Chronic Renal Insufficiency

Chronic Renal Insufficiency: Overview

Alternative Names: Chronic Kidney Disease, CKD.

Unlike acute renal failure with its sudden (but reversible) failure of kidney function, chronic renal failure is slowly progressive.  It most often results from some disease that causes gradual destruction of the kidneys and can range from mild dysfunction to severe kidney failure; progression may continue to end-stage renal disease (ESRD).  Chronic renal failure usually occurs over a number of years as the internal structures of the kidney are slowly destroyed.

Incidence; Causes and Development

Chronic renal failure occurs in approximately 2 out of every 10,000 people.

Causative diseases include glomerulonephritis of any type (one of the most common causes), polycystic kidney disease, hypertension, Alport syndrome, reflux nephropathy, obstruction, kidney stones, infection, and analgesic toxicity.  Diabetes mellitus is a major cause of chronic renal failure.

Chronic renal failure results in the accumulation of fluid and waste products in the body, causing low urine output and waste accumulation.  These may occur without symptoms.  Most bodily systems are affected by chronic renal failure.

Signs and Symptoms

In the early stages, there may be no symptoms.  Progression may be so gradual that symptoms do not occur until kidney function is less than one-tenth of normal.

Treatment and Prevention

Treatment of the underlying disorders may help prevent or delay development of chronic renal failure.  Treatment focuses on controlling the symptoms, minimizing complications, and slowing the progression of the disease.

Associated diseases that cause or result from chronic renal failure must be controlled.  Hypertension, congestive heart failure, urinary tract infections, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated as appropriate.  Blood transfusions or medications such as iron and erythropoietin supplements may be needed to control anemia.

Fluid intake may be restricted, often to an amount equal to the volume of urine produced.  Dietary restrictions may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting.  Salt, potassium, phosphorus, and other electrolytes may be restricted.

There are steps that can be taken, but must be taken early, to reduce the complications and symptoms as much as possible.  Some ways to help prevent or slow down the onset of chronic renal failure include:
  • monitoring blood pressure regularly
  • following recommended treatments for chronic diseases such as diabetes, lupus, and hypertension
  • not smoking – for people with diabetes, smoking can speed up the damage to the small blood vessels in the body
  • not abusing over-the-counter medications
  • getting treatment for urinary tract infections or any type of urinary problems as soon as possible
  • reducing autoimmunity activity

Prognosis

There is no cure for chronic renal failure.  Untreated, it usually progresses to end-stage renal disease.  Lifelong treatment may control the symptoms of chronic renal failure.  Dialysis or kidney transplant may eventually be required.

Chronic Renal Insufficiency

Information On This Page

Signs, symptoms & indicators of Chronic Renal Insufficiency:

Lab Values - Cells

Symptoms - Gas-Int - General

Symptoms - General

Hiccups may be a sign or symptom of Chronic Renal InsufficiencyHiccups
Persistent hiccups are a possible sign of kidney failure.

Symptoms - Metabolic

Symptoms - Nails

Nails turning white towards the ends may be a sign or symptom of Chronic Renal InsufficiencyNails turning white towards the ends
Leukonychia (partial or completely white nails) is a sign of renal failure.

Symptoms - Skin - General

Conditions that suggest Chronic Renal Insufficiency:

Circulation

Anemia may suggest Chronic Renal InsufficiencyAnemia
Anemia is almost always present in cases of chronic renal failure, and can occur through any of the basic mechanisms (blood loss, excessive destruction of red blood cells, or low production of red blood cells.) However, the typical anemia associated with CRF results from decreased production of red blood cells by the bone marrow: failing kidneys no longer produce sufficient erythropoietin, a hormone that stimulates the production of oxygen-carrying red blood cells (RBCs).  In addition to decreased levels of RBCs, patients often begin to accumulate toxic metabolites, which shorten the lifespan of existing RBCs.

Environment / Toxicity

Magnesium Toxicity often suggests Chronic Renal InsufficiencyMagnesium Toxicity
High levels of magnesium can develop in patients with kidney failure and in elderly people whose kidney functions are reduced.  This is especially true when supplementing with magnesium.  Kidney disease, rather than diet, is the usual cause of magnesium overload, because the kidneys lose the ability to remove excess magnesium.

Lab Values

Elevated Homocysteine Levels may suggest Chronic Renal InsufficiencyElevated Homocysteine Levels
Homocysteine levels in patients suffering from chronic renal failure are significantly elevated at an early stage.  The kidney plays a very significant role in homocysteine metabolism but this does not occur during chronic renal failure.  In addition, there is a decreased extra-renal catabolism, which contributes to the hyperhomocysteinemia state.  [Hyperhomocysteinemia: A Role in The Accelerated Atherogenesis of Chronic Renal Failure?, Netherlands Journal of Medicine, 1995;46: pp.244-251]

Metabolic

Musculo-Skeletal

Gout / Hyperuricemia may suggest Chronic Renal InsufficiencyGout / Hyperuricemia
Patients with impaired renal function filter and excrete less uric acid and therefore become hyperuricemic.  Interestingly, patients with renal failure do not develop gout as frequently as expected, despite their high plasma urate levels.  The explanation for this phenomenon may be that they have not incurred sustained hyperuricemia levels long enough to develop gout.  Only 1% of renal failure patients develop gout but nearly 30% of patients with adult polycystic kidney disease do.

Organ Health

Skin-Hair-Nails

Boils, Abscesses, Carbuncles may suggest Chronic Renal InsufficiencyBoils, Abscesses, Carbuncles
People with certain illnesses, including kidney failure, are more at risk of developing boils.

Symptoms - Urinary

Counter-indicators:

Risk factors for Chronic Renal Insufficiency:

Environment / Toxicity

Metabolic

Anorexia / Starvation Tendency may increase risk of Chronic Renal InsufficiencyAnorexia / Starvation Tendency
The common medical complications of being severely underweight include kidney damage.

Organ Health

Alport Syndrome increases risk of Chronic Renal InsufficiencyAlport Syndrome
Alport Syndrome causes progressive kidney damage.  This means that the glomeruli undergo a gradual but persistent process of destruction, leading to kidney failure in many cases.  Boys with Alport Syndrome inevitably develop kidney failure, but kidney failure in girls is unusual.  The age at which boys with Alport Syndrome develop kidney failure varies from family to family.  It may occur as early as 15-20 years of age, but in some families, kidney failure does not develop until the men are 40-50 years of age.
Glomerulonephritis increases risk of Chronic Renal InsufficiencyGlomerulonephritis
With about a million glomeruli in each kidney, there is an ample reserve of kidney function, and a person can go many years or even decades without feeling the effects of renal failure.  However, once a glomerulus is damaged, it cannot be repaired.  IgAN progressively destroys these glomeruli.  As more and more glomeruli become scarred and non-functional, the remaining ones start working harder (a process called hyperfiltration), and eventually, as more and more of them fail at an increasingly faster rate, the kidneys no longer have enough function left to perform their task of filtering waste products from the blood.
Diabetes Type II often increases risk of Chronic Renal InsufficiencyDiabetes Type II
Type II diabetes mellitus is the leading cause of chronic kidney disease, accounting for 35% of the new cases each year and 25% of all cases in the U.S.

Symptoms - Glandular

Reasonably controlled diabetes often increases risk of Chronic Renal InsufficiencyReasonably controlled diabetes
Diabetes mellitus is a major cause of chronic renal failure.  In Singapore, statistics have shown that out of the 500 newly diagnosed kidney failure patients each year, 50% were caused by diabetes and 9% were caused by hypertension.  When sugar levels rise enough to spill into the urine, as in diabetes, blood vessels in the kidneys are damaged.  This condition is known as diabetic nephropathy.  Symptoms related to kidney failure usually occur only in late stages of the disease, when kidney function has diminished to less than 25% of normal capacity.  For many years before that point, kidney disease of diabetes exists as a silent process.

Chronic Renal Insufficiency suggests the following may be present:

Organ Health

Chronic Renal Insufficiency may suggest Alport SyndromeAlport Syndrome
Alport Syndrome causes progressive kidney damage.  This means that the glomeruli undergo a gradual but persistent process of destruction, leading to kidney failure in many cases.  Boys with Alport Syndrome inevitably develop kidney failure, but kidney failure in girls is unusual.  The age at which boys with Alport Syndrome develop kidney failure varies from family to family.  It may occur as early as 15-20 years of age, but in some families, kidney failure does not develop until the men are 40-50 years of age.

Chronic Renal Insufficiency can lead to:

Circulation

Chronic Renal Insufficiency usually leads to AnemiaAnemia
Anemia is almost always present in cases of chronic renal failure, and can occur through any of the basic mechanisms (blood loss, excessive destruction of red blood cells, or low production of red blood cells.) However, the typical anemia associated with CRF results from decreased production of red blood cells by the bone marrow: failing kidneys no longer produce sufficient erythropoietin, a hormone that stimulates the production of oxygen-carrying red blood cells (RBCs).  In addition to decreased levels of RBCs, patients often begin to accumulate toxic metabolites, which shorten the lifespan of existing RBCs.

Lab Values

Chronic Renal Insufficiency often leads to Elevated Homocysteine LevelsElevated Homocysteine Levels
Homocysteine levels in patients suffering from chronic renal failure are significantly elevated at an early stage.  The kidney plays a very significant role in homocysteine metabolism but this does not occur during chronic renal failure.  In addition, there is a decreased extra-renal catabolism, which contributes to the hyperhomocysteinemia state.  [Hyperhomocysteinemia: A Role in The Accelerated Atherogenesis of Chronic Renal Failure?, Netherlands Journal of Medicine, 1995;46: pp.244-251]

Metabolic

Musculo-Skeletal

Chronic Renal Insufficiency often leads to Gout / HyperuricemiaGout / Hyperuricemia
Patients with impaired renal function filter and excrete less uric acid and therefore become hyperuricemic.  Interestingly, patients with renal failure do not develop gout as frequently as expected, despite their high plasma urate levels.  The explanation for this phenomenon may be that they have not incurred sustained hyperuricemia levels long enough to develop gout.  Only 1% of renal failure patients develop gout but nearly 30% of patients with adult polycystic kidney disease do.

Recommendations for Chronic Renal Insufficiency:

Animal-based

Chitosan is highly recommended for Chronic Renal InsufficiencyChitosan
In a study of patients with chronic renal failure undergoing long-term hemodialysis 450mg of chitosan 3 times a day for 12 weeks produced multiple benefits.  Mean serum cholesterol went down 43% and mean serum hemoglobin increased from 5.8 to 6.8 g/dl in those patients who received the chitosan.  Mean urea (from 75 to 45 mM) and creatinine (from 1.  001 to 0.875 mM) levels in serum showed significant reductions after 12 weeks of chitosan treatment.  Compared with the control group, the treatment group reported significantly improved appetite, sleep and feeling of physical strength.  No significant side effects were seen.  (Jing SB.  et al.  J Pharm Pharmacol 1997;49:72 1-723.)

Chemical

Baking Soda is highly recommended for Chronic Renal InsufficiencyBaking Soda
NaturalNews, August 26, 2009: Researchers in the United Kingdom have made a breakthrough in the treatment of advanced CKD – using a daily dose of sodium bicarbonate (baking soda.) Baking soda has been shown to slow the decline of kidney function in CKD, according to a study set for publication in the Journal of the American Society of Nephrology (JASN).  "This cheap and simple strategy also improves patients' nutritional status, and has the potential of translating into significant economic, quality of life, and clinical outcome benefits," said researcher Magdi Yaqoob, MD, of the Royal London Hospital.

Dr. Yaqoob studied 134 patients with advanced CKD and low bicarbonate levels, a condition known as metabolic acidosis.  One group of these patients was treated with a small daily dose of sodium bicarbonate in tablet form, in addition to their usual care.  The results? The rate of decline in kidney function was dramatically reduced in these patients.  Overall, the decline was about two-thirds slower than in patients not given sodium bicarbonate.  "In fact, in patients taking sodium bicarbonate, the rate of decline in kidney function was similar to the normal age-related decline," Dr. Yaqoob stated.

The patients taking sodium bicarbonate were also less likely to develop end-stage renal disease (ESRD) which causes people with CKD to require regular dialysis.

Detoxification

Heavy Metal Detoxification / Avoidance often helps with Chronic Renal InsufficiencyHeavy Metal Detoxification / Avoidance
A study evaluated 272 men and women with chronic renal failure and found that there was a significantly increased risk from exposure to lead, copper, chromium, tin, mercury, welding fumes, silicon containing compounds, grain dust and oxygenated hydrocarbons.  Occupational exposures were high amongst patients with diabetic nephropathy.

Diet

Plant-Based Nutrition is highly recommended for Chronic Renal InsufficiencyPlant-Based Nutrition
A low protein diet is important in reducing the processing responsibilities of compromised kidneys.
Reduced Water Consumption often helps with Chronic Renal InsufficiencyReduced Water Consumption
If the kidneys are not allowing the body to get rid of excess fluid, fluid intake may need to be restricted so that the kidneys don't have to work as hard.  Fluid restrictions are usually only used in severe cases or if the renal failure has developed into end-stage renal failure.
Not recommended:
Therapeutic Fasting is NOT recommended for Chronic Renal InsufficiencyTherapeutic Fasting
Lengthy fasting should generally be avoided by people with renal failure.  Short-term fasts may be helpful, but must be done under an experienced doctor's supervision.

Homeopathy

Homeopathic Remedies often helps with Chronic Renal InsufficiencyHomeopathic Remedies
Reports by doctors using homeopathy say that patient response is better in those who have not yet started with dialysis.  Long-term constitutional therapy as well as therapy aimed at improving kidney function helps to keep the patient relatively free of symptoms and complications.  Remedies such as Serum Anguillar Ichthyotoxin, Solidago and Urea have been found useful in dealing with chronic renal failure and its complications.  Hipuric acid has been found to be useful for the itching of skin arising from chronic renal failure.

Mineral

Not recommended:
Potassium is sometimes not recommended for Chronic Renal InsufficiencyPotassium
Individuals with kidney dysfunction may have trouble excreting potassium and should only take potassium supplements under the observation of their doctor.
Magnesium is often not recommended for Chronic Renal InsufficiencyMagnesium
If you have kidney problems, taking magnesium supplements may make you accumulate the mineral too quickly, which could be toxic.  In this case you should check with your doctor before taking magnesium supplements.

Nutrient

Essential Fatty Acids often helps with Chronic Renal InsufficiencyEssential Fatty Acids
There have been a variety of trials of omega-3 fatty acid supplementation in patients with a variety of renal disorders.  These trials suggest that such therapy may be of use in the treatment of IgA nephropathy and chronic renal failure.  Dietary polyunsaturated fatty acid manipulation results in an anti-inflammatory.  [Polyunsaturated Fatty Acids and Renal Disease, Proceedings of the Society For Experimental Biology and Medicine, 1996;213: pp.13-23.]

Fish oil supplementation is promising and does not produce the risks associated with corticosteroid and immunosuppressive drug use.

Vitamins

Folic Acid often helps with Chronic Renal InsufficiencyFolic Acid
Patients with chronic renal failure have homocysteine levels that are significantly elevated at an early stage.  Taking 5mg of folic acid daily can significantly lower these homocysteine levels.  [Hyperhomocysteinemia: A Role in The Accelerated Atherogenesis of Chronic Renal Failure?, Netherlands Journal of Medicine, 1995;46: pp.244-251]
Vitamin E often helps with Chronic Renal InsufficiencyVitamin E
Vitamin E levels, independent of dietary intake, have been found to be lower in patients with chronic renal failure.  This reflects increased oxidative activity and suggests the need for antioxidants such as vitamin E.  [Dietary Intake and Plasma Levels of Antioxidant Vitamins in Health and Disease: A Hospital-Based, Case-Control Study, Singh, Ram, B., M.D., et al, Journal of Nutritional & Environmental Medicine, 1995;5: pp.235-242]
Not recommended:
Vitamin C (Ascorbic Acid) is NOT recommended for Chronic Renal InsufficiencyVitamin C (Ascorbic Acid)
The authors of the following study believe it shows that vitamin C supplementation leads to a significant increase in serum oxalate levels in dialysis patients.  In renal insufficiency, vitamin C levels were elevated, but not oxalate levels.  Caution is advised with regard to vitamin C and renal insufficiency.

"Relationship Between the Serum Concentration of Oxalic Acid and Ascorbic Acid in Chronic Renal Insufficiency", Gerold, M., et al, Nieren-Und Hochdruckkrankheiten, May 1992;21(Suppl.  1): pp.58-61.  (Address: Dr. G.  Stein, Erlanger Allee 101, O-6902 Jena-Lobeda, Germany)

KEY

Weak or unproven link: may be a sign or symptom of; may suggest; may increase risk of
Weak or unproven link:
may be a sign or symptom of; may suggest; may increase risk of
Strong or generally accepted link: often suggests; often increases risk of; often leads to
Strong or generally accepted link:
often suggests; often increases risk of; often leads to
Definite or direct link: strongly suggests; increases risk of; usually leads to
Definite or direct link:
strongly suggests; increases risk of; usually leads to
Definitely or absolutely counter-indicates: strongly contraindicates
Definitely or absolutely counter-indicates:
strongly contraindicates
Moderately useful: often helps with
Moderately useful:
often helps with
Very useful: is highly recommended for
Very useful:
is highly recommended for
Caution: is sometimes not recommended for
Caution:
is sometimes not recommended for
Often counterindicated: is often not recommended for
Often counterindicated:
is often not recommended for
Should be avoided: is NOT recommended for
Should be avoided:
is NOT recommended for