Key facts and checkpoints

• At least 50 to 60 people per million of the population are treated for end-stage renal failure (ESRF) each year.

• Two-thirds of these are under 60 years of age.

• Approximately one-third have glomerulonephritis, 2-18% analgesic nephropathy, 10% diabetes mellitus, 7% polycystic kidney disease, 6% reflux nephropathy and 4% hypertension. ( Table 27.1 ) 3

• The commonest cause of nephritis leading to renal failure in Australia is IgA nephropathy.

• In children the incidence of chronic renal failure is quite low (1 to 2 per million of the population). 3

• Warmer climates, poorer living conditions and certain genetic predispositions are associated with a higher prevalence of renal failure.

• Renal failure should be considered in the diagnosis of patients with:

o unexplained anaemia o unexplained poor health o unusually high analgesic intake 3

• Uraemic symptoms are non-specific and usually are not recognised until the creatinine clearance is less than 20% of normal.

• CRF is characterised by the accumulation of uraemic toxins and a deficiency of renal hormones that cause dysfunction of organs other than kidneys.

• This interaction can cause phosphate retention, secondary hyperparathyroidism and bone disorders such as osteomalacia.

• It is possible to identify stages of renal failure ( Table 27.2 ).

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