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{{Chronic renal failure}}
{{Chronic renal failure}}
{{CMG}} {{AE}} {{AN}}
{{CMG}} {{AE}} {{AN}}
==History and symptoms==


Initially it is without specific symptoms and can only be detected as an increase in serum [[creatinine]]. As the [[kidney]] function decreases:
==Overview==
* [[Blood pressure]] is increased due to fluid overload and production of vasoactive hormones leading to [[hypertension]] and[[congestive heart failure]]
There are no pathognomonic symptoms associated with chronic renal failure. [[Malaise]], [[nausea]], unintentional [[weight loss]], [[pruritus]], [[lower extremity edema]], and [[sleep disorders]] are common non-specific symptoms of chronic renal failure.  
* [[Urea]] accumulates, leading to [[azotemia]] and ultimately [[uremia]] (symptoms ranging from lethargy to [[pericarditis]] and[[encephalopathy]])
* [[Potassium]] accumulates in the blood (known as [[hyperkalemia]] with symptoms ranging from [[malaise]] to fatal [[cardiac arrhythmia]]s)
* [[Erythropoietin]] synthesis is decreased (leading to [[anemia]] causing [[fatigue (physical)|fatigue]])
* [[Fluid balance|Fluid volume overload]] - symptoms may range from mild [[edema]] to life-threatening [[pulmonary edema]]
* [[Hyperphosphatemia]] - due to reduced phosphate excretion, associated with [[hypocalcemia]] (due to [[vitamin D3]] deficiency).
** Later this progresses to [[tertiary hyperparathyroidism]], with [[hypercalcaemia]], [[renal osteodystrophy]] and vascular calcification
* [[Metabolic acidosis]], due to decreased generation of [[bicarbonate]] by the kidney, leads to uncomfortable breathing and further worsening of bone health.
CRF patients suffer from accelerated [[atherosclerosis]] and have higher incidence of [[cardiovascular disease]], with a poorer prognosis.


In many CRF patients, previous renal disease or other underlying diseases are already known. A small number presents with CRF of unknown cause. In these patients, a cause is occasionally identified retrospectively. 
==Personal History and Symptoms==
===Dermatologic===
*Pruritus


It is important to differentiate CRF from [[acute renal failure]] (ARF) because ARF can be reversible. Abdominal [[medical ultrasonography|ultrasound]] is commonly performed, in which the size of the [[kidney]]s are measured.  Kidneys in CRF are usually smaller (< 9 cm) than normal kidneys with notable exceptions such as in [[diabetic nephropathy]] and [[polycystic kidney disease]].  Another diagnostic clue that helps differentiate CRF and ARF is a gradual rise in serum creatinine (over several months or years) as opposed to a sudden increase in the serum creatinine (several days to weeks). If these levels are unavailable (because the patient has been well and has had no blood tests) it is occasionally necessary to treat a patient briefly as having ARF until it has been established that the renal impairment is irreversible.
===Neuromuscular===
*Anorexia
*Fatigue
*Nausea (especially in the morning)
*Sleep disturbances and sleep apnea
*Hiccups
*Dry mouth
*Headache
*Reduced sense of smell and taste
*Lower extremity cramps and edema
*Restless legs
*Extremity numbness, paresthesias, and weakness (sensorimotor peripheral neuropathy)
*Seizures
*Decreased mental acquity
*Coma


Numerous uremic toxins (see link) are accumulating in chronic renal failure patients treated with standard dialysis. These toxins show various cytotoxic activities in the serum, have different molecular weights and some of them are bound to other proteins, primarily to albumin. Such toxic protein bound substances are receiving the attention of scientists who are interested in improving the standard chronic dialysis procedures used today.
===Cardiothoracic===
*Chest pain (uremic pericarditis)


==[[References]]==
===Abdominal===
{{reflist|2}}
*Abdominal distention (serositis)
*Abdominal discomfort
 
===Hematologic===
*Skin pallor
*Bleeding tendency
 
===Metabolic===
*Unintentional weight loss
*Amenorrhea
*Sexual dysfunction
**Loss of libido
**Impotence
*Failure to thrive (in children)
 
==Family History==
*Renal diseases
*History of dialysis or renal transplantation
*History of hearing loss ([[Alport's syndrome]])
*History of inborn errors of metabolism ([[Fabry disease]] or [[cystinuria]])


==Medications History==
*History of excessive NSAID use
*Chronic exposure to nephrotoxic agents (e.g. heavy metals)


==References==
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Nitrogen metabolism]]
[[Category:Kidney diseases]]
[[Category:Organ failure]]
[[Category:Causes of death]]
[[Category:Nephrology]]

Latest revision as of 01:06, 3 June 2015

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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

There are no pathognomonic symptoms associated with chronic renal failure. Malaise, nausea, unintentional weight loss, pruritus, lower extremity edema, and sleep disorders are common non-specific symptoms of chronic renal failure.

Personal History and Symptoms

Dermatologic

  • Pruritus

Neuromuscular

  • Anorexia
  • Fatigue
  • Nausea (especially in the morning)
  • Sleep disturbances and sleep apnea
  • Hiccups
  • Dry mouth
  • Headache
  • Reduced sense of smell and taste
  • Lower extremity cramps and edema
  • Restless legs
  • Extremity numbness, paresthesias, and weakness (sensorimotor peripheral neuropathy)
  • Seizures
  • Decreased mental acquity
  • Coma

Cardiothoracic

  • Chest pain (uremic pericarditis)

Abdominal

  • Abdominal distention (serositis)
  • Abdominal discomfort

Hematologic

  • Skin pallor
  • Bleeding tendency

Metabolic

  • Unintentional weight loss
  • Amenorrhea
  • Sexual dysfunction
    • Loss of libido
    • Impotence
  • Failure to thrive (in children)

Family History

Medications History

  • History of excessive NSAID use
  • Chronic exposure to nephrotoxic agents (e.g. heavy metals)

References

Template:WH Template:WS

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