Chronic renal failure involves the irreversible destruction of nephrons in both kidneys, leading to various stages characterized by different symptoms and diagnostic evaluations. Key causes include glomerular dysfunction, systemic diseases, and urinary tract obstruction, while manifestations can be neurological, integumentary, cardiovascular, pulmonary, gastrointestinal, hematologic, reproductive, and musculoskeletal. Management includes pharmacological therapy, nutritional support, and dialysis to replace lost kidney functions.

2. CHRONIC
RENAL
FAILURE
PRESENTED BY
SUBHASHREE MAHAPATRO
FACULTY OF KIIT

3. DEFINITION
Chronic renal failure involves progressive,
irreversible destruction of the nephrons in
both kidneys. The disease process progresses
until most nephrons are destroyed and
replaced by nonfunctional scar tissue.

4. CAUSES

5. I. GLOMERULAR
DYSFUNCTION
Glomerulonephritis
Diabetic nephropathy
Hypertensive nephrosclerosis

6. II. SYSTEMIC DISEASE
Sickle cell anemia
Scleroderma
Polyateritis nodosa
Systemic lupus erythematous
Vasculitis

7. III.URINARY TRACT
OBSTRUCTION
Prostatic & bladder tumors
Lymphadenopathy
Urethral obstruction
Calculi

8. IV. OTHERS
Chronic pyelonephritis
Nephrotic syndrome
Polycystic kidney disease
Multiple myeloma
Renal infraction

9. PATHOPHYSIOLOGY

10. STAGES OF CHRONIC
RENAL FAILURE

11. STAGE-1: REDUCED RENAL RESERVE
Characterized by a 40%-75% loss of nephron
function. The patient is usually
asymptomatic because the remaining
nephrons are able to carry out normal
function of kidneys.

12. STAGE-2: RENAL INSUFFICIENCY
Occurs when 75%-90% of nephron function
is lost. At this point, the serum creatinine
and BUN rise, the kidney losses its ability to
concentrate urine and anemia develops. The
patient may report polyuria & nocturia.

13. STAGE-3: REND STAGE RENAL
DISEASE
The final stage occurs when there is less than
10% of nephron function remaining. All normal
regulatory, excretory and hormonal functions of
the kidneys are severely impaired. ESRD is
evidence by elevated creatinine & BUN levels as
well as electrolyte imbalance. Dialysis is usually
indicated at this point.

14. CLINICAL
MANIFESTATION

15. 1. NEUROLOGIC
 Weakness and fatigue
 confusion
 inability to concentrate
 disorientation
 tremors
 seizures,
 restlessness of legs
 behavior changes

16. 2. INTEGUMENTARY
 Gray- bronze skin color
 dry, flaky skin
 pruritus
 ecchymosis
 purpura
 thin brittle nails

17. 3. CARDIOVASCULAR
 Hypertension
 pitting edema(feet, hands, sacrum)
 Pericarditis
 pericardial effusion
 pericardial tamponed
 Hyperkalemia
 hyperlipidemia

18. 4. PULMONARY
 Crackles
 thick tenacious sputum
 shortness of breath
 Tachypnea
 depressed cough reflex

19. 5. GASTRO- INTESTINAL
 ammonia odor to breath
 metallic taste
 mouth ulcerations & bleeding
 Anorexia
 nausea & vomiting
 constipation or diarrhea

20. 6. HEMATOLOGIC
 Anemia
 thrombocytopenia

21. 7. REPRODUCTIVE
 Amenorrhea
 testicular atrophy
 infertility

22. 8. MUSCULOSKELETAL
 muscle cramps
 loss of muscle strength
 renal asteodystrophy
 bone pain
 bone fractures
 foot drop

23. DIAGNOSTIC
EVALUATION

24. Test for renal function
O blood creatinine
O BUN test
O FBS
O Blood tests measures levels of waste products &
electrolytes.
O blood test for parathyroid hormone (PTH)
O Urinalysis & a urine test

25. Tests for anemia
O CBC
O A reticulocyte count
O Iron studies
O A serum ferritin test

26. ultrasound of the kidney
duplex Doppler study or angiogram of the
kidney
kidney biopsy

27. MANAGEMENT

28. PHARMACOLOGICAL THERAPY
Calcium & phosphorus Binders
Hyperphosphatemia and hypokalemia are tested with medications
that bind dietary phosphorus in the GI tract. Binders such as calcium
carbonate (caltrate) or calcium acetate (calphron) are prescribed.
Antihypertensive & cardiovascular agents
Acute failure & pulmonary edema may also require treatment with
fluid restriction, low sodium diets, diuretic agents such as digoxin
(lanoxin) or dobutamine (Dobutrex) and dialysis.

29. CONT…
Antiseizure agents
IV diazepam (valium) or phenytoin (Dilantin) is usually administered to
control seizures.
Diuretics
Furosemide (Lasix) only given with severe fluid overload.
Erythropoietin
Erythropoietin is administered intravenously or subcutaneously three
times a week in ESRD. It may take 2 to 6 weeks for the hematocrit to
increase, therefore, the medication is not indicated for patients who
need immediate correction of severe anemia.
Iron supplement
Supplementary iron include iron sucrose (venofer) and ferric gluconate
(ferrlecit).

30. NUTRITIONAL THERAPY
• careful regulation of protein intake, fluid intake to balance fluid
losses, sodium intake to balance sodium losses & some restriction of
potassium.
• adequate caloric intake and vitamin supplementation
• The allowed protein must be of high biologic value (diary products,
eggs, meats).
• Fluid restrictions, fluid allowance is usually 500-600 ml more that
the previous dialysis 24 hr. output.
• Calories are supplied by carbs & fats to prevent wasting &
malnutrition.

31. DIALYSIS
Dialysis is a type of renal replacement therapy
which used to provide artificial replacement
therapy for lost kidney function due to acute or
chronic kidney failure.
Dialysis has to duplicate both of these functions-
dialysis- waste removal, ultrafiltration fluid removal.
There are 2 main types of dialysis
1. Hemodialysis
2. Peritoneal dialysis

32. Hemodialysis
The dialysis process is very efficient (much higher than in the
natural kidneys), which allows treatments to take place
intermittently (usually 3 times a week), but fairly large volumes
of fluid must be removed in a single treatment.
Peritoneal dialysis
Works by using the body’s peritoneal membrane, which is
inside the abdomen, as a semipermeable membrane. Dialysis
fluid is instilled via a peritoneal dialysis catheter, which is
placed in the patient’s abdomen, running from the peritoneum
out to the surface, near the naval.

33. NURSING
MANAGMENT

34. ASSESSMENT
 Assess fluid status
 Assess nutritional dietary patterns
 Assess nutritional status
 Assess understanding of cause of renal failure. Its
consequences & its treatment.
 Assess patients & family’s responses and reaction
to illness & treatment.
 Assess for signs of hyperkalemia

35. NURSING DIAGNOSIS-1
Excess fluid volume related to decreases urine output,
dietary excesses and retention of sodium & water as
evidence by intake output chart.

36. Intervention
 Assess fluid status and identify potential sources of
imbalance.
 Limit fluid intake to prescribed volume.
 Assist patient to cope with the discomforts resulting
from fluid restriction.
 Provide or encourage frequent oral hygiene.

37. NURSING DIAGNOSIS- 2
Imbalanced nutrition less than body requirements related
to anorexia, nausea, vomiting, dietary restrictions and
altered oral mucous membranes as evidence by
malnutrition.

38. Intervention
 Assess nutritional status like weight changes &
laboratory values.
 Assess patient’s nutritional dietary patterns, diet
history, food preferences.
 Provide patent’s food preferences within dietary
restrictions.
 Promote intake of high biologic value protein foods,
eggs, dairy products, meats.

39. NURSING DIAGNOSIS- 3
Activity intolerance related to fatigue, anemia, retention of
waste products and dialysis procedure as evidence by lac
of personal hygiene.

40. Intervention
 Assess factors contributing to activity intolerance.
 Promote independence in self care activities as
tolerated, assist if fatigued.
 Encourage alternating activity with rest.
 Encourage patient to rest after dialysis treatments.

41. NURSING DIAGNOSIS- 4
Deficient knowledge regarding condition and treatment as
evidence by verbalization.

42. Intervention
 Assess understanding of cause of renal failure
consequences of renal failure & its treatment.
 Provide information at patient’s level of understanding
and guided by patient’s readiness to learn.
 Provide oral and written information about the treatment
plan.

43. COMPLICATION

45. Recent studies
.