Chronic Renal Insufficiency

Hyperkalemia can lead to paralysis of the muscles and arrhythmias. Fluid buildup can cause obvious edema.

Crush syndrome to the muscles can cause myoglobulin in the urine. Prolonged ischemia with reperfusion can lead to muscle breakdown products, such as phosphorus, potassium, and myoglobulin to enter the bloodstream (this is called rhabdomyolysis). The metabolites of myoglobulin injure the kidneys for reasons that aren’t clear.

In some cases of acute kidney injury or AKI, there is hypotension (for a variety of reasons, such as blood loss or other causes of low blood pressure) that contributes to the renal injury. Drug overdoses or excesses of drugs like antibiotics or chemotherapy drugs can cause acute damage to the kidneys. Bypass surgery to the heart may cause hypotension and acute renal injury. This is a possibly temporary problem that is reversible when the acute insult is reversed.

Patients with chronic renal failure may have hypertension, anemia, and heart disease as complications. The disease may be asymptomatic with the most common symptoms being secondary to anemia (fatigue, shortness of breath, dizziness, weakness, poor memory, and poor concentration).

The main causes of acute renal failure are different from chronic renal failure and include urinary tract obstruction, hypovolemia, myoglobin in the blood, hemolytic uremic syndrome, and medications. On the other hand, diabetes, nephrotic syndrome, hypertension, and polycystic kidney disease are common causes of chronic renal insufficiency.

The most common cause of CKD (chronic kidney disease) is diabetes mellitus. Other causes are uncontrolled hypertension and polycystic kidney disease. Overuse of acetaminophen and ibuprofen can cause chronic kidney disease as well. Certain viruses (hantavirus) can result in chronic renal insufficiency. People of African descent can have CKD from the APOL1 gene in the absence of other causes. HIV disease can cause nephropathy and CKD.

There are five stages of CKD that depend on the glomerular filtration rate. Stage 1 disease is mild, while stages 2-3 will require increased monitoring and a reduction in the use of nephrotoxic drugs. Stages 4 and 5 diseases are more serious with stage 5 disease resulting in kidney dialysis or renal transplant as they cannot maintain an adequate excretion of toxins.

Figure 2 describes the five stages of chronic kidney disease: