CHRONIC RENAL FAILURE

Chronic renal failure is a condition involving a decrease in the kidneys' ability to filter
waste and fluid from the blood. It is chronic, meaning that the condition develops over a
long period of time and is not reversible. The condition is also commonly known as chronic
kidney disease (CKD). Chronic renal failure is typically caused by certain other medical
conditions that put strain on the kidneys over time, including diabetes, high blood
pressure or hypertension and long-term inflammation of the kidneys. Early symptoms of
reduced kidney function include urinating more frequently, high blood pressure and
swelling of the legs.

Around 15 percent of adults, or 30 million people in the United States are thought to have
kidney disease at some stage. Because the condition takes some time to develop, it most
commonly affects older people. Women are affected slightly more often than men, and
people of African, Latin American and Native American descent are at higher risk of
CKD. People who are at risk of chronic renal failure should have regular health
checks, which include evaluating the glomerular filtration rate. This is a more reliable
method of diagnosing early stages of chronic renal failure than waiting for symptoms to
appear.

Treatment consists of managing the underlying condition and supporting kidney

function. Chronic renal failure requires careful, lifelong management, and can progress to
end-stage kidney failure which requires dialysis or transplant. However, many cases of
chronic renal failure are mild to moderate and can be managed by patients with support
from a doctor. 

Symptoms. In the early stages of chronic renal failure, affected people often do not

experience any symptoms. However, symptoms that may emerge during the early stages of
chronic renal failure include: 
 The urge to urinate more frequently
 Urine may be pale and foamy
 Hypertension, also known as high blood pressure
 Swelling of the legs
 Poor appetite
 Weight loss.
As the condition progresses, affected people may develop other symptoms such as: 
 Muscle cramps or twitches
 Developing brown spots on the skin
 Worsening of swelling, including on the hands, ankles, feet and around the eyes
 Drowsiness or lack of concentration
 Feeling lethargic and without energy
 Bruising easily
 Blood in the stool
 Amenorrhea (periods stopping)
 Itchy, dry skin
 Pain in the bones
 Increased susceptibility to infection
 Nausea and vomiting.

Causes. Chronic renal failure mostly occurs in people who have other medical
conditions which cause damage to the small units in the kidneys, called nephrons, which
are responsible for filtering waste and fluid from the blood.

Common conditions which can cause chronic renal failure include:

 Diabetes. One in three adults with diabetes are likely to develop chronic renal failure
 Hypertension. One in five adults with high blood pressure are likely to develop
chronic renal failure.
 People with diabetes and hypertension, who are at high risk of developing chronic
renal failure, should have regular health checks to measure their glomerular
 filtration rate. Diabetics should also have regular microalbumin tests. These tests
can detect early signs of the condition.
Less common conditions that can cause chronic renal failure include: 
 Polycystic kidney disease, a range of genetic disorders
 Nephrotic syndrome, also called nephritis and glomerulonephritis, is a condition
which damages the glomeruli 13 and can be caused by strep throat and lupus, among
other conditions
 Inflammation of the kidneys
 Repeated kidney infections and frequent kidney stones.

People who have some malformation of their kidneys or urinary tract are at higher
risk of eventually developing chronic renal failure. Once the kidneys have lost a significant
amount of function, they may not be able to recover, and the person may progress to end-
stage renal disease.

Diagnosis. Chronic renal failure can be diagnosed by measuring kidney function and is
typically tested for by taking blood and urine samples to measure creatinine levels. This
is a waste product of creatine, which is a chemical the body produces to supply energy,
primarily to muscles and the brain. 
The two main diagnostic tests are: 
 Glomerular filtration rate (GFR). Checks how well the glomeruli 18 are working. To
check the filtration rate, a blood sample is taken which is then tested in a lab. The
results are combined with factors including age, ethnicity, gender, height and weight
to estimate a person’s glomerular filtration rate.
 Creatinine clearance test. Another way of calculating the glomerular filtration rate.
To perform the test, a person needs to collect all their urine for a 24 hour period and
then provide a blood sample. Comparing creatinine levels in the blood and urine
allows a person’s glomerular filtration rate to be estimated.

If a person has a glomerular filtration rate of less than 60mL/min/1.73m2 for three
months or more, they are classed as having chronic renal failure or kidney
damage.  Normal results are in the 90mL/min/1.73m2 to 120mL/min/1.73m2
range. Additionally, an ultrasound of the kidneys and urinary tract may be necessary. In
some cases, it may be necessary to take a small sample of the kidney, called a biopsy, in
order to find the underlying cause for the condition. 

Diabetics should have regular microalbumin tests in addition to other tests. This test is
used to detect very small levels of albumin, a protein usually found in the blood, in the
urine. If the kidneys are damaged, albumin leaks into urine. 22

If you are worried that you or a loved one may have chronic renal failure, you can do a free
symptom assessment with the Ada app.

Treatment involves controlling the condition that is harming the kidneys. In

particular, people with hypertension or diabetes should make sure that these conditions
are well controlled. Keeping blood sugar and blood pressure under control will slow down
further kidney damage. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin
receptor blockers (ARBs) are the preferred option for managing hypertension. Other medical
conditions involving the kidneys can be managed with the help of a nephrologist (a
specialist kidney doctor). If chronic renal failure is diagnosed early and carefully
managed, this may help to prevent the condition from worsening and progressing to end-
stage renal failure. People with kidneys that no longer work well enough to filter blood and
fluid may need dialysis, a process in which the blood is cleaned by a machine. Everyone
with end-stage renal failure should be evaluated for a kidney transplant.  Good to
know: Some over-the-counter medications, including vitamins and herbal supplements,
can worsen chronic renal failure. It may be helpful to review medications with a doctor and
replace or stop any medications which can damage the kidneys. 

Prevention. Good control of medical conditions such as hypertension and diabetes is

important in preventing chronic renal failure. Other actions that can help prevent chronic
renal failure include: 
  Regular health check-ups, including evaluation of kidney function in highrisk
populations
 Losing weight
 Taking regular exercise, which can help regulate blood pressure and blood sugar
levels
 Eating a healthy diet
 Stopping smoking
 Drinking less alcohol
 Taking all prescribed medication as directed
 Avoiding certain over-the-counter painkillers such as aspirin or ibuprofen.

Complications. If kidney disease progresses, it can lead to kidney failure, also known as

end-stage renal disease. This means that the kidneys will no longer be able to process
waste and remove it from the body. This will require dialysis or, potentially, a kidney
transplant. 
1. Anemia is a common condition in people with chronic renal failure that tends to
occur after a person loses 20 to 50 percent of kidney function. Damaged kidneys do
not produce enough of a hormone called erythropoietin (EPO), which promotes the
creation of red blood cells. 30
2. Vitamin D deficiency. People with chronic renal failure do not process vitamin D
as efficiently as people with healthy kidneys and are at risk of vitamin D deficiency.
Some of the problems this can lead to include:
- Osteomalacia, a softening of the bones
- Osteoporosis, a weakening of the bones
- Increased susceptibility to infection.

FAQsQ: What diet should I eat for chronic renal failure?A: Eating healthily can help
slow the progression of chronic renal failure. Eating a diet that contains plenty of fruit and
vegetables, is low in fat, cholesterol, salt and potassium, is advisable. Be aware that white
beans, bananas, avocados and potatoes contain high amounts of potassium. For diabetics,
maintaining blood sugar levels is important.
Other names for chronic renal failure
 Chronic kidney failure
 CKD

Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of
kidney function. Your kidneys filter wastes and excess fluids from your blood, which are
then removed in your urine. Advanced chronic kidney disease can cause dangerous levels
of fluid, electrolytes and wastes to build up in your body.
In the early stages of chronic kidney disease, you might have few signs or symptoms. You
might not realize that you have kidney disease until the condition is advanced.
Treatment for chronic kidney disease focuses on slowing the progression of kidney damage,
usually by controlling the cause. But even controlling the cause might not keep kidney
damage from progressing. Chronic kidney disease can progress to end-stage kidney failure,
which is fatal without artificial filtering (dialysis) or a kidney transplant.

Signs and symptoms of chronic kidney disease develop over time if kidney damage
progresses slowly. Loss of kidney function can cause a buildup of fluid or body waste or
electrolyte problems. Depending on how severe it is, loss of kidney function can cause:

- Nausea, Vomiting, Loss of appetite, Fatigue and weakness, Sleep problems, Urinating
more or less, Decreased mental sharpness, Muscle cramps, Swelling of feet and
ankles, Dry, itchy skin, High blood pressure (hypertension) that's difficult to control,
Shortness of breath, if fluid builds up in the lungs, Chest pain, if fluid builds up
around the lining of the heart
Signs and symptoms of kidney disease are often nonspecific. This means they can also be
caused by other illnesses. Because your kidneys are able to make up for lost function, you
might not develop signs and symptoms until irreversible damage has occurred.
Causes
Chronic kidney disease occurs when a disease or condition impairs kidney function,
causing kidney damage to worsen over several months or years.
Diseases and conditions that cause chronic kidney disease include:
 Type 1 or type 2 diabetes, High blood pressure
 Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the
kidney's filtering units (glomeruli)
 Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the
kidney's tubules and surrounding structures
 Polycystic kidney disease or other inherited kidney diseases
 Prolonged obstruction of the urinary tract, from conditions such as enlarged
prostate, kidney stones and some cancers
 Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine
to back up into your kidneys
 Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Risk factors
Factors that can increase your risk of chronic kidney disease include:

 Diabetes, High blood pressure, Heart (cardiovascular) disease

 Smoking, Obesity, Being Black, Native American or Asian American
 Family history of kidney disease
 Abnormal kidney structure, Older age
 Frequent use of medications that can damage the kidneys

Complications. Chronic kidney disease can affect almost every part of your body. Potential
complications include:

 Fluid retention, which could lead to swelling in your arms and legs, high blood
pressure, or fluid in your lungs (pulmonary edema)
 A sudden rise in potassium levels in your blood (hyperkalemia), which could
impair your heart's function and can be life-threatening
 Anemia
 Heart disease
 Weak bones and an increased risk of bone fractures
 Decreased sex drive, erectile dysfunction or reduced fertility
 Damage to your central nervous system, which can cause difficulty
concentrating, personality changes or seizures
 Decreased immune response, which makes you more vulnerable to infection
 Pericarditis, an inflammation of the saclike membrane that envelops your heart
(pericardium)
 Pregnancy complications that carry risks for the mother and the developing fetus
 Irreversible damage to your kidneys (end-stage kidney disease), eventually
requiring either dialysis or a kidney transplant for survival

Prevention
To reduce your risk of developing kidney disease:

 Follow instructions on over-the-counter medications. When using

nonprescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB,
others) and acetaminophen (Tylenol, others), follow the instructions on the
package. Taking too many pain relievers for a long time could lead to kidney
damage.
 Maintain a healthy weight. If you're at a healthy weight, maintain it by being
physically active most days of the week. If you need to lose weight, talk with your
doctor about strategies for healthy weight loss.
 Don't smoke. Cigarette smoking can damage your kidneys and make existing
kidney damage worse. If you're a smoker, talk to your doctor about strategies for
quitting. Support groups, counseling and medications can all help you to stop.
  Manage your medical conditions with your doctor's help. If you have
diseases or conditions that increase your risk of kidney disease, work with your
doctor to control them. Ask your doctor about tests to look for signs of kidney
damage.
1. Differentiate between acute and chronic renal failure.
ANSWER: Renal failure refers to temporary or permanent damage to the kidneys that
results in loss of normal kidney function. There are two different types of renal failure--
acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible.
Chronic renal failure progresses slowly over at least three months and can lead to
permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and
chronic are different. Conditions that may lead to acute or chronic renal failure may
include, but are not limited to, the following:
Acute renal failure Chronic renal failure
Myocardial infarction. A heart attack may Diabetic nephropathy. Diabetes can cause
occasionally lead to temporary kidney failure. permanent changes, leading to kidney damage.
Rhabdomyolysis. Kidney damage that can occur Hypertension. Chronic high blood pressure
from muscle breakdown. This condition can occur (hypertension) can lead to permanent kidney
from severe dehydration, infection, or other causes. damage.
Decreased blood flow to the kidneys for a period Lupus (SLE). A chronic
of time. This may occur from blood loss or shock. inflammatory/autoimmune disease that can
injure the skin, joints, kidneys, and nervous
system.
An obstruction or blockage along the urinary tract. A prolonged urinary tract obstruction or
blockage.
Hemolytic uremic syndrome. Usually caused by an Alport syndrome. An inherited disorder that
E. coli infection, kidney failure develops as a result of causes deafness, progressive kidney damage,
obstruction to the small functional structures and and eye defects.
vessels inside the kidney.
Ingestion of certain medications that may cause Nephrotic syndrome. A condition that has
toxicity to the kidneys. several different causes. Nephrotic syndrome is
characterized by protein in the urine, low
protein in the blood, high cholesterol levels, and
tissue swelling.
Glomerulonephritis. A type of kidney disease that Polycystic kidney disease. A genetic disorder
involves glomeruli. During glomerulonephritis, the characterized by the growth of numerous cysts
glomeruli become inflamed and impair the kidney's filled with fluid in the kidneys.
ability to filter urine. Glomerulonephritis may lead to
chronic renal failure in some individuals.

Any condition that may impair the flow of oxygen Cystinosis. An inherited disorder in which the
and blood to the kidneys such as cardiac arrest. amino acid cystine (a common protein-building
compound) accumulates within specific cellular
bodies of the kidney, known as lysosomes.
  Interstitial nephritis or pyelonephritis. An
inflammation to the small internal structures in
the kidney.

2. differentiate AV fistula and a shunt

An AV fistula is an abnormal connection between an artery and a vein and is

sometimes surgically created to help with hemodialysis treatment. In these cases, a shunt
graft is inserted to aid the treatment. Unfortunately, sometimes the shunt will fail, known
as graft malfunction. If you experience this, your doctor may recommend that you have
endovascular treatment. The aim of this minimally invasive procedure is to stop narrowing
of the fistula and remove any blockages from the shunt, such as blood clots.

3. What is the uses during an emergency dialysis?

When is dialysis needed? You need dialysis when you develop end stage kidney failure --
usually by the time you lose about 85 to 90 percent of your kidney function and have a
GFR of <15. Click here to learn more about the stages of Chronic Kidney Disease and GFR

What does dialysis do? When your kidneys fail, dialysis keeps your body in balance by:

 removing waste, salt and extra water to prevent them from building up in the body
 keeping a safe level of certain chemicals in your blood, such as potassium, sodium
and bicarbonate
 helping to control blood pressure

Emergency and Hospital-Based Dialysis

When dialysis patients are hospitalized for any reason, or when a hospitalized patient
experiences acute kidney injury or acute renal failure and must immediately transition to
dialysis, the Nephrology Consultative Services ensure that life-sustaining dialysis can
proceed:  
Critical Care Nephrology: Specialists in Critical Care Nephrology provide advanced kidney
support for patients being cared for in University Hospital’s six intensive care units (ICUs).
They closely collaborate with cardiovascular medicine, pulmonary medicine, surgery and
other specialties providing critical care in the ICU setting in order to provide uninterrupted
kidney support when needed.
For patients in an ICU with acute or chronic renal failure, dialysis support is provided at
the bedside with the goal of optimizing therapy while maintaining patient stability.  This
can include use of continuous renal replacement therapy, a technique that allows for
optimal management of fluid, electrolyte and toxin balance in critically ill patients.
The Acute Dialysis Unit: Our eight bed state-of-the-art dialysis unit provides standard
hemodialysis care to inpatients with acute kidney injury or end stage renal disease. This
unit is staffed by a team of highly experienced nurses, patient care technicians, social
workers and renal dieticians. It operates six days a week, and staff is on call for emergency
care on weekends and after hours.
The unit provides optimal care for patients receiving dialysis using advanced equipment
and innovative dialysis technologies.
The Acute Dialysis Unit also has outpatient ESRD certification and has formal clinical and
administrative protocols in place designed for outpatient dialysis.

4. Discuss the complication that can arise if chronic renal failure is not treated
Complications. Chronic kidney disease can affect almost every part of your body. Potential
complications include:

 Fluid retention, which could lead to swelling in your arms and legs, high blood
pressure, or fluid in your lungs (pulmonary edema)
 A sudden rise in potassium levels in your blood (hyperkalemia), which could
impair your heart's function and can be life-threatening
 Anemia
 Heart disease
 Weak bones and an increased risk of bone fractures
 Decreased sex drive, erectile dysfunction or reduced fertility
 Damage to your central nervous system, which can cause difficulty
concentrating, personality changes or seizures
 Decreased immune response, which makes you more vulnerable to infection
 Pericarditis, an inflammation of the saclike membrane that envelops your heart
(pericardium)
 Pregnancy complications that carry risks for the mother and the developing fetus
 Irreversible damage to your kidneys (end-stage kidney disease), eventually
requiring either dialysis or a kidney transplant for survival

5. Enumerate appropriate discharge plan and health teaching for the patient.
How can you care for yourself at home? Treatments and appointments
Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or
nurse call line if you have any problems with your medicine. You also may take medicine to
control your blood pressure or to treat diabetes. Many people who have diabetes take blood
pressure medicine. If you have diabetes, do your best to keep your blood sugar in your
target range. You may do this by eating healthy food and exercising. You may also take
medicines. Go to your dialysis appointments if you have this treatment.
 Do not take ibuprofen, naproxen, or similar medicines, unless your doctor tells you
to. These may make the disease worse.
 Do not take any vitamins, over-the-counter medicines, or natural health products
without talking to your doctor first.
 Do not smoke or use other tobacco products. Smoking can reduce blood flow to the
kidneys. If you need help quitting, talk to your doctor about stop-smoking programs
and medicines. These can increase your chances of quitting for good.
 Limit your use of alcohol and avoid illegal drugs.
 Talk to your doctor about an exercise plan. Exercise helps lower your blood pressure.
It also makes you feel better.
 If you have an advance care plan, let your doctor know. If you don't have one, you
may want to prepare one. It lets your doctor and loved ones know your health care
wishes if you become unable to speak for yourself.
o Diet
 Talk to a registered dietitian. They can help you make a meal plan that is right for
you. Most people with kidney disease need to limit salt (sodium), fluids, and protein.
Some also have to limit potassium and phosphorus.
 You may have to give up many foods you like. But try to focus on the fact that this
will help you stay healthy for as long as possible.
 If you have a hard time eating enough, talk to your doctor or dietitian about ways to
add calories to your diet.
 Your diet may change as your disease changes. See your doctor for regular testing.
And work with a dietitian to change your diet as needed.

6. Research on reading or journal of current issues related to the case mentioned and
provide your reflection.