Chronic Renal Failure
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What is Chronic Renal Failure (CRF)?

 Chronic Renal Failure is a disease, which is also known by the name of acute kidney failure. It is a fatal disease and should be treated on an emergency basis. There is a rapid loss of renal function resulting from the damage of the kidneys, which takes place over a period of months or years. In fact the disease can be divided into five stages.

While undergoing each stage, the Glomerular Filtration Rate (GFR) progressively becomes low and deteriorates. The loss of renal function leads to the retention of the waste products -- nitrogenous (urea and certain) and non-nitrogenous --, which normally gets disposed off through the excretion by the kidney. This accumulation of the waste products leads to other metabolic symptoms like metabolic acidosis, which is acidification of the blood, hyperkalaemia, which is, heightened potassium levels, disturbance in the body fluid balance. Apart from affecting the kidney this disease also effects other organ systems.

Causes of Chronic Renal Failure

Most common causes of the Chronic Renal Failure are -- diabetes, inflammation, high blood pressure, hypertension, glomerulonephritis, long-term infection, blockage, polycystic kidney disease and reaction from certain medicines. The risk of getting afflicted with CRF increases after reaching the age of 60.

Technically, the causes for CRF are categorized under three sub-heads -- pre-renal, renal and post-renal.

Pre-renal causes are related to the blood supply. Sudden shock or dehydration and fluid loss, hepatorenal syndrome, vascular problems or systematic inflammation due to an infection are the major causes under this head. Renal causes are related to the damage to the kidney itself. Some medicines or toxins (like NSAIDs, aminoglycoside antibiotics, iodinated contrast, lithium) are major contributors to this cause. A major factor which triggers this disease is the breakdown of the muscle tissue, as a result if which myoglobin is released in the blood, affecting the kidney.

Hemolysis (due to which hemoglobin is released subsequently damaging the tubules may also become a cause under the renal head. Injury, stimulants and drugs may also induce the damage to kidneys. Post-renal causes deal with the obstruction in the urinary tract which might happen due to medication, benign prostatic hypertrophy or prostrate cancer, kidney stones, abdominal malignancy or obstructed urinary catheter.

Chronic Renal Failure Symptoms

Initially, the only way to detect the CRF might be by checking the increase in serum certain or protein in urine. As the disease progresses and the kidney loses its function, various symptoms can be noticed like increase in blood pressure due to fluid overload and production of the vasoactive hormones, hypertension or congestive heart failure, azotemia due to urea accumulation among others.

As the disease progresses one can also notice the formation of Uremic frost (crystallization of urea on skin while sweating). Accumulation of potassium in blood, loss of appetite, fatigue and anemia are the other common symptoms. People suffering from CRF may notice that they are passing Urine more often, especially at night. Some patients may also develop symptoms like itchy skin, nausea, impotence (in men) and fluid retention.

While the above-mentioned symptoms are the physical symptoms, a doctor may run a series of tests to check for the CRF. The most general check done is via testing the creatine or blood nitrogen. The results would be remarkably high in an ill patient. At the same time the doctor may also make a series of measurements of renal function in order to offer comparison and to diagnose this disease. A series of blood tests and urine tests are also run in order to confirm the CRF. People suffering from CRF are most likely to further develop diseases like arthrosclerosis and cardiovascular diseases.

Chronic Renal Failure Treatment

Generally, the main goal of the treatment should be to reduce or halt the progression of the CRF further. The key is to control the blood pressure and to treat the original disease. The use of Angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) is suggested, as they slow the progression of the disease.

At the same time replacement of the two main hormones processed by the kidney -- erythroprotein and Vitamin D3 -- along with calcium is also required. You can also use Phosphate Binders in order to reduce the serum phosphate count, which are inflated in the Chronic Renal Failure. The use of diuretics, though is widespread, is not suggestive as it may further complicate things, masking the problem only initially.

In case of a complete or Acute Renal Failure (ARF), a kidney dialysis and biopsy should be performed.

A change of a diet plan might also help reduce the burden on the kidneys. For example, the intake of protein, sodium, potassium and fluids should be modified ensuring that the body is not overloaded.

What Is The Prognosis of Chronic Renal Failure?

People suffering from CRF are known to suffer from depression as a result of their condition. Therefore they should receive psychological counseling. The overall mortality rate increases as the kidney function deteriorates. Most patients suffering from CRF die due to cardiovascular disease, regardless of the progression of the disease. The renal transplants though do provide a higher mortality rate. While the kidney replacement might prolong the patient's life, the quality of life is severely affected, as hemodialysis and peritoneal dialysis become a part of the lifestyle.

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