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The kidneys of someone that has chronic renal failure are generally smaller than average kidneys, with some notable and important exceptions (Rogers, 2004). Two of these exceptions would be polycystic kidney disease and diabetic nephropathy (Rogers, 2004). Another diagnostic tool that is used, that of the study of the serum creatinine levels, can not only diagnose chronic renal failure, but also help to distinguish it from acute renal failure, as the acute version would see a rapid and sudden spike in the serum creatinine levels over several days or several weeks, as opposed to a gradual rise that is seen over months or even over years (Rogers, 2004).
Sometimes, the levels of serum creatinine have not been measured in the past, and therefore the patient is often first treated as having acute renal failure. Only when blood tests continue to show elevated serum creatinine levels and it is determined that the renal failure is irreversible will the diagnosis be made as chronic renal failure as opposed to the previously assumed acute renal failure (Rogers, 2004). A numerous amount of uremic toxins also accumulate in individuals that have chronic renal failure and are involved in the treatment of standard dialysis, which cannot be avoided (Rogers, 2004).
There are many cytotoxic activities that these toxins have, and these are seen through studying the serum. They have different weights, molecularly, and they also bind to various proteins, although they seem to have a preference for albumin (Rogers, 2004). Many scientists are studying these toxin-bound proteins, because they feel that - through a better understanding of the issue - there may be a way to improve the dialysis that patients are undergoing now and therefore prolong not only these patients' lives, but the quality of their lives as well (Rogers, 2004).
In Europe and North America, there are some causes of chronic renal failure that are considered to be the most common. These are: hypertension, diabetic nephropathy, and glomerulonephritis (Rogers, 2004). When taken together, the three diseases mentioned above account for approximately 75% of the cases of chronic renal failure in adults. There are certain geographic areas, however, that also have a very high rate of chronic renal failure that is caused by HIV nephropathy (Rogers, 2004).
It is also important to understand how chronic renal failure and kidney disease is classified, as well, because it is often classified based on the part of the renal anatomy that is involved (Rogers, 2004). The vascular kind of kidney disease involves large vessel disease and small vessel disease (Rogers, 2004). The large vessel variety includes bilateral renal artery stenosis, and the small vessel disease includes problems such as hemolytic-uremic syndrome, vasculitis, and ischemic nephropathy (Rogers, 2004). In addition to the vascular kidney disease, there is also glomerular, tubulointerstitial, and obstructive kidney disease (Rogers, 2004).
Glomerular kidney disease involves a very diverse group of problems that is usually classified into primary and secondary glomerular disease (Rogers, 2004). The primary type of this disease involves problems such as IgA nephritis and focal segmental glomerulosclerosis, while the secondary type of the disease involves problems such as lupus nephritis and diabetic nephropathy (Rogers, 2004). Tubulointerstitial versions of kidney disease are related to reflux nephropathy, polycystic kidney disease, and drug and toxin-induced versions of chronic tubulointerstitial nephritis (Rogers, 2004). The last category, obstructive, involves diseases that are related to the prostate, as well as more common ailments such as kidney stones (Rogers, 2004).
As for treating chronic renal failure, the goal there is to either slow down or preferably halt the progression of the disease, which is often seen to be very relentless in what it does, the way it progresses, and the problems that it causes for the patient (Rogers, 2004). It is hoped that, by treating it aggressively and diagnosing it as soon as possible, it can be slowed down to the point that the patient with chronic renal failure will not progress to end-stage renal disease, which will involve dialysis (Vernon & Pfeifer, 2003). The health of the individual that is on dialysis is often not as good as someone that does not have to have this treatment, and although dialysis generally works well, it is not as good as keeping toxins out of the blood as the normal working of the kidneys (Vernon & Pfeifer, 2003).
The reason for this is that the kidneys filter the blood constantly, and they are always removing toxins from it. In dialysis, the person only goes and has these toxins removed from their blood at certain times - two or three times per week, for example. Dialysis is usually a complicated and long process, taking several hours to filter all of the blood in the body sufficiently, and in between treatments the toxins and chemicals that would normally be filtered out of the blood simply build up until the next dialysis treatment, which obviously is not healthy and can have long-term consequences for the patient (Vernon & Pfeifer, 2003).
It is important, in the treatment of chronic renal failure, to control the patient's blood pressure as much as possible, and also to treat whatever original and underlying disease the patient has that caused the chronic renal failure in the first place. The strong control of the patient's blood pressure and the underlying disease, therefore, can help to slow the progression of the chronic renal failure to the point where the patient will not end up in end-stage renal disease and on dialysis to survive. There are medications that can be given to those that have chronic renal failure in order to slow the progression of the disease. These medications include angiotensin II receptor antagonists (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) (Vernon & Pfeifer, 2003). These medications have been found, in studies and clinical trials, to slow the progression of end-stage renal disease.
In addition to these medications, vitamin D3 and erythropoietin, which are two hormones that are usually processed by the kidneys, are often given to the patient as a replacement for those that are lost when the kidneys cease to function properly (Vernon & Pfeifer, 2003). Another replacement that is generally needed is calcium. While all of these replacements are important, phosphate binders are also used in that they are needed to control the levels of serum phosphate in a patient that is dealing with chronic renal failure (Vernon & Pfeifer, 2003). During chronic renal failure, the serum phosphate levels generally rise, which can lead to other problems, and therefore the phosphate binders are necessary to keep these serum phosphate levels within normal limits (Vernon & Pfeifer, 2003).
For the patient that has chronic renal failure, however, the chances of progression to end-stage renal disease at some point are relatively high. Once this occurs, the only options are dialysis or a kidney transplant (Vernon & Pfeifer, 2003). Many patients that want and need transplants find that they are on a long waiting list, and they must remain on dialysis while they wait for their transplant, as there are only so many kidneys to go around and the blood type must match or the patient will reject the kidney, so there are many issues that must be addressed when a patient is waiting for a transplant.
In summary, it can be seen that chronic renal failure is a dangerous, serious, and ultimately progressive disease that can stop a patient from enjoying a high quality of life. While there are treatments available for it, it should be caught as early as possible, and this often does not happen because it has no symptoms in the early stages. If allowed to progress too far, there are many other problems that can result from it, and dialysis or a transplant may be required to avoid death from the toxins that will build up in the blood when the kidneys fail to filter it properly.
Definition and Types of Renal Failure
According to the Organ Procurement and Transplantation Network (2005), renal failure is "the inability of the kidneys to remove wastes and maintain electrolyte balance." There are two types of renal failure: chronic and acute. Chronic renal failure is a gradual and progressive loss of the ability of the kidneys to excrete waste, concentrate urine, and conserve electrolytes (Medline Plus, 2005). Chronic renal failure is not reversible, unlike acute renal failure. Acute renal failure is a sudden loss of renal function, usually attributable to an underlying cause which is treatable (Medline Plus, 2005). There is no cure for chronic renal failure, which may progress to end-stage renal disease.
Chronic Kidney Disease
The worldwide increase is the number of patients with chronic kidney disease and subsequent end-stage renal failure is threatening to reach epidemic proportions over the next decade (El Nahas & Bello, 2005). In most developed countries the annual rate of chronic kidney disease is expected to rise approximately five to eight percent annually (El…[continue]
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