Chronic renal failure is a progressive loss of kidney function over months to years that is irreversible and often asymptomatic in early stages. It is detected through raised creatinine levels, hypertension, edema, anemia, and kidney imaging. Common causes include diabetes, hypertension, glomerulonephritis, and polycystic kidney disease. Clinical features result from uremia and include fluid overload, electrolyte imbalances, anemia, and accelerated atherosclerosis. Management focuses on slowing progression through blood pressure and protein control, treating complications, and renal replacement therapy like dialysis or transplantation for late stages.

1. Chronic renal failure
Progressive azotemia
over months to years

2. CRF
 Irreversible
 May be asymptomatic
 Detection-
 Raised Creatinine
 HT
 Edema
 Anemia
 Broad casts in urine
 B/L shrunken kidneys on US

3. Causes
 Diabetic nephropathy
 Hypertension
 Chronic glomerulonephritis
 Lupus nephritis
 Polycystic kidney disease
 Reflux nephropathy
 Multiple myeloma
 B/L renal artery stenosis
 Obstructive uropathy

4. Clinical features
 Hypertension
 Uremia- nausea/vomiting, pericarditis,
encephalopathy, neuropathy
 Pruritis, easy bruisability
 Hyperkalemia- arrythmia
 Anemia, due to erythropoietin deficiency
 Fluid overload- edema, pulmonary edema
 Hyperphosphatemia & hypocalcemia
 Metabolic acidosis
 Accelerated atherosclerosis

5. Staging
 1- GFR >90 ml/min/1.73 square metres
 2- 60-89- estimate progression
 3- 30-59- evaluate & treat complications
 4- 15-29- prepare for RRT
 5- <15- need RRT

6. Management
 Diet- control Na, K, fluid, protein
 To slow progression-
 Treat HT with ACEI, target < 130/80 mm Hg
 Avoid nephrotoxins
 Treat complications-
 Fluid overload with diuretics
 Anemia with erythropoietin/darbopoietin & iron supplements
 Hyperphosphatemia with CaCO3 with meals
 Hypocalcemia with CaCO3 & vitamin D3
 Renal replacement therapy-
 Dialysis- hemo/peritoneal
 Transplant

7. Dialysis
 When GFR<10 or Cr>8,
in diabetics when GFR<15 or Cr>6
 Before development of malnutrition, encephalopathy,
neuropathy, pericarditis
 Other indications-
 Refractory hyperkalemia, fluid overload unresponsive to diuretics,
acidosis, uremic pericarditis/seizures/encephalopathy
 Types-
 Hemodialysis- institutional- ~10-12 hrs/week
 Peritoneal dialysis- domiciliary
 Px- 5-year survival ~ 36%- ~20%
for diabetics & ~45% for CGN

8. Transplantation
 Indication- end-stage renal disease- ESRD
 Donor- living related or unrelated or deceased
 Kidney placed in iliac fossa,
renal vessels connected to external iliac vessels
 Immunosuppressants-
tacrolimus/mycophenolate/prednisone
or cyclosporine/sirolimus/azathioprine
 Acute rejection in ~10-25%
 Better match, better result
 Average life of transplanted kidney- ~10-15 years