Chronic Renal Failure (ESRD-End stage Renal Disease)

Chronic Renal Failure (ESRD-End stage Renal Disease)

Definition

Chronic or irreversible renal failure is a progressive reduction of functioning renal tissue or loss of renal function in which the body’s ability to maintain metabolic and fluid electrolyte balance fails, resulting in uremia or azotemia over a period of months or years.

Causes

•               Diabetic Nephropathy

•               Hypertension

•               Glomerulonephritis

•               Pyelonephritis.

•               HIV nephropathy

•               Reflux nephropathy in children

•               Polycystic kidney disease

•               Kidney infections and obstructions

•               Chronic pyelonephritis

•               Head, Cadmium, mercury and chromium

Clinical manifestation

•               Amenorrhea

•               Testicular atrophy

•               Malaise and Fatigue

•               Pitting edema

•               Periorbital edema

•               Engorged neck veins

•               CHF

•               Anorexia

•               Nausea

•               Vomiting

•               Seizure

•               Constipation

•               Peptic ulceration

•               Diverticulosis

•               Anemia

•               Pruritus

•               Jaundice

•               Hypertension

•               Pericarditis

•               Peripheral neuropathy, dialysis dementia

Diagnosis

•               History collection

•               Physical examination

•               Identification of reversible renal disease

•               Renal ultrasound

•               CT scan / Doppler

•               Renal biopsy

•               Blood-BUN, creatinine, electrolytes, Hb level

•               Urine analysis

•               Renal biopsy

Management

Medical

•               Calcium and phosphorous binders and phosphate binders

•               Anti hypertensive drugs-to control BP

•               Hypoglycemic agents-to reduce and maintain blood sugar level

•               Fluid restriction-600 ml plus previous day output)

•               Diuretics-to increase the output

•               Erythropoien-to maintain RBC count

•               Dialysis

•               Peritoneal

•               Hemodialysis

Diet

•               Low protein - 0.8 gm protein/kg/day with normal carbohydrate

•               Low potassium (avoid bananas, dry fruits, fruit juices), low phosphorus (soak vegetables 24 hr prior to cooking).

•               Fluid allowances per day is 500 ml to 600 ml plus previous day urine output

Surgical management

•               Renal transplantation

Nursing management

•               Assessing fluid status and ideentifying potential source of imbalance

•               Implementing a dietery program to ensure proper nutrional intake

•               Promoting positive feelings by encouraging increased self-care and greater independence

•               Provide explanations and information to the patient and family concerning ESRD, treatment options and potential complications.

•               Provide emotional support to the patient and family

•               Health education on diet and fluids.

Complications

•               Hyperkalemia

•               Pericarditis

•               Pericardial effusion

•               Pericardial tamponade

•               Hypertention

•               Anaemia

•               Increased incidence of fracture