dialysis therapy.

Diagnosed

How is the disease diagnosed?

Although chronic renal failure usually has no symptoms, a physical examination by a healthcare professional can be helpful, especially if high blood pressure is discovered. Since many diseases lead to chronic renal failure, the path to diagnosis can vary.
There are a few common abnormalities associated with this condition:
  • A urinalysis may show protein, red blood cells, or different types of casts, which are structures made when injured cells collect from the kidneys and are excreted in the urine. They can be seen under a microscope.
  • A blood sample may show elevated creatinine and urea nitrogen.
  • Other kidney function tests like clearance studies or equations (like the MDRD or Cockgroft Gault) may be done.
  • Elevated protein in urine samples (a spot or 24 hour collection) may be discovered
  • Levels of serum potassium, phosphorus, parathyroid hormone, and magnesium may be high.
  • Calcium may be low
  • Anemia or blood count may be present (usual)
  • Malnourishment, especially proteins and calories, can result.
  • Kidneys may be small and scarred when looked at by ultrasound or CT examinations..
If the underlying kidney disease causing CRF is unclear, the healthcare professional may decide to do a kidney biopsy.

Long Term Effects

What are the long-term effects of the disease?

The long-term effects include:
  • calcium and phosphorus abnormalities, which may lead to many kinds of bone disease
  • electrolyte disturbances, especially with potassium. Electrolytes are compounds or elements that the body needs in order to function.
  • generalized swelling due to the body's inability to get rid of extra fluid (called edema)
  • high blood pressure
  • inability to get rid of the acids produced from protein digestion
  • increased susceptibility to infections
  • irregular periods and decreased sex drive
  • low levels of hemoglobin, called anemia
  • malnutrition
  • progression or development of heart disease with heart attacks more likely
  • progression to end-stage renal disease or CKD 5.

Treatments

What are the treatments for the disease?

Treatment of CRF includes the following actions:
  • controlling fluids using diuretics, called water pills, such as furosemide
  • controlling high blood pressure (very important) using medicines that treat the underlying causes, especially ACE inhibitors and ARBs.
  • Strictly controlling diabetes
  • smoking cessation
  • eating a protein-, potassium-, and phosphorus-restricted diet when it is prescribed by health care professionals.
  • hemodialysis, a process in which a machine filters wastes or impurities from the blood
  • limiting fluids
  • kidney transplantation, where a healthy kidney from another person is used to replace a diseased kidney
  • peritoneal dialysis, a filtering procedure that corrects the balance of electrolytes in the blood
  • using bicarbonate to improve acid-base status
  • using erythropoietin injections to improve anemia
  • using phosphate binders, such as calcium carbonate, to decrease absorption of phosphate
  • Giving vitamin supplements to improve calcium and bone metabolism.

After Treatment

What happens after treatment for the disease?

Many cases of CKD progress to end-stage renal disease or CKD 5. Most people who have this condition will eventually require dialysis or a kidney transplant to treat the symptoms and signs of end-stage renal disease.

Monitor

How is the disease monitored?

A healthcare professional will usually monitor a person for symptoms of complete kidney failure. Treatments described above that slow progression will be used.
Once CKD 5 symptoms appear, dialysis is a next step. The healthcare professional may also keep a watch on kidney function with repeated blood samples and 24-hour urine collections. Be sure to report any new or worsening symptoms to the healthcare professional.

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