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Renal failure

Renal failure is the condition where the kidneys fail to function properly. Physiologically, renal failure is described as a decrease in the glomerular filtration rate. Clinically, this manifests in an elevated serum creatinine. more...

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It can broadly be divided into two categories: acute renal failure and chronic renal failure.

  • Chronic renal failure (CRF) develops slowly and gives few symptoms initially. It can be the complication of a large number of kidney diseases, such as IgA nephritis, glomerulonephritis, chronic pyelonephritis and urinary retention. End-stage renal failure (ESRF) is the ultimate consequence, in which case dialysis is generally required while a donor for renal transplant is found.
  • Acute renal failure (ARF) is, as the name implies, a rapidly progressive loss of renal function, generally characterised by oliguria (decreased urine production, quantified as less than 400 to 500 mL/day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants), body water and body fluids disturbances and electrolyte derangement. An underlying cause must be identified to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these underlying causes.

Acute renal failure can present on top of (i.e. in addition to) chronic renal failure. This is called acute-on-chronic renal failure (AoCRF). The acute part of AoCRF may be reversible and the aim of treatment, like in ARF, is to return the patient to their baseline renal function, which is typically measured by serum creatinine. AoCRF, like ARF, can be difficult to distinguish from chronic renal failure, if the patient has not been followed by a physician and no baseline (i.e. past) blood work is available for comparison.


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Coenzyme Q10 for chronic renal failure
From Townsend Letter for Doctors and Patients, 10/1/05 by Alan R. Gaby

Ninety-seven patients (mean age, 48 years) with chronic renal failure (serum creatinine > 5 mg/dl), with a history of declining renal function for at least 12 weeks, were randomly assigned to receive, in double-blind fashion, water-soluble coenzyme Q10 (CoQ10; 60 mg, 3 times per day orally) or placebo for 12 weeks. The 45 patients who were receiving hemodialysis at the start of the study were encouraged to decrease the frequency or stop dialysis if there was an increase in urine output and a decrease in serum creatinine of more than 2 mg/dl. In the patients receiving hemodialysis and CoQ10, the mean serum creatinine concentration decreased from 9.5 to 6.7 mg/dl; mean BUN decreased from 88.2 to 79.8 mg/dl; mean creatinine clearance increased from 40 to 54.9 ml/min; and 24-hour urine output increased from 1,300 to 1,920 ml. Renal function tended to worsen in hemodialysis patients receiving placebo, and the differences in the changes between groups were significant (p < 0.01 to p < 0.001). Significant improvements in each of these parameters relative to the placebo group were also seen in the non-dialysis patients treated with CoQ10. The number of patients receiving dialysis decreased from 21 to 12 in the CoQ10 group, and remained unchanged at 24 in the placebo group (p < 0.02). Eighty-one percent of the patients receiving CoQ10 had a positive response to treatment.

Comment: These results suggest that CoQ10 can improve renal function and reduce the need for dialysis in patients with chronic renal failure. The public-health implications of this study are enormous, considering that chronic renal failure is a serious and debilitating disease and that the annual cost of dialysis in the United States is more than $22 billion.

According Dr. Singh, the lead author of this study (Interview with Kirk Hamilton; Clinical Pearls News, August, 2001, pp. 128-9), CoQ10 is usually effective if pre-treatment urine output, with or without furosemide, is at least 1,000 ml/day. However, if urine output is less than 500 ml/day, then CoQ10 usually does not work, presumably because the kidney has been irreversibly damaged. Dr. Singh recommends that that all patients with renal failure take 180 mg/day of water-soluble CoQ10 if their urine output is greater than 500 ml/day on dialysis. If urine output increases to 1,000 ml/day within 12 weeks, then CoQ10 is likely to be effective. Patients should be able to stop dialysis within 12-48 weeks if the urine output goes above 1,500 ml/day. If urine output does not increase in 12 weeks, then CoQ10 is unlikely to be effective.

While the mechanism by which CoQ10 improves renal function is not clear, it may work by improving cellular bioenergetics. Large controlled trials are urgently needed.

Singh RB, et al. Randomized, double-blind, placebo-controlled trial of coenzyme CoQ10 in patients with end-stage renal failure. J Nutr Environ Med 2003; 13:13-22.

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group

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