Chronic Renal Failure

Chronic renal failure (CRF) refers to an irreversible deterioration in renal function which classically develops over a year over a period of years. Initially, it is manifest only as a biochemical abnormality. Eventually, loss of the excretory, metabolic and endocrine functions of the kidney leads to the development of the clinical symptoms and signs of renal failure, which is referred to as uraemia.

Causes of CRF

The two main causes of chronic renal failure are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other conditions that affect the kidneys are:

  • Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney’s filtering units. These disorders are the third most common type of kidney disease.
  • Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.
  • Malformations that occur as a baby develops in its mother’s womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
  • Lupus and other diseases that affect the body’s immune system.
  • Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.
  • Repeated urinary infections.

Symptoms of CRF

If the kidneys continue to lose function and there is progression towards kidney failure (established renal failure or ERF), this will usually be tracked by blood tests and monitoring. If kidney failure does occur, the symptoms may include:

  • weight loss and poor appetite
  • swollen ankles, feet or hands (due to water retention) 
  • shortness of breath 
  • blood or protein in your urine (protein in your urine is not something you will notice as it can only be detected during a urine test) 
  • an increased need to urinate, particularly at night 
  • itchy skin 
  • muscle cramps
  • high blood pressure (hypertension)
  • nausea 
  • erectile dysfunction in men (an inability to get or maintain an erection)

Investigations

  • Serum Creatinine:  Creatinine  is a waste product that comes from the normal wear and tear on muscles of the body.  The level of creatinine in the blood rises, if kidney disease progresses.
  • Glomerular Filtration Rate(GFR): This test is a measure of how well the kidneys are removing wastes and excess fluid from the blood. 
  • Blood Urea Nitrogen (BUN): Urea nitrogen comes from the breakdown of protein in the foods you eat. As kidney function decreases, the BUN level rises.
  • Ultrasound: It may be used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.
  • CT Scan: This imaging technique uses contrast dye to picture the kidneys. It may also be used to look for structural abnormalities and the presence of obstructions.

Preventions

  • Restriction of dietary protein intake delays the progression of chronic renal failure.
  • Control of blood pressure.

References