Chronic renal failure: develops insiduously. It results from a gradual but progressive loss of normal renal function. In most instances, it occurs in four steps:
- Diminished renal reserve: These patients do not have clinical or laboratory signs of renal disease (BUN and Cr are normal). Additional testing will reveal that GFR is significantly reduced, and azotemia may develop during intercurrent diseases.
- Renal insufficiency: These patients have reduced GFR (20-50% of normal) and show signs of reduced tubular function. Laboratory findings include azotemia, anemia, and polyuria.
- Renal failure: These patients have markedly reduced GFR (<20% of normal), edema, metabolic acidosis, hypocalcemia, and multisystemic signs of uremia.
- End-stage renal failure: These patients have almost no measurable GFR (<5% of normal) and show clinical signs of uremia.
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