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Dr. Yael BOROVICH

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Chronic renal failure - Diagnosis

Alexey Kryvenko, Medical Reviewer, Editor
Last reviewed: 06.07.2025

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Inspection and physical examination

In the terminal stage of chronic renal failure, patients are sluggish and apathetic. The skin is pale, dry, icteric, with a gray tint (anemia and urochrome staining), with hemorrhages, bruises and traces of scratching. Pericarditis is accompanied by pericardial friction rubs.

Laboratory diagnostics of chronic renal failure

Early diagnosis of chronic renal failure is based on laboratory methods.

Polyuria with nocturia, persistent arterial hypertension combined with anemia, symptoms of gastroenteritis and secondary gout, hyperphosphatemia with hypocalcemia indicate chronic renal failure.

The most informative and reliable methods are the determination of the maximum relative density or osmolarity of urine, the value of the CF and the level of creatinine in the blood. Depression of the maximum relative density of urine below 1018 in the Zimnitsky test with a decrease in the CF below 60-70 ml/min indicates the initial stage of chronic renal failure. The method of calculating the CF using the Cockroft-Gault formula is more accurate, since it takes into account the age, body weight and sex of the patient.

CF (for men) = (140 - age, years) x m: (72 x Cr), CF (for women) = (140 - age, years) x m x 0.85: (72 x Cr),

Where m is body weight, kg; Cr is blood creatinine, mg/dl.

Azotemia (creatinine over 1.5 mg/dl) is detected at a later stage of chronic renal failure - with a decrease in CF to 30-40 ml/min. Chronic renal failure in diabetic nephropathy is more difficult to diagnose compared to non-diabetic nephropathies. Diagnosis of chronic renal failure using the Zimnitsky test is difficult due to glucosuria. In addition, with muscle mass deficiency and liver steatosis characteristic of severe diabetes, the level of creatinine and urea in the blood does not reflect the severity of chronic renal failure. Calculation of the CF value using the Cockroft-Gault formula is more informative.

In uremic hyperparathyroidism, hyperphosphatemia and hypocalcemia, an increase in the level of the bone fraction of alkaline phosphatase and PTH in the blood are detected. Hypoproteinemia and hypoalbuminemia indicate long-term nutritional status disorders caused by chronic renal failure.

Instrumental diagnostics of chronic renal failure

A decrease in the size of the kidneys is typical, according to ultrasound or radiographic examination of the kidneys.