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What is chronic renal failure?

Chronic renal failure is usually characterized by a progressive decline in renal function.

Causes of chronic kidney failure.

Chronic Glomerulonephritis
This is a non–infectious type of disease of the kidney. The symptoms are: Small volume of urine. Blood–stained urine. Protein in the urine. Body swelling. Chronic glomerulonephritis may have no symptoms for many years. High blood pressure.
Uncontrolled hypertension for many years can damage groups of blood vessels within the kidneys and cause kidney failure.
Diabetes Mellitus
Diabetes can damage the kidneys capacity to filter blood and excrete waste products in the urine. High levels of glucose make the kidney filter too much blood. This extra work load over a period of some years result in defective filtering capacity.
Chronic Kidney Infection
Long standing infections damage the structure of the kidneys. This damage reduces the kidney’s capacity to filter blood.
Obstructions Like Stone
Obstruction to the flow of urine leads to back pressure and cause damages the nephrons. This damage can be progressive and ultimately cause chronic kidney failure.
Many medicines cause damage to the kidneys. The most dangerous medicines are Aspirin, Ibuprofen, and Antibiotics such as Sulpha drugs and Gentamicin.

If I have been diagnosed with chronic renal failure how often should I see the doctor?

It is very important that the patients with chronic renal failure should be seen by a nephrologist. Generally these patients should be seen at least once in every three months.

My doctor asked me to do a 24hr urine collection. What is this test used for?

This test is used for:
To estimate accurately how much protein is spilling into the urine.

The total amount of creatinine excreted in 24hrs is estimated. By measuring the serum creatinine simultaneously the clearance of creatinine is calculated by the formula:
Cr Clearance= (U X V) / P
U: Creatinine in urine
V: Volume of urine
P: Plasma creatinine.
This clearance gives an idea about the function of the kidney.

Is there an absolute level of creatinine for starting dialysis?

No. Since the serum creatinine level is a reflection of the muscle mass a variation can exist between different individuals. Malnourished patients will have lower creatinine levels for the same level of kidney function.

What kind of diet do patients of chronic renal failure have?

The proteins intake should be 0.6 gm of protein / kg of body weight/day. Moderate protein restriction has been shown to slow the progress of chronic renal failure.

Does a patient with CRF require any vitamin supplements?

The diet should be supplemented with vitamins B, vitamins C and also folic acid. Vitamin D should be reserved for those for treatment with severe Renal Osteodystrophy. It is a condition which result from low calcium in the blood which stimulates secretion of a hormone called as PTH which acts on the bone. These patient will usually have low calcium and a high phosphorous. These patients should be treated with calcium supplements.
h3>Is there any restriction on intake of potassium? The patients should be watchful about their intake of potassium. High potassium containing foods like bananas, tomatoes, oranges, fruit juices should be avoided.

How much water am I permitted if I have chronic renal failure?

Intake of water should be based on the individual requirements as assessed by the physician. It is important to note that the patients with chronic renal failure are sensitive both to volume expansion and contraction and therefore should have regular follow up with the physicians. Generally mild fluid restriction is advised about 1–1.5 Lt/day.

How important is it to control the blood pressure in CRF?

The treatment of hypertension is extremely important as studies are shown that the control of hypertension slows the process of chronic renal failure.

What is the cause of anemia in CRF?

It is related to the deficient Erythropoietin production. Erythropoietin stimulates the bone marrow to produce red blood cells.

Is there any treatment for the anemia?

Erythropoietin injections can be used to treat the anemia. It is important to evaluate the iron status prior to starting these injections.

What are the different treatments available for the treatment of end stage renal failure?

The following methods are available.
  1. Hemodialysis.
  2. Peritoneal dialysis.
  3. Kidney transplant.

When is dialysis initiated in a patient with CRF?

Current recommendations are to initiate dialysis early i.e. when the kidney function falls below 25% of normal as measured by the creatinine clearance. It is not considered prudent to wait till symptoms of advanced renal failure have set in such as nausea, vomiting, or fluid accumulation in the lungs.