Chronic renal failure is a gradual loss of kidney function over time that cannot be reversed. It affects approximately 290,000 people in the United States. The kidneys gradually lose their ability to filter waste and excess fluid from the blood. Chronic renal failure is caused by conditions like hypertension, diabetes, kidney infections, and can lead to complications that affect many organ systems if not managed properly through treatments like dialysis and kidney transplantation. Proper management includes monitoring fluid and electrolytes, reducing metabolic rate, preventing infections, and providing nutritional therapy and skin care.

1. MR .ROMAN BAJRANG
BASIC BS.C NURSING 2ND YEAR
RELIANCE INSTITUTE OF NURSING
LIMTARA DHAMTARI
CHRONIC RENAL FAILURE

2. INTRODUCTION
 Chronic renal failure (CRF) affects approximately 290.000
people in the united states. It occurs with a gradual
decrease in the function of the kidneys over time this loss
of function is not reversible.
 Chronic kidneys disease also know as the chronic renal
failure is a rapidly progressive deterioration or loss of renal
function.

3. DEFINATION
 “According to BT basavanthappa”
Chronic
renal failure commonly classified as chronic kidney
disease and is listed as stage based on the patient level of
glomerular filtration capacity of the kidney stage 2 is
used for patient with a GRF of 60 to 90 ml per minute
 “According to medical dictionary”
Chronic kidney
disease also know as the chronic renal disease, chronic
renal failure or chronic kidney failure and usually means
the gradual loss of kidney function

4. INCIDENCE
Chronic renal failure is a globel
threed to health in general and for developing
countries in particular because therepy is expensive
and life long.
 In India 90% patient can not afford the case.
 Over 1 million people word wide are alive on
dialysis or with a functioning graft.
 Incidence of chronic renal failure has doubled in
the last 15 years.
 In the 30 million people suffer from chronic renal
failure.

5. ANATOMY & PHYSIOLOGY
Structure of the Kidney:-
1. Kidney is a bean shaped organ.
2. About 11 cm long, 6 cm wide, 3cm thick and 150 gram
weight.
3. They are embaded in and held in position by a mass
of fat a sheath of fibrous connective tissue the renal
fascia enclosed the kidney and the renal fat.
4. The kidney lie on the posterior abdominal wall on
are each side of vertebral column.
5. Behind the peritoneum and below the diaphagm.
6. They extend from the level of 12th thoracic vertebra to
the 3rd lumber vertebra.

7. Function of the Kidney:-
1. Formation and secration of urine which
regulated total body water electrolyte and acid
base balance and enable excretion of water.
2. Production and secration of erythropoietin the
hormone that stimulate formation of red blood
cells.
3. Production and secration of urine or renin on
important enzyme in the contral of blood
pressure.
4. Excretion of waste product.
5. Production and secretion of renin.

8. ETIOLOGY:-
1. Hypertension.
2. Diabetes mellitus.
3. Kidney stone and infection.
4. Injury or troama.
5. Nephrotic agent.
6. Certain and chemical.

9. PATHOPHYSIOLOGY
 Due to etiological factors renal function declines.
 Nephron damage is progessive damage nephron can
not function and to not recover.
 Decreased glomerular filtration rate.
 Remaining nephrons under go change.

10.  To compensate for those damaged nephrons.
 Compensatory excretion continue GFR diminished.
 Filtration of more concentrated blood by the remaining
nephrons.
 Damage of nephron results in hypertrophy and hyper
phosphatenia of remaining nephron.
 Urine may contain abnormal amount of protein RBCs, white
blood cells or casts.

11.  Increased serum creatinine bun level and retention of
urea and other introgenous
 Futher damage of the nephron 80-90% damage CFR
10-20%.
 Than lead to chronic renal failure.

12. CLINICAL MANIFESTATION:-
Chronic renal
failure(CRF) usually produce symptoms when renal function
which measured as the glomerular filtration rate falls below
the 30 million per minutes this is approximataly 30%of the
normal value.
Chronic symptom:-
Chronic symptoms can affect every organ
system. Most of noticeably the following :-
 Neurologocal systems.
 Gastrointestinal system.
 Blood forming system.
 Pulmonary system.
 Cardiovascular system.

13. Other symptoms:-
1. General illness feeling and fatigue.
2. Weakness.
3. Oliguria.
4. Weight loss.
5. Bone pain.
6. Sleeping disturbance.
7. Menstrual periods stops

14. DIAGNOSTIC EVALUATION
1. History taking.
2. Physical examination.
3. Blood testing.
4. Urine testing.
5. Electrocardiogram.
6. Imaging test.
7. Kidney biopsy.
8. Renal function test.

15. MANAGEMENT:-
(A) Medical management:-
 Kidney has excellent ability to recover the treatment aims to
restore normal chemical balance and prevent complication.
 Shock and infection it present should be treated.
 For maintained of fluid balance daily weight monitoring.
 Excess of fluid can be distended neck veins plural effusion occurs
circulatory failure can take place diaretic are provided to the
patient.
 Dialysis is some times necessary to prevent serious complication
related to electrolytes.

16. (B)Pharmacological management:-
s.no Name of the drug Dose Route Action Side effect
01 Azathioprine IV
02 Carticasteroids
methyl prednisolone
IV
03 Cycla phasphamide IV, IM
04 Cycla sporine IV
05 Ranitidine 150mg Orally, IM
06 Anatacids Orally

17. (C) Surgical management:-
1. kidney transplant surgary.
2. Dialysis.
3. Hemodialysis.
(D) nursing management:-
1. to monitor and manage fluid and electrolyte balance.
2. To reduce metabolic rate.
3. To promote pulmonary function.
4. To prevent infection.
5. To provide skin care.
6. To provide support.
7. To provide nutritonal therepy.

18. COMPLICATION
1. Food retention which could lead to sweeling in your arms and langs
high blood presure or fluid in your langs (palmonary adema).
2. A sudden risk in potassium levels in your blood which could impair
your heats ability to function and may be life threating.
3. Heart ans blood vessels .
4. Weak bones and on increased risk of bone fractures.
5. Anemia.
6. Decreased sex drive erectile dys functions or reduced fertility.
7. Damage to your central nervous system which can cause difficulty
concentration personality change or seizures.
8. Decrease immune response which makes you more vulnerable to
infaction.
9. Pregnecy complication that carry risk for the mother and the
deucloping factor.

19. PREVENTION:-
1. Maintain healthy weight.
2. Donot smooke.
3. Eat a healthy food.
4. Physical activity part of your routine.
5. Get enough sleeps.
6. Explore stress – reducing activity.
7. Regular exercise.
8. Be careful with pain killas.
9. Lower salt in your diet.

20. HEALTH EDUCATION:-
Intake output:-
 Drink safe water.
 Drink water 50ml/dl.
 Use chlorine in drinking water.
Hygiene:-
 maintain person hygiene.
 Wash the hand before intake water and food.
Excersize:-
 Active and pasive excersize.
 To protecte the injury.
 To maintain health.
Rest and sleep:-
 Giving the active in patient to feel better in rest, sleep.
 Rest for 8-10 hour.