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Care Of Patient With Renal Failure

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Objectives

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Define acute & chronic renal failures.

Identify causes of ARF & CRF. List the signs and symptoms. Describe the management & care. List the complications. Discuss relevant patient / family

education.

Acute & Chronic

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Alternative names   

Renal failure - acute; Kidney failure; Kidney failure - acute; Renal failure; Arf

Alternative names   

Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; CRF; Chronic kidney failure

Definition

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Definition    Acute renal failure is sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes. ("Acute" means sudden, "renal" refers to the kidneys.)

Definition   .Chronic renal

failure is a gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.

White Nail Syndrome (CRF)

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Causes ( ARF )

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Decreased blood flowSevere acute nephritic syndrome

Acute tubular necrosis (ATN)Direct injury to the kidneyMyoglobinuria (myoglobin in the urine)

Causes ( ARF )

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Urinary tract obstructionInfections such as acute pyelonephritis or septicemia

Disorders of the bloodAutoimmune disorders

Causes (ARF)

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Over-exposure to metals, solvents, radiographic contrast materials, certain antibiotics, and other medications or substances

In young children, hemolytic uremic syndrome

Causes (CRF)

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Decreased blood flow is one cause of kidney damage

Acute tubular necrosisDirect injury to the kidney Disorders of the blood

Causes (CRF)

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InfectionsUrinary tract obstructionTumorsKidney stones

Symptoms (ARF)

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Decreased urine output Decreased urine volume (oliguria)

No urine output (anuria) Urination, excessive at night (can

occur in some types of renal failure)

Symptoms (ARF)

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Generalized swelling, fluid retention

Decrease in sensation, especially the hands or feet

Slow, sluggish, movementsAnkle, feet, and leg swellin

g

Symptoms (ARF)

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Seizures Hand tremor Nausea, vomiting

May persist for days Morning sickness Vomiting blood

Symptoms (ARF)

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Prolonged bleeding, bruising easily Stools, bloody Nosebleed Growth, slow (child 0-5 years)

Symptoms (ARF)

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Changes in mental status or mood Agitation Drowsiness, lethargy Delirium or confusion Coma Fluctuating mood Difficulty paying attention (attention deficit) Hallucinations

Symptoms (ARF)

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Flank pain Fatigue Ear noise/buzzing Breath odor Breast development in males Blood pressure, high

Symptoms (CRF)

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Initial symptoms may include the following:

Unintentional weight lossNausea, vomiting General ill feeling Fatigue Headache

Symptoms (CRF)

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Frequent hiccups Generalized itching (pruritus)Later symptoms may include the following:

Increased or decreased urine output

Symptoms (CRF)

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Need to urinate at night Easy bruising or bleeding; May have blood in the vomit or in stools Decreased alertness

Drowsiness, somnolence, lethargy Confusion, delirium Coma

Symptoms (CRF)

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Muscle twitching or cramps Seizures Uremic frost -- deposits of white crystals in and on the skin

Decreased sensation in the hands, feet, or other areas

Symptoms (CRF)

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Additional symptoms that may be associated with this disease:

Excessive nighttime urination Excessive thirst

Symptoms (CRF)

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Abnormally dark or light skin Paleness Nail abnormalities Breath odor High blood pressure Loss of appetite Agitation

Signs  (ARF)

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Lab values may change suddenly (within a few days to 2 weeks):

Urinalysis may be abnormal. Serum creatinine may increase by

2 mg/dl or more over a 2-week period.

Creatinine clearance may be decreased.

Signs  (ARF)

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BUN may increase suddenly. Serum potassium levels may be increased.

Arterial blood gas and blood chemistries may show metabolic acidosis.

Signs  (ARF)

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Kidney or abdominal ultrasound is usually the best test, but abdominal x-ray, abdominal CT scan or abdominal MRI may also reveal the cause of acute renal failure. Kidney size is usually normal or slightly large.

Signs  (ARF)

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Chemical tests of blood and urine may also help to distinguish the causes. A clean catch urine specimen will indicate if the cause is infection within the urinary tract.

Signs  (ARF)

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Renal angiography (renal arteriography) may be used to diagnose causes within the blood vessels of the kidney.

Signs (CRF)

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Blood pressure may be high, with mild to severe hypertension. A neurologic examination may show polyneuropathy. Abnormal heart or lung sounds may be heard with a stethoscope.

Signs (CRF)

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A urinalysis may show protein or other abnormalities. An abnormal urinalysis may occur 6 months to 10 or more years before symptoms appear.

Creatinine levels progressively increase.

Signs (CRF)

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BUN is progressively increased. Creatinine clearance progressively

decreases. Potassium test may show elevated

levels. Arterial blood gas and

blood chemistry analysis may show metabolic acidosis.

Signs (CRF)

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Changes that indicate chronic renal failure, including both kidneys being smaller than normal, may be seen on:

Renal or abdominal x-ray.Abdominal CT scan.Abdominal MRI.Abdominal ultrasound.

Signs (CRF)

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This disease may also alter the results of the following tests:

Urinary casts Renal scan Pth Serum magnesium - test Erythropoietin

Care & Management (ARF)

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The goal of treatment is to identify and treat any reversible causes of the kidney failure (e.G., Use of kidney-toxic medications, obstructive uropathy, volume depletion).

Care & Management (ARF)

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Treatment also focuses on preventing excess accumulation of fluids and wastes, while allowing the kidneys to heal and gradually resume their normal function. Hospitalization is required for treatment and monitoring.

Care & Management (ARF)

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Your fluid intake may be severely restricted to an amount equal to the volume of urine you produce. You may be given specific dietary modifications to reduce build-up of toxins normally handled by the kidneys, including a diet plan high in carbohydrates and low in protein, salt, and potassium.

Care & Management (ARF)

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Antibiotics may be used to treat or prevent infection. Diuretics may be used to remove fluid from the kidney.

Care & Management (ARF)

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A major priority in treatment is to control dangerous hyperkalemia (increased blood potassium levels). A variety of different medications may be used, including IV (intravenous) calcium, glucose/insulin, and oral or rectal administration of potassium exchange resin (kayexalate).

Care & Management (ARF)

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Dialysis may be used to remove excess waste and fluids. This often makes the person feel better and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is frequently lifesaving, particularly if serum potassium is dangerously high.

Care & Management (ARF)

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Common symptoms that require the use of dialysis include decreased mental status, pericarditis, increased potassium levels, total lack of urine production, fluid overload, and uncontrolled accumulation of nitrogen waste products (serum creatinine > 10 mg/dl and BUN > 120 mg/dl).

Care & Management (CRF)

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Treatment focuses on controlling the symptoms, minimizing complications, and slowing the progression of the disease.

Care & Management (CRF)

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Associated diseases that cause or result from chronic renal failure must be controlled. Hypertension, congestive heart failure, urinary tract infections, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated as appropriate.

Care & Management (CRF)

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Blood transfusions or medications such as iron and erythropoietin supplements may be needed to control anemia.

Fluid intake may be restricted, often to an amount equal to the volume of urine produced. Dialysis or kidney transplant may be required eventually.

Care & Management (CRF)

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Dietary protein restriction may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting. Salt, potassium, phosphorus, and other electrolytes may be restricted.

Complications (ARF)

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  increased risk of infections gastrointestinal loss of blood chronic renal failure End-stage renal disease Damage to the heart or nervous

system Hypertension

Complications (CRF)

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End-stage renal disease Pericarditis Cardiac tamponade Congestive heart failure

Complications (CRF)

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Hypertension Platelet dysfunctionDecreased immune response

Complications (CRF)

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Loss of blood from the gastrointestinal tract Ulcers Hemorrhage Anemia Hepatitis B, hepatitis C, liver failure Decreased functioning of white blood cells

Complications (CRF)

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Increased incidence of infection Peripheral neuropathy Seizures Encephalopathy, nerve damage,

dementia Weakening of the bones Fractures

Complications (CRF)

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Joint disorders Changes in glucose metabolism Electrolyte abnormalities including

hyperkalemia Decreased libido, impotence Miscarriage, menstrual irregularities,

infertility Skin dryness, itching/scratching with

resultant skin infection

Patient / Family Education

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Call your health care provider if decreased urine output or other symptoms indicate the possibility of acute renal failure.

Call your health care provider if nausea or vomiting persists for more than 2 weeks.

Call your health care provider if decreased urine output or other symptoms of chronic renal failure occur.

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Any Question ?