RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure

RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure


RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure

Renal failure is the interruption or loss of kidney ability to carry out its function OR inability of the kidneys to work adequately to filter blood and excrete waste

"RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure"



Types Of Renal Failure

  • Acute renal failure (ARF) sudden, rapid, potentially reversible deterioration of renal function.
  • Chronic renal failure; this is the end result of gradual tissue destruction and loss of kidney function.


Causes of Acute Renal Failure

  1. Preneral failure: this is caused by factors that interfere with renal perfusion, they include;
  • Hypovolemia from hemorrhage
  • Myocardial infection
  • Burns
  • Shocks
  • Renal artery obstruction
  • Sepsis
  • Drugs such as diuretics
  1. Intrarenal or intrinsic failure: This is caused by renal tissue destruction. They include
  • Acute tubular necrosis
  • Acute glomerulonephritis
  • Acute pyelonephritis
  • Injuries
  • Sickle cell disease
  • Vasculitis
  • Bilatenal renal vein thrombosis
  1. Post renal obstruction: this is caused by conditions that occlude urine flow, they include:
  • Calculi
  • Strictures
  • Trauma
  • Pregnancy
  • Prostatic hypertrophy
  • Neoplasm
  • Hydronephosis
  • Inflammation or edema


"RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure"


Pathophysiology Of Acute Renal Failure

Reduce renal blood flow as a result of obstruction, neoplasm pregnancy, hypovolemia or any of the causes will lead to reduced or decreased glomerular filteration. This result in elevated sodium (NA) and water (H2o) re absorption bringing about oligumia (less than 400mH24hrs) fluid over load and elevated blood urea nitrogen (BUN) and creatinine levels, metabolic acidosis and uremia. Irritation of gastro intestinal tract by the disease process will lead to anorexia, nausea, vomiting, diarrhea. Uremic encephalopathy occurs if the condition affects the brain. Diuretic phase surfaces when the disease is been managed. This result in passage of 400ml of urine per day.



Clinical Manifestation of ARF

  • Oliguria
  • Fluid overload
  • Hypertension or hypotension (in diuretic phrase)
  • Tachychardia
  • Anorexia
  • Nausea and vomiting
  • Diarrhea
  • Lethargy
  • Weakness/fatigue
  • Polyuria during management


Diagnostic Evaluation of ARF

  • Blood analysis will reveal high levels of BUN, serum creatinine and potassium.
  • Blood PH, bicarbonate, hemoglobin and hematocit values are decrease.
  • Urine specimens, show casts, calcular debris, decreased specific gravity, proteinuria and reduced sodium level (less than 20m E.g./L) if there is oliguria.
  • ECG shows altered PQRST wave due to elevated potassium levels.
  • Kidney ultrasonography and kidney ureter bladder (KUB) radiography will reveal damaged/injured tissues.


"RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure"


Management of ARF

  • Acute reveal failure is usually reversible with medical treatment but can be fatal without prompt management pharmacology/drug therapy include;
  • Alkalinizing agents .e.g. insulin, glucose and sodium bicarbonate to elevate the blood/plasma PH, thereby causing potassium to move into the cells and lower serum potassium levels.
  • Antibiotics .e.g. ciprofloxacin and nitrofurantoin to prevent bacterial growth in the kidneys and bladder.
  • Other group of drugs used in the management of AFR are calcium supplement, histamine receptor blockers and phosphate bonding agents.
  • Dialysis is indicated in serious conditions to prevent brain cells damage. (Hemodialysis and peritoneal dialysis)


Nursing Management of AFR

  • Admission: During admission the nurse promotes comfort and encourage bed rest and ensure free noise environment.
  • Observation: Monitor vital signs and symptoms of uremia.
  • Diet /fluid: Provides and encourage high calories and low protein diet, provide or encourage low sodium and potassium diet. Restrict fluid during oliguric phase and encourage fluid intake during polyuric phase.
  • Drugs: Administer drugs as prescribed, especially drugs to control electrolyte levels.
  • Physical care: Assist in activities of daily living and carry out scheduled and structured passive and active exercises.
  • Promote measures to excess and prevent infection such as; checking for infection especially of the respiratory and urinary tracts, ensuring care of catheter when in place.
  • Psychological care; encourage patients verbalization of feelings and reassure in order to prevent anxiety.
  • Education / advice on discharge: Educate and advice patients on the need to follow dietary regimen, observation of uremic symptoms such as malaise , loss of appetite, muscle weakness and tingling sensation and encourage patients to adhere to prescribed drugs and keep medical appointments.


"RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure"


Nursing Diagnosis of ARF

  • Fluid volume excess related to sodium and fluid re absorption evidenced by fluid overload/weight gain.
  • Self care deficit related to effect of uremia evidence by inability to carryout activities of daily living.
  • Risk for infection related to reduce immunity activity.


Complication of ARF

  • Heart failure
  • Anemia Metabolic acidosis
  • Encephalopathy
  • Coma
  • Azotemia
  • Hyperkalemia


"RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure"


Chronic Renal Failure

Causes of chronic renal failure (CRF)

  • Chronic pyelonephritis
  • Chronic glomerulonephritis
  • Polyeystic kidney disease (congenital anoma lies)
  • Chronic hydronephrosis
  • Hypertensive nephropathy
  • Chronic nephritis
  • Renal calculi
  • Tuberculosis
  • Lupus erythematous
  • Nephrotoxic agents such as long term aminoglycoside therapy


Stages of Chronic Renal Failure (CRF)

CRF may progress through the following stages:

  • Reduced renal reserve. Glomerular filteration rate (GFR) is 35% to 50% of the normal rate.
  • Renal insufficiency GFR is 20% to 35% of the normal rate.
  • Renal failure; GFR is 20% to 25% of the normal rate.
  • End stage renal disease ; GFR is less than 20% of the normal rate.


"RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure"


Pathophysiology of CFR

When there is severe decline in renal function, there will be accumulation of nitrogen (product of protein metabolism) in the blood. This progresses to uremia which affects every system.

There is inability of the kidneys to excrete sodium because of their reduced function. This results in fluid overload, oedema and congestive heart failure. The presence of uremia leads to anorexia, nausea and vomiting.


Reduced functions of the kidneys reduce the secretion of erythropoietin which leads to reduced production of RBC leading to anemia. Neurologic complications/effects include convulsions, coma, altered mental function and personality and behavioral changes.


"RENAL FAILURE : Acute Renal Failure and Chronic Renal Failure"

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