Renal Disorders,

Renal Failure, &

Renal Dialysis
Prepared by:
Remerose C. Ragasa, R.N.
Renal Functions
Removal of metabolic wastes.
Regulation of fluid and electrolyte balance.
Regulation of acid-base balance.
Maintenance of blood pressure.
Regulation of erythropoiesis.
Performing other metabolic function such as activating Vit
D, making a new glucose, and detoxifying substances in the
blood.
Renal Functions
Renal Disorder
Kidney injury may be acute & rapidly progressive
(within hours) and process may be reversible.

Kidney injury can also be chronic, progressing to end

stage kidney failure over a period of months or years.
Acute Kidney Injury
Acute Renal Failure

Acute Kidney Injury (AKI) is a sudden decline in

kidney function with a decrease in glomerular filtration
and urine output with an accumulation of nitrogenous
waste products in the blood.
Causes of Acute Kidney Injury
Prerenal Intrarenal Postrenal
Hypovolemia Renal artery/vein Ureteral
occlusion destruction
Hemorrhagic Bilateral acute Neurogenic
blood loss pyelonephritis bladder
Massive PE Acute tubular Bladder neck
necrosis obstruction
Phases of Acute Kidney Injury
Initiation
Oliguria
Diuresis
Recovery
Clinical Manifestation
Decreased urine output
Jugular vein distention
Fluid retention causing edematous feet, legs
Shortness of breath
Confusion
Seizures or coma in severe cases
Diagnostic Testing
Blood test
Urine Analysis
Ultrasonography
CT scan or MRI
Medical Treatment
Eliminate underlying causes.
Correcting fluid and electrolyte disturbances
Managing blood pressure
Preventing and treating infections
Maintaining nutrition
Dialysis
Chronic Kidney Disease
Renal Insufficiency/Chronic Renal Failure

Chronic Kidney Disease (CKD) is the progressive loss

of renal function associated with systemic disease such
HTN, DM, SLE; or intrinsic kidney disease such as AKI,
chronic glomerulonephritis, chronic pyelonephritis.
Stages of Chronic Kidney Disease
Stage Severity GFR (ml/min) Symptom
1 Normal or increased >90 Usually none, HTN is common
GFR
2 Mild GFR 60 – 89 Subtle HTN
Increasing plasma creatinine & urea
3 Moderate GFR 30 – 50 Mild HTN, Anemia
Increasing plasma creatinine & urea
4 Severe GFR 15 – 29 Moderate HTN, Anemia
Metabolic Acidosis, Hyperkalemia
Salt & water retention,
Increasing plasma creatinine & urea
5 End – Stage Kidney <15 Severe HTN, Anemia
Disease Uremia
Systemic Effects of CKD & Uremia
Skeletal: spontaneous fractures & bone pain
Cardiopulmonary: pulmonary edema, kussmaul
respiration
Cardiovascular: IHD, pericarditis, dysrhythmias, HTN,
cardiomyopathy
Neurologic: encephalopathy, coma in advanced uremia
Endocrine: higher incidence of goiter, osteomalacia
Hematologic: anemia, platelet disorders with prolonged
bleeding time
Systemic Effects of CKD & Uremia
Gastrointestinal: anorexia, nausea, vomiting, mouth
ulcers, urinous breath
Integumentary: abdominal pigmentation & pruritus
Immunologic: increased risk of infection, increased risk
of carcinoma
Reproductive: amenorrhea and infertility in women,
decreased testosterone levels and infertility
in men
Systemic Effects of CKD & Uremia
Fluid & Electrolyte Balance
Metabolic Acidosis
Hypervolemia
Hyponatremia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Diagnostic Testing
Blood test
Ultrasonography
CT scan
Kidney biopsy
Medical Management
Medications: antihypertensive, calcium supplements,
phosphate binding agents, cardiac
medication, anticonvulsant medication,
Epoetin alfa

Diet: careful regulation of protein, fluid, sodium intake,

some restriction of potassium

Dialysis & Kidney transplant

Nursing Management
1. Assess fluid status.
2. Assess level of conscious.
3. Encourage high caloric, low protein, low sodium &
low potassium.
4. Limit fluid intake to prescribed volume.
5. Monitor electrolyte levels & CBC.
6. Encourage alternating activity with rest.
7. Provide / encourage frequent oral hygiene
Renal Dialysis
Dialysis is a procedure to remove waste products and
excess fluid from the blood when the kidneys stop
working properly.

Types of dialysis
Hemodialysis, Peritoneal dialysis, Continuous Renal
Replacement Therapy (CRRT)
Hemodialysis
In hemodialysis, a hemodialyzer is used to remove waste
and extra chemicals and fluid from your blood. 
Hemodialysis
Hemodialysis
Nursing Consideration

Before the Hemodialysis

Allow the client to void.
Document the client’s weight.
Obtain vital signs as baseline.
Review the last ordered lab results.
Hemodialysis
Check the medications history of the patient before the
procedure.
 Assess the access site.

During the Hemodialysis

Obtain vital signs periodically between 30 minutes.
Observe proper body alignment, allow frequent
position changes.
Hemodialysis
Monitor for episodes of nausea and vomiting which
may occur during the procedure.
Monitor for signs of bleeding 

After Dialysis
Obtain a set of vital signs and a weight measurement
and assess the access site.
Assess for complications.
Continuous Renal Replacement Therapy
(CRRT)
Continuous Renal Replacement Therapy (CRRT) is a
therapy indicated for continuous solute removal and/or
fluid removal in the critically ill.

CRRT therapy indications may be renal, non renal or a

combination of both.
Peritoneal dialysis
Peritoneal dialysis uses the
inside lining of your abdomen
(the peritoneum) as the filter,
rather than a machine. Like the
kidneys, the peritoneum contains
thousands of tiny blood vessels,
making it a useful filtering
device.
Peritoneal dialysis
Peritoneal dialysis
Nursing Consideration

Patient Preparation
Allow the client to void before catheter insertion.
Institute abdominal skin preparation.
Document the client’s weight before the dialysis.
Take baseline vital signs.
Peritoneal dialysis
During the Procedure
Monitor the vital signs every 30 minutes.
Provide proper positioning for the dialysate to return
from the peritoneal cavity. Place the patient in semi-
Fowler’s position.
Peritoneal dialysis
After Dialysis
Obtain a set of vital signs and a weight measurement
and assess the access site.
Assess for complications.
Pyelonephritis
Pyelonephritis is an
infection of one or both
upper urinary tracts
(ureter, renal pelvis,
kidney interstitium).
Urinary obstruction and
reflux of urine from the
bladder are the most
underlying risk factor.
Clinical Manifestations
Fever, chills
Flank or groin pain
Symptom characteristic of UTI
Diagnostic Testing
Urine culture, urinalysis
Ultrasound
Intravenous Pyelography
Medical Management
Treatment is related to underlying cause.
Antibiotic
Nursing Management
1. Encourage adequate fluid intake.
2. Provide adequate rest periods and activity levels that
can be tolerant.
3. Instruct the patient to empty the bladder completely.
Acute Glomerulonephritis
Acute
Glomerulonephritis is
an inflammation of the
glomerulus caused by
primary glomerular injury
such as free radicals,
drugs, toxins, infection;
secondary glomerular
injury, a consequence of
systemic disease like DM,
Clinical Manifestations
Silent, mild, moderate, severe in symptom
There is no specific clinical sign.

Oliguria
HTN
Edema
Weight gain
Renal failure
Diagnostic Testing
Urinalysis: hematuria, proteinuria
Blood test
Imaging
Renal biopsy
Medical Management
Treating the primary cause : antibiotic, corticosteroid,
cytotoxic agents

Correct accompanying problems

Dialysis
Nursing Management
1. Monitor fluid status
2. Monitor lab test results
3. Sodium restriction along with fluid restriction diet
4. Importance of seeking treatment for infections of
skin/throat
 Thanks
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