Chronic renal failure is characterized by the progressive and irreversible deterioration of renal function that eventually leads to death. It is caused by the slow destruction of renal parenchyma over time from diseases like glomerulonephritis, diabetes nephropathy, hypertension, infections, toxins, and obstructions. The stages of chronic renal failure progress from a decreased renal reserve with normal lab values and no symptoms, to renal insufficiency with elevated BUN and creatinine and symptoms like polyuria, to renal failure with severe loss of renal function, to end stage kidney disease requiring dialysis or transplant. Chronic renal failure results in both primary renal manifestations like metabolic acidosis and secondary manifestations affecting other organs systems like anemia

1. CHRONIC
RENAL FAILURE
By: Miss Santoshi Naik
Assistant Professor
Yenepoya Pharmacy College & Research Centre

2. Defination
Chronic renal failure is a syndrome characterised
by progressive and irreversible deterioration of
renal function due to slow destruction of renal
parenchyma, eventually terminating in death
when sufficient number of nephrons have been
damaged.

3. Etiopathogenesis/ Causes of Chronic
Renal Failure
Disease causing
Glomerular pathology
Diseases causing
tubulointerstitial
pathology

4. Glomerular destruction results in changes in
filtration process and leads to development of
the nephrotic syndrome characterised by
proteinuria, hypoalbuminaemia and oedema.
Disease causing Glomerular pathology

5. Glomerular pathology
Primary glomerular
pathology
Abnormalities or dysfunctioning
in the Glomerulus
(Glomerulonephritis)
Systemic glomerular
pathology
Abnormalities outside renal
system
Eg: Diabetes nephropathy

6. Damage to tubulointerstitial tissues results in
alterations in reabsorption and secretion of
important constituents leading to excretion of
large volumes of dilute urine
Diseases causing tubulointerstitial pathology

7. Causes of Tubulointerstitial diseases
INFECTIOUS
CAUSES
VASCULAR
CAUSES
OBSTRUCTIVE
CAUSES
TOXIC
CAUSES

8. 1) Vascular causes – Hypertension leading to changes in
arteries & arterioles referred as Nephrosclerosis
2) Infectious causes – Chronic pyelonephritis (renal
inflammation and fibrosis by renal infection).
3) Toxic causes – Nephrotoxins eg. Analgesics like
aspirin & paracetamol, Exposure to lead, cadmium &
uranium.
4) Obstructive causes – obstruction in urinary tract by
kidney stones, blood clots, tumours.

9. Stages of Chronic Renal Failure
Decreased renal reserve
Renal insufficiency
Renal failure
End stage kidney

10. 1) Decreased renal reserve
 Damage to renal parenchyma is marginal and the kidneys are
functional.
 The GFR is 50% of normal, BUN and creatinine values are
normal and the patients are usually asymptomatic.
2) Renal insufficiency
 About 75% of renal parenchyma has been destroyed.
 The GFR is 25% of normal & elevation in BUN and serum
creatinine
 Symptoms: Polyuria and nocturia

11. 3) Renal failure
 About 90% of functional renal tissue has been
destroyed.
 The GFR is 10% of normal & tubular cells are non
functional.
4) End stage kidney
 GFR is less than 5% of normal.
 Results in complex uremic syndrome.

12. Clinical features of Chronic Renal Failure
PRIMARY RENAL
MANIFESTATIONS
 Metabolic acidosis
 Hyperkalaemia.
 Na+ & water imbalance
 Hyperuricaemia
 Azotaemia.
SECONDARY RENAL
MANIFESTATIONS
 Anaemia
 Uraemic frost
 Congestive heart failure
 Stomach ulcers
 Osteomalecia

13. Symptoms of Chronic Renal Failure
 Haematuria
 High BP
 Fatigue
 Loss of appetite
 Nausea & vomiting
 Bad taste & breath
 Weight loss
 Muscle twitching
 Itchy skin
 Yellow brown tint to skin
 Puffy eyes, hands & feet (edema)

14. Diagnosis of Chronic Renal Failure
 Blood & urine examination
 X –Ray of kidney
 Abdominal MRI (Magnetic Resonance Imaging)
 Abdominal ultrasound

15. Treatment of Chronic Renal Failure
 Low protein & high carbohydrate diet
Managing electrolyte imbalance
 Dialysis
 Kidney transplant
 Managing blood pressure

16. THANK
YOU