Chronic Renal Failure (Hand-out)
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Chronic renal failure or chronic kidney
Disease is a gradual and progressive loss of
the ability of the kidneys to function
normally. The change is irreversible and is
due to loss of nephrons of the kidney. The
nephrons are basic functioning unit of the
kidney and there are normally about one
million nephrons in each kidney.
The kidney is no longer able to clean toxins
& waste product from blood and concentrate
the urine. When patients begin to experience
symptoms of kidney failure, most of their
kidney function is lost. Simply it can be
interpreted as kidneys gradually stopping to
working.
As per data, it is most commonly seen in
long standing diabetics (most common);
Black males; those with high blood pressure;
those on long term drug usage, mainly
analgesics like acetaminophen and other
NSAIDS; some patients with acute renal
failure progress to chronic renal failure if
inadequately treated; those with family
history of chronic renal failure; and all age
groups are susceptible to chronic renal
failure but increased incidence is seen with
advancing age.
Risk Factors:
Some of the important risk factors in the
development of chronic renal failure are
those patients with family history of renal
diseases like polycystic kidney disease and
glomerulonephritis, long standing diabetes
mellitus, obesity-related hypertension, and
untreated acute renal failure.
Signs and Symptoms:
The early symptoms of chronic kidney
disease often occur with other illnesses,
as well. These symptoms may be the
only signs of kidney disease until the
condition is more advanced.
Symptoms may include:
• General ill feeling and fatigue
• Generalized itching (pruritus) and dry
• Headaches
• Weight loss without trying to lose
weight
• Appetite loss
• Nausea
Other symptoms that may develop,
especially when kidney function has
worsened:
• Abnormally dark or light skin
• Bone pain
• Brain and nervous system symptoms
(drowsiness and confusion, problems
concentrating or thinking, numbness
in the hands, feet, or other areas and
muscle twitching or cramps)
• Breath odor
• Easy bruising, bleeding, or blood in the
stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and
impotence
• Menstrual periods stop (amenorrhea)
• Sleep problems, such as insomnia,
restless leg syndrome, and obstructive
sleep apnea
• Swelling of the feet and hands
(edema)
• Vomiting, typically in the morning
Clinical Manifestations:
Stage 1 CKD: clients usually have normal
blood pressure, kidney damage with normal
or increased GFR (>90 mL/min/1.73 m2), no
laboratory test abnormalities, and no clinical
manifestations.
Stage 2 CKD: clients are generally
asymptomatic, but may develop
hypertension, mild reduction in GFR (60-89
mL/min/1.73 m2), and laboratory test
abnormalities exist.
Stage 3 CKD: clients are still usually
asymptomatic but laboratory values suggest
abnormalities in several organ systems (e.g.
anemia, metabolic acidosis, dyslipidemia,
bone disease, protein-energy malnutrition,
and neuropathy), moderate reduction in GFR
(30-59 mL/min/1.73 m2), and hypertension is
frequently present.
Stage 4 CKD: clients begin to experience
severe reduction in GFR (15-29 mL/min/1.73
m2), and clinical manifestations associated
with CKD such as fatigue and poor appetite.
Stage 5 CKD: full-blown clinical
manifestations, kidney failure (GFR <15
mL/min/1.73 m2 or dialysis), and end-stage
renal disease (ESRD) are evident.
Diagnosis:
Chronic renal failure is diagnosed by the
observation of a combination of symptoms,
physical examination and elevated blood
urea nitrogen (BUN) and creatinine (Cr)
levels. The following abnormalities found in
the blood may signal CRF:
Anemia (low red blood cell count)
High level of parathyroid hormone
Hypocalcemia (low blood level of calcium)
Hyperphosphatemia (high blood level of
phosphate)
Hyperkalemia (high blood level of potassium)
Hyponatremia (low blood level of sodium)
Low blood level of bicarbonate
Low plasma pH (blood acidity)
Proteinuria (excess protein in urine)
CT scan and MRI might also help.
• Ultrasound may show that the
kidneys are small in size (However
patients with diabetic nephropathy often
have preservation of kidney size despite
CRF.)
Whether renal failure is acute or chronic
usually can be distinguished by comparing
prior test results (e.g., from the past several
months or years). It is difficult to make the
distinction without previous test results.
Medical Management
1. Controlling blood pressure is the key to
delaying further kidney damage.
• Angiotensin-converting enzyme (ACE)
inhibitors or angiotensin receptor
blockers (ARBs) are used most often.
• The goal is to keep blood pressure at
or below 130/80 mmHg
2. Other tips for protecting the kdineys and
preventing heart disease and stroke:
• Do not smoke.
• Eat meals that are low in fat and
cholesterol
• Get regular exercise (talk to your
doctor or nurse before starting).
• Take drugs to lower your cholesterol, if
necessary.
• Keep your blood sugar under control.
Always talk to your kidney doctor before
taking any over-the-counter medicine,
vitamin, or herbal supplement. Make sure all
of the doctors you visit know you have
chronic kidney disease.
3. Other treatments may include:
• Special medicines called phosphate
binders, to help prevent phosphorous
levels from becoming too high
• Treatment for anemia, such as extra
iron in the diet, iron pills, special shots
of a medicine called erythropoietin,
and blood transfusions
• Extra calcium and vitamin D (always
talk to your doctor before taking)
4. You may need to make changes in your
diet.
• You may need to limit fluids.
• Your health care provider may
recommend a low-protein diet.
• You may have to restrict salt,
potassium, phosphorous, and other
electrolytes.
• It is important to get enough calories
when you are losing weight.
4. Different treatments are available for
problems with sleep or restless leg
syndrome.
5. Everyone with chronic kidney disease
should be up-to-date on important
vaccinations, including:
 • Pneumococcal polysaccharide vaccine
(PPV)
• Influenza vaccine
• H1N1 (swine flu) vaccine
• Hepatitis B vaccine
• Hepatitis A vaccine

6. When loss of kidney function becomes

more severe, you will need to prepare for
dialysis or a kidney transplant.

• When you start dialysis depends on

different factors, including your lab
test results, severity of symptoms, and
readiness.
• You should begin to prepare for
dialysis before it is absolutely
necessary. The preparation includes
learning about dialysis and the types
of dialysis therapies, and placement of
a dialysis access.
• Even those who are candidates for a
kidney transplant will need dialysis
while waiting for a kidney to become
available.