Nephrology Book

Chronic Renal Failure

Aka: Chronic Renal Failure, End Stage Renal Disease, Chronic Kidney Disease, Chronic Renal Insufficiency, ESRD, CRF, Renal Insufficiency
  1. See Also
    1. Chronic Kidney Disease related Bone Disease (Renal Osteodystrophy)
    2. Proteinuria
    3. Drug Dosing in Chronic Kidney Disease
    4. Nephrotoxic Drugs
    5. Prevention of Kidney Disease Progression
    6. Intravenous Contrast Related Acute Renal Failure
    7. Gadolinium-Associated Nephrogenic Systemic Fibrosis (Nephrogenic Fibrosing Dermopathy)
    8. Hypotension in the Dialysis Patient
  2. Epidemiology: Prevalence
    1. Chronic Kidney Disease
      1. Adults in U.S.: 20 million (11% of the adult population)
    2. End Stage Renal Diseases
      1. Actual 2002: 435,000 in U.S.
      2. Estimated 2010: 650,000 in U.S.
  3. Causes: Percentage is that of conditions responsible for ESRD
    1. Diabetes Mellitus (37%)
      1. See Diabetic Nephropathy
      2. Glycemic control is critical to slow progression
      3. Type I Diabetes Mellitus (represents 5% of ESRD patients)
        1. Progresses to ESRD in 40% of patients
      4. Type II Diabetes Mellitus (represents 32% of ESRD patients)
        1. Progresses to ESRD in 20% of patients
        2. Type II Diabetes is 10 times as common as Type
    2. Hypertension (30% overall, 40% in black patients)
    3. Human Immunodeficiency Virus Infection (HIV Infection)
    4. Glomerulonephritis and other glomerular diseases (21%)
      1. Includes Vasculitis (e.g. Systemic Lupus Erythematosus)
    5. Hereditary conditions
      1. Polycystic Kidney Disease (7%)
      2. Alport Syndrome
      3. Medullary Cystic disease
    6. Tubulointerstitial disease (4%)
      1. Infection with scarring
        1. Chronic Urinary Tract Infections (Pyelonephritis)
        2. Reflux nephropathy in children
      2. Urologic obstruction
        1. Nephrolithiasis (obstruction)
        2. Benign Prostatic Hyperplasia (BPH)
      3. Medication-induced Nephrotoxicity (Nephrotoxins)
        1. See Intravenous Contrast Related Acute Renal Failure
        2. See Risk Score for Prediction of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention
  4. Risk Factors
    1. Diabetes Mellitus (leading cause)
    2. Autoimmune Conditions
    3. Chemical exposures (Lead, Cadmium, Arsenic, Mercury, Uranium)
    4. Nephrotoxin exposure (e.g. Intravenous Contrast Related Acute Renal Failure)
    5. Family History of Chronic Kidney Disease
    6. Hypertension
    7. Low birth weight
    8. Lower Urinary Tract Obstruction
    9. Cancer
    10. Nephrolithiasis
    11. Advanced age
    12. Acute Kidney Injury in past
    13. Decreased Renal Mass
    14. Serious systemic infection (e.g. Sepsis)
    15. Recurrent Urinary Tract Infections
    16. Minority status (blacks, native american, asian, pacific islander)
  5. History
    1. Recent infections
      1. Poststreptococcal Glomerulonephritis
    2. STD risk factors
      1. HIV Infection
      2. Hepatitis B Infection
      3. Hepatitis C Infection
    3. Arthritis or dermatitis
      1. Systemic Lupus Erythematosus
      2. Cryoglobulinemia
    4. Urinary symptoms
      1. Urinary Tract Infection
      2. Nephrolithiasis
      3. Urinary outflow obstruction
    5. PMH
      1. Diabetes Mellitus
        1. Present for 5-10 years: Microalbuminuria, Pre-Hypertension
        2. Present for 10-15 years: Albuminuria, Retinopathy, Hypertension
      2. Hypertension
        1. Severe Hypertension
        2. End-organ effects
    6. Family History
      1. Polycystic Kidney Disease
      2. Alport Syndrome (X-linked)
  6. Exam
    1. Vital Signs
      1. Hypertension
      2. Increased Body Mass Index
    2. Eye Exam
      1. Hypertensive retinopathy (A-V Nicking)
      2. Diabetic Retinopathy
    3. Cardiovascular Exam
      1. Congestive Heart Failure
      2. Ventricular Hypertrophy
      3. Carotid Bruit
      4. Decreased peripheral pulses
    4. Abdominal Exam
      1. Renal artery bruit
      2. Flank pain
      3. Bladder distention
  7. Symptoms: Stage 4-5
    1. Fatigue (75% of patients)
    2. Pruritus (75% of patients)
    3. Weakness
    4. Headaches
    5. Anorexia
    6. Nausea
    7. Vomiting
    8. Polyuria
    9. Nocturia
    10. Pain
      1. Musculoskeletal pain
      2. Dialysis associated pain
      3. Peripheral Neuropathy
      4. Peripheral Vascular Disease related pain
  8. Signs
    1. See Edema in Chronic Renal Failure
    2. Hypertension
    3. Congestive Heart Failure
    4. Proteinuria
    5. Pericarditis
  9. Criteria: Chronic Kidney Disease
    1. Kidney damage for >3 months or
    2. GFR < 60 ml/min/1.73 m2 (based on two GFR calculations 3 months or more apart)
      1. Men: Serum Creatinine >1.5 mg/dl
      2. Women: Serum Creatinine >1.3 mg/dl
    3. Significant Proteinuria for >3 months
      1. Urine Albumin >300 mg/24 hours or
      2. Urine Albumin to Creatinine Ratio 200 mg/gram
  10. Stages: NKF Classification System
    1. Stage 1: GFR >90 ml/min despite Kidney damage
      1. Microalbuminuria present
    2. Stage 2: Mild reduction (GFR 60-89 min/min)
      1. GFR of 60 may represent 50% loss in function
      2. Parathyroid Hormone starts to increase
    3. Stage 3: Moderate reduction (GFR 30-59 ml/min)
      1. Calcium absorption decreases
      2. Malnutrition onset
      3. Anemia secondary to Erythropoietin deficiency
      4. Left Ventricular Hypertrophy
    4. Stage 4: Severe reduction (GFR 15-29 ml/min)
      1. Serum Triglycerides increase
      2. Hyperphosphatemia
      3. Metabolic Acidosis
      4. Hyperkalemia
    5. Stage 5: Kidney Failure (GFR <15 ml/min)
      1. Azotemia
    6. References
      1. (2002) Am J Kidney Dis 39:S1 [PubMed]
      2. Snively (2004) Am Fam Physician 70:1921-30 [PubMed]
  11. Labs: Screening for Chronic Kidney Disease
    1. Indications
      1. History or Family History of causes listed above
      2. All patients over age 60 years old
    2. Initial Screening Tests
      1. Serum Creatinine
      2. Urinalysis with microscopy
    3. Assess Glomerular Filtration Rate (GFR)
      1. Estimations generally as accurate as 24 hour urine
        1. See Creatinine Clearance for exceptions
      2. Formyla
        1. Cockcroft-Gault equation or
        2. Modification of Diet in Renal Disease (MDRD)
    4. Assess for Proteinuria
      1. General
        1. First morning void spot urine is preferred sample
      2. Step 1: Standard Urine Dipstick for screening
      3. Step 2a: Urine Dipstick 1+ or greater
        1. Obtain protein to Creatinine ratio
        2. Ratio > 200 mg protein/gram Creatinine
          1. Evaluate Proteinuria
        3. Ratio > 200 mg protein/gram Creatinine
          1. Repeat protein to Creatinine ratio yearly
      4. Step 2b: Urine Dipstick negative or trace
        1. Obtain microalbumin to Creatinine ratio
        2. Ratio > 30 mg microalbumin/gram Creatinine
          1. Evaluate Microalbuminuria
        3. Ratio < 30 mg microalbumin/gram Creatinine
          1. Repeat microalbumin to Creatinine ratio yearly
    5. Assess other urinary sediment on Urinalysis
      1. Lipiduria (seen in nephrotic sediment)
        1. Indicated by fatty casts, oval fat bodies, or free fat in urine sediment
        2. Increases significance of Proteinuria
      2. Hematuria
      3. Urine White Blood Cells
  12. Labs: Urine sediment found in causes of Chronic Kidney Disease
    1. Polycystic Kidney Disease
      1. Protein to Creatinine ratio 200-1000 mg/g
      2. Red Blood Cells present
    2. Diabetic Nephropathy
      1. Albumin to Creatinine ratio 30-300 early (and exceeds 300 in later disease)
    3. Hereditary Nephritis
      1. Protein to Creatinine ratio <1000 mg/g
      2. Red Blood Cells, tubular cells and granular casts present
    4. Hypertensive Nephropathy
      1. Protein to Creatinine ratio 200-1000 mg/g
    5. Noninflammatory Glomerular Disease
      1. Protein to Creatinine ratio >1000 mg/g
    6. Proliferative Glomerulonephritis
      1. Protein to Creatinine ratio >500 mg/g
      2. Red Blood Cells, Red Blood Cell casts, White Blood Cells, White Blood Cell casts present
    7. Tubulointerstitial Nephritis
      1. Protein to Creatinine ratio 200-1000 mg/g
      2. Red Blood Cells, White Blood Cells, White Blood Cell casts present
  13. Imaging: Renal Ultrasound (indicated in most patients on initial presentation)
    1. Doppler Ultrasound
      1. Renal veins: Venous thrombosis
      2. Renal arteries: Lower efficacy in diagnosing Renal Artery Stenosis
    2. General findings
      1. Nephrocalcinosis
      2. Hydronephrosis
      3. Renal Mass or complex cysts (concerning for malignancy risk)
      4. Renal stones
    3. Increased echogenicity
      1. Renal disease
    4. Enlarged Kidneys
      1. Renal tumors
      2. Infiltrating disease
      3. Nephrotic Syndrome related conditions
    5. Asymmetric Kidney size or scarred Kidneys
      1. Vascular disease
      2. Urologic disease
      3. Tubulointerstitial disease
    6. Small, hyperechoic Kidneys
      1. Chronic Kidney Disease
  14. Imaging: Other advanced imaging
    1. Consider CT or MRI of Kidneys and Liver
    2. Consider Voiding Cystourethrogram
  15. Labs: Findings in Chronic Kidney Disease Stages 3-4
    1. Anemia (Normochromic, Normocytic)
      1. Hematocrit decreases
        1. Serum Creatinine > 2-3
        2. Glomerular Filtration Rate <20-30
      2. Results from decreased Erythropoietin synthesis
    2. Azotemia
    3. Decreased Serum Protein
    4. Serum chemistry abnormalities
      1. Hyperkalemia or Hypokalemia
      2. Metabolic Acidosis
      3. Hypocalcemia
      4. Hyperphosphatemia
  16. Labs: Screening
    1. Indications
      1. Diabetes Mellitus
      2. Hypertension
      3. Age over 55 years old
    2. Tests (combined)
      1. Estimated Glomerular Filtration Rate and
      2. Urine Protein to Creatinine Ratio
  17. Labs: Initial presentation
    1. Basic labs
      1. Basic metabolic panel
      2. Serum Calcium
      3. Serum Phosphorus
      4. Complete Blood Count (CBC)
      5. Vitamin D
    2. Additional labs as indicated
      1. Antinuclear Antibody (ANA)
        1. Lupus Nephritis
      2. Urine and Serum Protein Electrophoresis
        1. Multiple Myeloma
      3. Infectious Disease serologies
        1. HBsAg (Membranous Nephropathy, membranoproliferative nephritis)
        2. xHBC Antibody (Membranous Nephropathy, membranoproliferative nephritis)
        3. HIV Test (focal and segmental glomerulosclerosis)
      4. Antistreptolysin O Antibody (ASO Titer)
        1. Post-Streptococcal Glomerulonephritis
      5. Antineutrophil Cytoplasmic Antibody (ANCA)
        1. Wegener granulomatosis
        2. Microscopic Polyangiitis
        3. Pauci-immune Rapidly Progressive Glomerulonephritis
      6. Anti-Glomerular Basement Membrane Antibody (Anti-GBM Antibody)
        1. Goodpasture Syndrome (xGBM Antibody associated with rapid progression)
      7. Consider complement studies (C3, C4, CH50)
        1. Post-Streptococcal Glomerulonephritis
        2. Membranoproliferative Glomerulonephritis
        3. Lupus Nephritis
        4. Cryoglobulinemia
      8. Cryoglubulin Test
        1. Cryoglobulinemia
      9. Eosinophiluria
        1. Tubulointerstitial Disease
  18. Labs: Monitoring
    1. See Also Chronic Kidney Disease related Bone Disease (Renal Osteodystrophy)
    2. Labs to repeat every 3-12 months
      1. Serum Creatinine
      2. Serum electrolytes
      3. Serum Calcium
      4. Serum Phosphorus
      5. Serum Albumin
      6. Intact Parathyroid Hormone (iPTH)
    3. Labs to repeat every 12 months
      1. Quantitative measurement of Proteinuria
      2. Complete Blood Count, TIBC, Ferritin
      3. Serum Alkaline Phosphatase
  19. Diagnostics: Renal Biopsy
    1. Indications
      1. Hematuria and low Creatinine Clearance or Proteinuria
      2. Nephrotic range Proteinuria
      3. Chronic Renal Failure with normal or large Kidneys
      4. Acute Renal Failure of unknown cause
    2. Contraindications
      1. Renal length <9 cm
      2. Severe Hypertension
      3. Multiple large Renal Cysts
      4. Uncorrected bleeding tendency
      5. Hydronephrosis
      6. Acute infection
  20. Management: Secondary Prevention
    1. Preventive strategies
      1. See Prevention of Kidney Disease Progression
      2. See Drug Dosing in Chronic Kidney Disease
      3. See Renal Osteodystrophy
      4. See Nephrotoxic Drugs
      5. See Intravenous Contrast Related Acute Renal Failure
      6. See Gadolinium-Associated Nephrogenic Systemic Fibrosis (Nephrogenic Fibrosing Dermopathy)
    2. Referral to nephrology indications
      1. Chronic Kidney Disease Stage 4 (GFR <30 ml/minute)
        1. Consider initial evaluation when GFR <60 ml/minute
      2. Chronic Kidney Disease with rapid progression
        1. Unexplained decrease in GFR >30% over 4 months
      3. Acute failure complicating Chronic Kidney Disease
      4. Unclear etiology for Renal Failure
      5. Renal biopsy
      6. Nephrotic sediment (e.g. lipiduria)
      7. RBC casts (indicates an urgent referral)
      8. Urine Eosinophils
      9. Refractory Hypertension despite at least 3 antihypertensives
      10. Significant Proteinuria
        1. 24 Hour Urine Protein > 1000 mg
        2. Protein to Creatinine ratio >500-1000 mg/g
        3. Albumin to Creatinine ratio >300 mg/g
      11. Acute Tubular Necrosis
      12. Significant comorbidity (e.g. cardiovascular disease)
      13. Complications of Chronic Kidney Disease
        1. Anemia of Chronic Kidney Disease
        2. Bone and mineral disorders of Chronic Kidney Disease
        3. Hyperkalemia (Potassium >5.5 meq despite modification of therapy)
  21. Management: End Stage Renal Disease
    1. Hemodialysis or Peritoneal Dialysis
      1. Absolute Dialysis Indications
        1. Uremic Symptoms
        2. Uremic Pericarditis
      2. Relative Dialysis Indications
        1. Hypervolemia
        2. Hyperkalemia or other electrolyte abnormalities
        3. Severe Metabolic Acidosis
        4. Creatinine Clearance <10 ml/min (<15 ml/min in Diabetes Mellitus)
    2. Renal transplantation
      1. Less rejection if transplant before Dialysis started
      2. Mange (2001) N Engl J Med 344:726-31 [PubMed]
    3. Conservative management options
      1. Non-Dialysis with Hospice care
      2. Delayed Dialysis until Creatinine Clearance <5 ml/min (similar morbidity and mortality)
        1. Cooper (2010) N Engl J Med 363(7):609-19 [PubMed]
  22. Management: Anemia
    1. Erythropoietin (EPO)
      1. Efficacy
        1. Initial studies showed benefit for Erythropoietin
          1. Renicki (1995) Am J Kidney Dis 25:548-54 [PubMed]
        2. Recent studies show no benefit and higher risk of Cerebrovascular Accident
          1. Outcomes are the same with and without normalized Hemoglobin via erythropoetin
          2. Morbidity and patient sense of well-being is not improved on erythropoetin
          3. Pfeffer (2009) N Engl J Med 361 [PubMed]
      2. Indications for Erythropoeitin
        1. Hemoglobin <9 mg/dl
      3. Adverse effects
        1. Increased risk of Cerebrovascular Accident
    2. Iron Supplementation
      1. Often indicated in Hemodialysis patients
      2. Parenteral replacement is often needed (decreased oral absorption)
        1. Non-dextran IV Iron
          1. Indicated in significant Iron Deficiency refractory to oral replacement
          2. Options: Ferumoxytol (Feraheme), iron sucrose (venafer) or Sodium Ferric Gluconate (Ferrlecit)
        2. Ferric pyrophosphate (Triferic)
          1. Available in 2015 (U.S.)
          2. Indicated for maintenance iron infusion
          3. May be delivered inline with Hemodialysis
      3. References
        1. (2015) Presc Lett 22(4)
  23. Management: Symptomatic Management in ESRD
    1. Agitation
      1. Haloperidol 1 mg PO, IV or IM every 12 hours
    2. Anorexia
      1. Minimize Uremia with adequate Dialysis frequency
      2. Consider Major Depression, Gastroparesis, and Xerostomia
      3. Dronabinol 2.5 mg orally before meals
      4. Megestro 400 mg orally daily
      5. Prednisone 10 mg orally daily
    3. Dyspnea
      1. Regular Physical Activity to prevent deconditioning
      2. Fentanyl (Duragesic) 12.5 mg IV or SQ every two hours as needed for end-of-life
    4. Fatigue
      1. Treat Anemia if present
      2. Consider Depression Management with Fluoxetine 20 mg daily or Sertraline 50 mg daily
    5. Nausea and Vomiting
      1. Minimize Uremia with adequate Dialysis frequency
      2. Ondansetron 4 mg orally every 8 hours
      3. Metoclopramide (Reglan) 5 mg twice daily
      4. Haloperidol (Haloperidol) 0.5 mg orally every 8 hours
    6. Pruritus
      1. Minimize Uremia with adequate Dialysis frequency
      2. Phosphate Binders
      3. Standar Dry Skin therapy (e.g. barrier creams)
      4. Ondansetron 4 mg orally every 8 hours
      5. Hydroxyzine (Atarax or Vistaril), 25 mg orally every 6 hours
      6. Naltrexone (Revia) 50 mg orally daily
      7. Phototherapy (UV-B Light)
    7. Insomnia
      1. See Sleep Hygiene
      2. Treat Restless Leg Syndrome
      3. Treat Obstructive Sleep Apnea
      4. Zolpidem 5 mg orally at bedtime
      5. Temazepam (Restoril) 15 mg orally at bedtime
  24. Management: Advanced Directives
    1. Cardiopulmonary Resuscitation (CPR)
      1. Survival in ESRD is only 8% at hospital discharge and 3% at six months
      2. Contrast with CPR in non-ESRD with survival of 12% at discharge and 9% at six months
      3. Discuss Do-Not-Reuscitate status at routine visits
    2. Hospice
      1. Criteria to qualify for Hospice services paid by medicare in End Stage Renal Disease
        1. ESRD on no-Dialysis management or
        2. ESRD on Dialysis and other Hospice qualifying condition (e.g. cancer)
  25. Complications
    1. Cardiovascular Disorders
      1. See Hypotension in the Dialysis Patient
      2. Coronary Artery Disease (21% of ESRD cases)
      3. Peripheral Vascular Disease
      4. Cardiac arrhythmias
      5. Congestive Heart Failure
      6. Erectile Dysfunction
      7. Pericarditis
      8. Hypertension
      9. High-output Heart Failure (secondary to Anemia or arteriovenous fistula)
      10. Uremic Pericardial Effusion
        1. Consider in Chronic Renal Failure with Dyspnea
    2. Neurologic disorders
      1. Uremic encephalopathy (memory loss, slurred speech, asterixis)
      2. Dialysis Dementia (associated with >2 years on Dialysis)
      3. Peripheral Neuropathy
      4. Restless Leg Syndrome
      5. Sleep Disorders
      6. Thiamine deficiency (and Wernicke's Encephalopathy)
        1. Hung (2001) Am J Kidney Dis 38(5):941-7 +PMID:11684545 [PubMed]
    3. Fluids, Electrolytes and Nutrition
      1. Metabolic Acidosis
      2. Muscle wasting and malnutrition
      3. Pseudogout
      4. Uremia (Nausea, Vomiting, anorexia)
    4. Gastrointestinal disorders
      1. Chronic Constipation
      2. Gastritis
      3. Peptic ulcers
      4. Uremic Gastroparesis
    5. Skin disorders
      1. Pruritus
      2. Uremic frost
        1. Occurs in end-stage renal disease with high BUN (untreated or missed Hemodialysis)
        2. Crystallized urea from sweat forms and deposits on the skin
        3. Uremic frost resembles Seborrhea
    6. Miscellaneous disorders
      1. Chronic Kidney Disease related Bone Disease (Renal Osteodystrophy)
      2. Amenorrhea
      3. Uremic platelet disorder
  26. Course
    1. Progression of Chronic Kidney Disease (<55 mmHg) is predictable
      1. Glomerular Filtration Rate (GFR) decreases -4 ml/min per year if no intervention
      2. Intensive management may halt GFR decline
        1. See Prevention of Kidney Disease Progression
    2. Major causes of death in ESRD
      1. Myocardial Infarction
      2. Cerebrovascular Accident
  27. Prognosis
    1. Annual mortality of ESRD: 24%
    2. Five Year survival
      1. All ages: 38%
      2. Age over 65 years: 18%
  28. References
    1. Golder (2003) AAFP Board Review, Seattle
    2. (2002) Am J Kidney Dis 39:s1-266 [PubMed]
    3. Baumgarten (2011) Am Fam Physician 84(10): 1138-48 [PubMed]
    4. Hood (1996) Postgrad Med 100(5):163-75 [PubMed]
    5. Snyder (2005) Am Fam Physician 72(9):1723-32 [PubMed]
    6. (2007) Am J Kidney Dis 49(2 suppl 2):S12-S154 [PubMed]
    7. O&#39;Connor (2012) Am Fam Physician 85(7):705-10 [PubMed]
    8. Rivera (2012) Am Fam Physician 86(8): 749-54 [PubMed]

Kidney Failure, Chronic (C0022661)

Definition (NCI) Impairment of the renal function due to chronic kidney damage.
Definition (CSP) irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance.
Definition (MSH) The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION.
Concepts Disease or Syndrome (T047)
MSH D007676
ICD9 585.6
ICD10 N18, N18.9, N18.0, N18.90
SnomedCT 46177005, 155856009, 197654000, 197755007, 197655004, 90688005
LNC LP146090-8
English Kidney Failure, Chronic, Renal Failure, Chronic, KIDNEY FAILURE CHRONIC, End-Stage Kidney Disease, ESRD, End-Stage Renal Disease, Renal Disease, End-Stage, Renal Failure, End-Stage, Disease, End-Stage Kidney, Disease, End-Stage Renal, End-Stage Renal Failure, Kidney Disease, End-Stage, Renal Disease, End Stage, Renal Failure, End Stage, End Stage Kidney Disease, End Stage Renal Disease, RENAL FAILURE CHRONIC, CRF, Chronic renal failure, unspecified, ESCRF - End stge chr renl fail, End stage renal failure, End-stage renal disease, RENAL FAILURE CHRONIC <UREMIA>, End stage chronic renal failure, End stage chronc renal failure, END STAGE KIDNEY DIS, RENAL DIS END STAGE, END STAGE RENAL DIS, end stage renal failure, chronic renal failure, end stage renal disease, end stage renal disease (diagnosis), chronic renal failure (diagnosis), ESRD (end stage renal disease), Kidney failure chronic, Renal failure chronic, End stage renal disease (ESRD), RENAL FAILURE CHRONIC UREMIA, CRF - Chronic Renal Failure, Chronic renal disease, Chronic renal failure NOS, Kidney Failure, Chronic [Disease/Finding], Unspecified chronic renal failure, chronic kidney insufficiency, Failure;renal;chronic, chronic renal insufficiency, end stage renal disease (ESRD), end-stage renal disease, end-stage renal failure, esrd, chronic kidney failure, end-stage kidney disease, chronic renal failure (CRF), end stage kidney disease, Chronic renal insufficiency, Renal failure, chronic, End-stage renal failure, Renal failure - chronic, Renal failure (chronic), End stage renal failure (disorder), Failure, renal -chronic, Chronic kidney failure, Chronic renal failure, Chronic renal failure syndrome, End-stage kidney disease, End stage renal disease, End stage kidney disease, CRF - Chronic renal failure, ESCRF - End stage chronic renal failure, ESRD - End stage renal disease, ESRF - End stage renal failure, Chronic renal failure syndrome (disorder), End stage renal disease (disorder), disease (or disorder); kidney, end-stage, disease (or disorder); renal, end-stage, Chronic renal failure syndrome, NOS, Chronic Renal Failure, Chronic Renal Disease, Chronic Kidney Failure
French INSUFFISANCE RENALE CHRONIQUE, Défaillance rénale terminale, Insuffisance rénale chronique au stade ultime (IRSU), Insuffisance rénale chronique, Défaillance rénale chronique
Portuguese INSUFICIENCIA RENAL CRONICA, Insuficiência renal de fase terminal, Doença renal de fase terminal, Falência Crônica do Rim, Insuficiência renal crónica, ESRD, Doença Renal Terminal, Insuficiência Renal Terminal, Nefropatia Terminal, Falência Crônica Renal, Falência Renal Crônica
Spanish INSUFICIENCIA RENAL CRONICA, Fallo renal terminal, Fallo renal crónico, Enfermedad renal terminal (ERT), RINON, INSUFICIENCIA CRONICA, Fallo Crónico del Riñón, Fracaso Renal Crónico, enfermedad renal terminal, insuficiencia renal en estadio terminal (trastorno), insuficiencia renal en estadio terminal, Insuficiencia renal crónica, NFF, Enfermedad Renal Terminal, Insuficiencia Renal Terminal, Nefropatía Terminal, Fallo Crónico Renal, Fallo Renal Crónico
Dutch nierfalen chronisch, terminaal nierfalen, terminale nierziekte, aandoening; nier, terminaal, aandoening; renaal, terminaal, Chronische nierinsufficiëntie, niet gespecificeerd, Terminale nierziekte, chronisch nierfalen, Nierfalen, chronisch, Nierfalen, eindstadium-, Nierziekte, eindstadium-, Chronische nierinsufficiëntie, Insufficiëntie, chronische nier-, Nierinsufficiëntie, chronische, Renale insufficiëntie, chronische
German chronisches Nierenversagen, terminales Nierenversagen, terminale Nierenerkrankung (ESRD), Chronische Niereninsuffizienz, nicht naeher bezeichnet, Chronische Niereninsuffizienz, NIERENVERSAGEN CHRONISCH, RENALES VERSAGEN CHRONIC, Terminale Niereninsuffizienz, Nierenversagen chronisch, ESRD, Nierenkrankheit, Endstadium, Nierenversagen, chronisches, Renales Versagen, Endstadium, Renales Versagen, chronisches, Terminale Nierenerkrankung, Chronisches Nierenversagen
Italian Insufficienza renale in stadio terminale, Nefropatia in stadio terminale, ESRD, Malattia del rene allo stadio terminale, Insufficienza renale allo stadio terminale, Malattia renale allo stadio terminale, Insufficienza renale cronica
Japanese 末期腎不全, 末期腎疾患(ESRD), マンセイジンフゼン, マッキジンシッカンESRD, マッキジンフゼン, 腎不全-慢性, 腎機能不全-慢性, 慢性腎不全, 慢性腎機能不全, 腎不全末期, 腎臓疾患末期, 腎不全-末期, 腎臓疾患-末期
Swedish Njursvikt, kronisk
Czech chronická renální insuficience, Konečné stadium renálního onemocnění, Chronické selhání ledvin, Chronické renální selhání, chronické selhání ledvin, ledviny - selhání chronické, Chronic Kidney Disease, CKD
Finnish Krooninen munuaisten vajaatoiminta
Korean 상세불명의 만성 콩팥(신장)기능상실, 만성 콩팥(신장)기능상실, 말기 콩팥(신장)병
Polish Schyłkowa niewydolność nerek, Niewydolność nerek przewlekła krańcowa, Niewydolność nerek przewlekła całkowita, Przewlekła nieodwracalna niewydolność nerek, Niewydolność nerek schyłkowa
Hungarian Chronikus veseelégtelenség, chronikus veseelégtelenség, végstádiumú veseelégtelenség, végstádiumú vesebetegség (ESRD)
Norwegian Kronisk nyresvikt, ESRD
Derived from the NIH UMLS (Unified Medical Language System)

Renal Insufficiency (C1565489)

Definition (MSH) Conditions in which the KIDNEYS perform below the normal level in the ability to remove wastes, concentrate URINE, and maintain ELECTROLYTE BALANCE; BLOOD PRESSURE; and CALCIUM metabolism. Renal insufficiency can be classified by the degree of kidney damage (as measured by the level of PROTEINURIA) and reduction in GLOMERULAR FILTRATION RATE.
Concepts Disease or Syndrome (T047)
MSH D051437
SnomedCT 197657007, 236423003
Italian Danno renale, Insufficienza dei reni, Funzionalità renale ridotta, Danno renale NAS, Insufficienza renale
Dutch renale insufficiëntie, nierfunctie verminderd NAO, afgenomen nierfunctie, insufficiëntie; nier, nier; insufficiëntie, nierfunctie verminderd
French Troubles de la fonction rénale, Atteinte de la fonction rénale SAI, Insuffisance du rein, Atteinte de la fonction rénale, Insuffisance rénale
German Insuffizienz der Niere, Niereninsuffizienz NNB, beeintraechtigte Nierenfunktion, Nierenfunktionsbeeintraechtigung, Niereninsuffizienz, Renale Insuffizienz
Portuguese Compromisso renal NE, Insuficiência renal, Função renal insuficiente, Compromisso renal, Insuficiência Renal, Insuficiência do Rim
Spanish Fallo renal, Alteración renal NEOM, Función renal alterada, Insuficiencia renal, Insuficiencia del Riñón, compromiso de la función renal, disfunción renal (trastorno), disfunción renal, fallo renal, Alteración renal, Insuficiencia Renal
Japanese 腎機能不全, 腎機能障害NOS, ジンキノウフゼン, ジンキノウショウガイ, ジンキノウショウガイNOS, 腎機能障害, 腎機能異常, 腎機能低下
Swedish Njurfunktion, nedsatt
Czech ledviny - nedostatečnost, renální insuficience, Renální poškození, Renální postižení NOS, Renální insuficience, Renální nedostatečnost
Finnish Munuaisten pitkäaikainen vajaatoiminta
English renal insufficiency, renal insufficiency (diagnosis), Renal impairment NOS, Renal Insufficiency [Disease/Finding], Insufficiency;renal, kidney insufficiency, renal insufficiencies, impaired renal function, impairments renal, function impaired renal, impairment renal, renal impairment, Renal insufficiency, Impaired renal function, Renal impairment, Renal impairment (disorder), insufficiency; renal, kidney; insufficiency, Insufficiency renal, Kidney Insufficiency, Kidney Insufficiencies, Renal Insufficiencies, Insufficiency, Kidney, Renal Insufficiency
Polish Niedomoga nerek, Zaburzenia czynności nerek, Niewydolność nerek
Hungarian Károsodott vesefunkció, vesekárosodás k.m.n., Veseelégtelenség, vesekárosodás
Norwegian Nyreinsuffisiens, Nyrefunksjon, nedsatt
Croatian Renalna insuficijencija, Zatajivanje bubrega
Derived from the NIH UMLS (Unified Medical Language System)

Chronic kidney disease stage 5 (C2316810)

Definition (NCI) Long-standing and persistent renal disease with glomerular filtration rate (GFR) less than 15 ml/min.
Definition (NCI_FDA) Chronic, irreversible renal failure.
Concepts Disease or Syndrome (T047)
ICD10 N18.6, N18.5
SnomedCT 433146000
LNC LP128701-2, LP135358-2, MTHU040642
English End Stage Kidney Disease, End Stage Kidney Failure, End Stage Renal Failure, chronic kidney disease stage 5 (diagnosis), chronic kidney disease stage 5, Chronic kidney disease stage 5 (disorder), chronic kidney disease, stage 5, Chronic Kidney Disease, Stage 5, End Stage Renal Disease, Chronic kidney disease stage 5, End stage renal disease, CKD stage 5, Chronic kidney disease, stage 5, End-Stage Renal Disease, End-stage renal disease, RENAL DISEASE, END STAGE, END STAGE RENAL DISEASE (ESRD), DISEASE (ESRD), END STAGE RENAL, RENAL DISEASE (ESRD), END STAGE, ESRD, END STAGE RENAL DISEASE, ESRD
Spanish enfermedad renal crónica, estadio 5 (trastorno), enfermedad renal crónica estadio 5, enfermedad renal crónica estadio 5 (trastorno), enfermedad renal crónica, estadio 5
Derived from the NIH UMLS (Unified Medical Language System)

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