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Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
Renal failure
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Renal failure

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  1. Renal Failure Wendy DeMartino, MD PGY-2
  2. Objectives  Anatomy  Function  Acute Renal Failure (ARF)  Causes  Symptoms  Management  Chronic Renal Failure (CRF)  Causes  Symptoms  Dialysis
  3. Anatomy  2 Kidneys  2 Ureters  Bladder  Urethra
  4. Kidney Function  Detoxify blood  Increase calcium absorption  calcitriol  Stimulate RBC production  erythropoietin  Regulate blood pressure and electrolyte balance  renin
  5. Classifications  Acute versus chronic  Pre-renal, renal, post-renal  Anuric, oliguric, polyuric
  6. Acute Versus Chronic  Acute  sudden onset  rapid reduction in urine output  Usually reversible  Tubular cell death and regeneration  Chronic  Progressive  Not reversible  Nephron loss  75% of function can be lost before its noticeable
  7. Acute Renal Failure  Pre-renal = 55%  Renal parenchymal (intrinsic)= 40%  Post-renal = 5-15%
  8. Causes of ARF  Pre-renal =  vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure  cardiac failure, liver dysfunction, or septic shock  Intrinsic  Interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia, toxins  Post-renal =  prostatic hypertrophy, cancer of the prostate or cervix, or retroperitoneal disorders  neurogenic bladder  bilateral renal calculi, papillary necrosis, coagulated blood, bladder carcinoma, and fungus
  9. Symptoms of ARF  Decrease urine output (70%)  Edema, esp. lower extremity  Mental changes  Heart failure  Nausea, vomiting  Pruritus  Anemia  Tachypenic  Cool, pale, moist skin
  10. Diagnosis of Renal Failure
  11. Acute Renal Failure Management  Make/think about the diagnosis  Treat life threatening conditions  Identify the cause if possible  Hypovolemia  Toxic agents (drugs, myoglobin)  Obstruction  Treat reversible elements  Hydrate  Remove drug  Relieve obstruction
  12. ARF: Life Threatening Conditions  Hyperkalemia  Volume overload  Vascular access
  13. Hyperkalemia Symptoms  Weakness  Lethargy  Muscle cramps  Paresthesias  Hypoactive DTRs  Dysrhythmias
  14. Hyperkalemia & EKG  K > 5.5 -6  Tall, peaked T’s  Wide QRS  Prolong PR  Diminished P  Prolonged QT  QRS-T merge – sine wave
  15. Hyperkalemia Treatment  Calcium gluconate (carbonate)  Sodium Bicarbonate  Insulin/glucose  Kayexalate  Lasix  Albuterol  Hemodialysis
  16. Chronic Renal Failure  150–200 cases per million people = new cases each year  Chronic renal failure and ESRD affect more than 2 out of 1,000 people in the U.S  Mortality = 20%
  17. Chronic Renal Failure Causes  Diabetic Nephropathy  Hypertension  Glomerulonephritis  HIV nephropathy  Reflux nephropathy in children  Polycystic kidney disease  Kidney infections & obstructions
  18. CRF Symptoms  Malaise  Weakness  Fatigue  Neuropathy  CHF  Anorexia  Nausea  Vomiting  Seizure  Constipation  Peptic ulceration  Diverticulosis  Anemia  Pruritus  Jaundice  Abnormal hemostasis
  19. Acute Problems in CRF  Relating to underlying disease  Relating to ESRD  Dialysis related problems
  20. Problems Related to ESRD  Metabolic – K/Ca  Volume overload  Anemia, platelet disorder, GI bleed  HTN, pericarditis  Peripheral neuropathy, dialysis dementia  Abnormal immune function
  21. Dialysis  ½ of patients with CRF eventually require dialysis  Diffuse harmful waste out of body  Control BP  Keep safe level of chemicals in body  2 types  Hemodialysis  Peritoneal dialysis
  22. Hemodialysis  3-4 times a week  Takes 2-4 hours  Machine filters blood and returns it to body
  23. Types of Access  Temporary site  AV fistula  Surgeon constructs by combining an artery and a vein  3 to 6 months to mature  AV graft  Man-made tube inserted by a surgeon to connect artery and vein  2 to 6 weeks to mature
  24. Temporary Catheter
  25. AV Fistula & Graft
  26. What This Means For You  No BP on same arm as fistula  Protect arm from injury  Control obvious hemorrhage  Bleeding will be arterial  Maintain direct pressure  No IV on same arm as fistula  A thrill will be felt – this is normal
  27. Access Problems  AV graft thrombosis  AV fistula or graft bleeding  AV graft infection  Steal Phenomenon  Early post-op  Ischemic distally  Apply small amount of pressure to reverse symptoms
  28. Peritoneal Dialysis  Abdominal lining filters blood  3 types  Continuous ambulatory  Continuous cyclical  Intermittent
  29. EMS Considerations  Make sure the dressing remains intact  Do not push or pull on the catheter  Do not disconnect any of the catheters  Always transport the patient and bags/catheters as one piece  Never inject anything into catheter
  30. Dialysis Related Problems  Lightheaded –give fluids  Hypotension  Dysrhythmias  Disequilibration Syndrome  At end of early sessions  Confusion, tremor, seizure  Due to decrease concentration of blood versus brain leading to cerebral edema

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