RENAL FAILURE

GROUP MEMBERS
Markita Witter
Eshonna Smartt
Jamelle Herbert

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OBJECTIVES

State the definition of acute renal failure

State the definition of chronic renal failure
Explain the etiology of both acute and chronic renal failure
Outline the incidence of acute and chronic renal failure
Understanding the pathophysiology of acute renal failure
Understanding the pathophysiology of chronic renal failure
Explain the clinical manifestation of acute renal failure
Explain the clinical manifestation of chronic renal failure
State the complications of acute renal failure
State the complications of chronic renal failure
State the laboratory investigation for (acute, chronic) renal failure

OBJECTIVES CONTD
Understanding the management (medical,surgical,nursing) of both
chronic, acute renal failure
Construct a nursing care plan for a patient with acute renal failure
Construct a nursing care plan for a patient with chronic renal failure

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DEFINITION OF ACUTE RENAL FAILURE

Acute renal failure can be defined as a rapid decreased

in the renal function, leading to the accumulation of
metabolic waste in the body. This situation differs from
the much more gradual decline in renal failure seen in
clients with CRF, although ARF can occur in people with
chronic renal failure insufficiency (CRI). Acute renal
failure in clients with CRI may result in end stage renal
disease to nearly the pre-ARF level of renal function.

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DEFINITION OF CHRONIC RENAL FAILURE

Chronic renal failure (CRF) is a clinical syndrome of

progressive, irreversible kidney injury. When kidney
function is inadequate for sustaining life, chronic renal
failure is referred to as end stage renal disease ESRD

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ETIOLOGY OF ACUTE RENAL FAILURE

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ETIOLOGY OF CHRONIC RENAL FAILURE

The etiology of chronic renal failure is complex more than 100 different
disease processes can cause progressive loss of renal function. The over
lapping nature of the causes of CRF are related to a variety of
classification schemes used to organize the disorders.
Uncontrolled high blood pressure over many years
High blood sugar over many years
Infections such as, pyelonephritis or glomerulonephritis
A narrowed or blocked artery in the kidney
Long term use of medicines such as NSAIDS ( ibuprophen, celecoxib)
Sickle cell disease

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INCIDENCE OF ACUTE RENAL FAILURE

In the past five years there have been major advances in
understanding the epidemiology of ARF. This is no small feat, since
we still lack a centralized registry of patients with ARF. The incidence
of azotemia (including pre- and post-renal ARF), ascertained from
DRG coding of hospital discharge summaries, is projected to be
approximately 275,000 per year in 1997 and increasing at a rate of
16,000 patients per year according to the yearly National Hospital
Discharge Survey. The incidence of ARF is harder to ascertain. Since
ARF is present in about 42% of patients with azotemia9, the
incidence of intrinsic acute renal failure is about 115,000 cases/year.
Thus, intrinsic acute renal failure qualifies as an orphan drug
indication, which has important implications for future drug
discovery.

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PATHOPHYSIOLOGY OF ACUTE RENAL FAILURE

Pre renal failure is caused by a condition that diminishes blood flow
to the kidneys, leading to hypo-perfusion. Hypo-perfusion leads to excess
nitrogenous waste in the blood, this develops into 40%-80% of all cases of
acute renal failure. The accumulation of the waste interrupts renal blood
flow and oxygen delivery which causes hypoxemia and ischemia which
causes damage to the kidney.
The impaired blood flow constricts the afferent arterioles increasing
glomerular permeability resulting in decrease glomerular filtration rate
(GFR) which leads to electrolyte imbalances and metabolic acidosis. The
kidney responds to decrease blood flow by conserving sodium and water.

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PATHOPHYSIOLOGY OF ACUTE RENAL FAILURE CONTD

Intra renal failure

Nephrotoxicity or inflammation damages the delicate layer of the
epithelial cells of the kidneys. Severe or prolonged lack of blood flow by
ischemia leads to renal damage plus there will be excess nitrogen in the
blood.
The fluid loss
hypotension ischemia ischemic cells
toxic
oxygen free radicles causes swelling, injury and necrosis.
The necrosis cause by nephrotoxins tends to be uniform and limit to the
proximal tubules, whereas ischemia, necrosis tends to be patchy and
distribute along various parts of the nephron.

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PATHOPHYSIOLOGY OF ACUTE RENAL

FAILURE CONTD
Postrenal failure
Bilateral obstruction of urine out flow ( the
bladder, ureter, urethra) necrosis,
inflammation, blood clots, prostatic hyperplasia,
tumors postrenal failure.

CLINICAL MANIFESTAION OF ACUTE RENAL FAILURE

Oliguria due to decrease GRF
Tachycardia due to hypotension
Hypotension due to hypovolemia
Edema due to fluid retention
Muscle weakness, when your body's fluids and electrolytes are out of
balance, muscle weakness can result.
Confusion
Shortness of breath, acute kidney failure may lead to a buildup of
fluid in your chest, which can cause shortness of breath.

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Complications
Chronic renal failure
Ischemic parenchymal injury
Intrinsic renal azotemia
Electrolyte imbalance
Metabolic acidosis
Pulmonary edema
Infection

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PATHOPHYSIOLOGY OF CHRONIC RENAL FAILURE

Stages of renal failure, the kidneys tend to fail in an organize fashion., the client
progression towards (ESRD) usually begins with a decreased in renal function.

STAGE 1
Diminished renal Reserve: renal function is reduced but no accumulation of
metabolic wastes occurs:
1. The healthier kidney compensates for the diseased kidney
2. Ability to concentrate urine is deceased, resulting in nocturia and polyuria
3. A 24hour urine for creatinine clearance is necessary to detect that renal
reserve is less than normal

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STAGE 2 RENAL INSUFFIENCY

1.
2.
3.
4.

Metabolic wastes begin to accumulate in the blood because the

unaffected nephrons can no longer compensate
Responsiveness to diuretics is decrease resulting in oliguria and
edema
The decrease of in sufficiency id determined by decreasing GRD
and is classified as mild moderate or severe
Treatment

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STAGE 3 END STAGE RENAL FAILURE

Excessive amount of metabolic waste such as
urea and creatinine accumulate in the blood.
The kidney is unable to maintain
homestatasis.
Treatment is by replacement therapy.

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CLINICAL MANIFESTATION OF CHRONIC RENAL FALIURE

Pericarditis: Can be complicated by cardiac tamponed, possibly

resulting in death.
Encephalopathy: Can progress to coma and death

Peripheral neuropathy

Restless leg syndrome

Gastrointestinal symptoms: Anorexia, nausea, vomiting, diarrhea

Skin manifestations: Dry skin, pruritus, ecchymosis

Fatigue, increased somnolence, failure to thrive

Malnutrition

Erectile dysfunction, decreased libido, amenorrhea

Platelet dysfunction with tendency to bleed

COMPLICATIONS OF CHRONIC RENAL FAILURE

1.
2.
3.
4.
5.
6.
7.

Chronic kidney disease-associated anemia

CKD-associated Mineral and Bone Disorders
Cardiovascular Risk
Dyslipidemia
Nutritional Issues
Sexual Dysfunction
Liver failure

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LABORATORY INVESTAGATIONGS FOR BOTH ACUTE AND

CHRONIC RENAL FAILURE

Blood tests
Urine tests
Liver biopsy
Ultrasounds
Ct scan

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MEDICAL MANAGEMENT FOR ACUTE RENAL FAILURE

Measures to correct underlying causes of acute kidney injury (AKI) should
begin at the earliest indication of renal dysfunction.
Maintenance of volume homeostasis and correction of biochemical
abnormalities remain the primary goals of treatment and may include the
following measures:
Correction of fluid overload with furosemide
Correction of severe acidosis with bicarbonate administration, which can
be important as a bridge to dialysis

Management for Acute renal failure contd.

Correction of hyperkalemia
Hyperkalemia in patients with AKI can be life-threatening. Approaches to
lowering serum potassium include the following:

Decreasing the intake of potassium in diet or tube feeds

Exchanging potassium across the gut lumen using potassium-binding
resins
Promoting intracellular shifts in potassium with insulin, dextrose
solutions, and beta agonists
Instituting peritoneal dialysis to correct fluid and electrolyte imbalance

Correction of hematologic abnormalities (e.g., anemia, uremic platelet

dysfunction) with measures such as transfusions and administration of
desmopressin or estrogens

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Medical management of chronic renal

failure.
Chronic Kidney Disease Medical Treatment

1.
2.
3.
4.

There is no cure for chronic kidney disease.

The four goals of therapy are to:
slow the progression of disease;
treat underlying causes and contributing factors;
treat complications of disease; and
Replace lost kidney function.

Strategies for slowing progression and treating conditions underlying

chronic kidney disease include the following:

Control of blood glucose i.e. hypertonic glucose, insulin

Control of high blood pressure
Diet
Anemia
Fluid retention
Bone disease.
Metabolic acidosis (sodium bicarbonate (baking soda) to correct the
problem)

RENAL FAILURE .

NURSING MANAGEMANT FOR BOTH ACUTE AND CHRONIC RENAL

FAILURE.

Monitor for potential complications.

Assist in emergency treatment of fluid and electrolyte imbalances.
Assess progress and response to treatment; provide physical and emotional support.
Keep family informed about condition and provide support.
Monitoring fluid and Electrolyte Balance
Screen parenteral fluids, all oral intake, and all medications for hidden sources of
potassium.
Monitor cardiac function and musculoskeletal status for signs of hyperkalemia.

NURSING MANAGEMENT CONTD.

Prescribed IV medications should be administered in the smallest volume possible.

Maintain daily weight and intake and output records.

Prepare for emergency treatment of hyperkalemia.
Prepare patient for dialysis as indicated to correct fluid and electrolyte imbalances.
Reduce exertion and metabolic rate with bed rest.
Prevent or treat fever and infection promptly.
Promoting Pulmonary Function.
Assist patient to turn, cough and take deep breaths frequently.
Encourage and assist patient to move and turn.

NURSING MANAGEMENT CONTD.

Practice asepsis when working with invasive lines and catheters.

Avoid indwelling catheters if possible.

Bath the patient with cool water, turn patient frequently, keep the skin
clean and well moisturized and fingernails trimmed for patient comfort
and to prevent skin breakdown.

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SURGICAL MANAGEMENT FOR CHRONIC

RENAL FAILURE

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A NURSING CARE PLAN FOR A PATIENT

WITH CHRONIC RENAL FAILURE
ASSESSMENT:
upon assessment patient was observed to have puffiness of the
eye, distended abdomen due to the accumulation of fluids, edema
to the pherphial extremities (the ankles).
Patient was also observed to be mentally confused and uneasy.
Patient complaint about sever pain to the lower lumbar area of
the vertebrae.

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NURSING CARE PLAN CONTD

NURSING DIAGNOSIS:
Accumulation of fluid built up related to the
dysfunction of the kidneys.

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PLANNING

To reduce the pain within 24hrs from a scale of 1 to 10. where 10

been the most.
Want to reduce the puffiness under the patient eyes within 42hrs.
Reduce the gurd of the abdomen by drainage.
Treat edema and reduce the intertissual fluid
Want to stabilize the patient mentally within 42hrs

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INTERVENTION

Administer prescribed analgesics e.g.

dicolfenac

Assess the patient vital signs

Want to reduce the gurd of the

abdomen

Treat the edema

RATIONAL
To reduce the pain to 5( from a
scale 1 to 10 where 10 been the
most
To obtain a baseline data
especially paying attention to
the respiratory, and blood
pressure
Reduce the accumulation of the
fluid built up in the abdominal
cavity. This will provide comfort
to the patient and aid in
respiration

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GOALS IN EVALUATING
Homeostasis achieved.

Complications prevented or minimized.

Dealing realistically with current situation.
Disease process, prognosis, and therapeutic regimen understood.
Plan in place to meet needs after discharge.