Chronic renal failure
This is a persistant non-reversible impairment of renal function.
Commonest causes are…
 Diabetes
 Hypertension
 Glomerulonephritis
 Pyelonephritis
 Acute renal failure which doesn’t recover
The symptoms are vague such as nausea, fatigue, oliguria and vomiting.
The signs of chronic renal failure can include
 Uraemic frosting
 Yellow skin
 Easy bruising
 Peripheral neuropathy
It is investigate chronic renal failure…
 Urea and Creatinine
 H+/ HCO3 Fluid balance (see hand out on fluid balance)
 Heamoglobin ( CRF decreases erythropoietin (EPO)so there is normocytic anaemia)
 Calcium ( low due to decreased production of vitamin D)
Increased urea and creatinine in chronic renal failure are usually accompanied by low calcium and
normocytic anaemia.
Chronic renal failure is treated by…
 Managing BP according to guidelines
 Managing Anaemia try giving too many transfusions can iron overload patients (occasionally
EPO) Give a vitamin D supplement if possible (alfacalcidol)
 Diet (low salt, low protein not too much fluid if overloading)
 Dialysis
If deteriorating to the point of severe symptoms dialysis can be administered, it comes in two forms
in Malawi…
Haemodialysis- done by machine, filtering the blood, units only exist in Lilongwe and Blantyre and
patients should come 3 times a week. This is not possible or affordable for most Malawians, also it is
done through either a fistula (needs a secialist surgeon not present in Malawi) or a central line which
is prone to infection.
Peritoneal Dialysis- done by infusing diasylate fluid into the peritoneum several times a day.
Relatives and patients can be trained to do this at home. The line for this can also become infected
and blocked giving peritonitis.
Provided by T. Whitfield 2012