RENAL •MAMTA KUMARI

•ASST.PROF.
FAILUR •IGIMS-CON

E
 OBJECTIVES
RENAL  State the definition of acute renal failure
FAILURE  State the definition of chronic renal failure
 Explain the etiology of both acute and chronic renal failure
 Outline the incidence of acute and chronic renal failure
 Understanding the pathophysiology of acute renal failure
 Understanding the pathophysiology of chronic renal
failure
 Explain the clinical manifestation of acute renal failure
 Explain the clinical manifestation of chronic renal failure
 State the complications of acute renal failure
 State the complications of chronic renal failure
 State the laboratory investigation for (acute, chronic)
renal failure
OBJECTIVES CONT’D
 Understanding the management
(medical,surgical,nursing) of both
chronic, acute renal failure
 Construct a nursing care plan for a
patient with acute renal failure
 Construct a nursing care plan for a
patient with chronic renal failure
 RENAL FAILURE

DEFINITION OF ACUTE RENAL FAILURE

Acute renal failure can be defined as a rapid decreased in the renal

function, leading to the accumulation of metabolic waste in the body.
This situation differs from the much more gradual decline in renal
failure seen in clients with CRF, although ARF can occur in people
with chronic renal failure insufficiency (CRI). Acute renal failure in
clients with CRI may result in end stage renal disease to nearly the
pre-ARF level of renal function.
 RENAL FAILURE

INCIDENCE OF ACUTE RENAL FAILURE

In the past five years there have been major advances in understanding
the epidemiology of ARF. This is no small feat, since we still lack a
centralized registry of patients with ARF. The incidence of azotemia
(including pre- and post-renal ARF), ascertained from DRG coding of
hospital discharge summaries, is projected to be approximately 275,000
per year in 1997 and increasing at a rate of 16,000 patients per year
according to the yearly National Hospital Discharge Survey. The incidence
of ARF is harder to ascertain. Since ARF is present in about 42% of
patients with azotemia9, the incidence of intrinsic acute renal failure is
about 115,000 cases/year. Thus, intrinsic acute renal failure qualifies as an
orphan drug indication, which has important implications for future drug
discovery.
RENAL
FAILURE
ETIOLOGY OF
ACUTE RENAL
FAILURE
RENAL FAILURE

PATHOPHYSIOLOGY OF ACUTE RENAL FAILURE

Pre renal failure is caused by a condition that diminishes blood flow to the kidneys, leading to hypo-
perfusion. Hypo-perfusion leads to excess nitrogenous waste in the blood, this develops into 40%-
80% of all cases of acute renal failure. The accumulation of the waste interrupts renal blood flow and
oxygen delivery which causes hypoxemia and ischemia which causes damage to the kidney.

The impaired blood flow constricts the afferent arterioles increasing glomerular permeability
resulting in decrease glomerular filtration rate (GFR) which leads to electrolyte imbalances and
metabolic acidosis. The kidney responds to decrease blood flow by conserving sodium and water.
RENAL FAILURE

PATHOPHYSIOLOGY OF ACUTE RENAL FAILURE

CONT’D
Intra renal failure
Nephrotoxicity or inflammation damages the delicate layer of the
epithelial cells of the kidneys. Severe or prolonged lack of blood flow
by ischemia leads to renal damage plus there will be excess nitrogen
in the blood.
The fluid loss hypotension ischemia ischemic cells toxic
oxygen free radicles causes swelling, injury and necrosis.
The necrosis cause by nephrotoxins tends to be uniform and limit to
the proximal tubules, whereas ischemia, necrosis tends to be patchy
and distribute along various parts of the nephron.
RENAL FAILURE

 PATHOPHYSIOLOGY OF ACUTE RENAL

FAILURE CONT’D
Postrenal failure
Bilateral obstruction of urine out flow ( the bladder, ureter,
urethra) necrosis, inflammation, blood clots, prostatic
hyperplasia, tumors postrenal failure.
CLINICAL MANIFESTAION OF ACUTE RENAL FAILURE

 Oliguria due to decrease GRF

 Tachycardia due to hypotension
 Hypotension due to hypovolemia
 Edema due to fluid retention
 Muscle weakness, when your body's fluids and electrolytes are out of
balance, muscle weakness can result.
 Confusion
 Shortness of breath, acute kidney failure may lead to a buildup of fluid
in your chest, which can cause shortness of breath.
RENAL FAILURE

MEDICAL MANAGEMENT FOR ACUTE RENAL

FAILURE
Measures to correct underlying causes of acute kidney injury
(AKI) should begin at the earliest indication of renal dysfunction.
Maintenance of volume homeostasis and correction of

biochemical abnormalities remain the primary goals of treatment

and may include the following measures:
 Correction of fluid overload with furosemide
 Correction of severe acidosis with bicarbonate administration,
which can be important as a bridge to dialysis
Management for Acute renal failure
cont’d.

 Correction of hyperkalemia
Hyperkalemia in patients with AKI can be
life-threatening. Approaches to lowering
serum potassium include the following:
 Decreasing the intake of potassium in
diet or tube feeds
 Exchanging potassium across the gut
lumen using potassium-binding resins
 Promoting intracellular shifts in
potassium with insulin, dextrose
solutions, and beta agonists
 Instituting peritoneal dialysis to correct
fluid and electrolyte imbalance

 Correction of hematologic abnormalities

(e.g., anemia, uremic platelet
dysfunction) with measures such as
transfusions and administration of
desmopressin or estrogens
 Complications
 Chronic renal failure
 Ischemic parenchymal injury
 Intrinsic renal azotemia
RENAL  Electrolyte imbalance
FAILURE  Metabolic acidosis
 Pulmonary edema
 Infection
 DEFINITION OF CHRONIC RENAL
FAILURE

RENAL
FAILURE Chronic renal failure (CRF) is a
clinical syndrome of progressive,
irreversible kidney injury. When
kidney function is inadequate for
sustaining life, chronic renal failure
is referred to as end stage renal
disease ESRD
 ETIOLOGY OF CHRONIC RENAL FAILURE
RENAL
FAILURE
The etiology of chronic renal failure is complex more
than 100 different disease processes can cause
progressive loss of renal function. The over lapping
nature of the causes of CRF are related to a variety of
classification schemes used to organize the disorders.
Uncontrolled high blood pressure over many years
High blood sugar over many years
Infections such as, pyelonephritis or
glomerulonephritis
A narrowed or blocked artery in the kidney
Long term use of medicines such as NSAIDS
( ibuprophen, celecoxib)
Sickle cell disease
 PATHOPHYSIOLOGY OF CHRONIC
RENAL FAILURE

Stages of renal failure, the kidneys tend to

fail in an organize fashion., the client
progression towards (ESRD) usually begins
with a decreased in renal function.

STAGE 1
RENAL Diminished renal Reserve: renal function is
FAILURE reduced but no accumulation of metabolic
wastes occurs:
1. The healthier kidney compensates for
the diseased kidney
2. Ability to concentrate urine is deceased,
resulting in nocturia and polyuria
3. A 24hour urine for creatinine clearance
is necessary to detect that renal reserve
is less than normal
RENAL FAILURE

STAGE 2 RENAL INSUFFIENCY

1. Metabolic wastes begin to accumulate in the blood

because the unaffected nephrons can no longer
compensate
2. Responsiveness to diuretics is decrease resulting in
oliguria and edema
 RENAL FAILURE

STAGE 3 END STAGE RENAL FAILURE

 Excessive amount of metabolic waste such as urea and creatinine

accumulate in the blood.

 The kidney is unable to maintain homestatasis.

 RENAL FAILURE

CLINICAL MANIFESTATION OF CHRONIC RENAL FALIURE

 Pericarditis: Can be complicated by cardiac tamponed, possibly
resulting in death.
 Encephalopathy: Can progress to coma and death
 Peripheral neuropathy
 Restless leg syndrome
 Gastrointestinal symptoms: Anorexia, nausea, vomiting, diarrhea
 Skin manifestations: Dry skin, pruritus, ecchymosis
 Fatigue, increased somnolence, failure to thrive
 Malnutrition
 Erectile dysfunction, decreased libido, amenorrhea
 Platelet dysfunction with tendency to bleed
 Medical management of chronic
renal failure.

Chronic Kidney Disease

Medical Treatment
RENAL • There is no cure for chronic kidney
disease.
FAILURE • The four goals of therapy are to:
• slow the progression of disease;
• treat underlying causes and
contributing factors;
• treat complications of disease; and
• Replace lost kidney function.
 Strategies for slowing progression
and treating conditions underlying
chronic kidney disease include the
following:

• Control of blood glucose i.e. hypertonic

glucose, insulin
• Control of high blood pressure
• Diet
• Anemia
• Fluid retention
• Bone disease.
• Metabolic acidosis (sodium bicarbonate
(baking soda) to correct the problem)
• Dialysis- After all other methods are failed.
RENAL FAILURE

SURGICAL MANAGEMENT FOR CHRONIC RENAL

FAILURE
COMPLICATIONS OF CHRONIC RENAL
FAILURE

1. Chronic kidney disease-associated anemia-Anemia due

to decreased erythropoietin production decreased RBC
lifespan, bleeding in the GI tract from irritating toxins and 
ulcer formation, and blood loss during hemodialysis.

2. CKD-associated Mineral and Bone Disorders-Bone

disease and metastatic and vascular calcifications due to
retention of phosphorus, low serum calcium levels,
abnormal vitamin D metabolism, and elevated aluminum
levels.

3. Cardiovascular Risk-Hypertension due to sodium and

water retention and the malfunction of the renin-
angiotensin-aldosterone system
 Hyperkalemia. Hyperkalemia due to decreased excretion,
metabolic acidosis, catabolism, and excessive intake (diet,
medications, fluids).

 Pericarditis. Pericarditis due to retention of uremic waste

products and inadequate dialysis.
Prevention

 Preventing renal failure involves the following:

 Hydration. Provide adequate hydration to patients at risk for dehydration.
 Shock. Prevent and treat shock promptly with blood and fluid replacement.
 Close monitoring. Monitor central venous and arterial pressures and hourly
urine output of critically ill patients to detect the onset of renal failure as early as
possible.
 Blood administration. Take precautions to ensure that the appropriate blood is
administered to the correct patient in order to avoid severe transfusion reactions.
 Infections. Prevent and treat infections promptly because they can produce
progressive renal damage.
 Toxic drug effects. To prevent toxic drug effects, closely monitor dosage,
duration of use, and blood levels of all medications metabolized or excreted by
the kidneys.
 NURSING MANAGEMANT FOR BOTH ACUTE AND
CHRONIC RENAL FAILURE.

Monitor for potential complications.

Assist in emergency treatment of fluid and electrolyte

imbalances.

Assess progress and response to treatment; provide

RENAL physical and emotional support.

FAILURE . Keep family informed about condition and provide

support.

Monitoring fluid and Electrolyte Balance 

Screen parenteral fluids, all oral intake, and all

medications for hidden sources of potassium.

Monitor cardiac function and musculoskeletal status for

signs of hyperkalemia.
NURSING MANAGEMENT CONT’D.

Prescribed IV medications should be administered in the smallest

volume possible.

Maintain daily weight and intake and output records.

Prepare for emergency treatment of hyperkalemia.

Prepare patient for dialysis as indicated to correct fluid and electrolyte

imbalances.

Reduce exertion and metabolic rate with bed rest.

Prevent or treat fever and infection promptly.

Promoting Pulmonary Function.

Assist patient to turn, cough and take deep breaths frequently.

Encourage and assist patient to move and turn.

NURSING MANAGEMENT CONT’D.

 Practice asepsis when working with invasive lines and

catheters.
 Avoid indwelling catheters if possible.
 Bath the patient with cool water, turn patient frequently,
keep the skin clean and well moisturized and fingernails
trimmed for patient comfort and to prevent skin
breakdown.
RENAL FAILURE

A NURSING CARE PLAN FOR A PATIENT WITH

CHRONIC RENAL FAILURE

ASSESSMENT:
 upon assessment patient was observed to have puffiness of
the eye, distended abdomen due to the accumulation of
fluids, edema to the pherphial extremities (the ankles).
 Patient was also observed to be mentally confused and
uneasy. Patient complaint about sever pain to the lower
lumbar area of the vertebrae.
RENAL FAILURE

PLANNING

 To reduce the pain within 24hrs from a scale of 1 to

10. where 10 been the most.
 Want to reduce the puffiness under the patient eyes
within 42hrs.
 Treat edema and reduce the intertissual fluid
 Want to stabilize the patient mentally within 42hrs
 RENAL FAILURE

INTERVENTION RATIONAL
• Administer prescribed analgesics e.g. • To reduce the pain to 5( from a scale 1 to
dicolfenac 10 where 10 been the most

• To obtain a baseline data especially

• Assess the patient vital signs
paying attention to the respiratory, and
blood pressure

• Want to reduce the gurd of the abdomen • Reduce the accumulation of the fluid
built up in the abdominal cavity. This
will provide comfort to the patient and
aid in respiration

• Treat the edema • By using prescribed medications to

reduce the swelling.
RENAL FAILURE

GOALS IN EVALUATING

 Homeostasis achieved.
 Complications prevented or minimized.
 Dealing realistically with current situation.
 Disease process, prognosis, and therapeutic regimen
understood.
 Plan in place to meet needs after discharge.