The following steps should be adopted for a proper management of
patients with chronic renal failure.Step 1. CONFIRMATION OF CHRONICITY OF THE KIDNEY
DISEASE.
This could be achieved through the following:
a. History: A long history of renal disease suggests chronicity while
absent previous history suggests acute renal failure.
b. Kidney size as detected by ultrasonography: A small atrophic kidney
favours the diagnosis of chronic renal failure, while a normal sized
kidneys is more in favour of acute renal failure.c. Magnitude of the increase in serum creatinine in relation to the
presenting symptoms: High serum creatinine with minimal symptoms is
in favour of chronic renal disease, while relatively low serum creatinine
with severe symptoms is in favour of acute renal disease.d. Hyperphosphataemia and osteodystrophy are present more with
chronic cases.e. Anaemia is more with chronic cases.f. Renal biopsy: extensive renal interstitial fibrosis and tubular atrophy in
renal biopsy are features of chronic cases.