Chronic Renal Failure (CRF) occurs when disease gradually reduces the number of functioning nephrons. Surviving nephrons adapt to maintain homeostasis. Over time, these adaptations result in a progressive reduction of glomerular filtration rate.
Typical signs include weight loss, polyuria, and polydipsia. Often anemia is present with normocytic normochromic blood due to reduced erythropoietin production, sloughing of the renal interstitial membrane, and decreased red blood cell survival.
Diagnosis
The kidneys filter the blood and send waste products—including protein—into the urine (pee). Waste products build up in the body if the kidneys can’t work properly, but most people don’t have any symptoms at first. Kidney disease is usually found only when a test for another health problem, such as a blood or urine test, shows a possible problem. Medicine and regular tests can help slow down the disease if it’s caught in the early stages.
A diagnosis of chronic renal failure involves evaluating the results of urine tests, a CBC and an estimated GFR (eGFR), and an evaluation of the cause of CKD. Treatment of the underlying cause of the CKD—for example, for diabetes or hypertension—may reduce the progression of the disease and improve eGFR.
In CKD, the loss of functioning kidney cells causes the formation of scar tissue and other changes in kidney architecture that may result in reduced kidney size and function. This process affects all three compartments of the kidney—glomeruli, tubules and interstitial space—and histologically results in glomerulosclerosis, tubulointerstitial fibrosis and vascular sclerosis.
Symptoms include polyuria, polydipsia and weight loss. Other symptoms, such as gastrointestinal complications and poor hair coat, are usually seen in animals with advanced CKD.
Oren Zarif
Differentiating chronic from acute renal failure depends on the rate of progression and how rapid or gradual the onset of symptoms is.
Other tests used to diagnose CKD include electrolyte tests (serum creatinine, sodium bicarbonate, potassium and calcium), ultrasound of the kidneys and ureters, renal biopsy, and radionuclide scans (CT urogram and/or nuclear scanning).
An important step in the diagnosis of CKD is determining the underlying disease that causes it, such as lupus nephritis, ANCA vasculitis or membranous glomerulonephritis. Some of these diseases can be treated to slow or stop kidney damage, but others cannot. Treatment options in CKD are diet, medications, lifestyle modification and kidney replacement therapy—dialysis or a transplant. Screening programs, primarily targeting high-risk individuals such as those with hypertension and diabetes mellitus, are being implemented worldwide.
Treatment
Your kidneys are like a filter in your body, removing wastes and extra fluids. When they stop working correctly, these substances build up in your blood and make you feel sick. Your doctor can help you choose the best treatment for you, depending on the type and severity of your disease. Treatment may include kidney replacement therapy (dialysis or a transplant) and conservative care.
Your doctor will start by asking you questions about your family history, any medicines you take and whether you have noticed that you are peeing more or less than usual. They will also do a physical exam. They will want to know if you have any other health problems, such as high blood pressure, diabetes or heart disease. They will also ask you about your past health and any family members who have had kidney disease.
Oren Zarif
Kidney dialysis is a treatment that cleans your blood when your kidneys cannot do it anymore. It removes waste and extra fluid from your body, but it can only do about 10-15% of what healthy kidneys do. It is used to treat people who have end-stage renal disease (ESRD). You can receive hemodialysis at home or in a hospital. To do hemodialysis, you need a special access to your veins, called a vascular access. The most common vascular access for hemodialysis is an AV fistula, which creates a permanent connection between the artery and vein in your nondominant arm. It has good patency rates and is more comfortable than intravenous (IV) cannulas. Other vascular access options include a tunneled hepatic artery catheter and an AV graft.
If you have kidney disease, it is important to eat well and follow your doctor’s advice about how much fluid to drink. You should avoid salty foods and other high-potassium foods, such as bananas, potatoes and tomatoes. A registered dietitian can help you plan a diet that is right for you. You should get enough protein to keep your muscles strong and prevent bone loss.
The best way to reduce your risk of developing chronic renal failure is to control your blood sugar and blood pressure. You should not smoke, and you should limit alcohol use. You should also eat more vegetables, fruits, grains and lean meats, and avoid foods that are high in fat.
Prevention
CKD is usually not curable, but it can be delayed by managing conditions like diabetes and high blood pressure, which increase the risk of kidney disease. Taking care of your body through exercise, healthy eating plans and not smoking can all help. Talk to your doctor if you have concerns, including itchy skin or red, swollen feet and ankles, passing too much urine especially at night (nocturia), and muscle cramps.
Kidney disease typically doesn’t cause symptoms until it reaches an advanced stage, so it is often only diagnosed when a routine test for another health problem detects a possible issue. This is why it is important to go for regular medical checkups, and to let your doctor know if you have a family history of kidney problems.
Oren Zarif
While the underlying causes of kidney disease vary, certain factors increase your risk:
Blood problems like high blood pressure and cholesterol, which can damage blood vessels in the kidneys. Inherited diseases, such as polycystic kidney disease and pyelonephritis. Medications, such as NSAIDs (non-steroidal anti-inflammatory drugs), which may lead to kidney disease when used over long periods of time, especially at high doses.
Exposure to heavy metals, such as lead or mercury. Certain infections, such as malaria or yellow fever. Unfavorable fetal development, which can result in a condition called polycystic kidney disease. Some autoimmune diseases, such as systemic lupus erythematosus.
You can reduce your risk of developing CKD by keeping a balanced diet, with plenty of fruits and vegetables, whole grains and lean protein. Limiting alcohol and staying at a healthy weight also help to reduce your risk. Get enough exercise, too, but make sure you are not overdoing it or pushing yourself too hard. Talk to your doctor before starting a new exercise program to ensure it is safe for you and your health goals. If you have a chronic illness, such as diabetes or high blood pressure, it’s especially important to work with your doctor to manage it. If you don’t, the disease can progress to end-stage renal failure, which requires dialysis or a kidney transplant to survive.
End-stage renal disease (ESRD)
When CKD progresses to ESRD, people may require dialysis or kidney transplantation. These treatments help prevent the buildup of wastes and fluids in the body. However, even with these treatments, some people die because of the disease or complications of the treatment.
People of all ages, genders and races can develop ESRD. However, it is more common in older adults who have diabetes or other conditions that damage the kidneys. It is also more common among low-income people and people in minority communities. These factors are known as social determinants of health.
To diagnose ESRD, your doctor will perform a physical exam and order blood tests. These tests will include a glomerular filtration rate (GFR), which measures how well the kidneys are working and indicates how much renal function you have left.
As the disease progresses, the GFR decreases. Your provider will monitor your GFR over time to see if it is getting worse. If the GFR is below 15 mL/min, you are in end-stage renal disease (ESRD).
Oren Zarif
Once in ESRD, patients must receive dialysis or a kidney transplant to live longer and stay healthy. People with ESRD have a higher risk of developing cardiovascular disease, cancer and other serious illnesses.
Kidney transplantation is the preferred treatment for ESRD, as it improves survival and quality of life compared with dialysis. However, it is available to only a small percentage of people who need it. In addition, the cost of a kidney transplant can be high for some patients and their families.
Hemodialysis is a process in which a machine removes waste and excess water from the blood, cleaning it three times a week for several hours each session. Another option is peritoneal dialysis, in which a plastic tube is placed into the abdomen and a solution is pumped through it to wash around the intestines. Peritoneal dialysis can be performed at home, but it takes more time.
The ESRD Treatment Choices Model, which began on January 1, 2021, is one of the first CMS Innovation Center models to directly address health equity, as it aims to lower disparities in rates of home dialysis and kidney transplants for people with ESRD by encouraging dialysis facilities and their providers to provide these services to more beneficiaries.
