What Is Renal Failure - Causes, Types, and treatment

What Is Renal Failure? – Causes, Types, and treatment

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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 –
  1. Acute renal failure
  2. Chronic renal failure
  • Acute renal failure is also called acute kidney Disease (AKD).

Renal failure 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

  1. Prerenal cause
  2. Intrarenal cause
  3. Post renal cause

Renal failure Prerenal cause

  • Severe fluid and blood loss.
  • Hemorrhage 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 diseases 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 –
  1. Stage of oliguria
  2. Stage of diuresis
  3. 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 returned to 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.
  • The nurse monitor sign of infection and WBC count.
  • Provide a modified diet.
  • The nurse prepared for dialysis.
  • Nurses provide emotional and physiological support.

Key Points

  1. Urine output less than 400 ml/day – oliguria.
  2. Urine output less than 100 ml/day – Anuria.
  3. Reversible renal failure disorder – Acute kidney Disease.
  4. Nursing action, when patient on diuretic therapy –Check daily patient weight.
  5. Common finding diuretic therapy – Polyuria.

Reference – NCLEX Sounders 2nd Edition Page no. 822-823

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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 a gradual 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
  • Hypertension
  • Acute kidney Disease
  • Glomerular dysfunction
  • Pyelonephritis
  • 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)

Renal insufficiency

Loss of nephron function

Loss of renal excretory and excretory function

Renal failure.

renal failure Clinical manifestation  

CVS

  •  hypertension (due to decrease GFR)
  • Hypervolemia
  • Arrhythmia
  • Tachycardia.

Gastric system 

  • nausea, vomiting
  • Anorexia
  • Diarrhoea, constipation
  • Stomatitis, peritonitis
  • Gastric haemorrhage
  • Uremic colitis
  • Foul ammonia smell.

Respiratory system

  • kussmaul respiration
  • Pleural effusion
  • Pulmonary edema
  • Tachypnea
  • Depressed cough reflex
  • Uremic pneumonia.

Neurological system

  • lethargy
  • Confusion
  • Paraesthesia
  • Seizure and tremor
  • Slurred speech
  • Sleep disturbance
  • Ataxia, coma.

Skeletal system 

  • Renal rickets
  • Joints pain.

Integumentary 

  • Dry skin
  • Uremic Frost
  • Itching and pruritus
  • Decreased skin turgor
  • Pallor skin.

Metabolic

  • Proteinuria
  • Acidosis
  • Increase triglyceride.

renal failure Diagnostic examination

  • History collection and physical examination.
  • Blood urea nitrogen (elevated).
  • Serum test for – creatinine ( elevated )

Electrolytes

Phosphate (elevated)

Calcium (decrease)

Protein (low).

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  • 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 anemic conditions.
  • Provide sodium bicarbonate to treat acidosis conditions.
  • Provide vitamins and minerals to patients.
  • Provide aluminum and calcium antacids to treat hypophosphatemia.
  • Dialysis (hemodialysis, peritoneal dialysis).

Dietary management

  • Mild to moderate protein diet.
  • Height carbohydrate diet.
  • Low potassium and low phosphorus diet.
  • Restrict the fluid intake.

renal failure Surgical management

  • Renal transplant.

Nursing management  

  • 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.

Key Points

  1. Glomerular filtration rate (GFR) status in chronic renal failure – Less than 60 ml/minute.
  2. GFR in the end stage of kidney Disease – Less than 15 ml/ minute.
  3. The most common cause of chronic kidney disease – Diabetes mellitus.
  4. The most common surgical Management in chronic kidney disease – Kidney transplant.
  5. Common medical management in chronic kidney disease – Dialysis
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