As a result of slow or chronic involvement of both the kidneys, the size of the kidneys reduces, i.e. they become small in size. As the disease progresses, they become more and more small. An ultrasonographic examination of the kidneys can give a fair idea of the progress of the disease, by measuring the size of the kidneys. However, in acute renal failure (ARF), discussed in the earlier topic, the size of the kidneys remains almost their normal size, since the condition has developed suddenly.

Besides the size of the kidneys, an ultrasonographic examination of the concerned organs may also indicate the underlying pathology causing CRF, e.g. BEP, or urinary stones, or any congenital abnormality of the kidneys, responsible for obstruction in the urinary tract, leading to chronic UTI. As detailed in the topic of UTI, whenever there is an obstruction in the urinary tract, chances of infection in the urinary tract increase considerably.

As a result of small/ shrinking kidneys, their functioning becomes markedly deranged and blood urea, serum creatinine start increasing, leading to various signs and symptoms of CRF. This happens when the disease manifests itself in clinical form, after its hidden phase.

As time passes, due to the constant adverse effects of the disease on the" kidneys, the size of the kidneys may be so markedly reduced, that their functioning may be adversely affected, and these organs may never attain normalcy, i.e., there may occur an irreversible damage to the kidneys, and the patient may have to live on repeated dialysis. Such is the importance of the kidneys in the body, and these are indeed vital for the life of an individual, like other organs of the body, e.g. heart, lungs, liver, brain, etc. Therefore, the kidneys should also be given due attention and care in maintaining the normal health of an individual.

This disease remains hidden for years together; therefore, it can only be diagnosed through a periodic estimation of serum creatinine and urine for albumin, especially in cases that are more prone to the disease, for example, those with GN, with a history of earlier attacks of acute GN, of hypertension, of diabetes mellitus, of UTI, etc. It is ideal if the above tests like serum creatinine and urine exarpination are carried out in all normal persons, at least once a year, and more preferably six-monthly, if facilities are readily available. At least a urine examination for albumin should be done regularly.

If one fails to detect the disease in its hidden form, it should be suspected if the patient complains of any of the vague symptoms, like loss of appetite, general weakness, nausea, vomiting, more so in the morning, especially when these symptoms cannot be accnunted for. Though vague, these are some of the early symptoms of the disease. In such cases, the level of serum creatinine can be determined in the blood, and if it is raised, or even slightly raised, it shows that chronic renal failure should be seriously considered. The raised levels of serum creatinine in the blood shows the extent of derangement of the functions of the kidneys.

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