RENAL FAILURE

Manelle R. Singzon BSN 4A1-1

RENAL FAILURE
renal

insufficiency Inability to excrete metabolic waste products and water, as well as causing functional disturbances of all body systems. Decrease in glomerular filtration rate.

(2) TYPES
ACUTE

RENAL FAILURE (ARF)

CHRONIC

RENAL FAILURE

ACUTE RENAL FAILURE

acute kidney injury Rapidly progressive loss of renal function with progressive elevations of BUN, Creatinine and Potassium. Generally characterized by oliguria and fluid & electrolytes imbalance.

(3) MAJOR CLASSIFICATIONS:

PRERENAL INTRARENAL POST-RENAL

PRERENAL
Hypovolemia

Shock
Blood

loss Cardiovascular d/o Burns sepsis

INTRARENAL
inflammation

Parenchymal
Ischemia Nephrotoxic

changes

substances

POST-RENAL
Stones

Blood

clots BPH (Benign Prostatic Hypreplasia) Urethral edema from invasive procedures

(4) STAGES OF ARF

INITIATING OLIGURIC DIURETIC

PHASE PHASE

PHASE
PHASE

RECOVERY

INITIATING PHASE
Onset/

initial phase of injury. 1-3 days with ^ BUN and creatinine and possible decreased urine output.

OLIGURIC PHASE
Urine

output > 400cc/day for older (600-700cc/day ) Lasts 8-14 days or 1-2 weeks k+, Na, Mg

DIURETIC PHASE

Lasts 10 days 3-5mL/day BUN & Creatinine level DANGER! FVD hyponatremia hypotension shock

RECOVERY PHASE
Lasts

from 6- 12 months Avoid nephrotoxic drugs

ASSOCIATED PROBLEMS
METABOLIC

ACIDOSIS HYPERPHOSPHATEMIA HYPOCALCEMIA ANEMIA

PREVENTION
Avoid

nephrotoxic drugs Aminoglycosides Cyclosporine Amphotericin B BUN and Creatinine monitoring

Serum

MANAGEMENT
Restore

chemical balance and prevent complications Identification and treatment of the underlying cause Maintain fluid balance Monitor for over hydration Dialysis- hyperkalemia, severe metabolic acidosis, pericarditis, pulmonary edema

MANAGEMENT
Pharmacologic:
Retention

enema Diuretic therapy Low dopamine dose (1-3g/kg) Phosphate binding agents
Nutritional
Proteins Restrict

therapy

high potassium, sodium and phosphate foods May require parenteral nutrition

NURSING MANAGEMENT
Monitor

fluid and electrolyte balance Reducing metabolic rate Promote pulmonary function Prevent infection Provide skin care Providing support

CHRONIC RENAL FAILURE

chronic

kidney disease Progressive irreversible deterioration of renal function.

CAUSES
DM

Hypertension
Chronic

glumerulonephritis Obstruction of the urinary tract Polycystic kidney disease Infections Nephrotoxic medications

STAGES

STAGE 1

Reduced renal reserve 40-75% loss of nephron function Asymptomatic

STAGE 2

Renal insufficiency 75-90% Increase in serum BUN and creatinine Inability to concentrate urine With polyuria and nocturia

STAGES
STAGE

End

stage of renal disease <10% of nephron function remaining Regulatory, excretory and hormonal functions are lost dialysis

SIGNS and SYMPTOMS

CARDIOVASCULAR
Hypertension
Heart

failure Pericarditis Pulmonary edema

DERMATOLOGIC
Pruritus Uremic

frost (deposit of urea crystals)

ASSESSMENT and DIAGNOSIS

GFR

(Glomerular Filtration Rate) SeruM electrolytes ABG CBC

COMPLICATIONS
Hyperkalemia

Pericarditis
Pleural

effusion Cardiac Tamponade Hypertension Anemia

MEDICAL MANAGEMENT
Maintain

kidney function and homeostasis Treat the underlying cause and contributory factors 1. Pharmacologic therapy
a. Antihypertensives Intravascular control Fluid restriction Sodium restriction

b. Sodium bicarbonate c. Erythropoietin - Hct 33-38% - IV or SC 3x a week - 2-6 weeks to increase Hct d. Iron supplementation e. Anti-seizure agents - diazepam -phenytoin f. Antacids -aluminum based antacids -calcium carbonate

2. Nutritional therapy -regulation of protein intake -regulation of fluid intake -regulation of soduim intake -regulaiton of potassium intake -adequate calories and vitamins 3. Dialysis

NURSING MANAGEMENT
Avoid

complications of reduced renal function Assess fluid status Identify potential sources of imbalance Implement a dietary program Encourage self care and independence

THE END!!!!!

GODBLESS!!