Who is prone to chronic renal failure?

Who is prone to chronic renal failure? What are the stages of chronic renal failure? 

The kidney is the main excretory organ of the human body. It regulates water, electrolyte and acid-base balance by excreting metabolites, thereby maintaining the stability of the body’s environment. In addition, the kidney can also produce bioactive substances such as renin and erythropoietin to regulate blood pressure and hematopoietic function.

Chronic renal failure usually occurs on the basis of various chronic kidney diseases, and irreversible renal damage appears slowly and progressively worsens. It can lead to retention of metabolites, disturbance of water and electrolytes, and acid-base imbalance, and various complications such as hypertension, heart failure, and anemia in the late stage. Known as the “second cancer”.

Chronic renal failure is not an independent disease, but a pathological state. Any disease that can destroy the normal structure and function of the kidney can cause renal failure. Clinically, the decrease of glomerular filtration rate and the increase of blood creatinine and urea nitrogen are used as indicators to evaluate the degree of renal damage.

01 What are the stages of chronic renal failure?

Glomerular filtration rate (GFR) is an important indicator for evaluating kidney function, and it should normally be above 100ml/min. When renal insufficiency occurs, the glomerular filtration rate will decrease.

CKD1 stage (compensated renal function), GRF≥90ml/min, renal function is slightly impaired, but for excretion of metabolites, the ability to regulate water, electrolyte and acid-base balance is good, so there is generally no special clinical manifestations.

CKD stage 2 (renal function decompensation stage), GRF 60～89ml/min, renal function is mild to moderately impaired, clinically there may be fatigue, loss of appetite, nausea, etc., various degrees of anemia, increased blood creatinine and urea nitrogen.

In CKD stage 3, GRF is 30～59ml/min, renal function is moderately damaged, and blood creatinine and urea nitrogen are further increased.

CKD stage 4 (renal failure stage), GRF 15-29ml/min, renal function is moderately to severely damaged, blood creatinine and urea nitrogen are significantly increased, acidosis, water and sodium retention. There may be obvious anemia and gastrointestinal symptoms, as well as neuropsychiatric symptoms.

CKD stage 5 (uremia stage), GRF <15ml/min, severely impaired renal function, advanced chronic renal failure, systemic multiple organ failure, severe imbalance of the metabolic system. The clinical manifestations can be nausea and vomiting, irritability, increased blood pressure, palpitation, chest tightness, severe anemia, convulsions, and even coma. This period requires dialysis to maintain life.

02 Who are susceptible to chronic renal failure?

Chronic renal failure is the result of progressive deterioration of various primary or secondary kidney diseases. In primary kidney disease, it is common in chronic glomerulonephritis, chronic pyelonephritis, chronic interstitial nephritis, polycystic kidney disease and so on.

The most common secondary kidney diseases are diabetic nephropathy, gouty nephropathy, purpuric nephritis, lupus nephritis, hypertensive nephropathy, obstructive nephropathy, etc.

According to reports, the common causes of chronic renal failure in some countries are: chronic glomerulonephritis, diabetic nephropathy, hypertensive nephropathy, polycystic kidney disease, obstructive nephropathy, etc.

03 What are the high-risk factors that aggravate the deterioration of renal function?

The renal damage of chronic renal failure generally progresses gradually. If the patient shows a sharp decline in renal function in a short period of time, there may be risk factors that aggravate the deterioration of renal function, such as:

• Kidney disease recurs or worsens.
• Application of nephrotoxic drugs: common non-steroidal anti-inflammatory drugs, antibiotics, contrast agents and aristolochic Chinese medicines.
• Infection: Both systemic infection and urinary tract infection may accelerate the deterioration of kidney function and aggravate azotemia.
• Urinary tract obstruction: urinary tract stones, prostate hyperplasia.
• Insufficient blood volume: Overtreatment with diuretics, or due to nausea, vomiting, diarrhea, etc.
• Uncontrolled high blood pressure: severe high blood pressure, heart failure, rapid blood pressure drop, etc.

For the rapid deterioration of renal function in the course of the disease, if the aggravating factors can be removed in time, it is often reversible, and the patient’s renal function is restored; but if the diagnosis and treatment are delayed, or the high-risk factors are extremely serious, the renal failure is irreversible.

The treatment of chronic renal failure mainly includes several aspects such as intervention in the progress of chronic renal failure, reducing uremia and complications, and preparing for renal replacement therapy. Therefore, it is necessary to control blood pressure and proteinuria, correct malnutrition, anemia and metabolic acidosis, and attach importance to the prevention and treatment of heart, brain and neuropathy.

(source:chinanet, reference only)

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