ACUTE RENAL FAILURE AND CHRONIC RENAL FAILURE.pptx

ARF, CRF

1. ARF AND CRF

2. RENAL FAILURE Renal failure or kidney failure (formerly called renal insufficiency) is a situation in which the kidneys fail to function adequately.

3. TYPES OF RENAL FAILURE ACUTE RENAL FAILURE (ARF) CHRONIC RENAL FAILURE (CRF)

4. ACUTE RENAL FAILURE Acute renal failure is the sudden and complete loss of the ability of the kidneys to remove waste. It occurs when the kidneys stop working over a period of hours, days, or in some cases, weeks.

5. CAUSES OF ARF PRERENAL INTRARENAL POSTRENAL

6. PRERENAL CAUSE Sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness.

7. Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply. INTRARENAL CAUSE

8. Sudden obstruction of urine flow due to enlarged prostrate, kidney stones, bladder tumor or injury. POSTRENAL CAUSE

9. RISK FACTORS Being hospitalized, especially for a serious condition that requires intensive care Advanced age Diabetes High blood pressure Heart failure, Kidney diseases, Liver disease etc.

10. Renal damage is occurring. The child may be asymptomatic 1. Initiation phase

11. 2. Oliguric phase This phase starts when urinary volume less than 30 ml to 400 ml/ 24 hours. Impaired glomerular filtration Waste cannot be remove Uremia develops CCF(Congestive cardiac failure), HTN, anemia

12. 3. Diuresis Phase Diuresis phase is marked by increased urine secretion of more than 400 ml/ 24 hours. Gradual return to normal Dehydration and electrolyte imbalance due to excess urination.

13. 4. Recovery Phase It takes months - if left untreated it result in fluid overload, electrolyte imbalance, uremia(abnormally high level of waste product in the blood) and coma.

14. CLINICAL MANIFESTAIONS Severe oliguria/ Anuria Child may be extremely sick Nausea / Vomiting Lethargy Dehydration Altered consciousness Irregular cardiac rate, rhythm Edema

15. DIAGNOSTIC EVALUATIONS Careful history taking : Vomiting, diarrhea , fever, other renal disease Laboratory investigations: Anemia , raised serum creatinine level, blood urea, electrolytes etc. Urine examination: Proteinuria, Hematuria , presence of casts (tiny tube shaped particles made up of WBC, RBC or kidney cells).

16. DIAGNOSTIC EVALUATIONS USG IVP Renal biopsy

17. Pharmacologic Therapy Fluid and dietary restrictions Use of diuretics Maintain Electrolytes Stimulate production of urine with IV fluids, diuretics, etc. Hemodialysis

18. Nursing management Monitor I/O, including all body fluids Monitor lab results Watch hyperkalemia symptoms: malaise, anorexia, muscle weakness, ECG changes etc. Watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions.

19. Nursing management Maintain nutrition Mouth care Daily weights Assess for signs of heart failure Skin integrity problems

20. CHRONIC RENAL FAILURE OR ESRD

21. DEFINITION Crf or esrd is a progressive, irreversible deterioration(becoming worse) in renal function in which the body’s ability to maintain metabolic and fluid and electrolyte balance fails resulting in uremia or azotemia (elevation of nitrogen in blood).

22. ETIOLOGY AND RISK FACTORS Decreased renal blood flow Systemic diseases Diabetes mellitus Hypertension Sle Sickle cell disease (RBC disorder) Glomerulonephritis Arf

23. ETIOLOGY AND RISK FACTORS Obstruction of the urinary tract Hereditary lesions Polycystic kidney disease (cluster of cysts develop in the kidneys) Infections Vascular diseases (heart diseases)

24. ETIOLOGY AND RISK FACTORS Environmental or occupational agents. (chemical elements) Lead Cadmium Mercury Chromium

25. PATHOPHYSIOLOGY Due to etiological factors Decreased gfr Hypertrophy(increase in size) of nephrons Inability to concentrate urine Further loss of nephron function Loss of non-excretory(secretion of hormones,Vit D etc.) and excretory function

26. STAGES OF CRF Reduced Renal reserve BUN is high or normal Client has no C/M 40 to 75 % loss of nephron function

27. STAGES OF CRF 2. Renal Insufficiency 75 to 90 % loss of nephron function Impaired urine concentration Nocturia, mild anemia, increased creatinine and BUN

28. STAGES OF CRF 3. Renal failure Severe azotemia Impaired urine dilution Severe anemia Electrolyte Imbalances Hypernatremia, Hyperkalemia , Hyperphosphatemia

29. STAGES OF CRF 4 . End Stage Renal Disease 10 % nephrons functioning Multisystem dysfunction

30. CLINICAL MANIFESTATIONS Early symptoms Weakness Anorexia Nausea Failure to thrive Unexplained anemia Osteodystrophy (bone disorder that affects bone growth) Growth failure

31. CLINICAL MANIFESTATIONS 2. Late manifestations Gastrointestinal bleeding Pericarditis (inflammation of pericardium) Congestive cardiac failure Altered sensorium (inability to think clearly)

32. CLINICAL MANIFESTATIONS 3. Indications of poor prognosis Convulsions Coma Cardiomyopathy(chronic disease of the heart muscle)

33. DIAGNOSTIC EVALUATION Blood examination – Decreased hematocrit , increased K+ & phosphorus Renal function test – Gradual increase in BUN, uric acid & creatinine Urinalysis – Variation in specific gravity, increased urine creatinine, change in total urine output.

34. DIAGNOSTIC EVALUATION X-Ray – Chest, hands, knees, pelvis, spine to detect bony defect. ECG and IVP Other abnormal findings – Metabolic acidosis, Fluid imbalance, Insulin resistance

35. MANAGEMENT Preserve the renal function and dialysis Controlling the disease process. Controlling BP by diet control, weight control and medication. Reducing dietary protein intake

36. MANAGEMENT 2) Alleviate extra renal manifestations. Pruritis – Topical emollient and lotion. Antihistamine. IV Lidocaine

37. MANAGEMENT b) Neurological manifestations. Safety measures to protect from injury. Anticonvulsants. Sedatives

38. MANAGEMENT 3. Improve body chemistry . Dialysis Medications Diet

39. MANAGEMENT Dialysis Hemodialysis Peritoneal dialysis

40. HEMODIALYSIS VS PERITONEAL DIALYSIS Hemodialysis  uses a machine and a filter to remove waste products and water from the blood. Peritoneal  dialysis  uses a fluid (dialysate) that is placed into the patient's abdominal cavity to remove waste products and fluid from the body.

41. MANAGEMENT Medications Hyperkalemia Insulin administration – I/V Sodium bicarbonate Calcium Gluconate – I/V

42. MANAGEMENT Medications Sodium and fluid restriction Anti hypertensive drugs

43. MANAGEMENT Diet Protein restriction 0.6 to 0.75 gm/kg of ideal body weight/day 1.2 to 1.3 gm/kg of ideal body weight/day once the patient starts dialysis

44. MANAGEMENT Diet Phosphate restriction Potassium restriction Sodium restriction

45. SURGICAL MANAGEMENT Renal Transplantation