Chronic Renal Failure

Overview, Causes, & Risk Factors

Chronic renal failure, called CRF, is a disease in which the kidneysgradually 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 theblood. 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 mostcommon toxins are urea, a nitrogen waste product, and creatinine. The amount oftoxins that remains in the blood is a rough measure of how well the kidneys are workingat 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 toother diseases that affect kidneys, such as diabetesor high blood pressure.Other common causes include:

  • glomerulonephritis,the swelling of the glomerulus, which is a part of the kidney made up of blood vesselsand 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 peopleare 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 nosymptoms. Uremia is another form of CRF where the stored toxins do causesymptoms. 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 physicalexamination by a doctor can be helpful. Since many diseases lead to chronic renalfailure, the path to diagnosis can vary. There are a few common abnormalitiesassociated with this condition.

  • A urinalysis may show protein, red blood cells, or different types of casts, whichare structures made when minerals collect on the walls of the kidneys.
  • A blood sample may show elevated creatinine and urea nitrogen, which are bothtoxins.
  • Levels of erythropoietin, a hormone produced by the kidneys, may be low.
  • Levels of serum potassium, phosphorus, parathyroid hormone, magnesium, andcalcium may be high.
  • Malnourishmentcan result.
  • Kidneys may be small and scarred.
  • If the underlying kidney disease causing CRF is unclear, the doctor maydecide 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 thanpreventing the underlying disease that causes it. But the best ways to slow theprogression of this disease are:

  • to control blood pressure using ACE inhibitor medicine that reduces the proteinoverflow 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 bonediseases
  • electrolyte disturbances, especially with potassium. Electrolytes arecompounds 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 asfurosemide
  • 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 electrolytesin the blood
  • using bicarbonate to improve acid-base status
  • using erythropoietininjections 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 havethis condition will eventually need dialysis or a kidney transplant to treat the symptomsof end-stage renal disease.

    How is the disease monitored?

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

    Article type: xmedgeneral