a. Chronic renal failure is a progressive deteriorization of renal function.

Renal insufficiency progresses to renal failure, ending in uremia and its complications. Uremia is the accumulation, in the blood, of substances ordinarily filtered by the kidneys and excreted in the urine.

b. As renal function declines, the kidneys become increasingly unable to remove (filter) the body’s metabolic wastes. The products of protein metabolism accumulate in the blood and other body fluids, causing disruption and imbalances throughout the body. Such alterations include:

(1) Gastrointestinal: anorexia, nausea, vomiting, and diarrhea.

(2) Hematological: anemia, bleeding tendencies.

(3) Integumentary: skin discoloration, pruritis.

(4) Skeletal: osteomalacia, uremic bone disease.

(5) Sexual/reproductive: decreased libido, impotence, amenorrhea.

(6) Cardiovascular: HTN, pulmonary congestion, pulmonary edema, and congestive heart failure.

(7) Neurological: anxiety, personality changes, delusions, hallucinations, and convulsions.

(8) Metabolic: water retention, sodium retention, potassium retention, and metabolic acidosis.

c. Chronic renal failure may be caused by:

(1) Chronic glomerulonephritis.

(2) Pyelonephritis.

(3) Uncontrolled hypertension.

(4) Nephrotoxic agents (drugs/toxins).

(5) Dehydration.

d. Onset of symptoms begins with generalized weakness, lethargy, headache, and mild GI complaints, such as anorexia, nausea, and vomiting. If not diagnosed and treated, uremia will progress to a state of total body involvement. The patient will become increasingly somnolent. An ammonia odor will be evident on the breath, and respirations will become Kussmaul in character. “Uremic frost,” a powdery substance composed of uric acid salts, will appear on the skin. Muscle twitching is followed by convulsions, coma, and death.