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.

Chronic renal failure (CRF)
Fig: Chronic renal failure (CRF)

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):

Points of Difference

Acute Renal Failure (ARF)

Chronic Renal Failure (CRF):


Duration to develop

Within days to weeks

Over period of years


Usually present

Usually not present





Usually present






Usually reversible


Size of kidney





May be present



May be present



May be present

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top