Understanding Chronic renal failureChronic Renal Failure (CRF) or end-stage renal disease is a chronic renal failure is progressiveand irreversible. Where the ability of the body fails to maintain metabolism and fluid andelectrolyte balance, leading to uremia (retention of urea and other nitrogen wastes in the blood)(KMB, Vol 2 p. 1448).EtiologyCauses of chronic renal crow quite a lot but for clinical purposes can be divided into 2 groups:1. Renal parenchymal diseasePrimary renal disease: Glomerulonephritis, Mielonefritis, polycystic kidney, renal tuberculosisSecondary renal disease: lupus nephritis, nephropathy, kidney Amilordosis, Poliarteritis nodasa, progressive systemic sclerosis, gout, DmEtiology2. Obstructive renal disease: an enlarged prostate, urinary tract stones, ureteric reflux,Broadly speaking, the causes of kidney failure can be categorizedInfections are recurrent and the deteriorating nephronUrinary tract obstructionDestruction of blood vessels due to diabetes and hypertension of the oldScar tissue and direct trauma to the kidneyPathophysiologyTwo theoretical approaches are usually proposed to explain the renal failure in chronic renalfailure:1. Traditional viewpointTo say that all units of the nephron have been stricken with the disease but in different stages,and specific parts of the nephron is associated with certain functions can be completely destroyedor changed its structure, such as organic lesion in the medulla will damage the anatomicarrangement of the loop of Henle .2. Bricker hypothesis approach or an intact nephron hypothesisArgues that if the diseased nephron of its units will be destroyed, but the remaining intactnephrons continue to work normally. Uremia will arise when the number of nephrons that have been so reduced so that the fluid and electrolyte balance can not be maintained anymore.Important adaptation performed by the kidneys in response to the threat of fluid and electrolyteimbalance. Existing remnant nephrons hypertrophy in its effort to implement the entire kidneyworkload, there is increased filtration speed, load and reabsorption of solutes in each nephrontubules contained in normal kidney dibawab down.Adaptation mechanism is quite successful in maintaining fluid and electrolyte balance of the body to a low level of kidney function.But eventually if 75% nephron mass has been destroyed, then the filtration speed and load for each nephron solutes so high that the balance glomerolus-tubules can no longer be maintained.