Items in Chronic Renal Insufficiency
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The Foundation for IgA Nephropathy
Chronic Renal Insufficiency
What is renal insufficiency?
Renal
insufficiency, also called renal failure, is when your kidneys no
longer have enough kidney function to maintain a normal state of
health. Note that the term renal failure is beginning to be replaced by
renal insufficiency when in the context of chronic kidney disease.
There are two kinds.
Acute renal failure (ARF).
This is kidney failure that happens rather suddenly, where something
has caused the kidneys to shutdown. This may be due to infection, drugs
(prescription, over-the-counter, recreational), traumatic injury, major
surgery, nephrotoxic poisons, etc. Emergency dialysis may be needed
until the situation resolves and the kidneys begin functioning again
(this might take a short time, or months, or it might be permanent).
While more acute episodes are possible in the case of IgAN (we often
refer to them as "flare-ups"), IgA nephropathy is a condition that
mainly causes chronic renal insufficiency (CRI), not usually acute
renal failure (ARF). However, some people may experience
spontaneously-reversing acute renal failure as well. The latter are
cases where serum creatinine goes up dramatically but later returns to
a more normal baseline. In such cases, dialysis may be needed until the
condition improves. ARF in the context of IgAN is usually more
associated with the person developing a flare-up of HSP.Chronic renal insufficiency (CRI). This
is when a disease such as IgA nephropathy slowly and gradually destroys
the filtering capacity of the kidneys. It is sometimes referred to as
progressive renal insufficiency, chronic kidney disease or chronic
renal failure (CRF). This kind of damage cannot currently be repaired,
and as such, it is irreversible. A person may have chronic renal
failure for many years, even decades, before dialysis or a kidney
transplant become necessary. Chronic renal insufficiency does not, by
itself, mean complete shutdown of the kidneys, and a person with
chronic renal insufficiency may still pass urine normally, and may have
more than enough kidney function left for normal functioning of the
body. Note that you cannot judge the efficiency of your kidneys by the
amount of urine you produce. People with quite advanced renal
insufficiency, and even people on dialysis may still produce a fair
amount of urine. But this does not mean that the kidneys are filtering
waste nor regulating serum electrolyte levels efficiently. Chronic renal insufficiency itself causes more loss of kidney function.
One important aspect of kidney disease is that, once a kidney is
damaged by it to a certain degree, it continues to deteriorate even if
the underlying kidney disease can or could be cured. This is commonly
referred to as the point of no return (PNR).What happens is that the
chronic renal insufficiency (CRI) continues to progress on its own,
scarring of the glomeruli continues, and kidney function continues to
gradually decline. It's possible that controlling blood pressure with
an ACE inhibitor like ramipril, or an angiotensin II receptor blocker
like Cozaar or Avapro may slow this progression of chronic renal
insufficiency. There is also beginning to be some evidence that the
class of anti-cholesterol drugs called "statins" (like Lipitor, for
example) may help slow progression of CRI. The point of no return is
generally considered to be when serum creatinine reaches 2.0 mg/dl in
U.S. measurements, or about 175 umol/L in international SI measurement.
End-stage renal disease.
As chronic renal insufficiency continues and progresses, the person may
eventually reach the point where it is considered to be end-stage renal
disease (ESRD), which is the subject of a different section on this
website (see main menu).
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© 2002-2006 Foundation for IgA Nephropathy
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