Renal Failure (1)

8/3/2019 Renal Failure (1)

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Acute Renal FailureAcute Renal Failure

a life- threatening disorder

sudden decline in renal function

resulting in the inability to maintain

fluid and electrolyte balance and

excretion of waste products

Categories : Prerenal, intrarenal/

inrtrinsic, postrenal If not treated correctly it will lead to

Chronic RF


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Has three distinct phases

Oliguric

Diuretic

Recovery

1-21 days

usually reversible with treatment

May progress into ESRD, prerenal

azotemia, death Also known as acute kidney injury


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Risk factorsRisk factors

Diabetes (Type I or II)

Chronic renal insufficiency

Heart disease (heart failure)

Hypertension

Advanced age

Sepsis


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CausesCauses

Prerenal conditions do not damage the kidney, but can

cause diminished kidney function.

They are the most common cause of ARF

Shock, hemorrhage, burns, CHF Postrenal conditions cause kidney failure by

obstructing the urinary tract.

inflammation of the prostate gland in men

(prostatitis); enlargement of the prostate gland(benign prostatic hypertrophy); bladder or pelvic

tumors; and kidney stone (renal calculi).


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Intrarenal conditions involve kidney disease or direct

injury to the kidneys.

lack of blood supply to the kidneys (ischemia); the use

of radiocontrast agents during diagnostic tests in

patients with kidney problems; drug abuse or

overdose; long-term use of nephrotoxic medications,

like certain pain medicines; acute inflammation of theglomeruli, or filters, of the kidney; and kidney

infections

Acute Tubular necrosis


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DiagnosticDiagnostic

Blood tests ABG, platelet count, serum and

electrolytes, Bun Urine tests

Urine osmolality, urinalysis Culture & sensitivity CXR Renal Ultrasound/ Sonography ECG

Renal biopsy MRI of abdomen CT Scan


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Sx & symptomsSx & symptoms

Oliguric phase- 1-21 days

Diuretic phase

Metabolic acidosis (pt may have

anorexia Nause and vomiting

Headache


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Twitching convulsions due to uremia(severe)

Hiccups, drowsinesLethargyStupor present by the 6th day and coma by 10th

death may occur after that


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ComplicationsComplications

Renal shutdown

Electrolyte imbalance

Metabolic acidosis Acute pulmonary edema

Hypertensive crisis

HyperkalemiaI infection


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Medical ManagementMedical Management

Low protein, low potassium, low sodiumdiet. Carbs OK.

Prerenal conditions may be treated withreplacement fluids given through a vein,

diuretics, blood transfusion, restrictedsalt intake, or medications.

Postrenal conditions and intrarenalconditions may require surgery and/ormedication.

Dialysis & hemofiltration, to filter fluidsand wastes from the bloodstream untilthe primary medical condition can becontrolled


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Administration off insulin and glucose for hyperkalemia


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Nursing responsibilitiesNursing responsibilities

Measure and record I&O

Weigh patient daily

Maintain proper electrolyte balance

Use sterile technique patients with

ARF are highly susceptible to

infection.

Provide good mouth care. Monitor GI bleeding


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Chronic Acute Renal FailureChronic Acute Renal Failure

a long term (usually slow) deterioration

in kidney function, it is irreversible

is the end result of gradual tissuedestruction

Also known as chronic kidney disease


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CausesCauses

Diabetes mellitus (type 1 or type 2

diabetes) and high blood pressure

Accounts for 75% of CRF

The most common cause of end-stage

renal failure worldwide is IgA nephropathy

Other causes:

Polycystic kidney disease Autoimmune disorders


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Stage GFR Description Treatment

1 90+ Normal kidney function but urine or other abnormalities

point to kidney disease

Observation, control of

blood pressure

2 60-89 Mildly reduced kidney function, urine or other abnormalities

point to kidney diseas

Blood pressure control,

monitoring, find outunderlying cause

3 30-59 Moderately reduced kidney function More of the above, and

probably diagnosis, if not

already made.

4 15-29 Severely reduced kidney function Planning for end stage

renal failure

5 14 or

less

Very severe, or ESRD Renal replacement

therapy

StagesStages


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NDDNDD--CKD vs ESRDCKD vs ESRD

The term non-dialysis dependent CKD,also abbreviated as NDD-CKD, is adesignation used to encompass thestatus of those persons with anestablished CKD who do not yet

require the life-supporting treatmentsfor renal failure known as renalreplacement therapy. Stages 1-4

The condition of individuals with CKD,

who require either of the 2 typesof renal replacement therapy isreferred to as the end-stage renaldisease (ESRD). Stage 5


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Diagnostic TestsDiagnostic Tests

Abdominal Ultrasound

Serum creatinine

Additional tests

MAG3 scan

DMSA scans

*both MAG3 and DMSA are

chelated with the radioactiveelement Technetium-99


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Sx & symptomsSx & symptoms

CKD is initially without specificsymptoms and can only be detectedas an increase in serum creatinine orprotein in the urine. As the kidney

function decreases: Hypertension

Azotemia

Uremia

Uremic frost Pruritus

Hyperkalemia


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Anemia

Edema

Hyperphosphatemia

Metabolic acidosis

Lethargy

Memory impairment Altered mental status *encepalopathy


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ComplicationsComplications

Tertiary hyperparathyroidism

Peripheral Neuropathy

Cardiopulmonary complications GI complications

Sexual dysfunction

Skeletal defects Paresthesias


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TreatmentTreatment

- The goal of therapy is to slow downor halt the otherwise relentlessprogression of CKD tostage 5

Diuretics ACE inhibitors and ACE II inhibitors

Replacementof erythropoietin and calcitriol or

Alfacalcidol, two hormonesprocessed by the kidney, is oftennecessary in patients with advancedCKD.


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Phosphate binders (eg Phosex, Calcichew,

Calcium 500, Renagel, Fosrenol)

Diet: Low protein, salt, potassium and

phosphate

Hemofiltration

Administer Aluminum Hyrdoxide gels as

prescribed alternagel (antacids)


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Renal Replacement therapy

Dialysis

Kidney Transplant


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Nursing ManagementNursing Management

Strict I&O monitoring, weigh the patient

daily

Prevent neurological complications

Promote GI function

Promote maintenance of skin integrity

Monitor or assess signs of bleeding

complications Assess for hyperphosphatemia


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Provide care for patients receiving

dialysis

Prevention of heart disease, stroke and

vascular disease

Encourage smoking cessation

Encourage exercise

Discourage NSAIDS as they can worsenkidney function unless prescribed by AP.


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Types of Kidney DialysisTypes of Kidney Dialysis


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PrePre--dialysisdialysis

Assess clients weight

Assess vital signs before and

every 30mins during procedure Withhold hypertensive drugs,

sedatives and vasodilators

Assemble specially prepareddialysate


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PostPost--dialysisdialysis

Weigh patient

Assess for signs of hypovolemic shock

Asses for signs dialysis disequilibrium

syndrome

urea is more rapidly cleared from the

plasma than from the brain

Irritability, restlessness, nausea ,emesis,hypertension, blurred vision, asterixis,

confusion


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Complications of HemodialysisComplications of Hemodialysis

ComplicationComplication CauseCauseFever Bacteria or fever-causing substances

(pyrogens) in the bloodstream

Overheated dialysate

Life-threatening allergic reaction

(anaphylaxis)

Allergy to a substance in the dialyzer or

blood tubing

Low blood pressure Removal of too much fluid or excessive fluid

gain between dialysis

Abnormal heart rhythms Abnormal levels of potassium and other

substances in the blood

Low blood pressure

Air embolus Air entering blood in the machine

Bleeding in the intestine, brain, eyes, or

abdomen

Use of heparin to prevent clotting in the

machine

Infection Bacteria entering the bloodstream through a

dialysis catheter or through a needle inserted

into veins for hemodialysis access

Renal Failure (1)

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