Acute Renal Failure and Chronic Kidney Failure

- Sudden, (hours to days) life threatening loss of kidney functions characterized by and increase in blood urea nitrogen (BUN) and serum creatinine. The kidneys are no longer able to eliminate waste products of metabolism and azotemia results. *This condition is reversibile.

• •Pre-renal ( factors that reduce renal bloodflow and decreased glomerular filtration and perfusion)
• decreased vascular volume, decreased cardiac output, abnormal distribution of vascular fluids(septic shock,peritonitis)and renal artery obstruction.

• •Intra Renal- conditions that cause direct damage to therenal tissue.
• Infectious process (strept), Nephrotoxic injury, blood transfusion reaction, contrast media (x-rays),trauma-massive tissue destruction,drugs/chemicals,Toxemia of Pregnancy , Malignant Hypertension and Liver-renal diseases (hepatorenal)

•Post Renal- caused by mechanical obstruction of the flow of urine by:BHP, calculi,neoplasms,strictures and Spinal Cord Disease (urine retension).

• 1. Initiating Phase- begins at the time of insult and continues until signs and symptoms become apparent.
• 2. Oliguric Phase-Oliguria/anuria(less than 400ml/day),has an of onset (1-7 days), may last days to weeks,increased sodium in urine and protein appear in urine.
• 3. Diuretic Phase- Early-begins when output is GREATER than400ml and ends when lab values stop rising. Late-begins when lab values start to decline and ends when lab values stabilize. Time span-approx. 14 days.Urine output may be greater than 5L/day.
• 4. Recovery Phase-Begins when lab values stabilize,ends when renal functions return to normal,time Span 4-6 months and output 1400ml/day or above/or 30ml/hr.

• Onset- administer NS per physician’s order (may be 250ml in 15 min.), Monitor lab values (for urinalysis, sodium, BUN, creatinine, glucose, and electrolytes,)and administer diuretics as ordered(mannitol,lasix).
• Oliguric -I&O, V/S,lab data and LOC.
• Diuretic- I&O, V/S,Lab (decreasing),signs of dehydrations and signs of hypovolemia.

- Progressive, non-reversible destruction of the nephrons in the kidneys and the nephrons are replaced by scar tissue.

• •Diminished renal reserve-characterized by normal BUN and creatinine. There are no signs or renal failure.
• •Renal Insufficiency-characterized by easy fatigue, weakness, headache, nausea, pruritis- During the night client voids 3-5X
• •End Stage Renal Disease (ESRD)-GFR is very low(5-10%) of normal and client has difficulty with ADLs .

• •Cardiovascular- HTN,CHF,dysrhythmias, and systemic edema.
• •Respiratory- pulmonary edema,pneumonia and Kussmaul’s respiriations.
• •Reproductive- infertility and decreased libido
• •Hematological- anemia, alterations in coagulation, and increased susceptilbility to infection.
• •Integumentary- pallor, yellowish color, dryness, pruritis, purpura, ecchymoses, and uremic frost.
• •Acid/Base- Hyperkalemia. Ca++ and P--- alterations, and metabolic acidosis.
• •Skeletal-hypocalcemia and soft tissue calcification.

• •Conservative care- drugs, dietary restriction of proteins, sodium, potassium, and water. treatment of underlying clinical manifestations.
• •Dialysis- Movement of fluid and molecules across a semi-permeable membrane from one compartment to another.
• -Types of Dialysis
• Hemodialysis- blood from a shunt, graft, or fistual flows into an external dialyzer and flitered and put back into the body.
• Peritoneal- the peritoneal membrane acts as ssemipermiable filter membrane that filters the blood.