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Nephrology

Chronic Renal Failure (CRF)

Chronic renal failure (CRF) is a slowly progressive loss of renal function over a period of months or years.

Causes

  • IgA nephropathy (Berger's disease)
  • Glomerulonephritis (chronic or severe acute cases)
  • Nephrotic syndrome (longstanding)
  • Hypertension
  • Diabetes mellitus (all types, dependant on duration and glycemic control)
  • Amyloid
  • Lupus erythematosus (lupus nephritis)

Signs and symptoms

Initially it is without symptoms. As the kidney functions less:

  • blood pressure is increased (leading to hypertension)
  • urea accumulates, leading to uremia (lethargy and encephalopathy)
  • potassium accumulates, leading to malaise and cardiac arrhythmias
  • erythropoietin synthesis is decreased (leading to anemia)
  • vitamin D3 synthesis is impaired (leading to renal osteodystrophy and secondary hyperparathyroidism)
  • fluid balance disturbances are generally mild.

CRF patients suffer from accelerated atherosclerosis, mostly due to hypercholesterolemia. Coagulation is often disrupted, leading to a prothrombotic state (a high likelihood of developing thrombosis). Pericarditis occurs at an increased rate in CRF patients.

Diagnosis

In many CRF patients, previous renal disease or other underlying diseases are already known. A small number presents with CRF of unknown cause. In these patients, a cause is occasionally identified retrospectively.

Treatment

The most important differential diagnosis is to decide whether the renal failure is acute or chronic. History could provide indications as to the onset of problems from the history of urinary changes in terms of quantity and quality; and history of a loss in body weight, chronic fatigue etc. The presence of anaemia suggests CRF; bilateral small kidneys suggest CRF; neuropathy, lipiduria, and osteodystrophy. The presence of loin pain is always a good sign indicating that the kidney is still responsive.

CRF cannot be treated apart from by renal transplant. In the period usually required to find a transplant, dialysis (renal function replacement therapy) is the only way to clear waste products from the blood that are usually excreted through the urine (urea, potassium).

Replacement of erythropoietin and vitamin D3, two hormones processed by the kidney, is usually necessary, as is calcium.

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