Renal failure
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This document discusses renal failure, including anatomy and function of the kidneys, classifications of acute and chronic renal failure, causes and symptoms of acute and chronic renal failure, diagnosis, management of acute renal failure including life-threatening conditions like hyperkalemia, dialysis options including hemodialysis and peritoneal dialysis, and potential problems related to end stage renal disease and dialysis.
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Renal failure
- 1. Renal Failure Sanjay Kumar Kulchania (LECTURER) GURU NANAK COLLEGE OF NURSING, DHAHAN KALERAN
- 2. Objectives Anatomy Function Acute Renal Failure (ARF) – Causes – Symptoms – Management Chronic Renal Failure (CRF) – Causes – Symptoms Dialysis
- 5. Kidney Function Detoxify blood Increase calcium absorption – calcitriol Stimulate RBC production – erythropoietin Regulate blood pressure and electrolyte balance – renin
- 8. Classifications Acute versus chronic Pre-renal, renal, post-renal Anuric, oliguric, polyuric
- 9. Acute Versus Chronic Acute – sudden onset – rapid reduction in urine output – Usually reversible – Tubular cell death and regeneration Chronic – Progressive – Not reversible – Nephron loss 75% of function can be lost before its noticeable
- 10. Acute Renal Failure Pre-renal = 55% Renal parenchymal (intrinsic)= 40% Post-renal = 5-15%
- 12. Causes of ARF Pre-renal = – vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure – cardiac failure, liver dysfunction, or septic shock Intrinsic – Interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia, toxins Post-renal = – prostatic hypertrophy, cancer of the prostate or cervix, or retroperitoneal disorders – neurogenic bladder – bilateral renal calculi, papillary necrosis, coagulated blood, bladder carcinoma, and fungus
- 13. Symptoms of ARF Decrease urine output (70%) Edema, esp. lower extremity Mental changes Heart failure Nausea, vomiting Pruritus Anemia Tachypenic Cool, pale, moist skin
- 14. Diagnosis of Renal Failure
- 15. Acute Renal Failure Management Make/think about the diagnosis Treat life threatening conditions Identify the cause if possible – Hypovolemia – Toxic agents (drugs, myoglobin) – Obstruction Treat reversible elements – Hydrate – Remove drug – Relieve obstruction
- 16. ARF: Life Threatening Conditions Hyperkalemia Volume overload Vascular access
- 17. Hyperkalemia Symptoms Weakness Lethargy Muscle cramps Paresthesias Hypoactive DTRs Dysrhythmias
- 18. Hyperkalemia & EKG K > 5.5 -6 Tall, peaked T’s Wide QRS Prolong PR Diminished P Prolonged QT QRS-T merge – sine wave
- 22. Hyperkalemia Treatment Calcium gluconate (carbonate) Sodium Bicarbonate Insulin/glucose Kayexalate Lasix Albuterol Hemodialysis
- 23. Chronic Renal Failure 150–200 cases per million people = new cases each year Chronic renal failure and ESRD affect more than 2 out of 1,000 people in the U.S Mortality = 20%
- 24. Chronic Renal Failure Causes Diabetic Nephropathy Hypertension Glomerulonephritis HIV nephropathy Reflux nephropathy in children Polycystic kidney disease Kidney infections & obstructions
- 26. Acute Problems in CRF Relating to underlying disease Relating to ESRD Dialysis related problems
- 27. Problems Related to ESRD Metabolic – K/Ca Volume overload Anemia, platelet disorder, GI bleed HTN, pericarditis Peripheral neuropathy, dialysis dementia Abnormal immune function
- 28. Dialysis ½ of patients with CRF eventually require dialysis Diffuse harmful waste out of body Control BP Keep safe level of chemicals in body 2 types – Hemodialysis – Peritoneal dialysis
- 29. Hemodialysis 3-4 times a week Takes 2-4 hours Machine filters blood and returns it to body
- 30. Types of Access Temporary site AV fistula – Surgeon constructs by combining an artery and a vein – 3 to 6 months to mature AV graft – Man-made tube inserted by a surgeon to connect artery and vein – 2 to 6 weeks to mature
- 32. AV Fistula & Graft
- 33. What This Means For You No BP on same arm as fistula Protect arm from injury Control obvious hemorrhage – Bleeding will be arterial – Maintain direct pressure No IV on same arm as fistula A thrill will be felt – this is normal
- 34. Access Problems AV graft thrombosis AV fistula or graft bleeding AV graft infection Steal Phenomenon – Early post-op – Ischemic distally – Apply small amount of pressure to reverse symptoms
- 35. Peritoneal Dialysis Abdominal lining filters blood 3 types – Continuous ambulatory – Continuous cyclical – Intermittent
- 36. EMS Considerations Make sure the dressing remains intact Do not push or pull on the catheter Do not disconnect any of the catheters Always transport the patient and bags/catheters as one piece Never inject anything into catheter
- 37. Dialysis Related Problems Lightheaded –give fluids Hypotension Dysrhythmias Disequilibration Syndrome – At end of early sessions – Confusion, tremor, seizure – Due to decrease concentration of blood versus brain leading to cerebral edema