ARF, CRF

1. ARF AND CRF

2. RENAL FAILURE
Renal failure or kidney failure (formerly called renal
insufficiency) is a situation in which the kidneys fail to
function adequately.

3. TYPES OF RENAL FAILURE
ACUTE RENAL
FAILURE
(ARF)
CHRONIC
RENAL
FAILURE
(CRF)

4. ACUTE RENAL FAILURE
Acute renal failure is the sudden and complete loss of the
ability of the kidneys to remove waste.
It occurs when the kidneys stop working over a period of
hours, days, or in some cases, weeks.

5. CAUSES OF ARF
PRERENAL
INTRARENAL
POSTRENAL

6. PRERENAL CAUSE
Sudden and severe drop in blood pressure
(shock) or interruption of blood flow to the kidneys
from severe injury or illness.

7. Direct damage to the kidneys by inflammation,
toxins, drugs, infection, or reduced blood supply.
INTRARENAL CAUSE

8. Sudden obstruction of urine flow due to
enlarged prostrate, kidney stones, bladder tumor
or injury.
POSTRENAL CAUSE

9. RISK FACTORS
Being hospitalized, especially for a serious condition that requires
intensive care
Advanced age
Diabetes
High blood pressure
Heart failure, Kidney diseases, Liver disease etc.

12. Renal damage is occurring.
The child may be asymptomatic
1. Initiation phase

13. 2. Oliguric phase
This phase starts when urinary volume less than 30 ml to 400
ml/ 24 hours.Impaired glomerular filtration
Waste cannot be remove
Uremia develops
CCF(Congestive cardiac failure), HTN, anemia

14. 3. Diuresis Phase
Diuresis phase is marked by increased urine secretion of more than
400 ml/ 24 hours.
Gradual return to normal
Dehydration and electrolyte imbalance due to excess urination.

15. 4. Recovery Phase
It takes months - if left untreated it result in fluid
overload, electrolyte imbalance, uremia(abnormally
high level of waste product in the blood) and coma.

16. CLINICAL MANIFESTAIONS
i. Severe oliguria/ Anuria
ii. Child may be extremely sick
iii. Nausea / Vomiting
iv. Lethargy
v. Dehydration
vi. Altered consciousness
vii. Irregular cardiac rate, rhythm
viii.Edema

17. DIAGNOSTIC EVALUATIONS
Careful history taking: Vomiting, diarrhea, fever, other renal disease
Laboratory investigations: Anemia, raised serum creatinine level,
blood urea, electrolytes etc.
 Urine examination: Proteinuria, Hematuria, presence of casts(tiny
tube shaped particles made up of WBC, RBC or kidney cells).

18. DIAGNOSTIC EVALUATIONS
USG
IVP
Renal biopsy

19. Pharmacologic Therapy
Fluid and dietary restrictions
Use of diuretics
Maintain Electrolytes
Stimulate production of urine with IV fluids, diuretics, etc.
Hemodialysis

20. Nursing management
Monitor I/O, including all body fluids
Monitor lab results
Watch hyperkalemia symptoms: malaise, anorexia, muscle weakness,
ECG changes etc.
Watch for hyperglycemia or hypoglycemia if receiving TPN or insulin
infusions.

21. Nursing management
Maintain nutrition
Mouth care
Daily weights
Assess for signs of heart failure
Skin integrity problems

22. CHRONIC RENAL FAILURE
OR
ESRD

23. DEFINITION
Crf or esrd is a progressive, irreversible
deterioration(becoming worse) in renal function in
which the body’s ability to maintain metabolic and
fluid and electrolyte balance fails resulting in uremia
or azotemia(elevation of nitrogen in blood).

24. ETIOLOGY AND RISK FACTORS
Decreased renal blood flow
Systemic diseases
Diabetes mellitus
Hypertension
Sle
Sickle cell disease (RBC disorder)
Glomerulonephritis
Arf

25. ETIOLOGY AND RISK
FACTORS
Obstruction of the urinary tract
Hereditary lesions
Polycystic kidney disease (cluster of cysts develop in the kidneys)
Infections
Vascular diseases (heart diseases)

26. ETIOLOGY AND RISK FACTORS
Environmental or occupational agents. (chemical elements)
a) Lead
b) Cadmium
c) Mercury
d) Chromium

27. PATHOPHYSIOLOGY
Due to etiological factors
Decreased gfr
Hypertrophy(increase in size) of nephrons
Inability to concentrate urine
Further loss of nephron function
Loss of non-excretory(secretion of hormones,Vit D etc.) and excretory
function

28. STAGES OF CRF
1. Reduced Renal reserve
BUN is high or normal
Client has no C/M
40 to 75 % loss of nephron function

29. STAGES OF CRF
2. Renal Insufficiency
75 to 90 % loss of nephron function
Impaired urine concentration
Nocturia, mild anemia, increased creatinine and BUN

30. STAGES OF CRF
3. Renal failure
Severe azotemia
Impaired urine dilution
Severe anemia
Electrolyte Imbalances
Hypernatremia, Hyperkalemia, Hyperphosphatemia

31. STAGES OF CRF
4. End Stage Renal Disease
10 % nephrons functioning
Multisystem dysfunction

32. CLINICAL MANIFESTATIONS
1. Early symptoms
a) Weakness
b) Anorexia
c) Nausea
d) Failure to thrive
e) Unexplained anemia
f) Osteodystrophy (bone disorder that affects bone growth)
g) Growth failure

33. CLINICAL MANIFESTATIONS
2. Late manifestations
a) Gastrointestinal bleeding
b) Pericarditis (inflammation of pericardium)
c) Congestive cardiac failure
d) Altered sensorium (inability to think clearly)

34. CLINICAL MANIFESTATIONS
3. Indications of poor prognosis
a) Convulsions
b) Coma
c) Cardiomyopathy(chronic disease of the
heart muscle)

35. DIAGNOSTIC EVALUATION
Blood examination –
Decreased hematocrit, increased K+ & phosphorus
Renal function test –
 Gradual increase in BUN, uric acid & creatinine
Urinalysis –
 Variation in specific gravity, increased urine creatinine, change in total
urine output.

36. DIAGNOSTIC EVALUATION
X-Ray – Chest, hands, knees, pelvis, spine to detect bony
defect.
ECG and IVP
 Other abnormal findings –
 Metabolic acidosis, Fluid imbalance, Insulin resistance

37. MANAGEMENT
1. Preserve the renal function and dialysis
Controlling the disease process.
Controlling BP by diet control, weight control and medication.
Reducing dietary protein intake

38. MANAGEMENT
2) Alleviate extra renal manifestations.
a) Pruritis –
Topical emollient and lotion.
Antihistamine.
IV Lidocaine

39. MANAGEMENT
b) Neurological manifestations.
Safety measures to protect from injury.
 Anticonvulsants.
 Sedatives

40. MANAGEMENT
3. Improve body chemistry.
Dialysis
Medications
Diet

41. MANAGEMENT
Dialysis
i. Hemodialysis
ii. Peritoneal dialysis

42. HEMODIALYSIS VS
PERITONEAL DIALYSIS
Hemodialysis uses a machine and a filter to remove waste
products and water from the blood.
Peritoneal dialysis uses a fluid (dialysate) that is placed into the
patient's abdominal cavity to remove waste products and fluid
from the body.

43. MANAGEMENT
Medications
a) Hyperkalemia
Insulin administration – I/V
Sodium bicarbonate
Calcium Gluconate – I/V

44. MANAGEMENT
Medications
i. Sodium and fluid restriction
ii. Anti hypertensive drugs

45. MANAGEMENT
Diet
i. Protein restriction
0.6 to 0.75 gm/kg of ideal body weight/day
1.2 to 1.3 gm/kg of ideal body weight/day once the
patient starts dialysis

46. MANAGEMENT
Diet
i. Phosphate restriction
ii. Potassium restriction
iii. Sodium restriction

47. SURGICAL MANAGEMENT
Renal Transplantation