Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.

1. CHRONIC RENAL
FAILURE
MRS PALLAVIPARBHAT CHAUHAN

2. CHRONIC RENAL FAILURE

5. NORMALARF
CRF

6. CHRONIC KIDNEY DISEASE
• Chronic renal failure
• End stage renal failure
• Is a progressive, irreversible deterioration in renal
function in which the body’s ability to maintain
metabolic and fluid and electrolyte balance fails,
resulting in uremia and azotemia.

7. 2. Chronic Renal Failure
It is a permanent
irreversible destruction
of nephron leading to
severe deterioration of
renal function, finally
resulting to end stage
renal disease.

9. CRF - causes
Glomerulonephritis – the
most common cause in the
past
Diabetes mellitus
Hypertension
Tubulointerstitial nephritis
 are now the leading causes of
CRF

11. Pathophysiology
As renal function declines, the end products of CHON metabolism
(which are normally excreted in urine) accumulate in the blood.
Uremia develops and adversely affects every system in the
body.
Stages of CRF: are based on the GFR. The normal GFR is
125cc/min/1.73m2
1. Stage 1 = GFR > 90 ml/min/1.73m2. Kidney damage with
normal or increased GFR.
2. Stage 2 = GFR = 60-89 mL/min/1.73m2. Mild decrease in GFR.
3. Stage 3 = GFR = 30-59 mL/min/1.73m2. Moderate decrease in
GFR.
4. Stage 4 = GFR = 15-29 mL/min/1.73m2. Severe decrease in GFR.
5. Stage 5 = GFR <15 mL/min/1.73 m2. Kidney failure

13. Stages of Chronic Renal Failure
1. Diminished Renal Reserve
Normal BUN, and serum creatinine absence of symptoms
2. Renal Insufficiency
GFR is about 25% of normal, BUN Creatinine levels
increased
3. Renal Failure
GFR <25% of normal increasing symptoms
4. ESRD or Uremia
GFR < 5-10% normal, creatinine clearance
<5-10ml/min resulting in a cumulative effect

14. PATHOPHYSIOLOGY
In the early stage of disease child remains asymptomatic.
Advance renal damage will occur only in late stages.
Increased numbers of nephrons are destructed at various degrees
and a few remain intact but hypertrophied and functional.
This leads to insufficient adjustments in fluid and electrolyte
balance.
As the disease progress to end stage severe reduction in
number of nephrons occur and the kidney will not b able to
maintain fliud and electrolyte balance.
The accumulatin of various substances in blood result in
complications

16. CLINICAL MANIFESTATIONS
Early symptoms
• Weakness
• Anorexia
• Nausea
• Failure to thrive
• Unexplained
anemia
• Osteodystrophy
• Growth failure
Late manifestations
• Gastrointestinal
bleeding
• Pericarditis
• Congestive
cardiac failure
• Altered
sensorium
Indications of poor
prognosis
• Convulsions
• Coma
• Cardiomyopathy

17. Chronic Renal Failure
• Cardiovascular
–Hypertension
–Arrythmias
–Pericardial
effusion
–CHF
–Peripheral
edema
• Neurological
– Burning, pain, and
itching, parestnesia
– Motor nerve
dysfunction
– Muscle cramping
– Shortened memory
span
– Apathy
– Drowsy, confused,
seizures, coma, EEG
changes

18. Chronic Renal Failure
• GI
–Stomatitis
–Ulcers
–Pancreatitis
–Uremic fetor
–Vomiting
–consitpation
• Respiratory
– ^ chance of infection
– Pulmonary edema
– Pleural friction rub
and effusion
– Dyspnea

19. Chronic Renal Failure
• Endocrine
– Stunted growth in
children
– Amenorrhea
– Male impotence
– ^ aldosterone secretion
– Impaired glucose levels
R/T impaired CHO
metabolism
– Thyroid and parathyroid
abnormalities
• Hemopoietic
– Anemia
– Decrease in RBC survival
time
– Blood loss from dialysis
and GI bleed
– Platelet deficits
– Bleeding and clotting
disorders – purpura and
hemorrhage from body
orifices , ecchymoses

20. Chronic Renal Failure
• Skeletal
– Muscle and bone pain
– Bone demineralization
– Pathological fractures
– Blood vessel
calcifications in
myocardium, joints,
eyes, and brain
• Skin
– Yellow-bronze skin
with pallor
– Purities
– Purpura
– Uremic frost
– Thin, brittle nails
– Dry, brittle hair, and
may have color
changes and alopecia

23. DIAGNOSIS
• Blood examination
• Renal function test
• Urinalysis
• X-Ray
• ECG, IVP, MCU, radio nuclide imaging

24. MANAGEMENT
• Medical treatment
• IV glucose and insulin
• Na bicarb, Ca, Vit D, phosphate
binders
• Fluid restriction, diuretics
• Iron supplements, blood,
erythropoietin
• High carbs, low protein
• Dialysis - After all other methods
have failed

25. Medical Management
• Dialysis
• Fluid and dietary restrictions that
include :
• Low protein
• High calories
• Low sodium
• Low potassium

26. Medical Management
1. Pharmacologic Therapy
a. calcium carbonate (Os-cal) or calcium acetate (Phoslo) are
prescribed to treat hyperphosphatemia and
hypocalcemia
b. Antiseizure agents – diazepam (Valium) or phenytoin
(Dilantin)
c. Antihypertensive and CV drugs - digoxin (Lanoxin) and
dobutamine (Dobutrex)
d. Erythropoietin (Epogen) to treat anemia. It is initiated to
reach a hematocrit of 33% - 385 and a target
hemoglobin of 12g/dl.
2. Nutritional Therapy
a. low sodium, low CHON and low K diet
3. Dialysis

27. MANAGEMENT
• Conservative management
 Correction of reversible component of renal dysfunction
 Preservation of renal function
 Treatment of metabolic and psycho-social problems
 Optimization of growth
 Preparation for treatment of ESRD
 Treat for infection, accelerated hypertension, CCF, obstruction
of urine flow - to improve renal function

28. •Dietary therapy
• Low protein diet
• Severe protein restriction may produce protein calorie
malnutrition
• Diet should consist of 100 percent RDA for calories
• Protein should be of high biological value and should
comprise 6 – 10 % of all calories
• Salt restriction in patients with hypertension and fluid
overload
• Patients with salt losing nephropathy should take a liberal
amount of salt and water
• If the GFR falls <10ml/min/1.73m2, potassium intake should
be restricted.(hyperkalemia may develop)
• Vit D is essential to raise the serum calcium and suppress
parathormone secretion.

29. Dialysis therapy
• Dialysis is a process that artificially removes metabolic wastes
from the blood in order to compensate for kidney (renal)
failure.
• Most common type is homodialysis

30. • Dialysis

31. • Renal transplatation

32. COMPLICATIONS
• Azotemia
• Metabolic acidosis
• Electrolyte imbalance
• HTN
• Severe anemia
• Growth retardation
• Delayed or absent sexual maturation

33. NURSING MANAGEMENT
• Frequent monitoring
– Hydration and output
– Cardiovascular function
– Respiratory status
– Electrolytes
– Nutrition
• Mental status
– Emotional well being
• Ensure proper medication regimen
• Skin care
• Bleeding problems
• Care of the shunt
• Education to client and family