CHAPTER: 3

Renal Failure
BY
Mrs. K.SHAILAJA., M. PHARM.,
LECTURER
DEPT OF PHARMACY PRACTICE,
SRM COLLEGE OF PHARMACY.
Objectives

} Anatomy
} Function
} Acute Renal Failure (ARF)
} Causes
} Symptoms
} Management
} Chronic Renal Failure (CRF)
} Causes
} Symptoms
} Dialysis
Anatomy

}2 Kidneys
} 2 Ureters
} Bladder
} Urethra
Kidney Function

} Detoxifyblood
} Increase calcium absorption
} calcitriol
} Stimulate RBC production
} erythropoietin
} Regulate blood pressure and electrolyte
balance
} renin
Classifications

} Acute versus chronic

} Pre-renal, renal, post-renal
} Anuric, oliguric, polyuric
Acute Versus Chronic

} Acute
} sudden onset
} rapid reduction in urine output
} Usually reversible
} Tubular cell death and regeneration
} Chronic
} Progressive
} Not reversible
} Nephron loss
} 75% of function can be lost before its
noticeable
Acute Renal Failure

} Pre-renal = 55%

} Renal parenchymal (intrinsic)= 40%

} Post-renal = 5-15%
Causes of ARF
} Pre-renal =
} vomiting, diarrhea, poor fluid intake, fever, use of diuretics,
and heart failure
} cardiac failure, liver dysfunction, or septic shock
} Intrinsic
} Interstitial nephritis, acute glomerulonephritis, tubular
necrosis, ischemia, toxins
} Post-renal =
} prostatic hypertrophy, cancer of the prostate or cervix, or
retroperitoneal disorders
} neurogenic bladder
} bilateral renal calculi, papillary necrosis, coagulated blood,
bladder carcinoma, and fungus
Symptoms of ARF

} Decrease urine output (70%)

} Edema, esp. lower extremity
} Mental changes
} Heart failure
} Nausea, vomiting
} Pruritus
} Anemia
} Tachypenic
} Cool, pale, moist skin
Diagnosis of Renal Failure
Acute Renal Failure
Management
} Make/think about the diagnosis
} Treat life threatening conditions
} Identify the cause if possible
} Hypovolemia
} Toxic agents (drugs, myoglobin)
} Obstruction
} Treat reversible elements
} Hydrate
} Remove drug
} Relieve obstruction
ARF: Life Threatening
Conditions
} Hyperkalemia
} Volume overload
} Vascular access
Hyperkalemia Symptoms

} Weakness
} Lethargy
} Muscle cramps
} Paresthesias
} Hypoactive DTRs
} Dysrhythmias
Hyperkalemia & EKG
}K > 5.5 -6
} Tall, peaked T’s
} Wide QRS
} Prolong PR
} Diminished P
} Prolonged QT
} QRS-T merge – sine
wave
Hyperkalemia Treatment

} Calcium gluconate (carbonate)

} Sodium Bicarbonate
} Insulin/glucose
} Kayexalate
} Lasix
} Albuterol
} Hemodialysis
Chronic Renal Failure

} 150–200 cases per million people = new

cases each year
} Chronic renal failure and ESRD affect
more than 2 out of 1,000 people in the U.S
} Mortality = 20%
Chronic Renal Failure Causes
} Diabetic Nephropathy
} Hypertension
} Glomerulonephritis
} HIV nephropathy
} Reflux nephropathy in children
} Polycystic kidney disease
} Kidney infections & obstructions
CRF Symptoms

} Malaise } Seizure
} Weakness } Constipation

} Fatigue } Peptic ulceration

} Diverticulosis
} Neuropathy
} Anemia
} CHF
} Pruritus
} Anorexia
} Jaundice
} Nausea } Abnormal
} Vomiting hemostasis
Acute Problems in CRF

} Relating to underlying disease

} Relating to ESRD
} Dialysis related problems
Problems Related to ESRD

} Metabolic – K/Ca
} Volume overload
} Anemia, platelet disorder, GI bleed
} HTN, pericarditis
} Peripheral neuropathy, dialysis dementia
} Abnormal immune function
Dialysis

}½ of patients with CRF eventually require

dialysis
} Diffuse harmful waste out of body
} Control BP
} Keep safe level of chemicals in body
} 2 types
} Hemodialysis
} Peritoneal dialysis
Hemodialysis

} 3-4 times a week

} Takes 2-4 hours
} Machine filters
blood and
returns it to
body
Types of Access

} Temporary site
} AV fistula
} Surgeon constructs by combining an artery
and a vein
} 3 to 6 months to mature
} AV graft
} Man-made tube inserted by a surgeon to
connect artery and vein
} 2 to 6 weeks to mature
Temporary Catheter
AV Fistula & Graft
What This Means For You

} No BP on same arm as fistula

} Protect arm from injury
} Control obvious hemorrhage
} Bleeding will be arterial
} Maintain direct pressure

} No IV on same arm as fistula

} A thrill will be felt – this is normal
Access Problems

} AV graft thrombosis
} AV fistula or graft bleeding
} AV graft infection
} Steal Phenomenon
} Early post-op
} Ischemic distally
} Apply small amount of pressure to reverse
symptoms
Peritoneal Dialysis

} Abdominal lining filters blood

}3 types
} Continuous ambulatory
} Continuous cyclical
} Intermittent
EMS Considerations

} Make sure the dressing remains intact

} Do not push or pull on the catheter
} Do not disconnect any of the catheters
} Always transport the patient and
bags/catheters as one piece
} Never inject anything into catheter
Dialysis Related Problems

} Lightheaded –give fluids

} Hypotension
} Dysrhythmias
} Disequilibration Syndrome
} At end of early sessions
} Confusion, tremor, seizure
} Due to decrease concentration of blood
versus brain leading to cerebral edema