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).
Definition
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.
- Dehydration.
- Shock
- Decrease cardiac output
- Burn and sepsis
- Vasodilation
- 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
- Myoglobinuria
- Hemoglobinuria
- Diabetic nephropathy.
Post renal cause
- Urolithiasis and tumour
- Benign prostatic hyperplasia ( BPH )
- Bladder neck obstruction
- Ureteral obstruction
- UTI
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
- Dyspnoea
- Cough
- Right ventricular failure
- Edema
- Metabolic acidosis
- Kussmaul respiration
- Azotaemia
- Hypokalaemia
- 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
- Dehydration
- Tachycardia
Stage of recovery
- Strength pelvic muscles
- Return normal urine output
- Regain renal functions
- CNS – improved
- Blood pressure return normal
- Diagnostic investigations are normal.
Diagnostic examination
- History collection and physical examination
- BUN and creatinine ( increased )
- Urine analysis
- Urine electrolytes
- Serum electrolytes
- Renal USG
- CT scan and MRI
- Renal Biopsy
Medical management
- 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
- Antiemetic
- Antibiotics
- Dialysis – Dialysis helps to remove waste from the kidney, and improve renal functions.
Dietary management
- High-calorie diet.
- Low protein, low sodium and low potassium diet.
- Parenteral nutrition.
- Sometime avoid sodium and potassium diet.
Complication
- Infection
- Chronic renal failure
- Edema
- Pericarditis
- Hyperkalaemia
- Pulmonary edema.
Nursing management
- 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.
Key Points
- 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
