chronic renal failure

Introduction

chronic kidney disease (CKD) is a common condition which may lead to chronic renal failure (CRF) and end-stage renal failure (ESRF) which may require dialysis or a renal transplant

glomerulonephritis (GN)
infections eg. chronic acute pyelonephritis, tuberculosis (TB), COVID-19 coronavirus (2019-nCoV / SARS-CoV-2)
ureteral obstruction eg. stone, stricture, stenosis
incomplete recovery from acute kidney injury
vascular - ischaemia, hypertension
collagen vascular diseases eg. systemic lupus erythematosus (SLE), polyarteritis nodosa (PAN), haemolytic uraemic syndrome (HUS)
metabolic:
- diabetes mellitus
- amyloidosis
- gout
- hypercalcaemia
- chronic hypokalaemia
- drugs esp. analgesic abuse and toxins such as heavy metals
- dysproteinaemia esp. multiple myeloma
primary tubular disease eg. Fanconi syndrome, tubular acidosis
congenital - renal hypoplasia
common hereditary - polycystic kidney disease
miscellaneous:
- radiation nephritis
- Fabry's disease
- Alport's disease (familial nephritis with deafness)
NB. pre-menopausal women have lower incidence than men which may be related to a protective greater renal regeneration capacity as renal podocytes, from renal progenitor cells, are regenerated through oestrogen receptor–dependent signaling although this may fail during pregnancy ¹⁾

cardiovascular disease causes >50% of deaths in patients with advanced chronic kidney disease
hypertension
cardiac failure
- cardiac damage due to cellular apoptosis triggered via renal cell release of toxic CKD-EV-miRNA within circulating extracellular vesicles²⁾

encephalopathy with dementia
epilepsy
psychosis
depression
amaurosis
stroke (CVA)
basal ganglia lesions
cranial neuropathy
central pontinemyelopathy
peripheral neuropathy
muscle cramps
restless legs syndrome
complications of immunosuppressive Rx
- CNS infections including viral and fungal
- CNS lymphoma following renal transplant

ESRF uraemic calciphylaxis painful necrotic skin ulcers
- appears to be produced via up-regulation of the thymidine phosphorylase (TYMP), IL-6, and tissue factor (TF) signaling pathway which appears to be central to the skin lesion initiation and progression and produces microvessel thrombosis ³⁾

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