Acute Renal Failure Introduction
- Renal failure is a disorder in which the kidney is unable to remove waste and body fluid.
- Renal failure is divided into –
- Acute renal failure
- Chronic renal failure
- Acute renal failure is also called acute kidney Disease (AKD).
Acute renal failure sudden, rapid loss of kidney function and is associated with increased creatinine and blood urea nitrogen (BUN).
- Acute kidney Disease is a transient, temporary and reversible disorder.
- Recovery of acute renal disorder depends upon the cause, condition and loss of the client.
renal failure Cause
- Prerenal cause
- Intrarenal cause
- Post renal cause
renal failure Prerenal cause
- Sever fluid and blood loss.
- Haemorrhage and pancreatitis.
- Decrease cardiac output
- Burn and sepsis
- Decreased renal perfusion
- Decrease renal vascular blood flow.
renal failure Intrarenal cause
- Acute tubular necrosis
- Damage structure of renal parenchyma
- Injury in the glomerulus, nephron and renal tubules
- Vascular disease such as inflammation and occlusion
- Nephrolithiasis and nephrotoxic
- Diabetic nephropathy.
Post renal cause
- Urolithiasis and tumour
- Benign prostatic hyperplasia ( BPH )
- Bladder neck obstruction
- Ureteral obstruction
renal failure Signs and symptoms
- Acute renal failure affects renal function like excretion and regulation of body fluid and electrolytes.
- Stages of clinical manifestation –
- Stage of oliguria
- Stage of diuresis
- Stage of recovery.
Stage of oliguria
- Oliguria is defined as urine output less than 400 ml/day.
- Hypervolemia and hypertension
- Right ventricular failure
- Metabolic acidosis
- Kussmaul respiration
- Tingling of extremities
- Pericarditis and chest pain
- Anorexia, nausea, vomiting
Stage of diuresis
- In this stage, urine output more than 2 litre ( polyuria )
- Excessive urine output
- Hypovolemia and hypotension
Stage of recovery
- Strength pelvic muscles
- Return normal urine output
- Regain renal functions
- CNS – improved
- Blood pressure return normal
- Diagnostic investigations are normal.
- History collection and physical examination
- BUN and creatinine ( increased )
- Urine analysis
- Urine electrolytes
- Serum electrolytes
- Renal USG
- CT scan and MRI
- Renal Biopsy
- Monitor and correct fluid and electrolyte balance.
- Provide diuretic therapy ( furosemide and mannitol )
- Sodium bicarbonate and sodium lactate used to treat metabolic acidosis.
- Proton pump inhibitor
- Dialysis – Dialysis helps to remove waste from the kidney, and improve renal functions.
- High-calorie diet.
- Low protein, low sodium and low potassium diet.
- Parenteral nutrition.
- Sometime avoid sodium and potassium diet.
- Chronic renal failure
- Pulmonary edema.
- Nurses monitor vital signs, fluid and electrolyte balance.
- Maintain patient hydration status.
- Administer IV fluid as prescribed.
- Identify the stage of renal failure.
- Monitor urine input and output and urine characteristics.
- Monitor daily weight.
- Provide prescribed medications.
- Provide soda bicarbonate for metabolic acidosis.
- Nurse monitor sign of infection and WBC count.
- Provide the modified diet.
- The nurse prepared for dialysis.
- Nurses provide emotional and physiological support.
- Urine output less than 400 ml/day – oliguria.
- Urine output less than 100 ml/day – Anuria.
- Reversible renal failure disorder – Acute kidney Disease.
- Nursing action, when patient on diuretic therapy –Check daily patient weight.
- Common finding diuretic therapy – Polyuria.
Reference – NCLEX Sounders 2nd Edition Page no. 822-823
Chronic Renal Failure Introduction
- Chronic renal failure also known is chronic kidney disease.
- Chronic kidney disease occurs when GFR decreases to less than 60 ml/minute for 3 months or longer.
- Chronic kidney disease affects all body systems.
renal failure Definition
- Chronic renal failure is a slow, chronic, progressive and irreversible loss of kidney functions, and gradually decline in the GFR and creatinine clearance.
- Gradually decreasing GFR rate leads to the End stage of renal disease (ESRD).
Stage of CKD
- If GFR > 90 ml/minute = normal.
- If GFR 60-89 ml/ minute = mild chronic renal failure.
- If GFR 30-59 ml/minute = moderate chronic renal failure.
- If GFR 15-29 ml/minute = sever chronic renal failure.
- If GFR Less than 15 ml/minute = End stage of kidney disease.
renal failure Cause
- Diabetes mellitus
- Acute kidney Disease
- Glomerular dysfunction
- Chronic renal flow obstruction
- Renal artery obstruction
- Recurrent infection
- Autoimmune disorder
- Polycystic kidney disease
- Medication or toxic agents
- Environmental or occupational agent.
renal failure Pathophysiology
Cause / risk factor
Decrease glomerular filtration rate (GFR)
Loss of nephron function
Loss of renal excretory and excretory function
renal failure Clinical manifestation
- hypertension (due to decrease GFR)
- nausea, vomiting
- Diarrhoea, constipation
- Stomatitis, peritonitis
- Gastric haemorrhage
- Uremic colitis
- Foul ammonia smell.
- kussmaul respiration
- Pleural effusion
- Pulmonary edema
- Depressed cough reflex
- Uremic pneumonia.
- Seizure and tremor
- Slurred speech
- Sleep disturbance
- Ataxia, coma.
- Renal rickets
- Joints pain.
- Dry skin
- Uremic Frost
- Itching and pruritus
- Decreased skin turgor
- Pallor skin.
- Increase triglyceride.
renal failure Diagnostic examination
- History collection and physical examination.
- Blood urea nitrogen (elevated).
- Serum test for – creatinine ( elevated )
- Blood pH- acidosis.
- Urinalysis and urine culture.
- Renal angiography.
- Renal USG.
- Renal biopsy.
- CT scan and MRI.
- Renal scan.
- Random blood sugar (DM).
renal failure Medical treatment
- Insulin therapy for treating diabetes mellitus condition.
- Antihypertensive drugs provide for Hypertension.
- Provide diuretics in hypervolemia and oedema condition.
- Treat anaemic condition.
- Provide sodium bicarbonate to treat acidosis condition.
- Provide vitamins and minerals to patients.
- Provide aluminium and calcium antacid to treat hypophosphatemia.
- Dialysis (haemodialysis, peritoneal dialysis).
- Mild to moderate protein diet.
- Height carbohydrate diet.
- Low potassium and low phosphorus diet.
- Restrict the fluid intake.
renal failure Surgical management
- Renal transplant.
- Nurses monitor patients’ general appearance and urine output.
- Monitor hydration status and electrolyte balance.
- Provide oral care to prevent stomatitis.
- Provide proper skin care to prevent pruritus and itching.
- Provide high carbohydrate and low protein diet.
- Nurses prepare patients for dialysis and provide care during dialysis.
- Administer all prescribed medications.
- Provide physiological and emotional support.
- Assess kidney function and all diagnostic procedures.
- Nurses encourage patients to have a healthy lifestyle.
- Glomerular filtration rate (GFR) status in chronic renal failure – Less than 60 ml/minute.
- GFR in the end stage of kidney Disease – Less than 15 ml/ minute.
- A most common cause of chronic kidney disease – Diabetes mellitus.
- Most common surgical Management in chronic kidney disease – Kidney transplant.
- Common medical management in chronic kidney disease – Dialysis.