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Chronic Renal Failure

In this factsheet:
• The Facts on Chronic Renal Failure
• Causes of Chronic Renal Failure
• Symptoms and Complications of Chronic Renal Failure
• Diagnosing Chronic Renal Failure
• Treating and Preventing Chronic Renal Failure

The Facts on Chronic Renal Failure

Chronic renal failure, or chronic kidney disease (CKD), is a slow and progressive decline of kidney function. It's usually a result of a complication from another serious medical condition. Unlike acute renal failure, which happens quickly and suddenly, chronic renal failure happens gradually - over a period of weeks, months, or years - as the kidneys slowly stop working, leading to end-stage renal disease (ESRD).

The progression is so slow that symptoms usually don't appear until major damage is done. In the United States, approximately 1 in 1,000 people are getting treated for ESRD, and greater than 19 million adults are living with some type of CKD. In Canada, approximately 1.9 to 2.3 million people suffer from CKD.

The kidneys play three major roles:

• removing waste products from the body, keeping toxins from building up in the bloodstream
• producing hormones that control other body functions, such as regulating blood pressure and producing red blood cells
• regulating the levels of minerals or electrolytes (e.g., sodium, calcium, and potassium) and fluid in the body

It's entirely possible to live a full, healthy life with only one kidney - one fully functioning kidney can do the work of two - but it's essential to watch for signs of any problems with the remaining kidney.

When kidneys get to the point where they can't function at all, kidney dialysis or a transplant is the only way to remove the body's waste products.

Causes of Chronic Renal Failure

The most common causes of chronic renal failure in North America are diabetes mellitus (type 1 or type 2 diabetes) and high blood pressure. The most common cause of end-stage renal failure worldwide is IgA nephropathy (an inflammatory disease of the kidney).

One of the complications resulting from diabetes or high blood pressure is the damage to the small blood vessels in the body. The blood vessels in the kidneys also become damaged, resulting in CKD.

Other common causes of chronic renal failure include:

• recurring pyelonephritis (kidney infection)
• polycystic kidney disease (multiple cysts in the kidneys)
• autoimmune disorders such as systemic lupus erythematosus
• hardening of the arteries, which can damage blood vessels in the kidney
• urinary tract blockages and reflux, due to frequent infections, stones, or an anatomical abnormality that happened at birth
• excessive use of medications that are metabolized through the kidneys

Symptoms and Complications of Chronic Renal Failure

Chronic renal failure can be present for many years before you notice any symptoms. If your doctor suspects that you may be likely to develop renal failure, he or she will probably catch it early by conducting regular blood and urine tests. If regular monitoring isn't done, the symptoms may not be detected until the kidneys have already been damaged. Some of the symptoms - such as fatigue - may have been present for some time, but can come on so gradually that they aren't noticed or attributed to kidney failure.

Some signs of chronic renal failure are more obvious than others. These are:

• increased urination, especially at night
• decreased urination
• blood in the urine (not a common symptom of chronic renal failure)
• urine that is cloudy or tea-coloured

Other symptoms aren't as obvious, but are a direct result of the kidneys' inability to eliminate waste and excess fluid from the body:

• puffy eyes, hands, and feet (called edema)
• high blood pressure
• fatigue
• shortness of breath
• loss of appetite
• nausea and vomiting (this is a common symptom)
• thirst
• bad taste in the mouth or bad breath
• weight loss
• generalized, persistent itchy skin
• muscle twitching or cramping
• a yellowish-brown tint to the skin

As the kidney failure gets worse and the toxins continue to build up in the body, seizures and mental confusion can result.

Being diagnosed with chronic renal failure can be very frightening. The future of the condition, however, depends on the medical problem that caused the kidney failure, how much kidney damage has occurred, and what, if any, complications are present.

Some of these complications may include:

• anemia
• high blood pressure (hypertension)
• increased risk of bleeding
• increased risk of infection
• fluid overload (called edema)
• dehydration
• electrolyte abnormalities (e.g., hyperkalemia, high levels of potassium in the blood)
• mineral abnormalities (e.g., hypercalcemia (high levels of calcium in the blood) or hyperphosphatemia (high levels of phosphorus in the blood))
• brittle bones
• malnutrition
• seizures