Renal failure

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Renal failure

  1. 1. Renal Failure Wendy DeMartino, MD PGY-2
  2. 2. Objectives  Anatomy  Function  Acute Renal Failure (ARF)  Causes  Symptoms  Management  Chronic Renal Failure (CRF)  Causes  Symptoms  Dialysis
  3. 3. Anatomy  2 Kidneys  2 Ureters  Bladder  Urethra
  4. 4. Kidney Function  Detoxify blood  Increase calcium absorption  calcitriol  Stimulate RBC production  erythropoietin  Regulate blood pressure and electrolyte balance  renin
  5. 5. Classifications  Acute versus chronic  Pre-renal, renal, post-renal  Anuric, oliguric, polyuric
  6. 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. 7. Acute Renal Failure  Pre-renal = 55%  Renal parenchymal (intrinsic)= 40%  Post-renal = 5-15%
  8. 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. 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. 10. Diagnosis of Renal Failure
  11. 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. 12. ARF: Life Threatening Conditions  Hyperkalemia  Volume overload  Vascular access
  13. 13. Hyperkalemia Symptoms  Weakness  Lethargy  Muscle cramps  Paresthesias  Hypoactive DTRs  Dysrhythmias
  14. 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. 15. Hyperkalemia Treatment  Calcium gluconate (carbonate)  Sodium Bicarbonate  Insulin/glucose  Kayexalate  Lasix  Albuterol  Hemodialysis
  16. 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. 17. Chronic Renal Failure Causes  Diabetic Nephropathy  Hypertension  Glomerulonephritis  HIV nephropathy  Reflux nephropathy in children  Polycystic kidney disease  Kidney infections & obstructions
  18. 18. CRF Symptoms  Malaise  Weakness  Fatigue  Neuropathy  CHF  Anorexia  Nausea  Vomiting  Seizure  Constipation  Peptic ulceration  Diverticulosis  Anemia  Pruritus  Jaundice  Abnormal hemostasis
  19. 19. Acute Problems in CRF  Relating to underlying disease  Relating to ESRD  Dialysis related problems
  20. 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. 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. 22. Hemodialysis  3-4 times a week  Takes 2-4 hours  Machine filters blood and returns it to body
  23. 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. 24. Temporary Catheter
  25. 25. AV Fistula & Graft
  26. 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. 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. 28. Peritoneal Dialysis  Abdominal lining filters blood  3 types  Continuous ambulatory  Continuous cyclical  Intermittent
  29. 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. 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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