Chronic renal Disease and chronic renal failure. first part

Abstract

Chronic Kidney Disease is defined as a pathophysiologic process with multiple etiologies that produces a progressive and ineludible lost of the number offullctional nephrones, with the possibility of giving place to a condition called Chronic Renal Failure, which itself drives the patient to permanently depend on Renal Replacement Therapy. Chronic Renal disease is defined as: renal damage lasting 3 or more months, defined as structural or functional damage with or without decline in Glomerular filtration Rate (GFR), evidenced by pathological abnormalities or renal damage markers or GFR < 60ml/min/1.73 73m2 lasting 3 or more months, with or without renal damage markers. This is the parameter that establishes the stage of renal disease. In 2002 based on the estimates carried out in the North American population, approximately eight million people had a GFR < 60ml/min/1.73 m2, which corresponds to a Renal Disease at least in Stage 3. In absolute numbers, the population with CRF between ages of 45 alld 64 keeps growing and the total incidence since 1981 is tour times bigger (82 ro 334 per million habitants). Regardless of the underlying renal disease (primary  or secondary), the progression of Chronic Renal Disease ends in a common point, characterized by sclerotic and non-functioning glomeruli, tubular atrophy and interstitial fibrosis, with the accumulation of «uremic toxins». Even though, after 150 years of being described for the first time, its adequate characterization is still ellusive. Chronic Renal Disease has sorne associated conditions like anemic syndrome, malnutrition-intlammation syndrome, metabolic acidosis, dyslipidemia and bone disease that increases the morbimonality mainly cardiowascular morbimortality, in this group of patients. Thus, the success in the management of the patients in Renal Replacement Therapy (hemodialysis nr peritoneal dialysis) relies on the adequate and early predialysis managemem looking for slowing the progression speed of tbe disease independemly of the primary cause, but also, to decrease the severity and prevalence of the former mentioned conditions when the dialytic therapy is started.