Chronic renal failure overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Chronic renal failure (CRF), also known as chronic kidney failure (CKF) or chronic kidney disease (CKD), or chronic renal insufficiency (CRI) is a slowly progressive loss of renal function over a period of months or years defined as an abnormally low glomerular filtration rate. The glomerular filtration rate is usually determined indirectly by the creatinine level in blood serum.
CRF that leads to severe illness and requires some form of renal replacement therapy (such as dialysis) is called end-stage renal disease (ESRD).
Pathophysiology
CRF begins with damage to the nephrons, the filtering units of the kidneys, due to diseases such as diabetes, hypertension, immune complex deposition, toxin exposure, and inflammation. To compensate for the decreased glomerular filtration rate by the damaged nephrons, healthy nephrons hypertrophy and hyperfiltrate due to signals from the body. As the disease process progresses, this adaptive response becomes maladaptive, and the increased filtration pressure in the healthy nephrons leads to distortion of its structural architecture, causing sclerosis and eventual dropout of these nephrons.
Epidemiology and Demographics
The incidence and prevalence of chronic renal failure varies enormously depending on the level of affluence of the country. Developed countries have higher incident rates of treated end-stage renal failure, whereas emerging countries have very low incident rates. People with disorders that have adverse effects on the kidneys such as diabetes, and hypertension have increased chances of developing CRF.