ACUTE AND CHRONIC RENAL failure.ppt

8/10/2019 ACUTE AND CHRONIC RENAL failure.ppt

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ACUTE AND CHRONICRENAL

FAILURE

Mimi, Connie and Pat


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Acute renal failure (ARF):is the sudden andsevere reduction in previously normal renal function,may result from primary renal disease but is morefrequently associated with other organ failure. Failure isoften reversible, but should the kidneys fail to recover,

permanent treatment will be required.( Alexander et al, 2000).

Chronic renal failure (CRF)is the gradual and

progressive reduction in renal function. Failure mayoccur over weeks, months or even years. (Alexander etal, 2000).


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Causes

Renal failure, whether chronic or acute, is usuallycategorised according topre-renal, renalandpost-renal

causes. Researchers also report finding a significant

association between smoking, heavy alcohol intake and

chronic kidney disease.

Pre-renal(causes in the blood supply):

hypotension (decreased blood supply), usually from

shock or dehydration and fluid loss.

hepatorenal syndrome in which renal perfusion iscompromised in liver failure

vascular problems, such as atheroembolic disease and

renal vein thrombosis (which can occur as a

complication of the nephrotic syndrome)


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Renal(damage to the kidney itself):

infection usually sepsis (systemic inflammation due toinfection),rarely of the kidney itself, termed

pyelonephritis toxins or medication (e.g. some NSAIDs,

aminoglycoside antibiotics, iodinated contrast, lithium)

rhabdomyolysis (breakdown of muscle tissue) - theresultant release of myoglobin in the blood affects the

kidney; it can be caused by injury (especially crushinjury and extensive blunt trauma), statins, MDMA(ecstasy) and some other drugs

hemolysis (breakdown of red blood cells) - thehemoglobin damages the tubules; it may be causedby various conditions such as sickle-cell disease, andlupus erythematosus

multiple myeloma, either due to hypercalcemia or"cast nephropathy" (multiple myeloma can also causechronic renal failure by a different mechanism)


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Acute glomerulonephritis which may due to a variety ofcauses, such as anti glomerular basement membranedisease/Goodpasture's syndrome, Wegener'sgranulomatosis or acute lupus nephritis with systemiclupus erythematosus

Post-renal(obstructive causes in the urinary tract) due to:

medication interfering with normal bladder emptying.

benign prostatic hypertrophy or prostate cancer.

kidney stones. due to abdominal malignancy (e.g. ovarian cancer,

colorectal cancer).

obstructed urinary catheter.


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RENAL FAILURE SIGNS &

SYMPTOMS Decreased urine output.

Weight gain

Uraemic symptoms of anorexia, nausea &vomiting, fatigue, itchy skin, metallic taste in themouth, halitosis(bad breath).

Thirsty/dry mouth.

Breathlessness.

Fever & ankle swelling.

Congestive cardiac failure.

Confusion, twitching, irritability and convulsions.


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Signs

Anuria or oluguria


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Contd.

Initially it is without specific symptoms and can only bedetected as an increase in serum creatinine and as kidneyfunction decreases

Blood pressure is increased due to fluid overload andproduction of vasoactive hormones leading tohypertension and congestive heart failure.

Potassium accumulates in the blood.

Erythropoietin synthesis is decreased.

Fluid volume overload.

Hyperphosphatemia.

Metabolic acidosis.


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Diagnosis.

Blood test - to find out if waste substances have beenfiltered out

Urine test - to see if there is blood or protein in the urine.

Kidney scans such as MRI scan, CT scan or ultrasound -

to find if there are any unusual blockages in urine flow.When kidney disease is advanced, the kidneys areshrunken, have an uneven shape and are firm to touch.

Kidney biopsy - taking a small sample of tissue to test thecells and look for damage

Calculating the glomerular filtration rate (GFR) - to checkhow efficiently the kidneys are filtering waste, in particulara substance called creatinine.


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Treatment.

Treatment focuses on controlling the symptoms,

minimizing complications, and slowing the progression of

the disease

Three basic stages in treatment

Preserve remaining nephrons

Conservative treatment of uraemic syndrome

Renal dialysis and transplantation


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Preserve remaining nephron function

Control of hypertension and heart failure

Treatment of superimposed urinary tract infection

Correction of salt and water depletion Careful prescribing of drugs that are potentially

nephrotoxic

Dietary protein restriction

Conservative management of uraemic syndrome

Reduce protein intake

Aluminium hydroxide to reduce intestinal phosphate

absorption Vitamin D and calcium supplements to increase serum

calcium

Allopurinol to reduce serum uric acid

Erythropoietin to correct anaemia


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Dialysis is the option for ongoing treatment, often used

while waiting for a suitable transplant opportunity

Kidney transplant, in which a functioning kidney from a

donor is surgically grafted into the patient, has a good

rate of success


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Differencies

Acute renal failure

Most causes of acute renal failure can be treated and thekidney function will return to normal with time.

Replacement of the kidney function by dialysis (artificialkidney) may be necessary until kidney function hasreturned.

Chronic renal failure

Chronic kidney damage is usually not reversible and ifextensive, the kidneys may eventually fail completely.Dialysis or kidney transplantation will then becomenecessary


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Another diagnostic clue that helps differentiate CRF and

ARF is gradual rise in serum creatinine (over several

months or years) as opposed to a sudden increase in the

serum creatinine (several days to weeks).


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References

Alexander, M.F, Fawcett, J.N. and Ruciman, P.J.(2000) Nursing practice Hospital & Homes. The

Adult. 2nd Edition Edinburgh. HarcourtPublishers Limited.

Acute Renal Failure (online), Available fromwww.patient.co.uk/showdoc/400006 accesseson 07|11|2006

Redmond et al (2004): Acute renal failure:recognition and treatment in ward patients.Nursing Standard 18, 22, 46-53.

ACUTE AND CHRONIC RENAL failure.ppt

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