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- http://www.healthline.com/blogs/health_observances/uploaded_images/kidney 713543.jpg
Chronic Renal Failure: A Crucial Topic 2
Remington N. Thomas II
HNFS 251-C71
Abstract
Chronic renal failure or (chronic renal disease - CRD) is the slow deterioration of the
kidneys. The kidneys are the center of a complex blood filtration system. They remove waste
materials such as toxins and excess fluids from the blood stream.
The blood is provided to the kidneys through the renal arteries which branch off the main
artery which is known as the abdominal aorta. This artery is carrying oxygenated blood away
from the heart which enters the kidneys and then distributed through all the smaller and smaller
This is when blood filtration is done. Wastes are separated from the substances that the
body needs such as vitamins, minerals, etc…The substances that can be of use are reabsorbed
into the blood stream and the waste is excreted in the urine.
diseased or damaged, problems are likely to occur. This will interrupt the removal of wastes
from the blood stream by the kidneys and the body can react in a number of negative ways.
Chronic Renal Failure: A Crucial Topic 4
The kidneys are the main organs of excretion in the body, removing wastes and excess
water from the blood that would otherwise harm the body. The wastes and excess water removed
are excreted as urine. Two healthy kidneys excrete between 1.5 and 2.5 L of urine daily.
-http://lifeblood.anaemiaworld.com/en/chronic-kidney-disease/anatomy-of-the-kidneys.html
Chronic Renal Failure: A Crucial Topic 5
The kidneys, each about the size of a fist, are located near the center of the back, just
below the rib cage. Each kidney is surrounded by a membrane known as the renal capsule. The
renal cortex (outer section) and the renal medulla (inner section).
Blood enters the kidney through the renal artery and exits through the renal vein. Urine
is carried away from each kidney by a ureter, which leads to the urinary bladder. The filtering of
the blood takes. The filtering of blood by the kidneys takes place in tiny functional units called
nephrons. There are approximately 1 million nephrons in each kidney. In addition to filtration,
In the nephron, capillaries (tiny blood vessels) are intertwined with tubules (urine-
carrying tubes) that carry away wastes and water. Blood enters the nephron through the
glomerulus, a tuft of capillaries where filtration occurs. During filtration, blood fluid is forced
from capillaries into the tubules. As the fluid passes through the tubules, substances needed by
the body, including water, sodium, phosphorus, potassium, and glucose, are selectively
reabsorbed into the blood by the intertwined capillaries. In this way, the kidneys regulate the
In addition to removing wastes, the kidney releases 3 important substances into body’s
I am writing this in order for it to serve as an educational tool. I will explain what kidney
disease is, its implications and I will provide a dietary plan which I believe will be practical and
There is a high prevalence of chronic kidney disease in the United States, which has risen
over the past decade, according to a study led by researchers at the Johns Hopkins Bloomberg
School of Public Health. The study found that the overall prevalence of chronic kidney disease
increased from 10 percent of the population during a period from 1988-1994 to 13 percent from
1999-2004. The researchers conclude that the increase in chronic kidney disease is partly due to
the rise in number of Americans with diabetes and hypertension and the aging of the population
Chronic kidney failure (CRD) is the progressive loss of the kidneys' filtering ability. The
kidneys attempt to compensate for renal damage by hyper filtration (excessive straining of the
blood). This accelerated filtration with the remaining filtering units over time causes further loss
of kidney function.
Chronic loss of function causes generalized wasting (shrinking in size) and progressive
scarring within all parts of the kidneys. In time, overall scarring obscures the site of the initial
damage. Yet, it is not until over 70% of the normal combined function of both kidneys is lost that
most patients begin to experience symptoms of kidney failure. (Stanley J. Swierzewski III, S.J.,
M.D. 2001)
Chronic kidney disease (CKD) may result from any cause of renal dysfunction of
sufficient magnitude. The most common cause in the United States is diabetic nephropathy (an
renal arterioles reduces blood flow) and various primary and secondary glomerulopathies.
Chronic Renal Failure: A Crucial Topic 7
Metabolic syndrome in association with obesity, in which hypertension and type 2 diabetes are
When kidney function is seriously impaired, dangerous levels of fluid and waste can
In the early stages of chronic kidney failure, there may have few signs or symptoms.
Many people with chronic kidney failure don't realize they have a problem until their kidney
The main goal of treatment of chronic kidney failure is to halt or delay progression of the
disease, usually by controlling the underlying cause. Chronic kidney failure can progress to end-
stage kidney disease, which is fatal without artificial filtering (dialysis) or a kidney transplant.
Progressive kidney damage most often results from a chronic illness over a period of years.
http://www.cyclingnews.com/photos/2002/features/PRCA/anemia_kidneys_high.gif
Chronic Renal Failure: A Crucial Topic 8
• Diabetes: Diabetes is a leading cause of chronic kidney failure in the United States.
• High blood pressure (hypertension): Elevated blood pressure can damage the
glomeruli and ultimately cause the nephrons containing damaged glomeruli to lose their
vesicoureteral reflux — a condition that results when urine backs up into the kidneys
from the bladder — can block urine flow, increasing pressure in the kidneys and reducing
their function.
• Kidney diseases: These include clusters of cysts in the kidneys, kidney infection and
inflammation of the tufts of capillaries that do most of the blood filtering, a condition that
causes the kidneys to leak protein into the urine and damages nephrons.
• Kidney artery constriction: This is a narrowing or blockage of the kidney (renal) artery
before it enters the kidney, which impairs blood flow and leads to kidney damage.
• Toxins: Ongoing exposure to fuels and solvents, such as lead, soldering materials,
jewelry and even alcohol distilled in old car radiators (moonshine) can lead to chronic
kidney failure.
Others include:
A healthy kidney (left) eliminates waste from the blood and maintains the body's normal chemical balance. Fluid-
filled sacs (right), called cysts, characterize autosomal dominant polycystic kidney disease.
• Lupus erythematosus
• Age 60 or older
Symptoms:
• Anemia
• Nausea or vomiting
Chronic Renal Failure: A Crucial Topic 10
• Loss of appetite
• Sleep problems
• Bloody or tarry stools, which could indicate bleeding in ther intestinal tract
• Persistent itching
Chronic kidney failure can be difficult to detect initially. Signs and symptoms are often
nonspecific, meaning they can also be attributed to other illnesses. In addition, because the
kidneys are highly adaptable and able to compensate for lost function, signs and symptoms of
chronic kidney failure may not appear until irreversible damage has occurred.
If a chronic medical condition exists that increases risk of chronic kidney failure, a doctor
is likely to monitor blood pressure and kidney function with urine and blood tests during
regularly scheduled office visits. Call a doctor if any of the signs and symptoms of chronic
If the patient has diabetes,a doctor will likely schedule an annual test to measure small
amounts of protein in the urine (microalbuminuria). This test can screen for early kidney damage
If a doctor suspects chronic kidney failure, he or she is likely to order urine and blood
tests to check for increased levels of waste products, such as urea and creatinine. Also, have a
chest X-ray to check for fluid retained in the lungs (pulmonary edema) as well as tests to rule out
• Ultrasound imaging: This test uses high-frequency sound waves and computer
technology to generate images of the kidneys. Ultrasound images can indicate the shape
and structure of the kidneys and reveal obstructions contributing to the problem.
• Computerized tomography (CT) scan: This test uses computers to create more detailed
images of your internal organs — including your kidneys — than conventional X-rays
do.
• Magnetic resonance imaging (MRI): Instead of X-rays, this test uses a magnetic field
• Kidney biopsy: Sometimes a doctor may remove a small sample of kidney tissue to be
A doctor confirms a diagnosis of end-stage kidney disease when blood tests consistently
show very high levels of urea and creatinine — a sign that kidney function has been severely and
permanently damaged.
Complications:
Chronic Renal Failure: A Crucial Topic 12
Chronic kidney failure can affect almost every part of the body. Potential complications
may include:
• Fluid retention, which could lead to swollen tissues, congestive heart failure or fluid in
• A sudden rise in potassium levels in the blood (hyperkalemia), which could impair the
• Cardiovascular disease
• Anemia
• Stomach ulcers
• Insomnia
(pericardium)
• Irreversible damage to the kidneys (end-stage kidney disease), requiring either dialysis or
Complications in children:
Chronic kidney failure can cause children to stop growing normally. This complication
occurs partly because failing kidneys have reduced production of a hormone that helps generate
red blood cells and metabolize growth hormones. The kidneys also regulate the interactions of
Chronic Renal Failure: A Crucial Topic 13
calcium and vitamin D, both of which are essential for bone growth. In chronic kidney failure,
If a pregnant woman is suffering from chronic kidney failure, she will face a number of
potential complications. While pregnant, the amount of fluid in the body increases greatly, so the
kidneys must work especially hard. This may lead to worsening high blood pressure and an
These changes affect both the woman and the baby. Chronic high blood pressure means
the baby receives less blood through the placenta, which can seriously affect growth. Waste
products in the bloodstream may have an adverse effect on the baby as well.
In addition, pregnant women with chronic kidney failure are at high risk of a serious
condition of late pregnancy which causes a dangerous rise in blood pressure. If not treated, it can
lead to hemorrhages in the brain, liver or kidneys, and ultimately may be fatal for both her and
her baby.
Chronic kidney failure has no cure, but treatment can help control signs and symptoms,
reduce complications, and slow the progress of the disease. If chronic kidney failure is occurring,
a doctor will likely refer the woman to a kidney specialist (nephrologist) if she isn’t seeing one
already.
The first priority is controlling the condition responsible for the kidney failure and its
complications. If a person has diabetes or high blood pressure (hypertension), for instance, that
means carefully following a doctor's recommendations for diet and exercise and taking any
Chronic Renal Failure: A Crucial Topic 14
medications as directed. Most people with chronic kidney failure are treated with medications to
itself. Restricting the amount of protein consumed may help slow the progress of the disease. It
can also help ease such symptoms as nausea, vomiting and lack of appetite. It is also likely to
limit the amount of salt in ther diet to help control high blood pressure. Over time, restrictions
may also need to be placed on the amount of potassium and phosphorus consumed.
• Calories: For an adequate intake of energy with CRF calories from a variety of
drops to 13 calories per pound of body weight for individuals over the age of 60 due to a
• Sodium: For those with failing kidneys, sodium excretion eventually falls. Sodium
restrictions are mandatory to prevent things such as high blood pressure and heart failure.
many foods, but it is possible to limit the amount in a diet. Thus, high sodium foods must
be eliminated.
• Fluids: Fluid intake must be monitored and carefully controlled. Some cases require
that it must be restricted. Your physician will set a limit for you, somewhere between four
and eight cups maximum per day. Fluid is defined as anything that melts at room
temperature, so in addition to water and juices, you must count ice cream, gelatin
• Potassium: Potassium counts, too, and it's harder to control for several reasons. You
can't taste it, like you can salt, it's not a required item to be listed in the nutritional
contents of packaged food, and it's in many foods. The highest potassium amounts are
found in nuts, avocados, potatoes, winter squash including pumpkin, oranges, kiwi,
peaches, apricots, and anything dried -- fruits, beans and lentils. Low potassium foods,
safest to include frequently in a renal patient's diet, include applesauce, black berries,
grapes, tangerines, canned pears and plums; asparagus, green or waxed beans, corn,
cauliflower, cucumbers, water chestnuts, and summer squash. Juices such as apple,
cranberry, lemonade, grape, and fruit-flavored drinks are okay; just remember to count
• Protein: In CRF the excretion of wastes declines so it is mandatory to control the level
of protein intake. It plays an important role in the diet of any kidney patient. The amount
based upon phosphorous content are dairy products, whole grains, bran and barley, nuts,
coconut, figs and dates, raisins, salmon, sardines, oysters, and organ meats. Cola drinks
are also high in phosphorous, but soft drinks that are light colored (7-Up and Sprite, club
soda) are fine. Meat, poultry, fish and eggs are high in phosphorous, but are still an
important part of the dialysis patient's diet because of the protein content; they should not
be limited. Yet, due to the importance of limiting the amount of phosphorous in the blood
While it seems like an inordinate amount of food has been eliminated from a wise menu plan
for persons with renal failure, it is possible to have a healthy and delicious variety of food every
day. A daily plan based on the amount of protein recommended for the individual patient,
complemented by fresh, low-potassium fruits and vegetables and supplemented by low salty
snacks, not only tastes wonderful, but is worth the effort in the life-saving health benefits
achieved.
By the time end-stage kidney disease develops, the kidneys are functioning at less than
10 percent to 15 percent of capacity. At this point, conservative measures used to treat chronic
kidney failure — diet, medications and controlling the underlying cause and complications —
are no longer enough. The kidneys aren't able to keep up with waste and fluid clearance on their
own, and dialysis or a kidney transplant becomes the only option to support life.
Exactly when it becomes necessary to start dialysis varies from person to person. In most
cases, doctors try to manage chronic kidney failure as long as possible because both dialysis and
Leg ischemia is the condition when the leg does not receive the necessary amount of
oxygen (via the blood circulation) that is required for the activity underway.
• History of renal stones - a hard mineral and crystalline material formed within the kidney or
• Nonischemic cardiomyopathy - a disease of the heart muscle. The heart loses its ability to pump
blood and, in some instances, heart rhythm is disturbed, leading to irregular heartbeats, or
arrhythmias
• Crohn's disease post colonic resection - surgical procedure to remove a part or the entire colon
(large intestine)
• Monoclonal protein - An antibody found in unusually large amounts in the blood or urine of
• Thrombocytopenia - persistent decrease in the number of platelets in the blood that is often
• Vitamin B12 deficiency - a blood problem that occurs when there is not enough of this vitamin
• Peripheral vascular disease - a diseases of blood vessels outside the heart and brain, often
narrowing the vessels that carry blood to the legs, arms, stomach or kidneys. There are two types
Kidney dialysis:
Dialysis is an artificial means of removing waste products and extra fluid from the blood.
The blood is pumped out of the body, cleaned by a machine and then pumped back into the body
when the kidneys are no longer able to perform these functions. It's not a miracle treatment, and
it presents significant risks, including infection. Yet, it can help prolong life for people with end-
There are two main types of kidney dialysis, each with subtypes involving slightly different
Hemodialysis:
Hemodialysis removes extra fluids, chemicals and wastes from the bloodstream by
filtering the blood through an artificial kidney (dialyzer). Blood is pumped out of your body to
the artificial kidney through one of two routes; a catheter placed surgically in one of the main
blood veins, or a surgically created junction between a vein and artery in the arm. Inside the
Chronic Renal Failure: A Crucial Topic 21
artificial kidney, your blood moves across membranes that filter out waste before being returned.
- Adapted from National Institute of Diabetes and Digestive and Kidney Diseases.
-http://www.venofer.com/VenoferHCP/Venofer_kidneyFunction.html
Less than 1 cup (237 milliliters) of blood is outside the body in the dialyzer and tubing at any
one time. Hemodialysis is usually performed three times a week for three or more hours.
However, it's now recognized that more frequent dialysis — up to six times a week either
during the day or at night while the patient is sleeping — results in significantly better quality of
life, better control of complications and a reduction in risk of death. Newer, easy-to-use home
dialysis machines are making this option more feasible for many.
Chronic Renal Failure: A Crucial Topic 22
Peritoneal dialysis uses the peritoneal membrane, the lining of the abdomen, to remove
excess water, wastes, and chemicals from the body.10 A dialysate passes through the abdomen
via a surgically placed catheter. Fluid, wastes, and chemicals pass from capillaries in the
peritoneal membrane into the dialysate. After several hours, the waste-carrying dialysate is
Continuous ambulatory peritoneal dialysis is the most common type. The dialysate passes
from a plastic bag through a catheter and into the abdomen. No machine is necessary. After 4 to 6
hours, the solution is drained back into the bag and replaced with fresh solution. The solution is
- Adapted from National Institute of Diabetes and Digestive and Kidney Diseases.
-http://www.venofer.com/VenoferHCP/Venofer_kidneyFunction.html
Continuous cyclic peritoneal dialysis is like CAPD, except that a machine is used to fill and
drain the dialysate through the catheter.10 This procedure is performed nightly, for 10 to 12
hours, during sleep. Continuous cyclic peritoneal dialysis requires the help of a partner.
Intermittent peritoneal dialysis uses a machine, much like CCPD, to add and drain the
dialysate.10 Each session may last up to 24 hours. Intermittent peritoneal dialysis treatments are
Hemodialysis and peritoneal dialysis are treatments that take over the function of the failed
kidneys but do not cure ESRD.10 Problems frequently associated with long-term dialysis include
Kidney transplant:
transplant is usually a better option than dialysis, although the patient may need to undergo
A successful kidney transplant depends on finding the best immunologic match possible.
Ideally, the patient and the kidney's donor will have the same blood type, cell-surface proteins
and antibodies. The more closely these features are matched, the lower the risk that the body will
reject the new kidney. A sibling is likely to be the best donor. If that's not possible, another blood
relative, such as a parent, aunt, uncle or cousin, or even a non-blood-related adult may be
considered. When a living donor isn't available, tissue-typing centers throughout the country may
Chronic Renal Failure: A Crucial Topic 24
search for a cadaver kidney from an accident victim or other person who has offered to donate
24 Hour Dietary Plan for Someone Suffering From Chronic Renal Failure:
• Breakfast:
• Lunch:
• Dinner:
- Butter, 2 tsp.
• Snack:
Potassium: 3487 mg
Sodium: 1648 mg
References
Hark L, & Morrison G. (2003). Medical Nutrition & Disease: A case Based Approach (3rd.
Shils M., & Olson J., & Shike M., (1994). Modern Nutrition and Health and Disease (8th. Ed)
National Kidney Foundation. (2008)., Nutrition and Chronic Kidney Disease. Retrieved Nov. 1,
Silberberg C., Chronic Renal Failure., New York Medical College, Division of Nephrology,
Valhalla, NY. Review provided by VeriMed Healthcare Network. Retrieved Nov. 4, 2008
from http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm
Chronic Renal Failure: A Crucial Topic 26
Merck Online Medical Library (2008)., Chronic Kidney Disease (Chronic Renal Failure).
Dr. Wadhwa., Chronic Renal Failure. Retrieved from Stony Brook University Hospital,
http://www.uhmc.sunysb.edu/internalmed/nephro/webpages/Part_G.htm
Arora, P., (2008, September). Chronic Renal Failure. Retrieved Nov. 5, 2008 from
http://www.emedicine.com/med/topic374.htm
Mayo Clinic Staff, (May 13, 2008 ) Kidney failure, Chronic. Retrieved November 7, 2008 from
http://www.mayoclinic.com/health/kidney-failure/DS00682
Curtis, B., Brendan, J. & Levin, A (2001, December). Identifying and Slowing Progressive