Renal Failure

 Glossary
 Definition of ARF
 Etiology
 Risk Factor
 Symptoms of ARF
 Phases of ARF
 RIFLE Criteria
 Diagnoses

 Lab Finding
 Treatment
 Indication for Dialysis
 Nutrition therapy
 Prevention
 Complication
 NSG . management & NSG. Diagnosis
 Conclusion

Urea : waste product of protein.
Creatinine : waste product of muscle energy .
Azotemia : abnormal concentration of nitrogenous waste in blood.
Uremia : excess of urea and other nitrogenous waste in blood.
GFR : total rate of filtration of blood by the kidney
Creatinine Clerance : rate of filtration of creatinine by the kidney.
ESRF : end stage renal failure, uremia requiring transplantation or dialysis.

 Anuria – no urine output or less than
100mls/24 hours
 Oliguria - <500mls urine output/24 hours or
<20mls/hour
 Polyuria - >2.5L/24 hours

Filtration
Reabsorbtion
Secretion

 DEFINITIONS
 Different to renal insufficiency where kidney
function is deranged but can still support life
 Acute renal failure is a sudden reduction in kidney
function that results in nitrogenous wastes
accumulating in the blood.

 Pre renal (functional):
 Decreased renal perfusion without cellular injury
 70% of community acquired cases
 40% hospital acquired cases
 Renal-intrinsic (structural):
 Glomerulonephritis (GN)
 Acute interstitial Necrosis (AIN)
 Acute tubular necrosis (ATN)
 Post renal (obstruction):
 Post renal obstruction
 Obstruction to the urinary outflow tract

Problems affecting the flow of blood before it reaches
the kidneys
1) Dehydration
vomiting, diarrhea, or blood loss.
2) Disruption of blood flow to the kidneys
Major surgery with blood loss, severe injury or burns,
or infection in the bloodstream.
 Blockage or narrowing of a blood vessel carrying
blood to the kidneys.
 Heart failure or heart attacks causing low blood flow.

 Renal Problems with the kidney itself that prevent proper
filtration of blood or production of urine(25-40%).
 Blood vessel diseases
 Blood clot in a vessel in the kidneys
 Injury to kidney tissue and cells

Glomerulo nephritis
e.g, Streptococcal bacterial infections may damage
the glomeruli.
Acute interstitial nephritis
1) Medications such as antibiotics, anti-inflammatory
medicines (for example, aspirin, ibrufen), and water
pills .
2) infections and immune-related diseases such
as lupus , leukemia, lymphoma, and sarcoidosis.

 Causes include shock (decreased blood supply to
the kidneys), drugs (especially antibiotics)
and chemotherapy agents, toxins and poisons, and
dyes used in certain kinds of x-rays.
 Accidents, injuries
 complications from surgeries (eg.Heart-bypass
surgery)
 Polycystic kidney.
 produce less erythropoietin

 Advanced age
 Blockages in the blood vessels in your arms or legs
 Diabetes
 High blood pressure
 Heart failure
 Kidney diseases
 Liver disease

 Vomiting and/or diarrhea, which may lead to dehydration.
 Nausea.
 Weight loss.
 Nocturnal urination.
 pale urine.
 Less frequent urination, or in smaller amounts than usual,
with dark coloured urine
 Feeling tired and/or weak.
 Memory problems.
 Difficulty concentrating.
 Dizziness.
 Low blood pressure.

 Haematuria.
 Pressure, or difficulty urinating.
 Itching.
 Bone damage.
 Non-union in broken bones.
 Muscle cramps (caused by low levels of calcium which can
cause hypocalcaemia).:
 Abnormal heart rhythms.
 Muscle paralysis.
 Swelling of the legs, ankles, feet, face and/or hands.
 Shortness of breath due to extra fluid on the lungs
 Pain in the back or side

 Anorexia
 Pruritus
 Seizures (if blood urea nitrogen level is very high)
 Shortness of breath (if volume overload is present).
 Decrease osmolality(A measurement of urine concentration
that depends on the number of particles dissolved in it).
 Increase urinary sodium.
 Pericarditis.
 Pericardial effusion.
 Pleural effusion.
 Decrease calcium and bicarbonate.
 Defect in platelet functionings

 Initiating phase : period from elapse from the occurrence of
disease to beginning change of U/O and may be from several
hours to 2days

 Maintenance phase : intrinsic renal damage is established ,
GFR 5-10ml/min , and may be 400ml/24hrs (oligurea), and
may be from 8-14 day and may up to 11 month and renal
complication start.
 Recovery phase : renal tissue recovered & repair itself and
it may up to 4-6 months

 History collection.
 Physical examination.
1 Asterixis and myoclonus
2 Peripheral edema (if volume overload is present)
3 Pulmonary rales (if volume overload is
present)
4 Elevated right atrial pressure (if volume overload is
present)

 Rising creatinine and urea
 Rising potassium
 Decreasing Hb
 Acidosis
 Hyponatraemia
 Hypocalcaemia

 Identification of precipitating cause.
 Serum creatinine and BUN level .(n 7-18mg/dl)
 Serum electrolytes.
 Urine analysis.
 Renal bladder ultra sound.
 Renal scan.
 CT scans and MRI scan (to identify lesion and
masses)
 The urine will be examined under a microscope.
 biopsy

 correcting fluid and electrolyte balance.
 Correct dehydration.
 Correct dehydration.
 Keeps other body systems working properly
 Furosemide, Torsemide
 calcium gluconate
 Sodium bicarbonate
 Dialysis( it will be discussed later with Mai )

AEIOU
 Acidosis (metabolic)
 Electrolytes (hyperkalemia)
 Ingestion of drugs/Ischemia
 Overload (fluid)
 Uremia

 Provide protein diet.
 Calori requirements are met with high
carbo-hydrate meals (carbo-hydrates have
a protein-sparing effect).
 Foods and fluid containing potassium or
phosphorous (banana, coffee) are
restricted.
 Patient may require parenteral nutrition.

 A careful history(nephrotoxic antibiotic agent
aminoglycosides, gentamicin, tobramicine, etc.)
 blood tests and urinalysis
 Drink enough fluids
 Difficulties urinating or blood in the urine should
prompt a visit
 Treat hypotension promptly.
 Prevent and treat infections promptly.
 Pay special attention to wound, burns and other
precursors of sepsis.

 ARF can affect the entire body
 Infection
 Hyperkalaemia, Hyperphosphataemia, hyponatraemia
 water overload
 Pericarditis
 Pulmonary oedema.
 Reduced level of consciousness.
 Immune deficiency.

 Providing skin care
 Providing support
 Monitor weight daily
 Monitor lab results & Urine Out put
 Teach Pt about nutrition Diet
 Diagnoses
 Excess fluid volume related to decreased Glomerular
filtration rate and sodium retention
 Sleep pattern disturbances related to disease condition
 Risk for infection related to alterations in the immune system
and host defenses
 Imbalanced nutrition: less than body requirements

 Think about who might be vulnerable to acute
renal failure
 Think twice before initiating therapy that may
cause ARF
 Be a human while dealing with your Pt

Renal Failure

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