Chronic Renal Failure
Chronic renal failure is also known as “ureamia”, as the level of urea in blood is very high. When 90% of functioning renal tissue is destroyed ureamia occurs. It may be the acute glomerulonephritis, pyelonephritis and nephrotic syndrome. This articles tell you about the causes, symptoms and treatment of chronic renal failure.
A healthy working kidney plays an important role in keeping the whole body clean, well-fueled, strong and functioning properly. Kidney failure puts the body at risk, allowing waste to accumulate and damage the kidneys from inside. It is a good idea to do a kidney cleansing and keep a check on the health of the kidneys in your middle and old age. The toxins that build up results in nausea or feeling sick to the stomach, lack of concentration and blood pressure changes are all symptoms of kidney failure.
Chronic kidney failure can occur when:
- Progression of acute nephritis or nephrosis.
- Chronic infection of the urinary tract.
- Infections (chest infection)-subacute bacterial endocarditis.
- Diabetes mellitus especially type-1.
- Kidney stones
- Polycystic kidneys.
- High blood pressure.
- Abdominal surgical emergency.
- Exposure to toxic substances.
The urine volume depends upon GFR. Once chronic renal failure occurs, the normal functions of kidney like regulation of body fluids, electrolytes, pH and excretion of metabolites are disrupted.
Symptoms and signs of chronic kidney failure may include :
- Clinical symptoms results from the progressive loss of nephrons and the consequent decreased renal blood flow and glomerular filtration.
- Dehydration or water intoxication, sodium depletion, high serum potassium, acidosis, increased susceptibility to infection are the most general manifestation.
- When GFR falls below 5 ml/min., oedema, high blood pressure, irregular heart beats and pericarditis occur.
- Sleep problems.
- Changes in how much you urinate.
- Decreased mental sharpness.
- The symptoms of gastrointestinal system may be loss of appetite, vomiting and hiccups.
- Decreased mental sharpness.
- Muscle twitches and cramps.
- Haemolytic system may be affected leading to anaemia resulting in tiredness and breathlessness and tendency to bleed due to abnormal platelet function.
- Swelling of feet and ankles.
- Skin changes like pigmentation, itching and purpura.
- Neurological symptoms like peripheral neuropathy, twitching, convulsions and coma can also occur.
- Renal osteodystrophy metastatic calcification and dwarfism and ricket growth failure can also occur.
Non-volatile acids are excreted by kidneys. Chronic renal failure therefore produces acidosis that increases calcium resorption from bones leading to osteomalacia and renal osteodystrophies. In chronic renal failure, the activation of vitamin D and the action of parathyroid hormone in controlling serum calcium and phosphorus levels cannot proceed at normal levels. The impaired vitamin D metabolism results in a bone disease called osteodystrophy in which there is bone pain, various bone deformities, and awkward gait and in children impaired growth. There may be calcification of soft tissues further hindering renal function.
These metabolism impairments may cause hyperphosphatemia and hypocalcemia. Failure of renal tubular reabsorption results in hyperphosphatemia which in turn produces rickets. Phosphate intake has to be restricted. Aluminium hydroxide 1 ml/kg/day should be given. serum phosphate levels should be maintained at 4-6 mg/100 ml in children. Calcium and active form of vitamin D supplementation should be given.
The kidney releases an enzyme called renal erythropoietic factor. The enzyme acts on one of the plasma protein, a globulin to split the glycoprotein molecule. When kidneys are damaged there is depressed red blood cells production, red cells survive a shorter time but have their usual size and haemoglobin content.
Anaemia can also occur due to blood loss through nose bleeding, haematuria, ecchymosis or gastrointestinal bleeding due to deficient coagulatory factors and increased vascular fragility. Haemolysis may also contribute for anaemia. Those on haemodialysis lose blood due to blood sampling and in dialysis machine. Deficiency of iron, vitamin C and folic acid may result in anaemia.
- To prevent protein catabolism and minimise uraemia toxicity.
- To carefully correct acidosis.
- To maintain optimal nutritional status.
- To avoid dehydration or overhydration.
- To control fluid and electrolyte losses from vomiting and diarrhea.
- To maintain appetite and stimulate morale and a sense of well being.
- To retard progression of renal failure, thus postponing the ultimate necessity of dialysis.
- To correct electrolyte depletion and avoid excesses.
- To control complications such as hypertension, bone pain and control nervous system abnormalities.
Management varies according to the stage of illness. In mild cases active steps should be taken to control hypertension, salt, and water imbalance. During the course of illness in which oral feeding cannot be maintained, fluids and electrolytes should be given intravenously. Protein restriction may not be necessary in the absence of symptoms.
As renal failure progresses, the patient develops symptoms of ureamia and the patient may be treated dietetic measures alone or by regular haemodialysis or peritoneal dialysis or by renal transplantation.