Kidney Failure

Prepared by:

Dr. Abeer M. Aly

Definition:
Renal failure means, inability of the renal system to perform its normal functions.
What are the normal functions of the renal system???
Dr. Abeer M. Aly 2

Functions of urinary system:

1. 2. 3.

4.
5. 6.

Regulate blood volume and composition. Help regulate blood pressure. Regulation of blood glucose level. Excretion of wastes and foreign substances. Regulation of blood PH. Production of hormones
(Erythropoietin, Calcitriol)
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Dr. Abeer M. Aly

Dr. Abeer M. Aly

Dr. Abeer M. Aly

Urine Formation by Nephron

Blood pressure forces water, glucose, amino acids and urea from capillaries into nephron Glucose and amino acids are reabsorbed into blood from nephron Some water is reabsorbed into blood Urine is urea and salt concentrated in water

Dr. Abeer M. Aly

Dr. Abeer M. Aly

Definition:
The inability of nephrons to: Maintain fluid, electrolyte, & acidbase balance, Excrete nitrogen waste products, Regulate calcium in bones, Produce erythropoietin.
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Dr. Abeer M. Aly

Acute Renal Failure

Acute

Renal Failure

Is a sudden, usually reversible deterioration in normal renal function.

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Causes of acute renal failure:

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Causes of renal failure:

1. Prerenal causes:
a. Hypovolemia. b. Impaired cardiac efficiency. c. Vasodilatation.

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2. Postrenal obstruction:
a. Urinary tract obstruction. b. Tumors.

3. Intrarenal:
a. Acute nephritis. b. Antibiotics. c. NSAIDs.
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Causes of acute renal failure:-

Pre Renal Hypovolemia

Renal
polycystic kidney disease A.pyelonephritis

Post Renal Tumor Calculi

Drugs

Stricture Toxins Multiple-organ A.gloumerulnephritis Prostatic 14 Dr. Abeer M. Aly failure hypertrophy

Phases: Initiation phase:- (1-2 days)

The time from renal insult to

recognition of decrease
Glomerular Filtration Rate (GFR).

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 Oliguric phase ( maintenance phase 1-2 week)

-The period of time during which oliguria persists . - It is most life threatening period (Hyperkalemia)

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 Polyuric phase:- Diuretic phase

Progressive increase in urine volume.

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 Functional recovery phase:-

3-12 months, The patient repairing the renal injury & return to normal.

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Chronic Renal Failure:Is progressive , irreversible

deterioration in renal function.

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Acute Versus Chronic

Acute
- sudden onset - reversible - Tubular cell death and regeneration

oChronic
oProgressive oNot reversible oNephron loss

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Signs & Symptoms:Urine analysis. Hydration condition. Vital Signs.

Investigations.
GIT manifestations..

CNS manifestations..
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Investigation:
A urine analysis

levels progressively increase Creatinine

is progressively increased BUN

progressively decreases Creatinine clearance

may show elevated levels Potassium test Arterial blood gas and blood chemistry analysis may show metabolic acidosis
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Radiological investigations
Abdominal ultrasounds Abdominal CT scan

Abdominal MRI scan

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Management:1. prevention. Treatment:1. Renal replacement therapy. 2. Monitor serum electrolyte level. 3. Control hemodynamic condition.

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Nursing Diagnosis:Fluid Volume Excess & electrolyte imbalance

Activity Intolerance. Altered nutrition less than body requirement.

Self esteem disturbance.

Knowledge Deficit.
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 Diet.

Activity. Care of the vascular access. Personal Hygiene.

Psychological Care.

Follow up.
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 Diet
An optimum dietary program is important for patients on Renal failure. The diet usually involves some

adjustment or restriction of :Protein , Sodium , Potassium or fluid intake. Increase CHO in diet
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 Activity:-

The nurse should inform patient about:-

Importance of exercise. Type of exercise, ( flexibility ex.,

strengthening ex., aerobic or

endurance ex.)
Frequency & duration of Ex.

When exercise must be stopped.

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Preparation for of the vascular access.

Personal Hygiene.

Psychological&
spiritual care Care.
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Complications
-End- stage renal disease Pericarditis Cardiac tamponade

Congestive he0art failure

Hypertension

Platelet dysfunction
Loss of blood from the gastrointestinal tract

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Ulcers Hemorrhage Anemia Hepatitis B, Hepatitis C, liver failure

Decreased functioning of white blood cells

Decreased immune response of infection Increased incidence Peripheral neuropathy
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Seizures Encephalopathy, nerve damage, dementia Weakening of the bones Fractures

Joint disorders
metabolism Changes in glucose

abnormalities including Electrolyte

hyperkalemia
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Miscarriage, menstrual irregularities, infertility Decreased libido, impotence Skin dryness, itching/scratching with resultant skin infection.

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