Renal failure chronic N18.9

Irreversible impairment of the glomerular, tubular and endocrine function of the kidneys. The functional disorders persist over a period of > 3 months, detectable by a glomerular filtration rate (GFR) < 60ml/min/1.73qm KO.

Chronic kidney disease is classified according to CKD stages I-V of KDIGO (Kidney Disease: Improving Global Outcome); CKD=chronic kidney disease)

• Stage I (stage of full decompensation), GFR: > 90 (ml/min/1.73qm)
• Stage II (stage of mild renal insufficiency), GFR: 60-89(ml/min/1.73qm)
• Stage IIIa (stage of moderate renal insufficiency), GFR: 45-59 (ml/min/1.73qm)
• Stage IIIb (stage of moderate renal insufficiency), GFR: 30-44 (ml/min/1.73qm)
• Stage IV (stage of severe renal insufficiency), GFR: 15-29 (ml/min/1.73qm)
• Stage V (stage of renal failure), GFR: <15 (ml/min/1.73qm)

Note: The CKD stages are supplemented by the albuminuria factor. This parameter is divided into 3 degrees of severity according to A1-A3 (mg/24h). A1: < 30 mg/24h; A2: 30-300 mg/24h (microalbuminuria); A3: > 300 mg/24h (macroalbuminuria).

Glomerular filtration rate and albuminuria are independent prognostic parameters. With decreasing glomerular filtration rate and increasing albumin excretion, the risk of chronic kidney disease taking a progressive course increases.

Incidence in Western Europe: 10/100,000/year (USA 60/100,000/year)

Prevalence of chronic renal insufficiency (glomerular filtration rate (GFR) < 60/min): 12 %

Chronic renal insufficiency is caused by the following diseases:

• Diabetic nephropathy (35 %)
• Primary and secondary glomerulonephritis (15 %)
• Hereditary kidney diseases, e.g. polycystic kidney degeneration (up to 10 %)
• Chronic tubulointerstitial diseases
• Vascular (hypertensive) nephropathies

Pathogenetically, damage to individual nephrons leads to glomerular hyperinfiltration of healthy nephrons with consecutive endothelial damage and increasing glomerulosclerosis with consecutive interstitial fibrosis and tubular atrophy. The result is a disturbance of excretory (retention of toxic metabolic products) and secretory function.

Pale yellowish, pale (cafe-au-lait coloration) coloration of the skin; pallor of the mucous membranes (anemia).

Dryness of the skin, uraemic pruritus (see also renal insufficiency and skin changes)

Uremic fetor

Edema (hypalbuminemia)

Pulmonary congestion ("fluid lung" due to sodium and water retention)

Paresthesia (uremic polyneuropathy)

Hypertension (around 55-75% of all people with chronic renal insufficiency suffer from hypertension)

Renal osteopathy (diffuse bone pain, spontaneous fractures)

Uremic gastroenteropathy with loss of appetite and nausea

Myopathy (weakness of the proximal arm and leg muscles)

Hematological changes due to reduced erythropoietin production (renal anemia: normochromic, normocytic anemia, disorders of platelet function with uremic bleeding tendencies), disorders of water and electrolyte balance and acid-base balance, disorders of excretory functions)

Secondary hyperparathyroidism

Uremic encephalopathy

Medical history, clinic, laboratory, imaging procedures (sonographically small kidneys; exception: chronic renal insufficiency in systemic amyloidosis)

Differentiation of acute kidney failure.

Symptomatic, delaying the progression of renal insufficiency.

Treatment of the underlying disease.

Renal hypertension: ACE inhibitors, antihypertensives.

Metabolic acidosis: sodium bicarbonate, low-protein Mediterranean diet.

Hyperlipidemia: HMG-CoA reductase inhibitors.

Hypertriglyceridemia: fibrates.

Proteinuria: ACE inhibitors.

Secondary hyperparathyroidism: phosphate binders. Vit D3 supplementation.

Caution! Potassium-sparing diuretics: inhibit tubular potassium secretion, so that even at filtration rates < 50ml/min a threatening hyperkalemia can occur.

People at increased risk should participate in screening activities, in particular for:

diabetes or high blood pressure,

People who are overweight,

Smokers

>-50-year-olds with a family history of diabetes, high blood pressure or kidney disease.

Healthy kidneys have a glomerular filtration rate (GFR) of 95 to 110 ml/min. This means that the kidneys filter this amount of blood per minute and cleanse it of urinary substances. With increasing renal insufficiency, the glomerular filtration rate deteriorates.

The term "terminal renal insufficiency" refers to the terminal or final stage (stage 5 according to KDIGO) of a chronic kidney disease. This terminal stage is characterized by a renal performance of 15% of the norm or less (corresponding to a GFR < 15 ml/min/1.73 m²) and by the need for renal replacement therapy in the form of dialysis treatment or kidney transplantation.

1. Chan IH et al (2016) Itch Management: Physical Approaches (UV Phototherapy, Acupuncture). Curr Probl Dermatol 50:54-63.
2. Classen M et al (2004) Repetitorium Internal Medicine. Urban&Fischer Munich, Jena p.383
3. Kremer AE et al (2016) Pruritus in systemic diseases: Common and rare etiologies. Dermatologist 67:606-614.