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Chronic Renal Failure

Overview, Causes, & Risk Factors

Chronic renal failure, called CRF, is a disease in which the kidneys gradually stop working. As a rule, this process takes place over a period of a few years.

What is going on in the body?

In a healthy body, the kidneys filter waste and other impurities from the blood. These wastes are then excreted from the body in the urine. In people with CRF, toxins that the kidneys fail to get rid of build up slowly in the body. Two of the most common toxins are urea, a nitrogen waste product, and creatinine. The amount of toxins that remains in the blood is a rough measure of how well the kidneys are working at any given time.

What are the causes and risks of the disease?

A primary kidney disease may cause CRF. But it may also be due to other diseases that affect kidneys, such as diabetes or high blood pressure. Other common causes include:

glomerulonephritis, the swelling of the glomerulus, which is a part of the kidney made up of blood vessels and nerve fibers

interstitial disease, a disease within the cell walls of the kidney

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, a long-term disease that affects many parts of the body, including the kidneys

Everyone is at risk for chronic renal failure as they age. But some people are at greater risk, such as:

African Americans

males

those who have a family history of the disease

Symptoms & Signs

What are the signs and symptoms of the disease?

Azotemia is a form of CRF where the buildup of toxins causes no symptoms. Uremia is another form of CRF where the stored toxins do cause symptoms. These symptoms may include:

breathlessness

changes in the amount of urine output

fatigue

frequent hiccups

generalized swelling

itching

leg cramps

mental slowness or confusion

metallic taste

pale skin color, called pallor

poor appetite

nausea

sudden, uncontrollable body spasms, called seizures

vomiting

weight loss

Diagnosis & Tests

How is the disease diagnosed?

Although chronic renal failure usually has no symptoms, a physical examination by a doctor can be helpful. 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 minerals collect on the walls of the kidneys.

A blood sample may show elevated creatinine and urea nitrogen, which are both toxins.

Levels of erythropoietin, a hormone produced by the kidneys, may be low.

Levels of serum potassium, phosphorus, parathyroid hormone, magnesium, and calcium may be high.

Malnourishment can result.

Kidneys may be small and scarred.

If the underlying kidney disease causing CRF is unclear, the doctor may decide to do a kidney biopsy.

Prevention & Expectations

What can be done to prevent the disease?

Very little can be done to prevent chronic renal failure, other than preventing the underlying disease that causes it. But the best ways to slow the progression of this disease are:

to control blood pressure using ACE inhibitor medicine that reduces the protein overflow in urine

to keep blood glucose in a healthy range if a person has diabetes

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 diseases

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 fluids

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

progression to end-stage renal disease

Treatment & Monitoring

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 using medicines that treat the underlying causes

eating a protein-, potassium-, and phosphorus-restricted diet

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

What happens after treatment for the disease?

Most cases of CRF progress to end-stage renal disease. Most people who have this condition will eventually need dialysis or a kidney transplant to treat the symptoms of end-stage renal disease.

How is the disease monitored?

A doctor will usually monitor a person for symptoms of complete kidney failure. Once these symptoms appear, dialysis is a next step. The doctor may also keep a watch on kidney function with repeated blood samples and 24-hour urine collection. Be sure to report any new or worsening symptoms to the doctor.

Attribution

Author:Rajnish K. Dhingra, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:02/11/02
Reviewer:Lisa Sterling, PharmD
Date Reviewed:02/11/02

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