Chronic Renal Failure (CRF) & Renal Replacement Therapy (RRF)

What is chronic renal failure and end stage renal disease?

Usually we have 2 kidneys with about 1 million glomeruli each (Fig. 8). They help eliminate waste products of metabolism such as urea, creatinine and regulate acid-base and water balance. Kidneys are the source of hormone important in the production of red blood cells and responsible for the manufacturing of active vitamin D which is important in the regulation of calcium-phosphate metabolism. When kidneys fail, their functions progressively decrease and manifest clinically as growth failure (short stature), decrease in appetite, tiredness, pallor, hypertension (raised blood pressure), electrolyte disturbance (high potassium and high phosphate usually), metabolic acidosis, decrease in urine output, water retention, edema, rickets and uremia where major organ dysfunction is manifested such as mental disturbance, convulsion, heart failure, bleeding and pulmonary edema and death if left untreated.

End stage renal failure refers to the stage of chronic kidney failure which if not intervened with renal replacement therapy, will result in death of the patient.

(Fig. 8) normal urinary systems: 2 kidneys 2 ureters, bladder and urethra

What are the common causes of chronic renal failure (CRF)?

Common causes of CRF in children include:

  1. congenital renal developmental abnormality such as dysplasia
  2. congenital urinary tract abnormality such as obstruction
  3. hereditary renal disorder such as Alport's syndrome
  4. glomerulonephritis such as focal glomerulosclerosis, IgA nephropathy

* in adults, CRF is mostly due to acquired causes such as diabetes mellitus, hypertension and glomerulonephritis.

What are the different types of renal replacement therapy (RRF)?

When the child suffers from end stage renal disease (GFR<15ml/min/1.73m2), RRF is needed to prevent occurrence of uremia and sustain life and improve the quality of daily living. There are 3 types of RRF:

  1. peritoneal dialysis
  2. hemodialysis
  3. kidney transplantation