Chronic Renal Failure & End-Stage Renal Failure

SimpleNursing Editorial Team Mar 5, 2018
Doctor reviews an X ray

When talking about a disease that’s diagnosed to be chronic, it’s something that has been known for a while and has gotten to the point of progression; this is exactly what happens in chronic renal failure.

Here, we will be discussing the stages of chronic renal failure, its development, and fundamentally, how it worsens to end-stage renal failure.

Kidney Breakdown

Think of your kidneys as the washer or laundry machines of your body. Now, what happens if the organs responsible for cleaning your blood malfunction due to certain elements? Eventually, your kidneys will break down. Putting too much workload on your washer machines causes too much pressure that will destroy its overall integrity.

What are the main reasons for your kidneys to break down?

  1. Hypertension
  2. Hyperglycemia

So, if your client is either hyperglycemic, which is a condition wherein there is too much glucose in your blood, or hypertensive, the kidneys will collapse due to exhaustion of filtering all unnecessary components from your blood.

Situations inside the hospital can be much worse if your client has chronic congested heart failure and has high blood pressure. If this happens, the kidneys will be deprived of oxygen which can lead to necrosis.

Hyperglycemia + Hypertension = kidney breakdown = necrosis

Stages of Chronic Renal Failure

The first thing that would come to mind once you’ve been diagnosed with chronic renal failure is asking how severe the condition is. So, you’re primarily interested in the level of severity. This is where your staging comes in.

When knowing the stage of chronic renal failure, you are assessing how much percentage of your glomerular filtration rates are still working in terms of cleaning the blood and filtering the body’s waste products.

The stages of chronic renal failure are just identifying how much of your glomerular filtration rate is still working. Therefore:

  • Phase 1: 60% – 89% of the kidneys are not affected

Here, your kidneys are still in good condition because there’s only a small part of your glomerular filtration that’s not working. And since you’re on the first phase, lifestyle changes can still be applied to prevent progression to the succeeding stage.

But you have to keep in mind that when it comes to kidney failure, what was lost or destroyed cannot be regenerated unlike other organs in the body. The moment the glomeruli die, they’re dead forever.

For this reason, lifestyle and dietary changes are advised so as not to impair the rest of the kidneys further. If increased blood pressure and blood sugar are not controlled, the affectation will continue until the rest of the kidneys are destroyed entirely.

Phase 1 = requires lifestyle changes to prevent further destruction of the remaining healthy areas

  • Phase 2: 30% – 60% of the kidneys are not affected
  • Phase 3: 15% – 30% of the kidneys are not affected
  • Phase 4: End-stage renal failure

End-stage Renal Failure (ESRF)

In end-stage renal failure, only 15% of the kidneys are working but they will eventually fail, and it won’t take long until they deteriorate. Complete destruction of your kidneys is due to overworking and overcompensating for the increased pressure and blood sugar that’s flooding your washer machines and has fried the units entirely.

What is going to happen with a client who has an end-stage renal failure?

  • Decrease urine output
  • Increased toxins inside the body
  • Fluid volume overload

Two Options to Consider

Clients who have end-stage renal failure have two options that they can consider:

  1. Dialysis – You can either choose from:
  • Hemodialysis – a procedure wherein a shunt is inserted in the arm
  • Peritoneal dialysis – placing fluid in the peritoneal space
  1. Kidney transplant

The problem with kidney transplants is that most of the time, it does not go well. There is a considerable possibility that the body will reject the transplanted kidneys which will is why clients are required to take immunosuppressant medications to prevent the client’s immune system from attacking the new organs. This is one of the primary side effects of getting a transplant.

On our next lecture, dialysis will be discussed thoroughly. For other essential nursing topics, visit

Until next time!

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