Chronic Renal Failure
Definition
Gradual and progressive loss of the ability of the kidneys
o To excrete wastes,
o To concentrate urine,
o To conserve electrolytes.
chronic renal failure slowly gets worse.
gradual loss of kidney function.
mild dysfunction to severe kidney failure
Progression may continue to end-stage renal disease (ESRD).
o Usually occurs over a number of years as the internal structures of the kidney are slowly damaged.
The causes of chronic renal failure
o Glomerulonephritis of any type (one of the most common causes)
o Polycystic kidney disease
o Reflux nephropathy
o Obstructive uropathy
o Kidney stones and infection
o Analgesic nephropathy
Clinical Features
o In the early stages, there may be no symptoms.
o Progression may be so gradual that symptoms do not occur until kidney function is less than one-tenth of normal.
o Chronic renal failure ' accumulation of fluid and waste products in the body, causing azotemia and uremia.
o Azotemia is the buildup of nitrogen waste products in the blood.
Symptoms of Chronic Renal Failure
o Weight loss
o Nausea, vomiting
o General ill feeling
o Fatigue
o Headache
o Frequent hiccups
o Generalized itching (pruritus)
o Later symptoms :
o Increased or decreased urine output
o Need to urinate at night
o Easy bruising or bleeding
o May have blood in the vomit or in stools
o Decreased alertness
- drowsiness, somnolence lethargy
- confusion delirium
- coma
o Muscle twitching or cramps
o Seizures
o Uremic frost -- deposits of white crystals in and on the skin
o Decreased sensation in the hands, feet, or other areas
o Additional symptoms that may be associated with this disease:
o Excessive nighttime urination
o Excessive thirst
o Abnormally dark or light skin
o Pallor
o Nail abnormalities
o Breath odor
o Agitation
Signs and tests
o High blood pressure.
o Polyneuropathy.
o Abnormal heart or lung sounds
o A urinalysis may show protein or other abnormalities. An abnormal urinalysis may occur 6 months to 10 or more years before symptoms appear.
o Creatinine levels progressively increase
o BUN is progressively increased
o Serum Potassium : elevated levels
o potassium, phosphate - tend to increase in renal failure
o Calcium, pH, bicarbonate - tend to decrease in renal failure.
Treatment
Aim of the treatment
o Control the symptoms
o Minimize complications
o Slow down the progression of the disease.
Associated diseases that cause or result from chronic kidney failure must be controlled.
o High blood pressure
o Congestive heart failure,
o Urinary tract infections,
o Kidney stones,
o Obstructions of the urinary tract,
o Glomerulonephritis, and other disorders should be treated as appropriate.
o Blood transfusions
o Iron
o Erythropoietin supplements to control anemia.
o Fluid intake restricted often to an amount equal to the volume of urine produced.
o Dietary protein restriction
o Salt, potassium, phosphorus restricted.
o Dialysis or kidney transplant may be required
