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CHRONIC RENAL FAILURE

About chronic renal failure:

Kidney disease is a silent killer with no prominent signs of warning. In this disease the nephrons are severely affected, altering the normal functioning of the kidney.  It affects the kidney functions like regulating of fluid and electrolyte balance, controlling blood pressure through the renin-angiotensin system, governing blood count through erythropoietin synthesis, directing parathyroid and skeletal function through phosphate elimination and activation of vitamin D.

 The primary signs of renal failure are:

  • High blood pressure
  • Changes in the amount of urine passed and frequency of urination
  • Alteration in the urine composition
  • Presence of blood and pus cells in the urine
  • Swelling of ankles and legs
  • Loss of appetite and insomnia
  • Shortness of breath, nausea, vomiting and severe itching
  • Bad breath and metallic taste in the mouth

Chronic kidney damage is When the GFR rate is less than 60ml/min/1.73ml2 for more than 3 months or any other damage evidence for more than 3 months, calls for chronic kidney damage.

Kidney damage is of following types:

  • Albuminuria
  • Haematuria
  • Pathological abnormalities
  • Structural abnormalities.

Diagnosis of chronic renal disease:

  • Tests for presence of albumin and blood in urine
  • To check level of glomerular filtration rate and concentration of other waste products in the urine
  • Blood pressure tests, as kidney disease results in development of higher blood pressure
  • Ultrasound and CT scan to check any morphological abnormalities in the kidney and urinary tract, to locate tumours or kidney stones.

Results of the above tests determine :

  • Glomerular filtration rate
  • Albuminuria
  • Creatine
  • Urea composition
  • Potassium

 

Stages of chronic renal failure:

The rate of nephron duration differs for every individual ranging from several months to years. This progression of renal failure occurs in primarily 4 stages: diminishes renal reserve, renal insufficiency, renal failure and end-stage kidney disease.

  • Stage 1: normal GRR greater than or equal to 90 ml/min/1.73mI3
  • Stage 2: slightly decreased GFR 60-89 ml/min/1.73mI3
  • Stage 3a: mild-moderate decrease in GFR between 45-59 ml/min/1.73mI3
  • Stage 3b: moderate-severe decrease in GFR between 30-44 ml/min/1.73mI3
  • Stage 4: severe decrease in GFR between 15-29 ml/min/1.73mI3
  • Stage 5: kidney failure as GFR decreases to less than 15 ml/min/1.73mI3 or dialysis is started.

Patients at risk of chronic renal failure:

  • High blood pressure
  • Chronic Diabetes
  • History of heart problems like heart attack, failure or stroke
  • Genetic history of renal failure
  • Obese patients (BMI>30)
  • Chain smokers
  • Previous episode of acute kidney injury

 

Treatment :

  • Blockade of renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors or an angiotensin receptor blocker is the primary treatment to prevent progression of the disease
  • Blood pressure control (<140/90), reduces the renal disease progression and cardiology morbidity and mortality
  • Optimal management of comorbid diabetes and cardiovascular diseases
  • Monitoring of other related complications like anaemia, electrolyte abnormalities, irregular fluid balance, mineral bone disease and malnutrition
  • Dialyses like haemodialysis and periodontal dialysis or final kidney transplantation
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