Chronic Renal Disease: Pathophysiology, Causes, Stages, Symptoms, Diagnosis

CRD represents chronic renal disease. It explains the loss of kidney functions that takes place gradually. The human kidneys filter excess fluids and filter wastes from your blood gets excreted in your urine. As the chronic renal disease (CRD) catches the advanced stages, electrolytes, wastes and dangerous fluid levels increase in your body.

Chronic renal disease (CRD), in the initial stages shows very few symptoms or signs. It may be less apparent until the function of your kidney gets considerably damaged.

Chronic Renal Disease (CRD) is known as chronic renal insufficiency or chronic renal failure. Chronic renal insufficiency, this term is used by some experts to explain the beginning chronic renal disease (CRD) stages that damages the kidney and has impaired renal function already, but the systemic manifestations are nominal. This stage is diagnosed and detected from the elevated level of serum creatinine that is slightly high for over 3 months.

Failure of kidneys implies the filtering of the waste should be done artificially, whereas blood pressure must be controlled strictly through medication. When the kidney function is totally bad it is referred to as ESRF, end stage renal failure, where special treatment such as transplantation or dialysis is given, else it may result in death in few weeks or months.

With the presence of chronic renal disease (CRD), the kidneys are unable to efficiently filter waste and so the creatinine levels increase in the blood. Dialysis is recommended for adults having chronic renal disease (CRD) when the levels of creatinine reach 10.0mg/dL. Conversely, dialysis is equally recommended for babies having kidney disease when the level of creatinine is 2.0 mg/ dL. Signs of having high levels of creatinine are difficult to find out.

Kidney failure comes to be identified with extreme amounts of creatinine showing in the routine blood tests and does not have any signs. Yet, some experience signs such as:

• Shortness of breath
• Confusion
• Tired feeling or weakness
• Dehydration.

Despite the reason for main nephron loss, some are less damaged and also some survive. The nephrons will enlarge and adapt and there is a marked increase in clearance per nephron.

In case the process initiated diffuses and becomes severe, whereas some patients show progressive glomurelonephritis and there is sub-acute or acute renal failure developing with quick ESRD (End-stage renal disease) development.

• Mostly, the chronic renal disease (CRD) progression is gradual in patients and so adaptation of nephron is likely.
• Focal glomerulosclerosis builds up in these glomeruli and it becomes eventually non-functional.
• With the buildup of focal gluomerulosclerosis, there is an increase in proteinuria and the systemic hypertension worsens.
• The adaptation of nephron is a process that gets termed as the final common path for chronic renal disease (CRD).
• The nephrons adapted promote the kidneys ability to postpone uremia, eventually the process of adaptation leads to the nephrons demise.
• The adapted nephrons have improved GFR (Glomerular Filtration Rate); besides the tubular functions are also enhanced with respect to, proton and potassium secretion.

Chronic renal disease (CRD) happens when a condition or a disease impairs the kidney function, resulting in damage to kidney that it worsened in months or few years. Conditions and diseases commonly that cause the chronic renal disease (CRD) include:

• Type 2 or type 1 diabetes can cause chronic renal disease (CRD).
• Polycystic kidney disease can cause chronic renal disease (CRD).
• Interstitial nephritis can cause chronic renal disease (CRD) – kidney’s tubules and the surrounding structures inflammation.
• High blood pressure (high BP) can reason to chronic renal disease (CRD).
• Vesicoureteral reflux can lead to chronic renal disease (CRD) – It is a state when urine gets back up into the patients’ kidneys.
• Chronic renal disease (CRD) can be caused by glomerulonephritis, the filtering units of kidneys shows an inflammation (glomeruli.)
• Urinary tract has prolonged obstruction due to conditions such as kidney stones, enlarged prostate and some cancers.
• Chronic renal disease (CRD) can be caused by pyelonephritis, a recurrent kidney infection.

Signs and symptoms of chronic renal disease (CRD) develop slowly with the progress kidney damage. The signs and symptoms include:

• High blood pressure which is tough to control can be a sign of chronic renal disease (CRD)
• Nausea, Shortness of breath, fluid buildup in the lungs is a sign of chronic renal disease (CRD).
• Vomiting
• Chest pain, when there is a buildup of fluid around the heart lining
• Appetite loss
• Persistent itching
• Sleep problems
• Weakness and fatigue
• Ankles and feet swelling is a sign of chronic renal disease (CRD)
• Urine output changes is a symptom of chronic renal disease (CRD)
• Hiccups
• Mental sharpness decreased.
• Muscle cramps and twitches.

Chronic renal disease (CRD) risk factors that are high include:

• Ages 65 or more
• Diabetes is a risk factor for chronic renal disease (CRD)
• Kidney disease which runs in the family can be a risk factor for chronic renal disease (CRD).
• High blood pressure could be a risk factor for chronic renal disease (CRD).
• Being Native American, African-American or Asian- American
• High cholesterol, Smoking, Heart disease, obesity are all the possible risk factor for chronic renal disease (CRD).

Knowing about the stages of chronic renal disease (CRD) helps in improving the care quality for people suffering with kidney disease. This is a guideline created by the NKF, National Kidney Foundation to assist doctors in identifying the kidney disease level. The NKF categorizes kidney disease into five stages. As the doctor is aware of the kidney disease stage, he is able to provide perfect care, as with each stage the tests and treatments are different.

Here are five chronic renal disease (CRD) stages and GRF (Glomerular Filtration Rate) stages:

• Stage 1: Is with normal or high glomerular filtration rate (where GFR > 90 mL/ min)
• Stage 2: Is with mild chronic renal disease (CRD) (where GFR = 60-89 mL/ min)
• Stage 3A: Is with moderate chronic renal disease (CRD) (where GFR = 45-59 mL/ min)
• Stage 3B: With moderate chronic renal disease (CRD) (where GFR = 30-44 mL/ min)
• Stage 4: With severe chronic renal disease (CRD) (where GFR = 15-29 mL/ min)
• Stage 5: With chronic renal disease (CRD) in end stage (where GFR <15 mL/ min)

An individual in stage 3 chronic renal disease (CRD) has moderate damage to the kidney. This stage is divided into two: a glomerular filtration rate (GFR) decrease for stage 3A is 45-59mL/ min and for stage 3B it is 30-44 mL/ min. With the decline in the kidney function, the buildup of waste products in the blood causes ‘uremia’ a condition. In stage 3 there are more chances for a person to develop kidney disease complications such as anemia, blood pressure or even bone disease.

A stage 4 chronic renal disease (CRD) person has advanced stages of kidney damage showing a GFR severe decrease to 15-30 ml/ min. In fact, a person with stage 4 chronic renal disease (CRD) requires kidney transplant or dialysis in the near future.

As there is decline in the kidney function, there is buildup of waste products in the blood, thus it causes a condition ‘uremia’. A person in stage 4 chronic renal disease (CRD) may develop kidney disease complications such as anemia, high blood pressure, heart disease, bone disease and other cardiovascular diseases.

Chronic renal disease (CRD) affects almost each part of your body and the potential complications include:

• Anemia is a potential complication for chronic renal disease (CRD).
• Retention of fluid leading to legs and arms swelling, fluid in lungs or high blood pressure is a complication in chronic renal disease (CRD).
• Decreased immune response, which makes you prone to infections, is a potential complication of chronic renal disease (CRD).
• Cardiovascular disease is a possible complication for chronic renal disease (CRD)
• Chronic renal disease (CRD) complication can include central nervous system damage and can result in less concentration, seizures or personality changes.
• Another complication of chronic renal disease (CRD) is the patient is prone to bone fractures and weak bones
• Increase in potassium levels suddenly in your blood and this may impair the ability of your heart to function and is life-threatening.
• Irreversible damage to kidneys, eventually requiring dialysis or kidney transplant.
• Impotence or decreased sex drive is a complication for chronic renal disease (CRD).
• Complications of pregnancy carrying risks for the fetus developing and the mother.
• Inflammation of a membrane that is sac-like known as Pericarditis, enveloping your heart is a complication of chronic renal disease (CRD).

To make sure whether you have chronic renal disease (CRD), you need to undergo tests and procedures:

• Blood tests are conducted to diagnose chronic renal disease (CRD). These tests of kidney function look for the waste products level, such as urea and creatinine, in your blood.
• Urine tests are conducted to diagnose chronic renal disease (CRD). Urine sample is analyzed and it may reveal abnormalities to extreme levels such as chronic kidney failure and thus chronic renal disease (CRD) cause is identified.
• Imaging tests might be conducted to diagnose chronic renal disease (CRD). Usage of ultrasound helps in assessing the size and structure of your kidney.
• Removing kidney tissue sample for testing chronic renal disease (CRD). Your doctor can recommend a biopsy of kidney to remove the kidney tissue sample. Kidney biopsy is done using local anesthesia. This is a thin needle inserted to your skin and your kidney. The sample of biopsy is sent to a lab to determine the cause for your kidney problem.

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Also Read:

• Chronic Renal Disease: Treatment & Diet
• Chronic Renal Disease: Exercises, Yoga, Recovery Period, Rehab
• What is End Stage Kidney or Renal Disease: Causes, Symptoms, Treatment, Life Expectancy