CHRONIC RENAL FAILURE

Chronic kidney failure is a gradual loss of your kidneys' filtering ability, usually due to high blood pressure or diabetes. When kidney function is seriously impaired, dangerous levels of fluid and waste can quickly accumulate in the body.
Chronic loss of function causes generalized wasting (shrinking in size) and progressive scarring within all parts of the kidneys. In time, overall scarring obscures the site of the initial damage. Yet, it is not until over 70% of the normal combined function of both kidneys is lost that most patients begin to experience symptoms of kidney failure.

Causes-
Diabetes and hypertension are the two most common causes. Other conditions which responsible for the development of it are given below-
1. Pre- renal-
    a. Decreased Cardiac output
    b. Chronic liver failure
    c. Atherosclerosis
All these conditions are responsible for continuous hypoperfusion (low blood flow) of the kidneys, leading to kidney atrophy (shrinking), loss of nephron function, and chronic renal failure (CRF).
2. Renal-
Chronic renal failure caused by changes within the kidneys, is called renal CRF, and is broadly categorized as follows:

• Diabetic nephropathy, kidney disease associated with diabetes; the most common cause of CRF
• Hypertension nephrosclerosis, a condition that occurs with increased frequency in African Americans; the second leading cause of CRF
• Chronic glomerular nephritis, a condition caused by diseases that affect the glomeruli and bring about progressive dysfunction
• Chronic interstitial nephritis, a condition caused by disorders that ultimately lead to progressive scarring of the interstitium
• Renal vascular CRF, large vessel abnormalities such as renal artery stenosis (narrowing of the large arteries that supply the kidneys)
• Vasculitis, inflammation of the small blood vessels
• Cystic kidney disease, kidney disease distinguished by multiple cysts (lined cavities or sacs)
• Hereditary diseases of the kidney, such as Alport's syndrome (hereditary nephritis)

3. Post- renal-
 Interference with the normal flow of urine can produce backpressure within the kidneys, can damage nephrons, and lead to obstructive uropathy, a disease of the urinary tract. Abnormalities that may hamper urine flow and cause post-renal CRF include the following:

• Bladder outlet obstruction due to an enlarged prostate gland or bladder stone
• Neurogenic bladder, an overdistended bladder caused by impaired communicator nerve fibers from the bladder to the spinal cord
• Kidney stones in both ureters, the tubes that pass urine from each kidney to the bladder
• Obstruction of the tubules,the end channels of the renal nephrons
• Retroperitoneal fibrosis, the formation of fiberlike tissue behind the peritoneum, the membrane that lines the abdominal cavity
• Vesicoureteral reflux (VUR), the backward flow of urine from the bladder into a ureter.

Risk Factors-
Conditions that increase your risk of kidney failure include:

• Diabetes, which is the most common risk factor for chronic kidney failure in the United States
• High blood pressure (hypertension)
• Sickle cell disease
• Lupus erythematosus
• Atherosclerosis
• Chronic glomerulonephritis
• Kidney disease present at birth (congenital)
• Bladder outlet obstruction
• Overexposure to toxins and to some medications
• Family history of kidney disease
• Age 60 or older

Signs and Symptoms-
The early symptoms of chronic kidney disease often occur with other illnesses, as well. These symptoms may be the only signs of kidney disease until the condition is more advanced.

Symptoms may include:

• General ill feeling and fatigue
• Generalized itching (pruritus) and dry skin
• Headaches
• Weight loss without trying to lose weight
• Appetite loss
• Nausea

Other symptoms that may develop, especially when kidney function has worsened:

• Abnormally dark or light skin
• Bone pain
• Brain and nervous system symptoms

              >>Drowsiness and confusion
              >>Problems concentrating or thinking
              >>Numbness in the hands, feet, or other areas
              >>Muscle twitching or cramps

• Breath odor
• Easy bruising, bleeding, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep apnea
• Swelling of the feet and hands (edema)
• Vomiting, typically in the morning

Stages in chronic renal failure
1. Stage 1 CKD
Slightly diminished function; Kidney damage with normal or relatively high GFR (>90 mL/min/1.73 m2). Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.

2. Stage 2 CKD
Mild reduction in GFR (60-89 mL/min/1.73 m2) with kidney damage. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.
 
3. Stage 3 CKD
Moderate reduction in GFR (30-59 mL/min/1.73 m2).[1] British guidelines distinguish between stage 3A (GFR 45-59) and stage 3B (GFR 30-44) for purposes of screening and referral.
 
4. Stage 4 CKD
Severe reduction in GFR (15-29 mL/min/1.73 m2)[1] Preparation for renal replacement therapy.

5. Stage 5 CKD
Established kidney failure (GFR <15 mL/min/1.73 m2, or permanent renal replacement therapy (RRT).

Complications-
Chronic kidney failure can affect almost every part of your body. Potential complications may include:

• Fluid retention, which could lead to swollen tissues, congestive heart failure or fluid in your lungs (pulmonary edema)
• A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening
• Cardiovascular disease
• Weak bones that fracture easily
• Anemia
• Stomach ulcers
• Dry skin, changes in skin color
• Insomnia
• Decreased sex drive or impotence
• Damage to your central nervous system
• Decreased immune response, which makes you more vulnerable to infection
• Pericarditis, an inflammation of the sac-like membrane that envelops your heart (pericardium)
• Irreversible damage to your kidneys (end-stage kidney disease), requiring either dialysis or a kidney transplant for survival.

Investigations-
High blood pressure is almost always present during all stages of chronic kidney disease. A neurologic examination may show signs of nerve damage. The health care provider may hear abnormal heart or lung sounds with a stethoscope.
A urinalysis may show protein or other changes. These changes may appear 6 months to 10 or more years before symptoms appear.

Tests that check how well the kidneys are working include:

• Creatinine levels
• Blood Urea Nitrogen level
• Creatinine clearance

Chronic kidney disease changes the results of several other tests. Every patient needs to have the following checked regularly, as often as every 2 - 3 months when kidney disease gets worse:

• Potassium
• Sodium
• Albumin
• Phosphorous
• Calcium
• Cholesterol
• Magnesium
• Complete blood count (CBC)
• Electrolytes

Causes of chronic kidney disease may be seen on:

• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound
• Renal scan

This disease may also change the results of the following tests:

• Erythropoietin
• PTH
• Bone density test

Treatment
The goal of therapy is to slow down or halt the otherwise relentless progression of CKD to stage 5. Control of blood pressure and treatment of the original disease, whenever feasible, are the broad principles of management.
n some cases, dietary modifications have been proven to slow and even reverse further progression.

Diet for chronic kidney disease

• Need to limit fluids.
• Intake of low-protein diet.
• Restriction of salt, potassium, phosphorous, and other electrolytes.

Other tips for protecting the kdineys and preventing heart disease and stroke:

• Do not smoke.
• Eat meals that are low in fat and cholesterol
• Get regular exercise (talk to your doctor or nurse before starting).
• Take drugs to lower your cholesterol, if necessary.
• Keep your blood sugar under control.

Haemodialysis:
This should be started when the symptoms of uremia have become troublesome, despite adequate medical treatment, preferably before the patient develop serious consequences of uremia. First an arteriovenous fistula is created in the forearm, this results in distention and thickening of the vein wall which allows the repetitive insertion of needles for vascular access for heamodialysis. This is carried out for 3-5 hours 3 times weekly. Most patients notice a gradual reduction of their uremic symptoms during the first 6 weeks of treatment. They can lead relatively normal and active lives, and prolonged survival in excess of 20 years is now regularly reported.

Role of Homoeopathy
Homoeopathy does not recognise kidneys as a mere organ of excretion or selective filtration but always recognises it in relation to the individual as a whole. Kidneys have a generalised function--the fluids coming to it and going from it influence every organ, tissue and cell of our body. Kidney function influences the complete vital economy of our body.
Homoeopathic medicines does wonder in preventing the progression of disease, haemodialysis, also in reducing the number of dialysis in patient and renal transplantation.

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