physiological basis of renal failure, common causes, and presentation of A.R.F. and C.R.F.

1. 6/9/2013 1
RENAL FAILURE
• The loss of kidney function
• Sudden interruption of kidney function to
regulate fluid and electrolyte balance and
remove toxic products from the body

2. 6/9/2013 2
CLINICAL FINDINGS
OLIGURIC PHASE
Hypernatremia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hypermagnesemia
Metabolic acidosis
DIURETIC PHASE
Hyponatremia
Hypokalemia
Hypovolemia
CONVALESCENT PHASE
Normal Urine Volume
Increase in LOC
BUN stable and normal
May develop CRF

3. 6/9/2013 3
Acute Renal Failure
• Prerenal
• Intrarenal
• Postrenal

4. 6/9/2013 4
Phases of Acute Renal Failure
• 1. Oliguric phase
• 2. Diuretic phase
• 3. Recovery or convalescence
Four phases of acute renal failure
(Brunner and Suddarth)
1. Initiation phase
2. Oliguric phase
3. Diuretic phase
4. Convalescence or recovery phase

5. 6/9/2013 5
PRERENAL CAUSES INTRARENAL
CAUSES
POSTRENAL CAUSES
Calculi
BPH
Tumors
Strictures
Blood clots
Trauma
Anatomic malformation
Hypotension Acute tubular necrosis (ATN)
Diabetes mellitusCardiogenic shock
Acute vasoconstriction Malignant hypertension
Hemorrhage Acute glomerulonephritis
TumorsBurns
Septicemia Blood transfusion reactions
CHF
Nephrotoxins

6. 6/9/2013 6
NURSING CARE
• Monitor fluid and electrolyte balance.
• Monitor alteration in fluid volume.
• Promote optimal nutritional status
• Prevent complications from impaired mobility
• Prevent fever and infection
• Support client/S.O. & reduce/relieve anxiety

7. 6/9/2013 7
Diagnostics
• a. Increased BUN and serum creatinine level.
• b. Decreased urinary creatinine clearance.
• c. Elevated blood sugar and triglycerides.
• d. Increased scrum potassium.
• e. Anemia (decreased hemoglobin and
hematocrit).

8. 6/9/2013 8
Acute renal failure -PATHOPHYSIOLOGY
Prerenal CAUSE:
• Factors interfering with perfusion and
resulting in diminished blood flow and
glomerular filtrate, ischemia, and oliguria;
include CHF, cardiogenic shock, acute
vasoconstriction, hemorrhage, burns,
septicemia, hypotension, anaphylaxis

9. 6/9/2013 9
CLINICAL FINDINGS
STAGE 1
Diminished Renal
Reserve
STAGE 2
Renal Insufficiency
STAGE 3
End Stage

10. 6/9/2013 10
• Hemorrhage
• Shock
• Burns
• Hypovolemia
• Renal vascular
obstruction
-(A/V)thrombosis

11. 6/9/2013 11
Renal insufficiency
• a. GFR is 25 percent of normal.
• b. BUN and serum creatinine increased
(azotemia).
• c. Fatigue and weakness, mild anemia.

12. 6/9/2013 12
Chronic Renal Failure
Dermatologic dry skin, pruritus, uremic
frost
CNS seizures, altered LOC,
anorexia, fatigue
CVS Acute MI, edema,
hypertension, pericarditis
Pulmo Uremic lungs
Hema Anemia
Musculoskeletal loss of strength, foot
drop, osteodystrophy

13. 6/9/2013 13
Chronic Renal Failure
PATHOPHYSIOLOGY
STAGE 1= reduced renal reserve, 40-75% loss
of nephron function
STAGE 2= renal insufficiency, 75-90% loss of
nephron function
STAGE 3= end-stage renal disease, more than
90% loss. DIALYSIS IS THE TREATMENT!

14. 6/9/2013 14
Renal/Intrarenal(kidney tissue pathology)
• Acute tubular necrosis
• Nephrotoxins
• Aminoglycosides or
NSAIDs
• Heavy metals
-(carbon
tetrachloride, arsenic, lead, mer
cury

15. 6/9/2013 15
Prerenal disease
Inadequate
filtration
Nephrosclerosis
Heart Failure Vasodilatation Hypovolemia
Systemic Hypotension
Atherosclerois
Renal artery
stenosis
Renal Ischemia
Prerenal Disease

16. 6/9/2013 16
CLINICAL FINDINGS
Nausea and vomiting Uremic frost
Decreased urinary output Dyspnea
Hypotension (early)Azotemia
Hypertension (later) Lethargy
Convulsions Memory impairment
Pericardial friction rub CHF

17. 6/9/2013 17
Accumulation
of solute
Systemic Hormonal
Changes in blood
Inc. excretion of
Solute per nephron
Glomerulosclerosis
Extrarenal organ
Damage; uremic
Syndrome;toxic
Effects on renal cells
Tubular cell damage
& interstitial fibrosis
Tubular
hyperthrophy
High intraglomerular
Pressure and inc. filtration
of macromolecules
Glomerular hypertrophy
and inc. SNGFRLoss of Neprhons
Maintenance of internal
Environment up to limits
of Nephron adaptation
And hyperthrophy
Pathophysiology of CRF

18. 6/9/2013 18
Chronic Renal Failure
Predisposing factors:
–DM= worldwide leading cause
–Recurrent infections
–Exacerbations of nephritis
–urinary tract obstruction
–hypertension

19. 6/9/2013 19
• It occurs in stages, is irreversible, and results
in uremia or end-stage renal disease CRF
affects all of the major body systems and
requires dialysis or kidney transplant to
maintain life

20. 6/9/2013 20
• The result is azotemia to UREMIA
• The nephrons left intact are subjected to an
increased work load, resulting in hypertrophy
and inability to concentrate urine.

21. 6/9/2013 21
Chronic Renal Failure
• CRF is a progressive, irreversible reduction in
renal function such that the kidneys are no
longer able to maintain the body
environment.
• Gradual, Progressive irreversible destruction
of the kidneys causing severe renal
dysfunction.
• The GFR gradually decreases as the nephrons
are destroyed.

22. 6/9/2013 22
Prerenal(renal ischemia)
• Serious cardiovascular
disorders
• Peripheral vasodilation
• Severe
vasoconstriction

23. 6/9/2013 23

24. 6/9/2013 24
Kidney function
The Nephron produces
urine to eliminate waste
Impaired urine production
and azotemia
Secretes Erythropoietin to
increase RBC
ANEMIA
Metabolism of Vitamin D Calcium and Phosphate
imbalances
Produces bicarbonate and
secretes acids
Metabolic ACIDOSIS
Excretes excess
POTASSIUM
HYPERKALEMIA