Chronic renal failure overview: Difference between revisions
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==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Repeated episodes of acute renal injury from infections, drugs, toxins and immunological damage, may accelerate the progression to chronic renal failure, especially in the elderly. Once CRF is developed, the condition can cause systemic problems such as [[infertility]], [[myopathy]], [[sleep disorders]], [[pruritis]], [[congestive heart failure]], and [[pulmonary edema]] amongst other problems. The prognosis for a patient with CRF is not | Repeated episodes of acute renal injury from infections, drugs, toxins and immunological damage, may accelerate the progression to chronic renal failure, especially in the elderly. Once CRF is developed, the condition can cause systemic problems such as [[infertility]], [[myopathy]], [[sleep disorders]], [[pruritis]], [[congestive heart failure]], and [[pulmonary edema]] amongst other problems. The prognosis and quality of life for a patient with CRF is not good. Data indicates that the overall death rate increases as kidney function decreases. | ||
==References== | ==References== | ||
Revision as of 15:59, 26 July 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Chronic renal failure (CRF), also known as chronic kidney failure (CKF) or chronic kidney disease (CKD), or chronic renal insufficiency (CRI) is a slowly progressive loss of renal function over a period of months or years defined as an abnormally low glomerular filtration rate. The glomerular filtration rate is usually determined indirectly by the creatinine level in blood serum.
CRF that leads to severe illness and requires some form of renal replacement therapy (such as dialysis) is called end-stage renal disease (ESRD).
Pathophysiology
CRF begins with damage to the nephrons, the filtering units of the kidneys, due to diseases such as diabetes, hypertension, immune complex deposition, toxin exposure, and inflammation. To compensate for the decreased glomerular filtration rate by the damaged nephrons, healthy nephrons hypertrophy and hyperfiltrate due to signals from the body. As the disease process progresses, this adaptive response becomes maladaptive, and the increased filtration pressure in the healthy nephrons leads to distortion of its structural architecture, causing sclerosis and eventual dropout of these nephrons.
Epidemiology and Demographics
The incidence and prevalence of chronic renal failure varies enormously depending on the level of affluence of the country. Developed countries have higher incident rates of treated end-stage renal failure, whereas emerging countries have very low incident rates. People with disorders that have adverse effects on the kidneys such as diabetes, and hypertension have increased chances of developing CRF.
Risk Factors
Factors that damage small blood vessels or nephrons are risk factors for chronic renal failure. Some of the factors associated with CRF include diabetes, hypertension, autoimmune diseases, obesity, smoking, high cholesterol, heart disease, and racial background.
Causes
CRF is associated with diseases such as diabetic nephropathy, hypertension, glomerulonephritis, ischemic nephropathy, vasculitis, Hemolytic-uremic syndrome, IgA nephropathy, and polycystic kidney disease to name a few. Diseases of the blood vessels or diseases that damage the nephrons are usually linked to the development of CRF.
Differentiating Chronic renal failure from other Conditions
CRF can be discerned from acute renal failure by looking at the levels and rise of serum creatinine. Acute renal failure is identified by sharp rises in the levels of creatinine, while CRF is identified by a slow and gradual increase in serum creatinine.
Natural History, Complications and Prognosis
Repeated episodes of acute renal injury from infections, drugs, toxins and immunological damage, may accelerate the progression to chronic renal failure, especially in the elderly. Once CRF is developed, the condition can cause systemic problems such as infertility, myopathy, sleep disorders, pruritis, congestive heart failure, and pulmonary edema amongst other problems. The prognosis and quality of life for a patient with CRF is not good. Data indicates that the overall death rate increases as kidney function decreases.