RENAL FAILURE

ACUTE AND CHRONIC

GROUP 10 C
Bayagen, Jhexy Rhay
Bayawa, Dorie
Bayeng, Deborah
Becyagen, Raymund
Benbenen, Carlos Jr.
Bidodoy, Arsenia
Billo, Hazel
Bio, Fe Marie
Bolicday, Mary Ann
Cardona, Erlyn
Cassiw, Crystal Joy
Edic, Prenz
The kidneys are bean-shaped organs about the
size of the fist. The sit under the ribcage, toward
the back.
Kidneys have several jobs
1. Regulate ECF (plasma ad interstitial fluid)
through formation of urine (primary
function)
2. Regulate volume of blood plasma (BP)
3. Regulate waste products in the blood
4. Regulate concentration of electrolytes
5. Regulate pH
6. Secrete erythropoietin
 Renal failure results when the kidneys cannot remove the body’s
metabolic wastes or perform their regulatory functions. The
substances normally eliminated in the urine accumulate in the body
fluids as a result of impaired renal excretion, leading to a disruption
in endocrine and metabolic functions as well as fluid, electrolyte,
and acid-base disturbances.

 Renal failure is a systemic disease and is a final common pathway of

many different kidney and urinary tract diseases.
Acute Renal Failure
 Is a reversible clinical syndrome where
there is a sudden and almost complete
loss of kidney function (decreased GFR)
over a period of hours to days with
failure to excrete nitrogenous wastes
products and to maintain fluid and
electrolyte homeostasis (Porth, 2005)
 Categories of ARF
 Prerenal (hypoperfusion of kidney)- result of impaired blood flow
that leads to hypoperfusion of the kidney and a decrease of the GFR.
 Intrarenal ARF- is the result of actual parenchymal damage to the
glomeruli or kidney tubules.
 Postrenal ARF- is usually the result of an obstruction somewhere
distal to the kidney. Pressure rises in the kidney tubules and
eventually, the GFR decreases.
 Phases of Acute Renal Failure
1. Initiation period- begins with the initial insult and ends when oliguria
develops.

2. Oliguria period- is accompanied by an increase in the serum

concentration of substances usually excreted by the kidneys (urea,
creatinine, uric acid, organic acids, and the intracellular cations
<potassium and magnesium>). The minimum amount of urine needed to
rid the body of normal metabolic waste products is 400ml. In this phase
uremic symptoms first appear and life-threatening conditions such as
hyperkalemia develop.
3.Diuresis period- is marked by a gradual increase in urine output,
which signals that glomerular filtration has started to recover.
Laboratory values stop increasing and eventually decrease. Although
the volume of urinary output may reach normal or elevated levels,
renal function may still be marked abnormal.

4. Recovery period- signals the improvement of renal functions and

may take 3-12 months. Laboratory values return to the patient’s
normal level.
Signs and Symptoms

Nausea

Seizure Confusion
 Characteristics Prerenal Intrarenal Postrenal
Etiology Hypoperfusion Parenchymal damage Obstruction

BUN value Increased Increased Increased

Creatinine Increased Increased Increased
Urine Output Decreased Varies, often decreased Varies, may be decreased
or sudden anuria

Urine Sodium Decreased to Increased >40mEq/L Varies, often decreased to

<20mEq/L 20mEq/L or less

Urinary sediment Normal, few hyaline Abnormal casts and Usually normal
casts debris
Urinary osmolality Increased to 500 About 350 mOsm Varies, Increased or
mOsm similar to serum equal to serum
Urine Specific Increased Low to normal Varies
Gravity
 Causes
 PRERENAL FAILURE
1. Volume depletion resulting from: Hemorrhage, Renal losses
(diuretics, osmotic diuresis), Gastrointestinal losses (vomiting,
diarrhea, nasogastric suction)
2. Impaired cardiac efficiency resulting from: Myocardial Infarction,
heart failure, dysrhythmias, cardiogenic shock
3. Vasodilation resulting from: sepsis, anaphylaxis, antihypertensive
medications or other medications that cause vasodilation
 INTRARENAL FAILURE
1. Prolonged renal ischemia resulting from: Pigment nephropathy,
myoglobinuria (trauma, crush injuries, burns), hemoglobinuria
(transfusion reaction, hemolytic anemia)
2. Nephrotoxicity agents such as: aminoglycoside antibiotics
(gentamicin, tobramycin), radiopaque contrast agents, heavy metals
(lead, mercury), solvents and chemicals (ethylene glycol, carbon
tetrachloride, arsenic), NSAIDs, Angiotensin-converting enzyme
(ACE) inhibitors
3. Infectious processes such as: acute pyelonephritis, acute
glomerulonephritis
 POSTRENAL FAILURE
1. Urinary tract obstruction
2. Calculi (stones)
3. Tumors
4. Benign prostatic hyperplasia
5. Strictures
6. Blood clots
 Risk factors
 Advanced age
 Blockages in the blood vessels in your arms or legs
 Diabetes
 High blood pressure
 Heart failure
 Kidney diseases
 Liver diseases
 Diagnostics
 Urinalysis- it may reveal abnormalities that suggest kidney failure.
 Blood test- a sample of your blood may reveal rapidly rising levels
of urea and creatinine--- two substances used to measure kidney
function
 Imaging tests- such as ultrasound and computed tomography may be
used to help your doctor see your kidneys.
 Biopsy- removing a sample of kidney tissue for testing
 Complications
 ARF can affect the entire body
 Infection
 Hyperkalemia, hyperphosphatemia,
hyponatremia
 Water overload
 Pericarditis
 Pulmonary edema
 Reduced LOC
 Immune deficiency
 Prevention
1. Provide adequate hydration
2. Prevent and treat shock promptly with blood and fluid replacement
3. Monitor central venous and arterial pressures and hourly urine output of
critically ill patients to detect the onset of renal failure as early as possible
4. Treat hypotension promptly
5. Continually assess renal function (urinary output, laboratory values) when
appropriate
6. Take precautions to ensure that the appropriate blood is administered to the
correct patient in order to avoid severe transfusion reaction, which can
precipitate renal failure.
7. Prevent and treat infections promptly. Infections can produce
progressive renal damage.
8. Pay special attention to wounds, burns, and other precursors of
sepsis.
9. To prevent infections from ascending in the urinary tract, five
meticulous care to patients with indwelling catheters. Remove
catheters as soon as possible.
10. To prevent toxic drug effects, closely monitor dosage, duration of
use, and blood levels of all medications metabolized or excreted by the
kidneys.
 Medical Management
The kidneys have remarkable ability to recover
from insult. The objectives of treatment of ARF
are to restore normal chemical balance and
prevent complications until repair of renal
tissue and restoration of renal function can occur.
1. Maintenance of fluid

2. IV fluids of Blood Transfusion

3. Albumin infusion- if ARF is caused by

hypovolemia secondary to hypoproteinemia
4. Dialysis
Types of Dialysis
Nutritional Therapy

 High Carbohydrate meals- to meet

caloric needs
 Provide protein diet
 Foods and fluid containing potassium or
phosphorus (banana, citrus fruits and
juices, coffee)
 Pharmacologic treatment
1. Diuretics (Mannitol,
Furosemide, Ethacrynic acid
2. Sodium polystyrene sulfonate
(Kayexalate)
3. Sorbitol
4. Phosphate-binding agents
(aluminum hydroxide)
Nursing Management
 Monitoring Fluid and electrolyte balance
 Reducing metabolic rate
 Promoting pulmonary function
 Preventing infection
 Providing skin care
 Providing support
 Chronic Renal Failure
 Chronic renal failure or ESRD, is a
progressive, irreversible deterioration in
renal function in which the body’s
ability to maintain metabolic and fluid
and electrolyte balance fails resulting in
uremia or azotemia.
Stages of Chronic Kidney disease
Stage 5
GFR <15ml/min/1.73m²

Stage 4
GFR
=15-29ml/min/1.73m²

Stage 3
GFR
=30-59ml/min/1.73m²

Stage 2
GFR
=60-89ml/min/1.73m²

Stage 1
GFR ≥ 90ml/min/1.73m²
Signs and Symptoms
Risk Factors
 Complications of CRF
 Hyperkalemia
 Pericarditis, pericardial effusion, and pericardial tamponade
 Hypertension
 Anemia
 Bone disease and metastatic and vascular calcifications
Prevention
 Medical Management
 The goal of management is to maintain kidney function and
homeostasis for as long as possible
1. Nutritional therapy
- Dietary intervention is necessary with deterioration of renal function
and includes careful regulation of protein. The allowed protein
must be high of biologic value.
- Adequate caloric control intake and vitamin supplementation must
be ensured
- Potassium is carefully monitored

2. Dialysis
3. Kidney Transplant
 Pharmacologic Treatment
 Calcium and phosphorus binders (Callcium
carbonate, calcium acetate)
 Antihypertensive and Cardiovascular
Agents (Dobutamine, lanoxin)
 Antiseizure agents (IV diazepam,
Phenytoin)
 Erythropoietin
 Nursing Management
1. Teaching patient self care
-nutritional referral and explanations of nutritional needs
-teach patient how to check the vascular access device for patency and
appropriate precautions, such as avoiding venipuncture and blood
pressure measurements on the arm with access device
-teach patient and family about problems to report to health care
provider
2. Reiterate to the patient the importance of follow-up examinations
and treatment