Chronic Renal Failure

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Signs and Symptoms

Chronic renal failure (CRF) usually produces symptoms when renal function — which is measured as the glomerular filtration rate (GFR) — falls below 30 milliliters per minute (< 30 mL/min). This is approximately 30% of the normal value.

When the glomerular filtration rate (GFR) slows to below 30 mL/min, signs of uremia (high blood level of protein by-products, such as urea) may become noticeable. When the GFR falls below 15 mL/min most people become increasingly symptomatic.

Uremic symptoms can affect every organ system, most noticeably the following:

• Neurological system–cognitive impairment, personality change, asterixis (motor disturbance that affects groups of muscles), seizures (rare)
• Gastrointestinal system–nausea, vomiting, food distaste (often described as bland, metallic, "like cardboard")
• Blood-forming system–anemia due to erythropoetin deficiency, easy bruising and bleeding due to abnormal platelets
• Pulmonary system–fluid in the lungs, with breathing difficulties
• Cardiovascular system –chest pain due to inflammation of the sac surrounding the heart (pericarditis) and pericardial effusion (fluid accumulation around the heart)
• Skin –generalized itching

Diagnosis

Chronic renal failure (CRF) is diagnosed by the observation of a combination of symptoms 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)

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.

Ultrasound may show that the kidneys are small in size and echogenic (a sign of renal scarring), signs that supports a diagnosis of CRF. For unclear reasons patients with diabetic nephropathy often have preservation of kidney size despite CRF. They do however, typically have increased echogenicity.

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