Chronic renal failure is a gradual and progressive loss of the ability of the kidneys to function normally. The change is irreversible and is due to loss of nephrons of the kidney. The nephrons are basic functioning unit of the kidney and there are normally about one million nephrons in each kidney.

The kidney is no longer able to clean toxins & waste product from blood and  concentrate the urine . When patients begin to experience symptoms of kidney failure, most of their kidney function is lost. Simply it can be interpreted as kidneys gradually stopping to  working.

Chronic renal failure is classified as follows :

 Heredity : Polycystic Kidney disease, Hereditary Nephritis and some forms of glomerulonephritis

 Systemic Diseases like Diabetes and hypertension etc, ( forms most of the percentage of CRF )

 Urinary tract diseases like reflux nephropathy etc,

 Acute renal failure untreated can proceeds to a chronic state and cause chronic renal failure.

Pain Killer Drug usage over a prolonged period of time-can  lead to kidney failure. These are classified as Non Steroidal   Anti Inflammatory Drugs by doctors. These drugs are usually also called analgesics.

As per data, it is most commonly seen in 

long standing diabetics (most common)

black males,

those with high blood pressure,

those on long term drug usage, mainly analgesics like acetaminophen and other NSAIDS

Some patients with acute renal failure progress to chronic renal failure if inadequately treated

Family history  

All age groups are suspectible to chronic &nrenal failure but increased incidence is seen with advancing age. 

Chronic renal failure is diagnosed by the observation of a combination of symptoms, physical examination and elevated blood urea nitrogen (BUN) and creatinine (Cr) levels. The following abnormalities found in the blood may signal CRF :

Anemia (low red blood cell count)

High level of parathyroid hormone

Hypocalcemia (low blood level of calcium)

Hyperphosphatemia (high blood level of phosphate)

Hyperkalemia (high blood level of potassium)

Hyponatremia (low blood level of sodium)

Low blood level of bicarbonate

Low plasma pH (blood acidity)

Proteinuria (excess protein in urine)

CT scan and MRI might also help.

Ultrasound may show that the kidneys are small in size.

However patients with diabetic nephropathy often have preservation of kidney size despite CRF.

Whether renal failure is acute or chronic usually can be distinguished by comparing prior test results (e.g., from the past several months or years). It is difficult to make the distinction without previous test results.

A spectrum of complications arises along with development of chronic renal failure.

Some of the important ones are as follows :

End Stage Renal Disease (ESRD)

Congestive Cardiac failure due to fluid overload

Liver failure

Bone weakness and fractures

Increased susceptibility to infections and bleeding (ESRD)

Sexual dysfunction and impotence

Nervous disorders like seizures and delirium.

There are many ways to help delay or prevent kidney failure, especially when CKD is diagnosed in the mild to moderate stages. These include:

- Blood pressure control

Keep your blood pressure at 125/75 or lower if you have   diabetes and/or protein in your urine.

Keep your blood pressure at 130/85 or lower if you have    kidney problems but not diabetes.

Two types of blood pressure medication slow the action of angiotensin, a substance that may contribute to kidney disease progression. Studies have shown that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can help slow progression of kidney disease in people with diabetes, even if they do not have high blood pressure. The generic names of some common ACE inhibitors are captopril, enalapril, and lisinopril. Some common ARBs are losartan, candesartan, and valsartan.

- Blood glucose control

If you have diabetes, strict controls of your blood glucose levels can help slow the progression of kidney disease. Keep your hemoglobin A1c, which measures blood glucose control over the last two to three months, to less than 6.5%. To reach this level of strict glycemic control, you will need to monitor your blood glucose closely to avoid hypoglycemia. You may need to use frequent insulin injections or an insulin pump. Talk to your doctor about your diabetes treatment options.

- Repairing the damage

In some cases, the kidney disease itself can be treated. If you have an obstruction that blocks your urine flow, surgery may help. If you have an infection, antibiotics may clear it up.

If damage is due to the effects of prescription or non-prescription medications, your doctor maybe able to suggest a different medication that is less harmful to your kidneys. If you have CKD and are prescribed antibiotics talk to your doctor about the effect it may have on your kidneys. Painkillers (even over-the-counter medicines) can cause damage your kidneys. Talk to your doctor about all medication you take. Sometimes diagnostic studies are ordered with contrast dye. It may be necessary for you to have the study, but first find out if there are alternative methods.

Some diseases, such as IgA nephropathy, glomerulonephritis, and lupus can cause kidney damage when your immune system overreacts and inflammation occurs. It is sometimes possible to slow the disease process by controlling the immune system with steroids and/or other medications.

Smoking is a risk factor for faster progression of kidney disease, so stopping smoking can also help slow progression. Avoiding too much protein and phosphorus in the diet may help, as well.

Check with your doctor to find out whether any of these things might help to slow the progress of your kidney disease.

CRF is often slow in its onset and progression. The rate of progression is variable but usually renal function steadily declines resulting in end-stage renal disease (ESRD). Once ESRD is reached the patient requires renal replacement treatment in form of dialysis or kidney transplant. If this is not provided the patient's life is endangered due to fluid overload and accumulation of toxins in the blood

There is no definite prevention modality available but, adequate control of diabetes, hypertension and other risk factors delays the onset of disease process in suspected individuals.

A Nephrologist or a Physician with interest in kidney diseases. Nephrologist is a physician, whereas if surgery is necessary a surgeon performs it and this usually is a urologist.

Can I catch kidney disease from someone who has it?
No. Kidney disease is not contagious. You cannot catch it from someone. Most kidney disease is caused by diabetes, high blood pressure and conditions that can run in families. If you are a family member of someone who has diabetes, high blood pressure, or kidney disease, it is a good idea to ask your doctor to check your blood pressure and kidney function at your checkup.

What are kidney stones?
A kidney stone occurs when substances in the urine form crystals. Kidney stones can be large or small. Large ones can damage the kidneys; small ones may be able to pass in the urine. Because crystals have sharp edges, passing even small stones can be very painful. Treatment depends on what the stones are made of.

What is PTH?
Parathyroid hormone (PTH) is produced by several small, bean-like parathyroid glands in your neck. Its "job" is to tell your bones to release calcium into your bloodstream. Too much PTH can become a problem in people with kidney disease.

Healthy kidneys convert a hormone called calcitriol to its active form of vitamin D. Calcitriol lets your body absorb calcium from food you eat. When your kidneys are not working well, they start to make less calcitriol-so even if you eat calcium, your body can't absorb it. PTH kicks in to make sure you always have enough calcium in your blood. Over time, this can weaken your bones.

A blood test can show if your PTH levels are above normal. If they are, your doctor may prescribe a form of active vitamin D.

I have a family member with polycystic kidney disease (PKD). Should I be tested?
Since 60-70% of people with PKD have a family member with PKD, asking your doctor about being tested seems like a good idea. The first test used for PKD is an ultrasound to look at the kidneys and see if there are cysts. No contrast dye is needed, so this is a non-invasive test.

How can I find out if I have kidney disease?
Kidney disease can be found through lab tests or by symptoms. High blood levels of creatinine and urea nitrogen (BUN) or high levels of protein in your urine suggests kidney disease. Diabetics should have a yearly urine test for microalbumin, small amounts of protein that don't show up on standard urine protein test.

If I have signs of kidney disease, what should I do?
After you have basic screening tests done, if you have signs of kidney disease, you should ask for a referral to a nephrologist, a specialist in treating kidney disease. A nephrologist will perform an evaluation then suggest medications or lifestyle changes to help slow the progression of kidney disease.

I just found out I have kidney failure. Does this mean I am going to die?
No. Dialysis or a kidney transplant can keep you alive when your kidneys fail. The more you learn and take part in your treatment, the better you can feel. Some people live for decades with kidney failure.

What are the stages of chronic kidney disease (CKD) ?
In chronic kidney disease, the kidneys don't usually fail all at once. Instead, kidney disease often progresses slowly, over a period of years. This is good news because, if CKD is caught early, medications and lifestyle changes may help slow its progress and keep you feeling your best for as long as possible. With early diagnosis, it may be possible to slow, stop, or even reverse CKD, depending on the cause. The National Kidney Foundation (NKF) recently published information on the stages of Chronic Kidney Disease (CKD). In the table below, the "GFR level," or glomerular filtration rate, is a measure of how well your kidneys are cleaning your blood. Your doctor can calculate your GFR, based on a formula.

Stages of Chronic Kidney Disease Stage Description GFR Level

Normal kidney function Healthy kidneys 90 mL/min or more

Stage 1 Kidney damage with normal or high GFR 90 mL/min or more

Stage 2 Kidney damage and mild decrease in GFR 60 to 89 mL/min

Stage 3 Moderate decrease in GFR 30 to 59 mL/min

Stage 4 Severe decrease in GFR 15 to 29 mL/min

Stage 5 Kidney failure Less than 15 mL/min or on dialysis

In Stage 1 and Stage 2 CKD, there are often few symptoms. Hence detection is difficult but if diagnosed favorable results are achieved.
In Stage 3 CKD, anemia (a shortage of red blood cells) and/or early bone disease may appear and should be treated to help you feel your best and reduce problems down the road.
When CKD has progressed to Stage 4, it's time to begin preparing for dialysis and/or a kidney transplant.

Laboratory Values Showing You Have Kidney Failure

Diabetes or no Diabetes

Creatinine 6.0 mg/dl or higher 8.0 mg/dl or higher

Creatinine clearance 15 ml/min or lower 10 ml/min or lower

Glomerular Filtration Rate (GFR) calculated from creatinine, age, sex, race -15 ml/min or lower.

When should I be referred to a nephrologist?

You should be under the care of a nephrologist if your creatinine clearance, a measure of your kidney function, is 30 mL/min or lower. This translates to stage 4 chronic kidney disease (CKD).

When you first find out you have CKD (even if it is stage 2 or 3), seeing a nephrologist at least once can help you develop a plan of care. A nephrologist can help you and your primary care doctor to:

Slow the rate of decline of your kidney function

Decide if a kidney biopsy might be useful

Diagnose the type of kidney disease and whether it might be reversible with treatment

Manage complications of kidney disease, such as anemia, high blood pressure, metabolic acidosis, and changes in mineral balance

What about my diet and drugs?

Ongoing research continues on dietary changes and drugs that may help to slow the progression of CKD. Examples include:

Fish oil for IgA nephropathy

Pirfenidone (an anti-fibrotic drug) in the treatment of focal segmental glomerulosclerosis (FSGS)

Dietary intake of antioxidant or anti-inflammatory vitamins and foods

Blood pressure control

Study after study has confirmed that good blood pressure control can help slow the rate of CKD. This is especially true in people who have diabetes and protein in the urine (proteinuria). Keeping blood pressure under control also helps prevent heart disease and stroke.

According to National Kidney Foundation (NKF) guidelines, you should strive to keep your blood pressure at or below 130/85 if you have CKD. If you have diabetes and/or proteinuria too, their suggested target blood pressure is 125/75.

Lifestyle changes such as losing weight, exercising, meditating, eating less salt and drinking less alcohol can help lower your blood pressure.

For most people with CKD, blood pressure drugs are also needed. The first blood pressure drug is likely to be an "angiotensin converting enzyme inhibitor" (ACE inhibitor) or an "angiotensin receptor blocker" (ARB), because these drugs have been proven to slow the rate of some types of kidney disease. Other types of blood pressure drugs such as a diuretic (water pill) or a calcium-channel blocker may be added, as needed. Ask your doctor what you can do to keep your blood pressure at a healthy level.

Questions related to Dialysis :

When should I start the process to get a kidney transplant?
If your kidneys are failing, a kidney transplant may be a treatment option for you. The balance of risks and benefits varies, though, depending on your age and other health problems. If you want a kidney transplant, you must contact a transplant center and ask for a transplant evaluation. It is not automatic. Only a transplant team can tell you that you are definitely eligible (or not eligible) for a transplant.

You can contact one or more transplant centers and start to be evaluated when it seems likely that you will need dialysis within two to three years. Most kidney transplants are successful-more than 90% of transplants are still working one year later. Recent studies have found that the odds of good results are somewhat better with a "preemptive" transplant, done before dialysis is needed. Preemptive transplant requires a willing living kidney donor-probably a relative, spouse or friend.

How will my doctor treat transplant rejection?
If you have acute or chronic transplant rejection, your doctor may change your medication, or even hospitalize you. For example, if your cyclosporine dose is harming your transplanted kidney, your doctor might lower your dosage and change your other medications. All medication changes must be made by your transplant team.

Risk factors to be noted for chronic renal failure:

Diabetes – long standing

Hypertension – long standing

Family history of renal diseases like polycystic kidney disease and glomerulonephritis

Acute renal failure untreated