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Chronic renal failure
Alternative namesKidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; CRF; Chronic kidney failure
DefinitionChronic renal failure is a gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes .
Causes, incidence, and risk factors
Unlike acute renal failure with its sudden reversible failure of kidney function, chronic renal failure is slowly progressive. It most often results from any disease that causes gradual loss of kidney function. It can range from mild dysfunction to severe kidney failure . Progression may continue to end-stage renal disease (ESRD).
Chronic renal failure usually occurs over a number of years as the internal structures of the kidney are slowly damaged. In the early stages, there may be no symptoms. In fact, progression may be so gradual that symptoms do not occur until kidney function is less than one-tenth of normal.
Chronic renal failure results in the accumulation of fluid and waste products in the body, causing azotemia and uremia . Azotemia is the buildup of nitrogen waste products in the blood. It may occur without symptoms. Uremia is the state of ill health resulting from renal failure . Most body systems are affected by chronic renal failure. Fluid retention and uremia can cause many complications.
SymptomsInitial symptoms may include the following:
Later symptoms may include the following:
Signs and testsBlood pressure may be high, with mild to severe hypertension . A neurologic examination may show polyneuropathy. Abnormal heart or lung sounds may be heard with a stethoscope.
A urinalysis may show protein or other abnormalities. An abnormal urinalysis may occur 6 months to 10 or more years before symptoms appear.
TreatmentTreatment focuses on controlling the symptoms, minimizing complications, and slowing the progression of the disease.
Associated diseases that cause or result from chronic renal failure must be controlled. Hypertension , congestive heart failure , urinary tract infections , kidney stones , obstructions of the urinary tract, glomerulonephritis , and other disorders should be treated as appropriate.
Blood transfusions or medications such as iron and erythropoietin supplements may be needed to control anemia .
Fluid intake may be restricted, often to an amount equal to the volume of urine produced. Dietary protein restriction may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting . Salt, potassium, phosphorus, and other electrolytes may be restricted.
Dialysis or kidney transplant may be required eventually.
Support GroupsThe stress of illness can often be helped by joining a support group where members share common experiences and problems. See kidney disease - support group .
Expectations (prognosis)There is no cure for chronic renal failure. Untreated, it usually progresses to end-stage renal disease . Lifelong treatment may control the symptoms of chronic renal failure.
Calling your health care providerCall your health care provider if nausea or vomiting persists for more than 2 weeks.
Call your health care provider if decreased urine output or other symptoms of chronic renal failure occur.
PreventionTreatment of the underlying disorders may help prevent or delay development of chronic renal failure. Diabetics should control blood sugar and blood pressure closely and should refrain from smoking.
Update Date: 10/17/2003Irfan A. Agha, M.D., Department of Medicine, Renal Division, St. Louis University, St. Louis, MO. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT