Causes, Management and Complication of Chronic Renal Failure (CRF)

Definitions of Chronic Renal Failure (CRF):

Chronic Renal Failure refers to an irreversible deterioration in renal function which classically develops over a period of years.

Common Causes of Chronic Renal Failure (CRF):

1. Congenital and inherited:

• Adult Polycystic kidney disease (APKD)
• Alport’s syndrome.

2. Vascular disease: Renal artery stenosis

3. HTN

4. Glomerular disease: IgA nephropathy-most common.

5. Interstitial disease:

• Chronic pyelonephritis
• Reflux nephropathy.
• Analgesic nephropathy.

6. Systemic inflammatory disease:

• SLE
• Vasculitis (PAN).

7. Diabetes mellitus.

8. Amyloidosis.

9. Obstructive uropathy.

10. Unknown.

Clinical Features of Chronic Renal Failures (CRF):

Patients may remain asymptomatic until the GFR is 15 ml/min or less (until 70% nephrons are dead).

1. Anaemia

2. Renal osteodystrophy:

• Osteomalacia
• Osteitis fibrosa
• Osteoporosis
• Osteosclerosis

3. Generalized myopathy:

• Muscle cramps
• Restless leg syndrome

4. Neuropathy:

• Paracsthesia
• Foot drop

5. Endocrine abnormalities:

• Hypertension
• Atherosclerosis
• Pericarditis

6. Acidosis:

• Breathlessness
• Deep respiration

7. Infection: Urinary tract infection is common

8. Bleeding: Cutaneous ecchymoses and mucosal bleeds (in advanced causes)

9. Gastrointestinal disorders: Anorexia followed by nausea and vomiting is commonly seen (especially in the morning).

Stages of Chronic Renal Failure (CRF):

Below shows the five stages of CKD and GFR for each stage:

1. Stage 1 with normal or high GFR (GFR > 90 mL/min)
2. Stage 2 Mild CKD (GFR= 60-89 mL/min)
3. Stage 3A Moderate CKD (GFR 45-59 mL/min)
4. Stage 3B Moderate CKD (GFR =30-44 mL/min)
5. Stage 4 Severe CKD (GFR= 15-29 mL/min)
6. Stage 5 End Stage CKD (GFR <15 mL/min)

Investigation of Chronic Renal Failure (CRF):

1. Urine for RME, C/S: Volume increase, pH decrease.
2. Blood for TC, DC, Hb%, ESR: anaemia
3. Total platelet count: Low
4. Blood urea creatinine: Raised
5. Serum electrolytes: Hyperkalaemia
6. X-ray chest and KUB region
7. Ultrasonography of KUB region
8. CT scan (DTPA/DMSA)
9. Renal biopsy (confirmatory)

Management of Chronic Renal Failure (CRF):

1. Conservative (Symptomatic):

a) Diet: Restriction of dietary protein to about 40 g/day (0.58 g/kg/d in children) with adequate carbohydrate (250 g) and fat (60 g) to provide an adequate calorie (at least 1700 kcal)

b) Fluid: Fluid restriction if GFR is <5 ml/min or cardiac failure is present.

c) Electrolytes:

• No sodium restriction in absence of oedema, cardiac failure or hypertension.
• Restriction of potassium: Avoid high potassium foods (eg, banana, tomatoes, coffee chocolate)

d) Hypertension and cardiac failure:

• Hypertension: Antihypertensive drug (eg, ACE inhibitors, Ca-antagonists)
• Cardiac failure: Digoixn

e) Renal osteodystrophy:

Hypocalaemia: 1 a hydroxyl cholecalciferol 0.25-l ug/d

Hyper phosphataemia: Avoid high phosphate food (milk, cheese, eggs) and use of phosphate binding drug-

• Calcium carbonates 500 mg with each meal,
• Aluminum hydroxide capsules (Alucap) 300 -600 mg before cach meal.
• Parathyroidectomy may be needed.
• Correction of anaemia, infection if present.

f) Treatment of pruritus:

• Antihistamine
• UV rays
• Proper skin care + maintenance of hygiene

2. Replacement of renal function:

• Haemodialysis
• Continuous ambulatory peritoneal dialysis (CAPD)
• Renal transplantation (definitive treatment)

Complication of Chronic Renal Failures (CRF):

• Hypertension,
• Pericarditis,
• Cardiomyopathy,
• CCF,
• Severe anaemia,
• Bleeding, gastric ulcer,
• Hepatitis,
• Peripheral neuropathy.

Difference Between Acute Renal Failure (ARF) and Chronic Renal Failure (CRF):

Maria Mona

Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “maria.mona023@gmail.com”