And finally, if all else fails, call it "chronic glomerulonephritis". Seen here are atrophic kidneys with a thin cortex from a patient at autopsy with chronic renal failure (CRF). About a third to half of patients with CRF slowly reach end stage without significant signs or symptoms along the way, and at the end stage renal disease (ESRD) there are no diagnostic features and, therefore, no point in performing a renal biopsy. A steadily rising serum creatinine and urea nitrogen are clues. Most patients will also be hypertensive. (Some simple cysts are also seen here.)

The relationship of serum creatinine as a measure of renal function reflected in the creatinine clearance is shown below: