6/9/2013 1RENAL FAILURE• The loss of kidney function• Sudden interruption of kidney function toregulate fluid and electrol...
6/9/2013 2CLINICAL FINDINGSOLIGURIC PHASEHypernatremiaHyperkalemiaHyperphosphatemiaHypocalcemiaHypermagnesemiaMetabolic ac...
6/9/2013 3Acute Renal Failure• Prerenal• Intrarenal• Postrenal
6/9/2013 4Phases of Acute Renal Failure• 1. Oliguric phase• 2. Diuretic phase• 3. Recovery or convalescenceFour phases of ...
6/9/2013 5PRERENAL CAUSES INTRARENALCAUSESPOSTRENAL CAUSESCalculiBPHTumorsStricturesBlood clotsTraumaAnatomic malformation...
6/9/2013 6NURSING CARE• Monitor fluid and electrolyte balance.• Monitor alteration in fluid volume.• Promote optimal nutri...
6/9/2013 7Diagnostics• a. Increased BUN and serum creatinine level.• b. Decreased urinary creatinine clearance.• c. Elevat...
6/9/2013 8Acute renal failure -PATHOPHYSIOLOGYPrerenal CAUSE:• Factors interfering with perfusion andresulting in diminish...
6/9/2013 9CLINICAL FINDINGSSTAGE 1Diminished RenalReserveSTAGE 2Renal InsufficiencySTAGE 3End Stage
6/9/2013 10• Hemorrhage• Shock• Burns• Hypovolemia• Renal vascularobstruction-(A/V)thrombosis
6/9/2013 11Renal insufficiency• a. GFR is 25 percent of normal.• b. BUN and serum creatinine increased(azotemia).• c. Fati...
6/9/2013 12Chronic Renal FailureDermatologic dry skin, pruritus, uremicfrostCNS seizures, altered LOC,anorexia, fatigueCVS...
6/9/2013 13Chronic Renal FailurePATHOPHYSIOLOGYSTAGE 1= reduced renal reserve, 40-75% lossof nephron functionSTAGE 2= rena...
6/9/2013 14Renal/Intrarenal(kidney tissue pathology)• Acute tubular necrosis• Nephrotoxins• Aminoglycosides orNSAIDs• Heav...
6/9/2013 15Prerenal diseaseInadequatefiltrationNephrosclerosisHeart Failure Vasodilatation HypovolemiaSystemic Hypotension...
6/9/2013 16CLINICAL FINDINGSNausea and vomiting Uremic frostDecreased urinary output DyspneaHypotension (early)AzotemiaHyp...
6/9/2013 17Accumulationof soluteSystemic HormonalChanges in bloodInc. excretion ofSolute per nephronGlomerulosclerosisExtr...
6/9/2013 18Chronic Renal FailurePredisposing factors:–DM= worldwide leading cause–Recurrent infections–Exacerbations of ne...
6/9/2013 19• It occurs in stages, is irreversible, and resultsin uremia or end-stage renal disease CRFaffects all of the m...
6/9/2013 20• The result is azotemia to UREMIA• The nephrons left intact are subjected to anincreased work load, resulting ...
6/9/2013 21Chronic Renal Failure• CRF is a progressive, irreversible reduction inrenal function such that the kidneys are ...
6/9/2013 22Prerenal(renal ischemia)• Serious cardiovasculardisorders• Peripheral vasodilation• Severevasoconstriction
6/9/2013 23
6/9/2013 24Kidney functionThe Nephron producesurine to eliminate wasteImpaired urine productionand azotemiaSecretes Erythr...
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Diuretics, disorders.22.04.13

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physiological basis of renal failure, common causes, and presentation of A.R.F. and C.R.F.

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Diuretics, disorders.22.04.13

  1. 1. 6/9/2013 1RENAL FAILURE• The loss of kidney function• Sudden interruption of kidney function toregulate fluid and electrolyte balance andremove toxic products from the body
  2. 2. 6/9/2013 2CLINICAL FINDINGSOLIGURIC PHASEHypernatremiaHyperkalemiaHyperphosphatemiaHypocalcemiaHypermagnesemiaMetabolic acidosisDIURETIC PHASEHyponatremiaHypokalemiaHypovolemiaCONVALESCENT PHASENormal Urine VolumeIncrease in LOCBUN stable and normalMay develop CRF
  3. 3. 6/9/2013 3Acute Renal Failure• Prerenal• Intrarenal• Postrenal
  4. 4. 6/9/2013 4Phases of Acute Renal Failure• 1. Oliguric phase• 2. Diuretic phase• 3. Recovery or convalescenceFour phases of acute renal failure(Brunner and Suddarth)1. Initiation phase2. Oliguric phase3. Diuretic phase4. Convalescence or recovery phase
  5. 5. 6/9/2013 5PRERENAL CAUSES INTRARENALCAUSESPOSTRENAL CAUSESCalculiBPHTumorsStricturesBlood clotsTraumaAnatomic malformationHypotension Acute tubular necrosis (ATN)Diabetes mellitusCardiogenic shockAcute vasoconstriction Malignant hypertensionHemorrhage Acute glomerulonephritisTumorsBurnsSepticemia Blood transfusion reactionsCHFNephrotoxins
  6. 6. 6/9/2013 6NURSING CARE• Monitor fluid and electrolyte balance.• Monitor alteration in fluid volume.• Promote optimal nutritional status• Prevent complications from impaired mobility• Prevent fever and infection• Support client/S.O. & reduce/relieve anxiety
  7. 7. 6/9/2013 7Diagnostics• a. Increased BUN and serum creatinine level.• b. Decreased urinary creatinine clearance.• c. Elevated blood sugar and triglycerides.• d. Increased scrum potassium.• e. Anemia (decreased hemoglobin andhematocrit).
  8. 8. 6/9/2013 8Acute renal failure -PATHOPHYSIOLOGYPrerenal CAUSE:• Factors interfering with perfusion andresulting in diminished blood flow andglomerular filtrate, ischemia, and oliguria;include CHF, cardiogenic shock, acutevasoconstriction, hemorrhage, burns,septicemia, hypotension, anaphylaxis
  9. 9. 6/9/2013 9CLINICAL FINDINGSSTAGE 1Diminished RenalReserveSTAGE 2Renal InsufficiencySTAGE 3End Stage
  10. 10. 6/9/2013 10• Hemorrhage• Shock• Burns• Hypovolemia• Renal vascularobstruction-(A/V)thrombosis
  11. 11. 6/9/2013 11Renal insufficiency• a. GFR is 25 percent of normal.• b. BUN and serum creatinine increased(azotemia).• c. Fatigue and weakness, mild anemia.
  12. 12. 6/9/2013 12Chronic Renal FailureDermatologic dry skin, pruritus, uremicfrostCNS seizures, altered LOC,anorexia, fatigueCVS Acute MI, edema,hypertension, pericarditisPulmo Uremic lungsHema AnemiaMusculoskeletal loss of strength, footdrop, osteodystrophy
  13. 13. 6/9/2013 13Chronic Renal FailurePATHOPHYSIOLOGYSTAGE 1= reduced renal reserve, 40-75% lossof nephron functionSTAGE 2= renal insufficiency, 75-90% loss ofnephron functionSTAGE 3= end-stage renal disease, more than90% loss. DIALYSIS IS THE TREATMENT!
  14. 14. 6/9/2013 14Renal/Intrarenal(kidney tissue pathology)• Acute tubular necrosis• Nephrotoxins• Aminoglycosides orNSAIDs• Heavy metals-(carbontetrachloride, arsenic, lead, mercury
  15. 15. 6/9/2013 15Prerenal diseaseInadequatefiltrationNephrosclerosisHeart Failure Vasodilatation HypovolemiaSystemic HypotensionAtheroscleroisRenal arterystenosisRenal IschemiaPrerenal Disease
  16. 16. 6/9/2013 16CLINICAL FINDINGSNausea and vomiting Uremic frostDecreased urinary output DyspneaHypotension (early)AzotemiaHypertension (later) LethargyConvulsions Memory impairmentPericardial friction rub CHF
  17. 17. 6/9/2013 17Accumulationof soluteSystemic HormonalChanges in bloodInc. excretion ofSolute per nephronGlomerulosclerosisExtrarenal organDamage; uremicSyndrome;toxicEffects on renal cellsTubular cell damage& interstitial fibrosisTubularhyperthrophyHigh intraglomerularPressure and inc. filtrationof macromoleculesGlomerular hypertrophyand inc. SNGFRLoss of NeprhonsMaintenance of internalEnvironment up to limitsof Nephron adaptationAnd hyperthrophyPathophysiology of CRF
  18. 18. 6/9/2013 18Chronic Renal FailurePredisposing factors:–DM= worldwide leading cause–Recurrent infections–Exacerbations of nephritis–urinary tract obstruction–hypertension
  19. 19. 6/9/2013 19• It occurs in stages, is irreversible, and resultsin uremia or end-stage renal disease CRFaffects all of the major body systems andrequires dialysis or kidney transplant tomaintain life
  20. 20. 6/9/2013 20• The result is azotemia to UREMIA• The nephrons left intact are subjected to anincreased work load, resulting in hypertrophyand inability to concentrate urine.
  21. 21. 6/9/2013 21Chronic Renal Failure• CRF is a progressive, irreversible reduction inrenal function such that the kidneys are nolonger able to maintain the bodyenvironment.• Gradual, Progressive irreversible destructionof the kidneys causing severe renaldysfunction.• The GFR gradually decreases as the nephronsare destroyed.
  22. 22. 6/9/2013 22Prerenal(renal ischemia)• Serious cardiovasculardisorders• Peripheral vasodilation• Severevasoconstriction
  23. 23. 6/9/2013 23
  24. 24. 6/9/2013 24Kidney functionThe Nephron producesurine to eliminate wasteImpaired urine productionand azotemiaSecretes Erythropoietin toincrease RBCANEMIAMetabolism of Vitamin D Calcium and PhosphateimbalancesProduces bicarbonate andsecretes acidsMetabolic ACIDOSISExcretes excessPOTASSIUMHYPERKALEMIA

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