CHRONIC RENAL FAILURE

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

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
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.