The Foundation for IgA Nephropathy
Chronic Renal Insufficiency
What is renal insufficiency?
Renal insufficiency, also called renal failure, is when your kidneys no longer have enough kidney function to maintain a normal state of health. Note that the term renal failure is beginning to be replaced by renal insufficiency when in the context of chronic kidney disease. There are two kinds.
Acute renal failure (ARF). This is kidney failure that happens rather suddenly, where something has caused the kidneys to shutdown. This may be due to infection, drugs (prescription, over-the-counter, recreational), traumatic injury, major surgery, nephrotoxic poisons, etc. Emergency dialysis may be needed until the situation resolves and the kidneys begin functioning again (this might take a short time, or months, or it might be permanent). While more acute episodes are possible in the case of IgAN (we often refer to them as "flare-ups"), IgA nephropathy is a condition that mainly causes chronic renal insufficiency (CRI), not usually acute renal failure (ARF). However, some people may experience spontaneously-reversing acute renal failure as well. The latter are cases where serum creatinine goes up dramatically but later returns to a more normal baseline. In such cases, dialysis may be needed until the condition improves. ARF in the context of IgAN is usually more associated with the person developing a flare-up of HSP.
Chronic renal insufficiency (CRI). This is when a disease such as IgA nephropathy slowly and gradually destroys the filtering capacity of the kidneys. It is sometimes referred to as progressive renal insufficiency, chronic kidney disease or chronic renal failure (CRF). This kind of damage cannot currently be repaired, and as such, it is irreversible. A person may have chronic renal failure for many years, even decades, before dialysis or a kidney transplant become necessary. Chronic renal insufficiency does not, by itself, mean complete shutdown of the kidneys, and a person with chronic renal insufficiency may still pass urine normally, and may have more than enough kidney function left for normal functioning of the body. Note that you cannot judge the efficiency of your kidneys by the amount of urine you produce. People with quite advanced renal insufficiency, and even people on dialysis may still produce a fair amount of urine. But this does not mean that the kidneys are filtering waste nor regulating serum electrolyte levels efficiently.
Chronic renal insufficiency itself causes more loss of kidney function. One important aspect of kidney disease is that, once a kidney is damaged by it to a certain degree, it continues to deteriorate even if the underlying kidney disease can or could be cured. This is commonly referred to as the point of no return (PNR).What happens is that the chronic renal insufficiency (CRI) continues to progress on its own, scarring of the glomeruli continues, and kidney function continues to gradually decline. It's possible that controlling blood pressure with an ACE inhibitor like ramipril, or an angiotensin II receptor blocker like Cozaar or Avapro may slow this progression of chronic renal insufficiency. There is also beginning to be some evidence that the class of anti-cholesterol drugs called "statins" (like Lipitor, for example) may help slow progression of CRI. The point of no return is generally considered to be when serum creatinine reaches 2.0 mg/dl in U.S. measurements, or about 175 umol/L in international SI measurement.
End-stage renal disease. As chronic renal insufficiency continues and progresses, the person may eventually reach the point where it is considered to be end-stage renal disease (ESRD), which is the subject of a different section on this website (see main menu).