Progression of Chronic Renal Failure

Chronic Renal Failure (CRF) is a progressive condition characterized by the gradual loss of kidney function over time. This condition significantly impacts the body's ability to maintain homeostasis by filtering waste products and excess fluids.

Stages of Progression

CRF advances through several stages based on the glomerular filtration rate (GFR):

• Stage 1: Kidney damage with normal or increased GFR (>90 mL/min)
• Stage 2: Mild decrease in GFR (60-89 mL/min)
• Stage 3: Moderate decrease in GFR (30-59 mL/min)
• Stage 4: Severe decrease in GFR (15-29 mL/min)
• Stage 5: End-stage renal disease (GFR <15 mL/min), requiring dialysis or transplantation

Etiology and Pathogenesis

Common causes include diabetes mellitus, hypertension, glomerulonephritis, and polycystic kidney disease. The pathogenesis involves progressive nephron damage, inflammation, and fibrosis, ultimately leading to renal insufficiency.

Laboratory Findings

Diagnosis and monitoring involve key laboratory tests:

• Serum creatinine and blood urea nitrogen (BUN) levels increase.
• Proteinuria may indicate glomerular damage.
• Electrolyte imbalances, including hyperkalemia and metabolic acidosis.

Complications

CRF leads to numerous systemic complications:

• Cardiovascular disease (hypertension, heart failure).
• Bone disorders due to impaired calcium-phosphorus metabolism.
• Anemia caused by erythropoietin deficiency.

Management and Treatment

Management focuses on delaying progression and minimizing complications:

• Controlling hypertension and diabetes.
• Dietary modifications (low protein, controlled sodium and potassium intake).
• Dialysis or kidney transplantation in advanced stages.