Chronic Renal Failure

Chronic renal failure, also termed chronic kidney disease, is loss of the normal function of kidneys over time eventually leading to symptoms that are often observable only when the kidney function falls less than one-tenth of normal. ^[1]

Epidemiology

The condition is a global concern. Chronic renal failure is regarded as common.

Causes

Majority of cases are attributed to diabetes and high blood pressure. A lot of medical conditions can lead to kidney damage. Among these are urinary tract obstruction, vascular diseases (renal artery stenosis, hypertensive nephrosclerosis), primary glomerular diseases (minimal change disease, membranoproliferative glomerulonephritis) and secondary glomerular diseases due to other diseases like hepatitis, symphilis, systemic lupus erythematosus, rheumatoid arthritis, parasitic infection, malignancy, alport syndrome and use of drugs like heroin and penicillamine. Kidney abnormalities present at birth like polycystic kidney disease can also precipitate chronic renal failure. Likewise, kidney stones, infection, injury and trauma are also being associated in the development of the disease.

Signs and Symptoms

Usually, the manifestations of the disease become obvious only when the kidney function is far below normal. During the silent phase or early phase, the individual may only experience nonspecific symptoms such as appetite and weight loss, nausea, itching and fatigue. When the disease becomes advanced, the patient may notice urination changes such as increased frequency especially at night. There can be swelling of the legs and the areas around the eyes, shortness of breath, chest pain, nausea, vomiting, easy bleeding, easy bruising, bone pain, pale skin, decreased sexual interest and problems with erection among men. ^{[1] [3] [4]}

Diagnosis

A careful medical history and physical examination are important to suspect a failing kidney. Exams and tests are employed to know the status of kidney function and to determine complications. Laboratory exams include blood tests, urinalysis, bone density test, CT scan and ultrasound. ^[1]

Treatment

Control of blood pressure is important. This is often done by giving medications. Lifestyle changes are also essential such as smoking cessation, taking a regular exercise and having control in diet. Patients are advised to refrain from too much fat, cholesterol, salt and potassium. Some may need iron and calcium supplements. When the loss of kidney function is very much high, dialysis or kidney transplant may be advised. ^[1]

References:

1.  http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm

2.  http://emedicine.medscape.com/article/238798-overview#a0156

3.  http://www.emedicinehealth.com/chronic_kidney_disease/page5_em.htm#chronic_kidney_disease_symptoms_and_when_to_seek_medical_care

4.  http://www.webmd.com/a-to-z-guides/chronic-kidney-disease-topic-overview

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin D3 [1, 2, 3, 4]:

Recommendation: Strongly in favor 

Grade of Evidence: Moderate level of evidence

Summary References

Treatments:

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280034/

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878736/

3. http://www.ncbi.nlm.nih.gov/pubmed/17293681/

4. http://www.ncbi.nlm.nih.gov/pubmed/15577113