CHRONIC RENAL FAILURE

Chronic renal failure describes the situation in which there is advanced, irreversible, and usually progressive renal failure.

Causes

  • Chronic glomerulopathies
  • Hypertension
  • Chronic interstitial nephritis
  • Diabetes mellitus.

Manifestations of chronic renal failure:

  • There is poor growth.
  • At biochemical level in the blood, there is acidosis, hyperkalaemia, elevated blood urea and elevated serum creatinine.
  • At cardiovascular level there is pulmonary oedema, hypertension, pericarditis and cardiac tamponade and heart failure.
  • At skeletal level, there is bone pain and bone fractures (rare).
  • At nervous system level, there is encephalopathy (confusion, convulsions) and peripheral neuropathy.
  • At haematological system level there is anaemia, excessive bleeding, e.g, from gums, skin, nose.
  • At the skin level, there is scratching (pruritus) and darkening of skin.

Chronic renal failure should be suspected in the presence of the following:

  • A previous history of renal disease e.g. acute nephritis, nephrotic syndrome.
  • A known history of hypertension.
  • A known history of diabetes mellitus.
  • High blood urea and serum creatinine.
  • Some of the systemic manifestation listed under manifestations of chronic renal failure 

Management

  • Monitor clinical state regularly: This includes BP measurement and nutritional status (growth monitoring).
  • Monitor laboratory parameters: BUN, creatinine, alkaline phosphatase.
  • Adjust diet: High energy intake above recommended for age; protein 1.5g/kg/ day, preferably high quality types; watch out for micronutrient deficiency and correct when needed; sodium restriction (1–4mg/kg/24 hours) if oedema or
    CCF.
  • Watch potassium intake, especially when child needs dialysis.
  • Treat hypertension if present.
  • Do not transfuse blood unless HB is <6g/dl. Use packed cells.
  • For renal osteodystrophy, give high doses of vitamin D preferably the active form.
  • Avoid drugs that may worsen the problem, and adjust dosing according to degree of renal failure (creatinine levels).
  • Refer to specialist if
    • Chronic renal failure is diagnosed.
    • End stage renal failure.