ACUTE RENAL

FAILURE Rapid
onset of oliguria
(<400 ml /day) ,
with severe rise in
BUN & creatinine
(Azotemia –
accumulation of
nitrogen in blood )
Acute renal failure is
classified as pre renal,
intra renal or post renal.
All conditions that lead to
pre renal failure impair
blood flow to the kidneys
(renal perfusion), resulting
in a decreased glomerular
filtration rate and
increased tubular
resorption of sodium and
water. Intra renal failure
results from damage to
the
 Onset – 1-3 days with ^ BUN and creatinine and
possible decreased UOP
 Oliguric – UOP < 400/d, ^BUN,Crest, Phos, K, may
last up to 14 d
 Diuretic – UOP ^ to as much as 4000 mL/d but no
waste products, at end of this stage may begin to
see improvement
 Recovery – things go back to normal or may
remain insufficient and become chronic
 Complications ARF
Hyperkalemia – most
dangerous complication,
may lead to cardiac arrest if
rise in K+ is too fast
Nursing Care ARF

– Daily Weight
– CVP monitoring
– Diuretic as prescribed
– Low protein, K,Na & high
carbohydrate diet
Nursing Care ARF
– Emergency
management of
Hyperkalemia : insulin
& dextrose Kayexalate
enema
Chronic Renal failure

Chronic irreversible
progressive reduction of
functioning renal tissue
Common causes CRF
–Diabetic nephropathy
–Hypertensive nephropathy
–Glomerulonephritis
–Chronic pyelonephritis
Stages CRF
1. Reduced Renal Reserve high
BUN no clinical symptoms yet
2. Renal insufficiency- mild
Azotemia – impaired urine
concentration , nocturia
Stages CRF
3. Renal failure – Severe
azotemia,
acidosis,concentrated urine,
severe anemia & electrolyte
imbalances
CRF systemic SS

–Hyper K, Hypernatremia,
Hypocalcemia
–Anemia
–Anorexia, nausea & vomiting
CRF systemic SS

– Ammoniacal breath
– Immunosuppression
– HTN, CHF
– Pulmonary edema
– Severe pruritus
– Peripheral neuropathy
– Uremic amaurosis
Nursing Care ESRD

–Low Protein, Low Na diet

–Prepare client for
peritoneal / hemodialysis
–Monitor Anemia
Nursing Care ESRD

–Administer epoietin alpha

(Epogen), diuretics,
antihypertensives as prescribed
–Kidney transplant
Peritoneal Dialysis
Peritoneal Dialysis
Hemodialysis
HEMODIALYSIS:
–Is the diffusion of dissolved
particles from the blood into the
dialysate bath of the
hemodialysis machine across
the semipermeable membrane
of the dialyzer.
Hemodialysis requires vascular access:
–Subclavian vein/ Femoral vein
(temporary)
–Arteriovenous fistula, arteriovenous
shunt,/ arteriovenous graft
–( Permanent)
Hemodialysis
Hemodialysis
Nursing Management:
–Assess the integrity of the
hemodialysis access site
–Monitor VS
–Assess client for fluid overload
 Nursing Management:

–Weigh the client before and after the

dialysis treatment ( to determine fluid
loss)
–Hold meds that can be dialyzed off
–Monitor for SS of Shock & Disequilibrium
syndrome
Complication: Disequilibrium Syndrome

– is the rapid change in composition of

extracellular fluid where the solutes of the blood
are removed from the blood faster than that of
the CSF, causing osmotic movement of fluid into
the CSF causing cerebral edema.
Nursing Management: Disequilibrium syndrome:

–Assess for Nausea & vomiting

–Assess for headache
–Restlessness, agitation & or
confusion
–Watch out for seizures
Nursing Management: Disequilibrium syndrome

–Notify physician if SS of
disequlibrium syndrome occurs
–Reduce environmental stimuli
– Dialyze the patient at a shorter period
and at a slower rate
Kidney Transplant