helpful for nurses

1. RENAL FAILURE

2. 🞂It is the inability of the kidney to
excrete waste materials,
concentrate urine and conserve
electrolytes.
Definition

3. 🞂Acute renal failure
🞂Chronic renal failure
Types

4. 🞂It is a sudden deterioration in
renal function resulting in
retention of nitrogenous wastes
and biochemical elements.
Acute renal failure

5. 🞂1.5-2% of children
Incidence and etiology

6. It can be classified as
🞂 PRERENAL
🞂 RENAL
🞂 POSTRENAL
ETIOLOGY

7. 1.PRERENAL
1. Dehydration;
vomiting,diarrhea,burns,paralytic
ileus,nephrotic syndrome
2. hypovolemia;haemorrhage
3. Septic shock-gram negative infections
4. Cardiogenic;myocarditis,arrhythmias
5. Renal artery or renal vein thrombosis
6. Coagulation disorders;DIC,HUS

8. 2.RENAL
🞂 Inflammatory;AGN,acute pyelonephritis
🞂 Toxic;heavy metals,mercury,gold,copper
and sulphate poisoning,snake/scorpion
bites
🞂 Antibiotics;aminoglycosides,cephaloridine
🞂 Traumatic :Renal parenchymal
haemorrhage
3.POST RENAL
🞂 Obstruction at the collecting duct –
urate ,sulfonamide crystals -
stones,tumors,clots
🞂 Obstructive uropathy

9. 🞂 Obstruction at the ureter level
due to
stones,clots,debris,inadvertent
/accidental surgical ligations

10. 🞂 Congenital anomalies
🞂 Hypoperfusion-haemorrhage,hypoxia
🞂 Coagulation disturbances
🞂 Renal vein thrombosis
🞂 Obstruction-post.urethral valve
stenosis
Urethral stricture
Causes in newborn

11. 🞂
🞂 Pre-renal cause
Circulating volume depletion
Decrease renal blood flow
🞂 Decrease GFR and renal tissue perfusion
🞂 Severe intensic damage of parenchymal cells of kidney
🞂
🞂
PATHOPHYSIOLOGY

12. Obstruction of ureter
Increase pressure in ureter
🞂 Increase hydrostatic pressure in ducts
and tubules
🞂 Injury to bladder cells and bowels
decreased GFR
If not treatedsevere damage to
Post renal cause

13. SPECIFIC FEATURES
🞂 oliguria
🞂 Anuria
🞂 Uremia-accumulation of nitrogenous waste
🞂 Convulsions
🞂 Hyperkalemia
🞂 hyponatremia
NONSPECIFIC FEATURES
nausea
vomiting
drowsiness
Edema
Rapid breathing
Hypertension/hypotension
hematuria
CLINICAL FEATURES

14. 🞂 History collection
🞂 Diarrhoea,vomiting,fever,rash,toxins or drugs
🞂 Physical examination
🞂 Enlarged kidney and distended bladder
🞂 Blood test
🞂 URINALYSIS
🞂 BUN
🞂 cr
🞂 Blood chemistries
🞂 USG
DIAGNOSTIC EVALUATION

15. 🞂 Renal biopsy
🞂 A procedure in which tissue
samples are removed (with a needle or during
surgery) from the body for examination under
a microscope.

16. 🞂 The most effective management of
ARF is prevention. The treatment of
ARF is directed towards
🞂 Treatment of the underlying causes
🞂 Management of the complications of
renal failure
🞂 Dialysis
MANAGEMENT

17. 🞂 A)Treatment of the cause
🞂 Obstruction should be corrected or bypassed
🞂 Infection and shock should be treated
promptly
🞂 Dopamine may improve renal blood flow in
low doses and is effective in various stages
of poor cardiac output
🞂 Dobutamine may improve renal perfusion by
enhancing myocardial contractility
🞂 A catheter should be placed in the bladder to
assess the urine output and to remove the
urine promptly incase of intrinsic kidney
disease

18. 🞂 Correction of metabolic acidosis
🞂 It is common in ARF due to catabolism and
inability of the failed kidney to secrete
hydrogen ion
🞂Inj.sodium bicarbonate ,IV ,1-2meq/kg to
be given carefully because it can cause fluid
overload,hypernatremia and hypertension.
🞂 Severe acidosis requires dialysis.
(If sr.bicarbonate levels <12meq/L/pH is <7.2)
B)Management of the
complications

19. 🞂 Management of Hypocalcemia
🞂 It is common in ARF in association with
hyperphosphatemia
🞂 Treatment should be given to lower the
phosphorous level
🞂 Milk and other high phosphorous foods are
severely limited
🞂 Calcium carbonate is given to bind
phosphorous
🞂 Aluminum hydroxide gets previously used
to treat hyperphosphatemia have been
associated with aluminum intoxication

20. 🞂 Management of Hypocalcemia
🞂 It is common in ARF in
association with
hyperphosphatemia
🞂 Treatment should be given to
lower the phosphorous level
🞂 Milk and other high phosphorous
foods are severely limited
🞂 Calcium carbonate is given to
bind phosphorous
🞂 Aluminum hydroxide used to
treat hyperphosphatemia

21. 🞂 Treatment for hyperkalemia
🞂 Potassium containing fluids and diet
should be restricted until the renal function is
Improved.It should immediately be treated with
drugs
🞂 Calcium gluconate 10% solution 0.5 ml/kg IV to
be given over 10 minute.A variation of 20 beats
requires stopping the infusion
🞂 Sodium bicarbonate 7.5 % solution 1-3 MEq/kg
IV can be given
🞂 Glucose 25% solution, 2ml/kg/ with insulin 0.1
units/ kg to be given IV over 1 hour.The patient
should be closely monitored for hypoglycemia
🞂 Kayexalate 1 g/kg should be given orally or by
retention enema.

22. 🞂 1.close attention to the intake of fluid
and electrolytes
🞂 2.provision of proper nutrition
🞂 3.preventing complications
🞂 4.providing adequate rest
🞂 5. providing education and support to
family members.
Nursing management

23. 🞂It implies permanent severe
decrease in renal functions.
CHRONIC RENAL FAILURE

24. Glomerular diseases
🞂 Idiopathic glomerulosclerosis
🞂 Polycystic kidneys
🞂 HUS
🞂 Amyloidosis
Developmental anomalies
-Bilateral renal hypoplasia or dysplasia
Reflux nephropathy
Obstructive uropathy-renal stones,urethral valve
defect,pelviureteric junction obstruction
Others:bilateral wilms tumor,renal vein
thrombosis,renal cortical necrosis
Etiology

25. 1. Initial Causes
Diabetes Mellitus → Hypertension →
Glomerulonephritis → Polycystic Kidney Disease →
Other Renal causes results
↓
2. Nephron Damage
Loss of Functional Nephrons → Compensatory
Hyperfiltration in Remaining Nephrons → Accelerated
Nephron Damage
↓
3. Reduced Glomerular Filtration Rate (GFR)
↓ GFR → Decreased Ability to Excrete Waste
Pathophysiology

26. ↓
1. Retention of Waste Products
Urea & Creatinine Accumulation → Azotemia →
Uremia (Toxic Effects on Body)
↓
2. Fluid and Electrolyte Imbalances
Sodium Retention → Hypertension, Edema
Hyperkalemia → Cardiac Arrhythmias
↓ Acid Excretion → Metabolic Acidosis
↓
3. Hormonal Dysregulation
↓ Erythropoietin → Anemia
↓ Calcitriol → Hypocalcemia → Secondary
Hyperparathyroidism → Bone Demineralization

27. Systemic Complications
Cardiovascular: Hypertension, Atherosclerosis,
Heart Failure
Neurological: Encephalopathy, Peripheral
Neuropathy
Gastrointestinal: Nausea, Vomiting, Anorexia
Immune System: Increased Infection Risk
↓
End-Stage Renal Disease (ESRD)
GFR < 15 mL/min/1.73 m² Requires Dialysis
→
or Kidney Transplant

28. 🞂Early signs
🞂 Lack of energy
🞂 Fatigue on exertion
🞂 Pallor,anemia
🞂 Elevated BP
Clinical features

29. Late signs
🞂 Decreased appetite
🞂 Less interest in normal activities
🞂 Increased /decreased urine output
🞂 Muddy appearence of skin
🞂 Headache,muscular cramps and
nausea

30. 🞂 Weight loss
🞂 Facial edema
🞂 Malaise
🞂 Bone or joint pain
🞂 Growth retardation
🞂 Dryness or itching on skin
🞂 Bruised skin
🞂 Sensory or motor loss
🞂 Amenorrhoea in adolescent girls
🞂 Dental defects-
discoloration,malocclusion
Other features

31. 🞂 History
🞂 Lab tests
🞂 RFT-elevated BUN,creatinine,uric acid
🞂 Blood test-sr.electrolytes,PH and
biochemical disturbances
🞂 Urine analysis-Incr.specific gravity
🞂 X-ray-KUB
🞂 ECG-cardiac defects
🞂 IVP
DIAGNOSTIC EVALUATION

32. 🞂 Diet
🞂 Controlling hypertension
🞂 Managing anemia
🞂 Managing infections
🞂 Maintain growth
🞂 Dental care
Management

33. 🞂 Diet-protein 0.8-1g/kg/day
🞂 Edema-sodium restriction
🞂 Hyperkalemia-pottassium
restriction
🞂 Restrict diary products which
contain phosphate s

34. 🞂 Metabolic acidosis-sodium bicarbonate
🞂 Hypertension-antihypertensives
eg.atenolol,propanolol
🞂 Anemia- Inj erythropoietin s/c
🞂 PCV if Hb falls below 6gm/dl
🞂 Iron and folic acid supplements
🞂 Growth failure-Growth hormone
🞂 Infections-antimicrobials
🞂 Symptomatic treatment for seizures and
nausea,vomiting

35. 1.Dialysis
-Hemodialysis
-Peritoneal dialysis
2. Renal transplantation
Renal replacement therapy

36. 🞂 Early stage good prognosis
🞂 In end stage –dialysis and renal
transplantation .
Prognosis