Chronic Renal Failure

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Chronic renal failure, usually the end result of a gradually progressive loss of renal function, is caused by the gradual loss of nephrons. As more and more nephrons are destroyed, the kidneys gradually lose the ability to perform their normal functions. Without treatment, uremic toxins can accumulate and cause potentially fatal physiologic changes in all the major organ systems of the body.


Etiology of Chronic Renal Failure. The causes of chronic renal failure

(1) Chronic glomerular disease such as glomerulonephritis.

(2) Chronic infections such as tuberculosis.

(3) Vascular diseases such as hypertension.

(4) Obstructive processes such as calculi.

(5) Collagen diseases such as systemic lupus erythematosus.

(6) Endocrine diseases such as diabetic neuropathy.

b. Signs and Symptoms of Chronic Renal Failure. Characteristic signs and symptoms of chronic renal failure include:

(1) Dehydration - excessive loss of body fluid. Dehydration may occur early in renal failure when the kidneys cannot concentrate the urine and large amounts of water are eliminated.

(2) Edema - accumulation of fluid in the tissue spaces. This condition may occur late in chronic renal diseases when the kidneys cannot eliminate water in adequate amounts.

(3) Hypertension - high arterial blood pressure. Hypertension may occur as the result of fluid overload and the increased production of renin.

(4) Anemia - below normal concentration of hemoglobin in the blood for the patient's age and sex. This condition occurs when the kidneys cannot produce the hormone to activate the production of red bone marrow cells.

(5) Uremia - if levels of nitrogen waste products in the blood are very high, urea can be changed into ammonia in the stomach and intestine, causing ulcerations and bleeding.

c. Treatment of Chronic Renal Failure. There are three basic elements in the goal of medical management of a patient with chronic renal failure. First, maintain the patient's normal body fluid volume and electrolyte balance. Second, reduce the breakdown of tissue in the patient's body. And, third, try to prevent infection until healing occurs. To accomplish all this, a variety of measures are used, including restricting the patient's fluids to 400 ml per day for the average adult. Also included in the management plan are the following:

(1) Adjustment of the patient's diet to limit the sources of nitrogen, potassium, phosphate, and sulfate.

(2) Vigorous treatment of infection with antibiotics.

(3) Treatment of anemia with a transfusion of a small volume of packed, fresh red blood cells.

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