Chronic renal failure (CRF)

Chronic renal failure (CRF) implies that there is significant irreversible reduction in renal function; here we are using it to mean CKD stages 4-5, but that isn't a generally accepted convention.  There is a separate page on less severe CKD (stages 1-3).  Common causes of CKD/CRF are:

• Circulatory problems such as renal artery stenosis
• Inflammation within the kidneys - interstitial nephritis or glomerulonephritis
Diabetes is very important cause - diabetic kidney disease also affects glomeruli
• Urinary tract obstruction - in ureters, bladder, or below - more on obstruction
• Inherited diseases - more info on inherited/congenital diseases

Preventing progression of CKD

It is common for renal impairment to worsen slowly with time, even if the cause of damage is no longer present. There are various theories for this, including hyperfiltration stress on residual nephrons, and direct toxicity from proteinuria to the renal tubules. The following markers identify patients at greater risk of deterioration of renal function:

However this process can be slowed in many cases by the following:


Complications of CRF

Become increasingly evident as renal function deteriorates.

Bone disease (renal osteodystrophy) is prevented by

Gastrointestinal symptoms - anorexia, progressing to nausea and ultimately vomiting - are usually late symptoms, GFR usually well below 20, and sometimes not becoming prominent until GFR <10. They may be helped by dietary modification but are often an indication that dialysis is required.

Other complications such as itching, neuropathy, pericarditis are usually late manifestations that are prevented or controlled by dialysis.

Further info


CKD 1-3 << >> Conservative care