(CRF, or "chronic kidney failure", CKF, or "chronic kidney disease", CKD) is a slowly progressive loss of
Renal Function over a period of months or years and defined as an abnormally low
Glomerular Filtration Rate , which 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 (ESRD).
Initially it is without symptoms and can only be detected as an increase in serum
Creatinine . As the
Kidney function decreases:
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.
It is important to differentiate CRF from
Acute Renal Failure (ARF) because ARF can be reversible. Abdominal
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.
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.
The most common causes of CRF in North America and Europe are
Diabetic Nephropathy ,
Hypertension , and
Glomerulonephritis . Together, these cause approximately 75% of all adult cases. Certain geographic areas have a high incidence of HIV nephropathy.
Historically, kidney disease has been classified according to the part of the renal anatomy that is involved, as:
The goal of therapy is to slow down or halt the otherwise relentless progression of CRF to ESRD. Control of
Blood Pressure and treatment of the original disease, whenever feasible, are the broad principles of management. Generally,
Angiotensin Converting Enzyme Inhibitor s (ACEIs) or
Angiotensin II Receptor Antagonists (ARBs) are used, as they have been found to slow the progression to ESRD.
Replacement of
Erythropoietin and
Vitamin D3 , two hormones processed by the kidney, is usually necessary, as is
Calcium .
Phosphate Binders are used to control the serum
Phosphate levels, which are usually elevated in chronic renal failure.
After ESRD occurs,
Renal Replacement Therapy is required, in the form of either
Dialysis or a
Transplant .
