Renal Failure

Renal Failure

Kidneys are two bean-shaped organs located in lower back. It excretes wastes and extra fluids from the body and producing and balancing chemicals that are necessary for body to function

Types

Acute real failure(ARF)

•               Sudden onset

•               Rapid reduction in urine output-usually irreversible

Chronic renal failure(CRF)

•               Progressive

•               Not reversible

1. Acute Renal Failure

Definition

Acute Renal Failure –is a sudden and almost complete loss of kidney function caused by failure of the renal circulation or by glomerular or tubular dysfunction

Causes of ARF

•               Pre-renal (60-70 % )

•               Volume Depletion

•               Hemorrhage

•               Renal losses

•               Sepsis

•               Cardiac failure

•               Anaphylaxis

Intra renal (5-10%)

•               Pigment Nephropathy

•               Myoglobinuria

•               Hemoglobinuria

•               Nephrotoxic agents

Post-renal (20-40% cases)

•               Urinary tract obstruction

•               Calculi

•               Tumors in lower urinary tract

People in risk

•               Being hospitalized especially for a serious condition that requires intensive care

•               Advanced age

Post-renal (20-40% cases)

•               Urinary tract obstruction

•               Calculi

•               Tumors in lower urinary tract

People in risk

•               Being hospitalized especially for a serious condition that requires intensive care

•               Advanced age

•               Blockages in the blood vessels in arms or legs

•               Diabetes

•               High blood pressure

•               Heart failure

•               Kidney diseases

•               Liver disease

Signs and Symptoms of ARF

•               Oliguria - Urine output less than 400ml/ day

•               Anuria - Urine output less than 100ml/day

•               Increased BUN creatinine

•               Hyper Kalemia

•               Metabolic acidosis

•               Edema

•               Mental changes

•               Heart failure

•               Nausea, vomiting

•               Pruritus

Diagnosis

•               History of underlying cause

•               Blood- Increased potassium, BUN, Creatinine

•               Urine: decreased volume and specific gravity is fixed or increased

•               Renal ultrasound, renal scan, renal biopsy, CT scan or MRI, KUB X-ray, Retrograde pyelogram.

Management

•               Removal of the underlying cause

•               Diuretics

•               Fluid restriction (600 ml plus previous day output) Calcium supplements or phosphate binding agents

•               Nutritional therapy

•               -Protein intake 0.6/kg/day

•               -Potassium restriction

•               -sodium restriction

•               -Calorie intake 30 to 35 kcal/day/kg body weight

•               -Dialysis

2. 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