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