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April 07, 2008

Chronic Renal Failure

Chronic Renal Failure


The Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation (NKF) defines Chronic Kidney Disease (CKD) as either kidney damage or a decreased kidney glomerular filtration rate (GFR) of <60>m2, for 3 or more months.


K/DOQI (February 2002) published a classification of the stages of CKD, as follows:

Whatever the underlying etiology, the destruction of renal mass with irreversible sclerosis and loss of nephrons leads to a progressive decline in GFR.







The Cockcroft-Gault Formula
Severe Renal Impairmenta

CrCl must be calculated simply by using the Cockcroft-Gault formula in elderly people so that appropriate drug dosing adjustments can be made and nephrotoxins can be avoided in patients who have more extensive CKD than would be suggested by the serum creatinine alone.



Diferential Diagnosis

Acute Renal Failure


Medical Care:


  • Iron salts -- Nutritionally essential inorganic substances used to treat anemia.
    • Ferrous sulfate (Feosol, Feratab, Slow FE)
    • Iron dextran (DexFerrum, InFed) -- Used to treat microcytic, hypochromic anemia resulting from iron deficiency when oral administration is unfeasible or ineffective.
    • Iron sucrose (Venofer) -- Used to treat iron deficiency (in conjunction with erythropoietin) due to chronic hemodialysis.
    • Ferric gluconate (Ferrlecit) -- Replaces iron found in hemoglobin, myoglobin, and specific enzyme systems. Allows transportation of oxygen via hemoglobin.
  • Recombinant human erythropoietin -- Stimulates erythroid progenitor cells.
    • Darbepoetin (Aranesp) -- Erythropoiesis stimulating protein closely related to erythropoietin, a primary growth factor produced in kidney that stimulates development of erythroid progenitor cells.
  • Calcimimetic agents -- These agents reduce parathyroid hormone levels.
    • Cinacalcet (Sensipar) -- Directly lowers intact parathyroid hormone (iPTH) levels by increasing sensitivity of calcium sensing receptor on chief cell of parathyroid gland


Edited By C14

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