Renal Failure, its Causes and Clinical Symptoms

Definitions

Chronic renal disease (CRD) is a pathophysiologic process with multiple ethiologies, resulting in the inexorable attrition of nephron number and function and frequently leading to end-stage renal disease (ESRD).

In turn, ESRD represents a clinical state or condition in which there has been an irreversible loss of endogenous renal function, of a degree sufficient to render the patients permanently dependent upon renal replacement therapy (dialysis) in order to avoid life-threatening uremia.

Uremia is the clinical and laboratory syndrome, reflecting dysfunction of all organ systems as a result of untreated or under treated acute or chronic renal failure.

Given the capacity of the kidneys to regain function following acute injury, the vast majority(>90%) of patients with ESRD have reached this as a result of CRD.

Causes of chronic renal failure

Congenital and inherited disease

Polly cystic kidney disease (adult and infantile forms)
Medullary cystic disease
Tuberose sclerosis
Oxalosis
Cystinosis
Congenital obstructive uropathy

Glomerular disease

Primary glomerulonephritides including focal glomerulosclerosis Secondary glomerular disease (systemic lupus, polyangitis, wegener’s granulomatosis, amyloidosis, diabetic glomerulosclerosis, accelerated hypertension, haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura, systemic sclerosis, sickle cell disease)

Vascular disease

Hypertensive nephrosclerosis (common in black Africans)
Atherosclerotic main renal vascular disease
Small and medium-sized vessel vasculitis

Tubulointerstitial disease

Tubulointerstitial nephritis-idiopathic, due to drugs (especially nephrotoxic analgesics), immunologically mediated
Reflux nephropathy(chronic atrophic pyelonephritis)

Tuberculosis

Schistosomiasis

Nephrocalcinosis

Multiple myeloma (myeloma kidney)

Balkan nephropathy

Renal papillary necrosis (diabetes, sickle cell disease and trait, analgesic nephropathy)

Urinary tract obstruction

Calculous disease
Prostatic disease
Pelvic Tumours
Retroperitoneal fibrosis
Schistosomiasis

Clinical approach to the patient with chronic renal failure

History

Particular attention should be paid to:

• Duration of symptoms

• Drug ingestion, including non-steroidal anti-inflammatory agents, analgesic and other medications, and unorthodox treatments such as herbal remedies.

• Previous medical and surgical history, e.g. previous chemotherapy, multisystem disease such as SLE

• Previous occasions on which urinalysis or measurement of urea and creatinine might have been performed, e.g. per-employment or insurance medical examinations, new patients checks

• Family history of renal disease.

Symptoms

The early stages of renal failure are often completely asymptomatic, despite the accumulation of numerous metabolites. Serum urea and creatinine concentrations are measured in renal failure since methods for their determination are available and a rough correlation and symptoms.

Symptoms are common when the serum urea concentration exceeds 40 mml/L, but many patients develop uiraemic symptoms at lower levels of serum urea. Symptoms include.

• Malaise, loss of energy
• Los of appetite
• Insokmnia
• Nocturia and polyuria due to impaired concentrating ability
• Itching
• Nausea, vomiting and diarrhoea
• Paraesthesiae due to polyneuropathy
• ‘Restless legs’ syndrome
• bone pain due to metabolic bone disease
• paraesthesiae and tetany due to hypocalcaemia
• symptoms due salt and water retentionperipheral or pulmonary oedema
• symptoms due to anaemia
• amenorrhoea in women; erectile imprtence in men.

In the Uk, the prevalence of chronic renal impairment is approximately 600 individuals per million populations per year. The incidence of end-stage renal failure is of the order 200 per million populations per year.

Chronic renal failure implies long-standing, and usually progressive, impairment in renal function. In many instances, no effective means are available to reverse the primary disease process.

Exceptions include correction of urinary tract obstruction, immunosuppressive therapy for systemic vasculitis and good pasture’s syndrome.

Treatment of accelerated hypertension, and correction of critical narrowing of renal arteries causing renal impairments. A good deal, however, can be done to slow the rate of deterioration in renal function otherwise to be expected.

Wide geographical variations in the incidence of disorders causing chronic renal failure exist. For example, the most common cause of glomerulonephritis in sub-Saharan Africa is malaria.

Schistosomiasis is a common cause of renal failure due to urinary tract obstruction in parts of the Middle East, including southern Iraq. These disorder are seen in the Uk only in those who have resided in endemic areas.

The incidence of end-stage renal failure varies between racial groups, as dose the relative importance of different causes of chronic renal failure. For example, end-stage renal failure is three to four times as common in black

Africans in the Uk and USA as it is in whites, and hypertensive nephropathy is a much more frequent cause of end-stage renal failure in this the prevalence of diabetes mellitus and hence of diabetic nephropathy is higher in some Asian groups than in whites.

The age group involved is also of relevance. Fro example, chronic renal failure due to atherosclerotic renal vascular disease is much more common in the elderly than in the young.

Please check out this article on Pathogenesis and the Management of Renal Failure

About Renal Failure, its Causes and Clinical Symptoms