Kidneys suffer from various types of insults like immunological inflammation (nephritis), drug toxicities, systemic diseases like diabetes producing nephropathy, from hypertension, stone and urinary infection. 30% of patients with advanced kidney failure in Kerala are due to diabetes. All efforts should be put in preventing further progression and damage to the remaining kidney function so that End stage Renal Disease (ESRD) is delayed.

The diagnosis of chronic renal failure is by exclusion of detectable and correctable factors. Symptoms are very vague and may not attract attention of the patient or the treating physician. As the kidney fails, accumulation of waste materials and fluid do occur in the body. Usual symptoms are decreased urine, more urination at night, Oedema legs, puffiness face, hypertension, anorexia, vomiting, shortness of breath, anaemia etc. Kidney biopsy will give details of chronic renal parenchymal disease.

Despite good treatment kidney failure progress. Once kidney failure is permanent prevention/delaying the further progression of the disease should be aimed. When blood urea/creatinine exceeds consistently 130-150 mg%/6-8-mg% respectively or if patient is symptomatic early entry for dialysis support/transplantation is recommended.