Chronic Renal Failure

Chronic renal failure is a condition involving a decrease in the kidneys' ability to filter waste and fluid from the blood. It is chronic, meaning that the condition develops over a long period of time and is not reversible. The condition is also commonly known as chronic kidney disease (CKD).

Chronic renal failure is typically caused by certain other medical conditions that put strain on the kidneys over time, including diabetes, high blood pressure or hypertension and long-term inflammation of the kidneys. Early symptoms of reduced kidney function include urinating more frequently, high blood pressure and swelling of the legs.

Around 15 percent of adults, or 30 million people in the United States are thought to have kidney disease at some stage. Because the condition takes some time to develop, it most commonly affects older people. Women are affected slightly more often than men, and people of African, Latin American and Native American descent are at higher risk of CKD. 1

People who are at risk of chronic renal failure should have regular health checks, which include evaluating the glomerular filtration rate. This is a more reliable method of diagnosing early stages of chronic renal failure than waiting for symptoms to appear.

Treatment consists of managing the underlying condition and supporting kidney function. Chronic renal failure requires careful, lifelong management, and can progress to end-stage kidney failure which requires dialysis or transplant. However, many cases of chronic renal failure are mild to moderate and can be managed by patients with support from a doctor. 2

In the early stages of chronic renal failure, affected people often do not experience any symptoms. However, symptoms that may emerge during the early stages of chronic renal failure include: 3 4

• The urge to urinate more frequently
• Urine may be pale and foamy
• Hypertension, also known as high blood pressure
• Swelling of the legs
• Poor appetite
• Weight loss.

As the condition progresses, affected people may develop other symptoms such as: 3 4 5 6

• Muscle cramps or twitches
• Developing brown spots on the skin
• Worsening of swelling, including on the hands, ankles, feet and around the eyes
• Drowsiness or lack of concentration
• Feeling lethargic and without energy
• Bruising easily
• Blood in the stool
• Amenorrhea (periods stopping)
• Itchy, dry skin
• Pain in the bones
• Increased susceptibility to infection
• Nausea and vomiting.

Concerned that you may have a kidney problem? Start your free symptom assessment using the Ada app.

Chronic renal failure mostly occurs in people who have other medical conditions which cause damage to the small units in the kidneys, called nephrons, which are responsible for filtering waste and fluid from the blood.

Common conditions which can cause chronic renal failure include: 1

• Diabetes. One in three adults with diabetes are likely to develop chronic renal failure
• Hypertension. One in five adults with high blood pressure are likely to develop chronic renal failure

People with diabetes and hypertension, who are at high risk of developing chronic renal failure, should have regular health checks to measure their glomerular filtration rate. Diabetics should also have regular microalbumin tests. These tests can detect early signs of the condition.

Less common conditions that can cause chronic renal failure include: 4 7 8

• Polycystic kidney disease, a range of genetic disorders
• Nephrotic syndrome, also called nephritis and glomerulonephritis, is a condition which damages the glomeruli 9 and can be caused by strep throat and lupus, among other conditions
• Inflammation of the kidneys
• Repeated kidney infections and frequent kidney stones.

People who have some malformation of their kidneys or urinary tract are at higher risk of eventually developing chronic renal failure. Once the kidneys have lost a significant amount of function, they may not be able to recover, and the person may progress to end-stage renal disease.

Chronic renal failure can be diagnosed by measuring kidney function and is typically tested for by taking blood and urine samples to measure creatinine levels. This is a waste product of creatine, which is a chemical the body produces to supply energy, primarily to muscles and the brain. 10

The two main diagnostic tests are: 11 12 13

• Glomerular filtration rate (GFR). Checks how well the glomeruli 9 are working. To check the filtration rate, a blood sample is taken which is then tested in a lab. The results are combined with factors including age, ethnicity, gender, height and weight to estimate a person’s glomerular filtration rate.
• Creatinine clearance test. Another way of calculating the glomerular filtration rate. To perform the test, a person needs to collect all their urine for a 24 hour period and then provide a blood sample. Comparing creatinine levels in the blood and urine allows a person’s glomerular filtration rate to be estimated.

If a person has a glomerular filtration rate of less than 60mL/min/1.73m2 for three months or more, they are classed as having chronic renal failure or kidney damage. 14 Normal results are in the 90mL/min/1.73m2 to 120mL/min/1.73m2 range. 11

Additionally, an ultrasound of the kidneys and urinary tract may be necessary. In some cases, it may be necessary to take a small sample of the kidney, called a biopsy, in order to find the underlying cause for the condition. 4

Diabetics should have regular microalbumin tests in addition to other tests. This test is used to detect very small levels of albumin, a protein usually found in the blood, in the urine. If the kidneys are damaged, albumin leaks into urine. 15

If you are worried that you or a loved one may have chronic renal failure, you can do a free symptom assessment with the Ada app.

Treatment involves controlling the condition that is harming the kidneys. In particular, people with hypertension or diabetes should make sure that these conditions are well controlled.

Keeping blood sugar and blood pressure under control will slow down further kidney damage. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are the preferred option for managing hypertension. 3

Other medical conditions involving the kidneys can be managed with the help of a nephrologist (a specialist kidney doctor).

If chronic renal failure is diagnosed early and carefully managed, this may help to prevent the condition from worsening and progressing to end-stage renal failure.

People with kidneys that no longer work well enough to filter blood and fluid may need dialysis, a process in which the blood is cleaned by a machine. Everyone with end-stage renal failure should be evaluated for a kidney transplant. 5

Good to know: Some over-the-counter medications, including vitamins and herbal supplements, can worsen chronic renal failure. It may be helpful to review medications with a doctor and replace or stop any medications which can damage the kidneys. 3

Good control of medical conditions such as hypertension and diabetes is important in preventing chronic renal failure.

Other actions that can help prevent chronic renal failure include: 5 16

• Regular health check-ups, including evaluation of kidney function in high risk populations
• Losing weight
• Taking regular exercise, which can help regulate blood pressure and blood sugar levels
• Eating a healthy diet
• Stopping smoking
• Drinking less alcohol
• Taking all prescribed medication as directed
• Avoiding certain over-the-counter painkillers such as aspirin or ibuprofen.

If kidney disease progresses, it can lead to kidney failure, also known as end-stage renal disease. This means that the kidneys will no longer be able to process waste and remove it from the body. This will require dialysis or, potentially, a kidney transplant. 3 4

Anemia is a common condition in people with chronic renal failure that tends to occur after a person loses 20 to 50 percent of kidney function. Damaged kidneys do not produce enough of a hormone called erythropoietin (EPO), which promotes the creation of red blood cells. 17

Read more about Anemia »

People with chronic renal failure do not process vitamin D as efficiently as people with healthy kidneys and are at risk of vitamin D deficiency. Some of the problems this can lead to include:

• Osteomalacia, a softening of the bones
• Osteoporosis, a weakening of the bones
• Increased susceptibility to infection.

Read more about Vitamin D Deficiency »

• Chronic kidney failure
• CKD

Q: What diet should I eat for chronic renal failure?
A: Eating healthily can help slow the progression of chronic renal failure. Eating a diet that contains plenty of fruit and vegetables, is low in fat, cholesterol, salt and potassium, is advisable. Be aware that white beans, bananas, avocados and potatoes contain high amounts of potassium. For diabetics, maintaining blood sugar levels is important.