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    Renal Failuire

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    Ambrose
    1. Acute kidney injury (AKI) is the sudden loss of kidney function over hours to days, which can be caused by pre-renal, renal, or post-renal factors that decrease blood flow or damage the kidneys. 2. Symptoms of AKI include decreased urine output, swelling, and fatigue. Treatment focuses on treating the underlying cause, restricting fluids and proteins, and potentially using dialysis to remove waste if kidney function does not recover. 3. Chronic kidney disease is the gradual loss of kidney function over months or years. It is treated through controlling risk factors like high blood pressure, restricting dietary proteins and salts, and potentially long-term dialysis or a kidney transplant for

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    Renal Failuire

    Uploaded by

    Ambrose
    18 views39 pages
    1. Acute kidney injury (AKI) is the sudden loss of kidney function over hours to days, which can be caused by pre-renal, renal, or post-renal factors that decrease blood flow or damage the kidneys. 2. Symptoms of AKI include decreased urine output, swelling, and fatigue. Treatment focuses on treating the underlying cause, restricting fluids and proteins, and potentially using dialysis to remove waste if kidney function does not recover. 3. Chronic kidney disease is the gradual loss of kidney function over months or years. It is treated through controlling risk factors like high blood pressure, restricting dietary proteins and salts, and potentially long-term dialysis or a kidney transplant for

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    RENAL FAILUIRE

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    1. Acute kidney injury (AKI) is the sudden loss of kidney function over hours to days, which can be caused by pre-renal, renal, or post-renal factors that decrease blood flow or damage the kidneys. 2. Symptoms of AKI include decreased urine output, swelling, and fatigue. Treatment focuses on treating the underlying cause, restricting fluids and proteins, and potentially using dialysis to remove waste if kidney function does not recover. 3. Chronic kidney disease is the gradual loss of kidney function over months or years. It is treated through controlling risk factors like high blood pressure, restricting dietary proteins and salts, and potentially long-term dialysis or a kidney transplant for

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    18 views39 pages

    Renal Failuire

    Uploaded by

    Ambrose
    1. Acute kidney injury (AKI) is the sudden loss of kidney function over hours to days, which can be caused by pre-renal, renal, or post-renal factors that decrease blood flow or damage the kidneys. 2. Symptoms of AKI include decreased urine output, swelling, and fatigue. Treatment focuses on treating the underlying cause, restricting fluids and proteins, and potentially using dialysis to remove waste if kidney function does not recover. 3. Chronic kidney disease is the gradual loss of kidney function over months or years. It is treated through controlling risk factors like high blood pressure, restricting dietary proteins and salts, and potentially long-term dialysis or a kidney transplant for

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    of 39

    2021

    Definition
    This is the inability of the kidneys to remove the
    body’s metabolic wastes or perform their regulatory
    functions.
    It is classified into two forms:-
     Acute kidney injury-It’s potentially reversible renal
    failure of sudden onset
     Chronic kidney injury
    Acute kidney injury
    Definition
    A rapid decrease of glomerular filtration and, in
    consequence, reduced clearance of products of
    metabolism and other substances.
    Pathophysiology
    Acute kidney injury(AKI) is a sudden and almost complete
    loss of kidney function (decreased GFR) over a period of
    hours to days.
    Manifests with:-
    Oliguria (less than 400 mL/day of urine) -most common
    Anuria (less than 50 mL/day of urine)
    Normal urine output are not as common.
    Rising serum Creatinine and BUN levels and retention of
    other metabolic waste products (azotemia) normally
    excreted by the kidneys.
    Causes
    Causes of acute kidney failure are generally
    categorized in relation to where and how they affect
    the kidneys:
    Are grouped into :-
     Pre-renal
     Renal
     Post renal cause.
    Pre-renal. These are problems that interfere with the
    flow of blood on its way to the kidneys.
    Any condition that affects the Glomerular filtration
    e.g. decreased cardiac output or decreased intra
    vascular volume, cardiogenic shock, hemorrhage,
    severe burns, septic shock, cardiac temponade.
    Renal. These are causes that result in direct damage to
    the kidneys.
    Consists of primary parenchymal diseases and acute
    tubular necrosis.
     Primary parenchymal diseases include acute
    gromerulonephritis, and acute pyelonephritis
     Acute tubular necrosis is potentially reversible renal
    failure of sudden onset that usually results from ischemic
    or nephrotoxic damage to the tubular segment of the
    nephron . People predisposed to ATN include:- elderly >
    60 yrs and those with vascular disorders
    Post renal. These are problems with the flow of urine
    after it leaves the kidneys on its way out of the body.
    Obstruction of the renal flow can be due to:-
    stones, tumors, blood clots, prostatic hypertrophy or
    fibrosis
    This cause urine backflow and hydronephrosis,
    damage to the parenchymal tissue and decrease in
    Glomerular filtration.
    Risk factors
    Acute kidney injury almost always occurs in
    connection with another medical condition or
    event.
    This includes:-
     Severe injuries or burns
     Complicated surgery
     Overwhelming infection.
     Exposure to toxic substances.
     Drug overdose
     Long-term use of nephrotoxic drugs.
    Medical conditions that increase risk of acute kidney
    injury include:
    Chronic infection
    Diabetes
    High blood pressure
    Heart failure
    Various blood disorders
    Immune disorders, such as SLE
    Kidney diseases
    Liver diseases
    Prostate gland enlargement
    Bladder outlet obstruction
    Phases of acute renal failure
    There are four clinical phases of AKI:
    Initiation- Begins with the initial insult and ends
    when oliguria develops.
    Oliguria-accompanied by a rise in the serum
    concentration of substances usually excreted by the
    kidneys (urea, creatinine, uric acid, organic acids, and
    the intracellular cations [potassium and magnesium]).
    In this phase uremic
    symptoms first appear and life-threatening conditions
    such as hyperkalemia develop.
    Diuresis- , the patient experiences gradually
    increasing urine output, which signals that glomerular
    filtration has started to recover. Laboratory values stop
    rising and eventually decrease. Although the volume
    of urinary output may reach normal or elevated levels,
    renal function may still be markedly abnormal.
    Recovery-signals the improvement of renal function
    and may take 3 to 12 months. Laboratory values return
    to the patient’s normal level.
    Although a permanent 1% to 3% reduction in the GFR is
    common, it is not clinically significant
    Signs and symptoms
    The patient may appear critically ill and lethargic,
    Persistent nausea , vomiting and diarrhea
    Decreased urine output , skin and mucous
    membranes are dry from dehydration, and the
    breath may have the odor of urine (uremic fetor).
    Central nervous system signs and symptoms
    include, drowsiness, headache, muscle twitching,
    and seizures.
    Fluid retention, causing oedema and shortness of
    breath
    Screening and diagnosis tests
    Kidney function tests
    Blood urea and Creatinine -levels rise rapidly.
    Blood potassium level increases rapidly, often to life-
    threatening levels.
    Abdominal ultrasound exam.
    Abdominal computerized tomography (CT) or
    magnetic resonance imaging (MRI) scan.
    Kidney biopsy to identify the cause of acute kidney
    failure
    Treatment
    Goal of treatment:-
    First is to treat the illness or injury that originally
    damaged the kidneys.
    Preventing the accumulation of excess fluids and
    wastes in the blood while the kidneys heal.
     This is best accomplished by limiting fluid intake and
    following a high-carbohydrate, low-protein, low-
    potassium diet.
    Pharmacologic therapy
    Hyperkalemia is the most life-threatening, the
    elevated K levels may be reduced by administering
    cation-exchange resins (sodium polystyrene sulfonate
    [Kayexalate] orally or by retention enema. It works by
    exchanging sodium ions for potassium ions in the
    intestinal tract. Sorbitol may be administered in
    combination with Kayexalate to induce diarrhea type
    effect (induce water loss in the GIT)
    If hemodynamically unstable, IV dextrose 50%,insulin
    and calcium replacement may be administered to shift
    potassium back into the cells.
    Diuretics are often administered to control fluid
    volume, but they have not been shown to hasten the
    recovery form ARF.
    Medical management
    Goal: To restore normal chemical balance and prevent
    complications until repair of renal tissue and
    restoration of renal function can take place
    Medications and other products that the patient ingest
    must be reviewed. Any that might harm the kidneys
    will be eliminated or the dose reduced.
    Treatments will be offered, with the following goals:
    Correct dehydration - intravenous fluids, with
    electrolyte replacement if needed
    Fluid restriction - for those types of kidney failure in
    which excess fluid is not appropriately eliminated by
    the kidneys
    Increase blood flow to the kidney - Usually related to
    improving heart function or increasing blood pressure
    Clinical course and monitoring
    Accurate control of fluid balance (avoid volume
    overload or depletion)
    Daily measurement of serum electrolytes, potassium
    and sodium restriction, nutritional support
    Prevention of infection
    Prevention of gastrointestinal hemorrhage
    Careful drug dosing and avoidance of nephrotoxic
    drugs
    Impaired haemostasis: Active bleeding may require:
    Fresh frozen plasma and platelets ,
    Blood transfusion
    Dialysis

    Temporary dialysis to help remove toxins and excess fluids


    is necessary.
    Dialysis is a mechanical way of filtering waste from the
    blood.
    The most common form of dialysis used for acute kidney
    failure is haemodialysis.

     It removes extra fluids, chemicals and wastes from the


    bloodstream by filtering the blood through an artificial
    kidney (dialyzer).
    Indications for dialysis
    In acute kidney injury
    Severe hyperkalemia unresponsive to medical
    management
    Creatinine >500 mmol/L.
    Toxicity with drugs that can be dialyzed.
    Presence of clinical features of uremia (e.g.
    pericarditis gastritis, fits or encephalopathy)
    Fluid retention leading to pulmonary oedema:
    Severe acid-base disturbance (pH under 7.0) that
    cannot be controlled by sodium bicarbonate
    Nursing Management
    Monitoring fluid and electrolyte balance
    Reducing metabolic rate-bed rest, fever and infection
    prevention
    Promoting pulmonary function
    Preventing infection
    Providing skin care
    Providing psychological support
    Chronic renal failure
    Is a progressive, irreversible deterioration in renal
    function in which the body’s ability to maintain
    metabolic and fluid and electrolyte balance fails,
    Pathophysiology
    As renal function declines, the end products of protein
    metabolise accumulate in the blood. Uremia develops
    and adversely affects every system in the body.
    There are four well-recognized stages of chronic renal
    disease: reduced renal reserve, renal insufficiency,
    renal failure and ESRD
    The rate of decline in renal function and progression
    of chronic renal failure is related to the underlying
    disorder, the urinary excretion of protein, and the
    presence of hypertension.
    Stages of chronic renal failure
    1. Decreased renal insufficiency (renal
    impairment): GFR is 40- 50 % of normal
    2. Renal insufficiency: GFR is 20-40% of normal
    3. Renal failure: GFR is 10-20 % of normal
    4. End stage renal disease: GFR is less than 10%
    Clinical Manifestations
    Cardiovascular manifestations:
     Hypertension
     Pulmonary edema
     Pericarditis
    Dermatologic symptoms:
     Severe itching (pruritus) i.e. Uremic frost
    Other systemic manifestations:
     GI signs and symptoms :-anorexia, nausea, vomiting,
    and hiccups.
     Neurologic changes, :- altered levels of consciousness,
    inability to concentrate, muscle twitching, and seizures.
    Assessment and Diagnostics
    Glomerular filtration rate
    Sodium and water retention levels
    Acidosis
    Anemia
    Calcium and phosphorus imbalance
    Medical Management
    Goal of management is to maintain kidney function and
    homeostasis for as long as possible.
    All factors that contribute to ESRD and all factors that
    are reversible (eg, obstruction) are identified and
    treated.
    Management is accomplished primarily with
    medications and diet therapy and dialysis to decrease
    the level of uremic waste products in the blood if
    needed
    Treatment: is conservative since chronic kidney injury
    is irreversible condition.
    Pharmacologic therapy
    Antacids:-/calcium carbonate-Hyperphosphatemia and
    hypocalcemia are treated with aluminum-based antacids
    that bind dietary phosphorus in the GI tract.
    Antihypertensive and Cardiovascular Agents
    Antiseizure Agents-Intravenous diazepam or
    phenytoin is usually administered to control seizures
    Erythropoietin (Epogen).- for anemia
    Nutritional therapy
     Fluid allowance 500ml-600mls added to previous day urine
    out put
    Nursing management
    The goals of management are focused on: controlling
    the symptoms,
    preventing complications,
    delaying the progression of kidney failure.
    Nursing diagnosis (examples)
    Excess fluid volume related to decreased urine output,
    dietary excesses, and retention of sodium and water
    Imbalanced nutrition: less than body requirements
    relatedn to anorexia, nausea and vomiting, dietary
    restrictions, and altered oral mucous membranes
    Deficient knowledge regarding condition and treatment
    regimen
    Activity intolerance related to fatigue, anemia, retention of
    waste products, and dialysis procedure
    Low self-esteem related to dependency, role changes,
    changes in body image, and sexual dysfunction
    Maintain fluid and electrolyte balance
    Prevent infection and injury.
    Promote comfort by: providing pain medication if the
    pt is in pain, give antipruritic to relieve the itching,
    encourage rest for fatigue.
    Treatment of concurrent disorders e.G. Anemia,
    hypertension, diabetes mellitus and other infections
    Drug precautions the same as for AKI
    Give nutritional care same as for AKI
    The definitive treatment is renal transplant or
    dialysis
    Complications
    Hyperkalemia
    Pericarditis, pericardial effusion, and pericardial
    tamponade
    Hypertension
    Anemia
    Bone disease and metastatic calcifications

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