My Clinical Notes
- There are 5 stages of chronic renal failure
| Stage | GFR (ml/min) | Notes |
| 1 | >90 | Normal or GFR with other evidence of renal damage |
| 2 | 60-89 | Slight ¯GFR with other evidence of renal damage |
| 3 | 30-59 | Moderate ¯GFR with/without evidence of renal damage |
| 4 | 15-29 | Severe ¯GFR with/without evidence of renal damage |
| 5 | <15 | Established renal failure |
- Symptoms usually only occur once stage 4 is reached GFR <30
Causes
- GN
- Diabetes
- Renovascular disease
- Hypertension
- Pyelonephritis
- Polycystic disease
- Prostatic hypertrophy
- Interstitial nephritis
- Analgesic nephropathy
- Myeloma
- Amyloidosis
- Vasculitis
Signs
- Pallor, yellow skin pigmentation, brown nails, purpura, bruising, excoriation, hypertension, cardiomegaly, pericardial rub, pleural effusion, pulmonary or peripheral oedema, promixmal myopathy
- Later if untreated – arrhythmias, encephalopathy, seizures, coma
Tests
- Blood – normocytic normochromic anaemia, ESR, U&Es, glucose, reduced calcium, raised phosphate, raised alk phos (renal osteodystrophy) raised PTH
- Urine – microscopy, culture, dipstick, 24hr urine protein
- Renal ultrasound
- DTPA scan
- CXR – cardiomegaly, pulmonary oedema, pleural or pericardial effusion
- Consider renal biopsy
Treatment
- Refer early to a nephrologists
- Treat reversible causes – relieve obstruction, stop nephrotoxic drugs
- Hypertension – treat with ACEI or ARB
- Hyperlipidaemia – statin
- Oedema – high dose loop diuretics and restriction of fluid intake
- Anaemia – consider EPO
- Renal bone disease (osteodystrophy) – treat if raised PTH, phosphate rises in CRF further increasing PTH. Restrict dietary phosphate (milk, cheese and eggs), give binders (Calcichew) to reduce gut absorption. Give Vit D analogues and calcium
- Diet – Na restriction
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