CHRONIC RENAL FAILURE

Definition
Chronic Renal failure is a progressive reduction of functioning renal tissue such
that the remaining kidney mass can no longer maintain the body ‘s internal
environment.

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 and azotemia.

Etiology

 Chronic glomerular nephritis

 Acute renal failure
 Polycystic kidney disease
 Obstruction
 Repeated episodes of pyelonephritis
 Nephrotoxins
 Systemic disease such as DM,HTN,poly arthritis,Sickle cell
disease,amyloidosis

Stages of renal failure

Stage -I

Reduced renal reserve characterized by a 40% to 75% loss of

nephron function. The patient does not have symptoms of because of remaining
nephrons are able to carry out the normal function of the kidney.

Stage-II

Renal insufficiency occurs when 75%to 90% of nephron function is lost. The
serum creatinine and blood Urea nitrogen rises the kidney looses its ability to
concentrate urine and anaemic symptoms develop. The patient will have poly uria
and nocturia.
Stage: III

The end stage renal disease ESRD. The stage of CRF occurs when there is less
than 10% nephron function remaining. All the normal regulatory excretory and
normal functions of the kidney are severely impaired. ESRD is evidence increased
creatinine and increased Bun as well as electrolyte balance.

Clinical manifestations

 Cardiovascular system
 HTN, pitting edema
 Periorbital edema
 Pericardial friction rub
 Enlarged neck veins
 Pericarditis and pericardial effusion
 Hyperkalemia
 Hyperlipidemia
 Neurologic
 Weakness, fatigue, confusion, Inability to
concentrate,disoreientation,tumors,seizures,astrexis,restlessness of leg,
burning of soles of feet, behavior changes
 Integumentary
 Grey –bronze skin colour,flaky skin
 Pruritis
 Ecchymosis
 Perpura
 Course thinning hair
 Pulmonary
Crackles, thick tenacious sputum
Depressed cough reflex,pleuritic chest pain
Shortness of breath,tachypnea,kussmal type respiration
Uremic pneumonitis,uremic lung
 GI manifestations
 Ammonia odour of breath ,uremic feter
 Metallic taste,mouth ulceration and bleeding and anorexia
 Nausea,vomiting,constipation,diarrohoea,bleeding from GIT
 Reproductive
 Amenorrhoea
 Testicular atrophy
 Infertility
 Decreased libido
 Musculoskeletal
 Muscle cramps
 Loss of muscle strength
 Renal atrophy
 Bone pain
 Bone fracture
 Foot drop
 Urinary tract
 Oliguria
 Anaemia
 Proteinuria
 Haematuria
 Endocrine
 Thyroid abnormalities
 Increased BUN,hyperkalemia
 Increased serum creatinine
 Decreased calcium
 Finally patient goes in to renal encephalopathy.

Diagnosis

 Monitor electrolyte levels

 Urine examination for protein
 Monitor blood glucose level
 Monitor erythropoietin level.
Medical management
 Preserve renal function and delay dialysis
 Check BP every fourth hourly
 Contro B.p by diet restriction and weight reduction and anti hypertensives
 Reducing dietary protein and catabolism
 Evaluate client blood chemistry level
 Administer protein of high biologic value up to 50 mg /day
 Avoid high protein diet
 Pruritis can be corrected with topical lotions,anti histamine,Iv,UV rays
 Neurological manifestations then we can control by administration of
sedatives
 Improve body chemistry by dialysis, modification and transplantation.
Surgical management
 Kidney Transplantation
Nursing Management
 Frequent monitoring of patient
 Maintain I/O Chart
 Assess the function of cardiovascular system and respiratory system
 Monitor electrolytes
 Nutritional management
 Assess mental status and emotional well being
 Ensure proper medical regimen
 Maintain skin care
 Care of the shunt
 Education to family and patient.

Complications

 Hyperkalemia
 Pericarditis, pericardial effusion
 Hypertension due to sodium and water retention
 Anemia
 Bone diseases
 Metastatic and vascular calcifications