COLLEGE OF NURSING,

MEDICAL DIRECTORATE,
LAMPHELPAT
SEMINAR ON: RENAL FAILURE(ACUTE
AND CHRONIC RENAL FAILURE )
Submitted by:Bright Lianitkim
Rollno.41
BSC(N)2 year
nd

Submitted to:Madam Julia

Tutor,
CON,MD
INTRODUCTION:

Renal failure is characterized by the reduction in the excretory

and regulatory function of the kidney.It usually occurs at the
terminal stages of the disease process.If the kidney function
fails,the waste products accumulate in the blood and the body
leading to a disruption in endocrine and metabolic functions
as well as fluid,electrolyte, and acid-base disturbances.
DEFINITION:

• Renal failure also known as kidney failure is a

condition in which the kidneys lose the ability to
remove waste and balance fluids.
• Renal failure is a failure of the kidney to maintain
internal homeostasis.
TYPES OF RENAL FAILURE:

1. Acute renal failure

2. Chronic renal failure
ACUTE RENAL FAILURE:

Acute renal failure is the sudden and complete

loss of the ability of the kidneys to remove waste
and concentrate urine without loosing electrolytes.It
occurs when the kidneys stop working over a period
of hours,days or in some cases weeks.
ETIOLOGY:

• Pre renal failure

• Internal failure
• Post renal failure
 RISK FACTORS:

• Being hospitalized in intensive care unit

• Advanced age
• Blockages in blood vessels in arms or legs
• Diabetes
• High blood pressure
• Kidney Diseases
• Liver diseases
PATHOPHYSIOLOGY OF ACUTE RENAL
FAILURE
In response to renal injury increase in intra glomerular pressure with
glomerular hypertrophy as the kidney attempts to adapt to nephron loss to
maintain constant glomerular filtration
Failure of renal circulation and glomerular or tubular disfunction

Damage tubular cannot conserve sodium normally which activates renin-

angiotensin aldosterone system

Sodium and fluid retension which leads to oedema

Sudden and complete loss of kidney function

 Reduced blood flow to kidney due to renal
vasoconstriction decrease
Oliguria

Increased serum creatinine,BUN level and retention of other

metabolic waste

Increase circulatory overload and sodium rentension

Acute renal failure

CLINICAL MANIFESTATIONS:
• Patient may appear critically ill or lethargic
• Decreased urine production
• Skin and mucous membrane are dry from dehydration
• Shortness of breath
• Edema or fluid retention causing swelling in legs,ankles or feet
• General malaise and fatique
• Gastrointestinal System:Anorexia ,nausea etc
• Hypertension and Rapid heart rate
• Increase susceptibility to secondary infection
• Feeling dizzy when standing up
• Anaemia and platelet dysfunction
• Headache,drowsiness,
irritability,confusion,peripheral neuropathy
• Cardiac problems such as tachycardia and
dysrhythmias
DIAGNOSTIC EVALUATION:
•Blood test
•Urine test
•ECG
•Kidney biopsy
•USG
•Excretory urography
•Imaging tests
MANAGEMENT:

Treatment for acute renal failure involves identifying

problem or injury that originally damage the
kidneys.Once the cause is found the goal of
treatment include avoiding drugs that required renal
excretion.
• Balanching fluid intake with output
• High carbohydrate and low protein diet
• Weight management
• Electrolytes monitoring
• 100grams of glucose per day
• Essential amino acids replacement
• Vital signs monitoring
• Cardiac status and mental status monitoring
1. A Pharmacologic therapy
2. Fluid and electrolyte replacement
3. Nutritional therapy
4. Dialysis
CHRONIC RENAL FAILURE:

Chronic Kidney disease also known as chronic renal disease

is a rapidly progressive deterioration or loss of renal
function in which the bodys ability to maintain metabolic
and fluid and electrolyte balance fails,resulting in uremia or
azotemia over a period of months or years.This is
characterized by a slow,insidious and irreversible
impairment of renal excretory and regulatory function.
ETIOLOGY AND RISK FACTORS:
• A family history of kidney disease
• Chronic glomerulonephritis
• Diabetes mellitus
• High blood pressure
• Injury or trauma
• Kidney stones and infection
• Autoimmune disorders
• Polycystic kidney disease
PATHOPHYSIOLOGY OF CRF:
Due to etheological factors renal functions declines
that leads to
Nephron damage is progressive damage nephron
cannot function and do not recover
Decreased Glomerular filtration rate
Remaining nephrons undergo changes to compensate
for those damaged nephrons
Compensatory excretion continues as GRR diminishes
Filtration of more concentrated blood by the remaining
nephrons
Damage of nephrons results in hypertrophy and hyper
phosphatenia of remaining nephron.
Urine may contain abnormal Amount of protein,RBCs,white
blood cells or casts.
Increased serum creatinine,BUN level and retention of urea
and other nitrogenous waste
Further damage of nephron 80-90% damage GFR 10-20%
Chronic Renal Failure
CLINICAL MANIFESTATIONS:

• Neurological system
• Gastrointestinal system
• Blood forming system
• Pulmonary system
• Cardiovascular system
• Skin
• Other symptoms
General ill feeling and fatigue
Headaches
Bone pain etc.
DIAGNOSTIC EVALUATION:
Chronic renal failure is diagnosed by the obstruction of a cambination of symptoms
and elevated blood urea nitrogen(BUN)and creatinine levels.
The following abnormalities found in the blood may signal CRF:
• Anaemia
• High level of parathyroid hormone
• Hypercalcemia
• Hyperkalemia
• Hyponatremia
• Low blood level of bicarbonate
• Low plasma pH
Imaging studies-CT or ultrasound
Renal biopsy –In renal biopsy a small piece
of kidney tissue is removed and analyzed
MANAGEMENT :
• Treatment of chronic renal failure may include dietary therapy
such as a low protein diet to limit the accumulation of end
products of protein metabolism that the kidneys cannot excrete.
• To treat hyperkalemia and fluid imbalances dialysis may be
performed. Cation exchange resin such as sodium polystyrene
sulphonate may be administered orally or rectally.
• Drug therapy is commonly implemented as well Antiseptics
are used to relieve nausea,and vomiting,femotidine or ranitidine
decrease gastric
• To combat the hematologic effects of CRF Iron and
folate supplements or RBC transfusion are prescribed
to treat anemia and synthesis erythroprotein is used to
stimulate the bone marrow to produce RBCs.
• For itching that accompanies CRF,antiprurities such
as trimeprazine or diphen3are prescribed
• Peritoneal or hemodialysis may be performed help
control end stage renal disease.
NURSING MANAGEMENT:

• Nursing diagnosis:
1.Fluid volume excess related to decreased
glomerular filtration rate as evidenced by decreased
urine output and sodium retention.
Goal:
To maintain normal fluid and electrolyte level
INTERVENTION:

• Asses skin,face and dependent areas for edema

• Record accurate intake and output
• Assess for shortness of breath,tachycardia frothy
sputum,heart irregularities, hypertension, cold and
clammy skin.
• Monitor weight daily at same time.
• Administer and restrict fluid as indicated by the
NURSING DIAGNOSIS:

2.Imbalanced nutrition less than body requirement

related to catabolic state,anorexia,malnutrition as
evidenced by weight loss.
Goal:
To maintain normal nutritional status.
INTERVENTION:

• Provide or encourage frequent oral hygiene

• Assess and document sietary intake
• Encourage high calorie low protein ,low sodium and
low potassium snacks between meals.
• Provide enough fluid intakes to replace urine output
• Provide frequent small feedings.
NURSING DIAGNOSIS:

3.Risk for infection related to alterations in the

immune system as evidenced by lack of self care and
chance of infection.
Goal:
To prevent from infection.
INTERVENTION:

• Protect patient from any source of infection including infected

roommates,visitors or nursing staff.
• Promote good hand washing by client and staff.
• Encourage deep breathing, coughing and frequent position
change.
• Monitor for signs and symptoms of infection and report
promptly to physician.
• Administer antibiotic medication as prescribed by the physician.
NURSING DIAGNOSIS:

4. Activity intolerance related to fatigue as

evidenced by not able to perform daily activity.
Goal:
To maitain normal daily activity.
INTERVENTION:

• Assess the condition of the patient

• Assess the patient fir anaemia fluid and electrolyte
imbalance, retention of waste product
• Encourage use of energy saving and relaxation
techniques and diversion activities.
• Maintain the client on complete Bed rest.
• Provide comfortable position.
NURSING DIAGNOSIS:

5.Knowledge deficit related to diet ,treatment as

evidenced by frequent asking of question.
Goal:
To improve knowledge.
INTERVENTION:

• Determine clients ability to learn

• Provide information about addition learning
• Provide active role for client in learning process.
• Assess motivation and willingness of client.
• Explain purpose of activity restrictions and need for
between activity rest.
CONCLUSION:

When renal failure occurs as the end result of chronic kidney

illness, in which kidney tissue is destroyed progressively over
the course of several months or years,control of symptons and
preservation of functional abilities are achievable goals.
Dietary adjustment medications and preventionof additional
illnesses compensate for loss of kidney function in the early
stages of progressing renal failure.As renal failure continues to
deteriorate dialysis or transplantation become necessary for
supportive life.