acute renal failuare - kknursingcollege.comnew life college of nursing) date : 21st april 2016....

ACUTE RENAL FAILUAREPATHO PHYSIO PHARMA

PRESENTED BY:

SAJIDA PARVEEN(post RN BScN 2ndsemester, 1st year)

FACULTY:

SIR RAJA(NEW LIFE COLLEGE OF NURSING)

Date : 21st April 2016

PATHO PHYSIO PHARMAPRESENTED BY:


FACULTY:



ACUTE RENAL FAILUAREPATHO PHYSIO PHARMA

PRESENTED BY:


FACULTY:



PATHO PHYSIO PHARMAPRESENTED BY:


FACULTY:



OBJECTIVES

•Define Renal Failure?•Define Acute Renal Failure?•Describe causes & Pathophysiology of Acute RenalFailure?

•Signs and symptoms of Acute Renal Failure?•Enlist the diagnostic investigation?•Explore the management of Acute Renal Failure?







Renal Failure

A condition in which the kidneys fail toremove metabolic end-products from the bloodand regulate the fluid, electrolyte, and pH balanceof the extracellular fluids. The underlying causemay be renal disease, systemic disease, orurologic defects of nonrenal origin. Renal failurecan occur as an ACUTE or a CHRONIC disorder.

(Essentials of Pathophysiology Concepts of Altered Health States)







Acute Renal FailureAcute renal failure(ARF) now called Acute

Kidney Injury(AKI) represents a rapid decline in renalfunction or is defined as an abrupt (within 48 hours)reduction in kidney function based on an elevation inserum creatinine level, a reduction in urine output, theneed for renal replacement therapy (dialysis) in onsetand often is reversible if recognized early and treatedappropriately.

Acute renal failure is caused by differentconditions that produce an acute shutdown in renalfunction

Acute renal failure(ARF) now called AcuteKidney Injury(AKI) represents a rapid decline in renalfunction or is defined as an abrupt (within 48 hours)reduction in kidney function based on an elevation inserum creatinine level, a reduction in urine output, theneed for renal replacement therapy (dialysis) in onsetand often is reversible if recognized early and treatedappropriately.






Pathophysiology &Causes Of ARF/AKI

There are main THREE causes of ARF/AKI

1.Prerenal FailurePrerenal failure, the most common form of acute renal failure,is characterized by a marked decrease in renal blood flow. It isreversible if the cause of the decreased renal blood flow can beidentified and corrected before kidney damage occurs.



Pathophysiology &Causes Of ARF/AKI





Pathophysiology & Causes Of ARF/AKI

Causes of Prerenal:• Hypovolemia• Hemorrhage• Dehydration• Excessive loss of gastrointestinal tract fluids• Excessive loss of fluid due to burn injury• Decreased vascular filling• Anaphylactic shock• Septic shock• Heart failure and cardiogenic shock• Decreased renal perfusion due to vasoactive mediators, drugs, diagnostic

agents


agents



agents


agents


2. Intrinsic Renal Failure / Intra Renal

Intrinsic or intrarenal renal failure results fromconditions that cause damage to structures within thekidney— glomerular, tubular, or interstitial. The majorcauses of intrarenal failure are ischemia associated withPrerenal failure, toxic insult to the tubular structures ofthe nephron, and intratubular obstruction.









Causes of Intrinsic or Intrarenal• Acute tubular necrosis• Prolonged renal ischemia• Exposure to nephrotoxic drugs.• Intratubular obstruction resulting from hemoglobinuria,

myoglobinuria.• Acute renal disease (acute glomerulonephritis,

pyelonephritis)



pyelonephritis)




pyelonephritis)



pyelonephritis)

Pathophysiology & Causes Of ARF/AKI3. Post Renal FailurePost renal failure results from obstruction of urine outflow from thekidneys. The obstruction can occur in the ureter (i.e., calculi andstrictures), bladder (i.e., tumors or neurogenic bladder), or urethra (i.e.,prostatic hypertrophy).Post Renal• Bilateral ureteral obstruction• Bladder outlet obstruction• Calculi (stones)• Tumors• Benign prostatic hyperplasia• Strictures• Blood clots

3. Post Renal FailurePost renal failure results from obstruction of urine outflow from thekidneys. The obstruction can occur in the ureter (i.e., calculi andstrictures), bladder (i.e., tumors or neurogenic bladder), or urethra (i.e.,prostatic hypertrophy).Post Renal• Bilateral ureteral obstruction• Bladder outlet obstruction• Calculi (stones)• Tumors• Benign prostatic hyperplasia• Strictures• Blood clots

Pathophysiology & Causes Of ARF/AKI3. Post Renal FailurePost renal failure results from obstruction of urine outflow from thekidneys. The obstruction can occur in the ureter (i.e., calculi andstrictures), bladder (i.e., tumors or neurogenic bladder), or urethra (i.e.,prostatic hypertrophy).Post Renal• Bilateral ureteral obstruction• Bladder outlet obstruction• Calculi (stones)• Tumors• Benign prostatic hyperplasia• Strictures• Blood clots

3. Post Renal FailurePost renal failure results from obstruction of urine outflow from thekidneys. The obstruction can occur in the ureter (i.e., calculi andstrictures), bladder (i.e., tumors or neurogenic bladder), or urethra (i.e.,prostatic hypertrophy).Post Renal• Bilateral ureteral obstruction• Bladder outlet obstruction• Calculi (stones)• Tumors• Benign prostatic hyperplasia• Strictures• Blood clots

1. Pre-renal

Phases or Stages ARF

• Initiation/Onset: Begins with the initial disturbance and ends when oliguria develops. 1-3days with ^ BUN and Creatinine possible decreased Urine Out Put (UOP).

• Oliguric: UOP < 400/day, ^BUN, Cr, K+, may last up to 14 day.

• Diuretic: Patient experiences gradually increasing urine output

Laboratory values stop rising and eventually decrease.Volume of urinary output may reach normal or elevated levels, at end of this stage maybegin to see improvement.

• Recovery: Things go back to normal or may remain insufficient and become chronic
















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Signs and symptoms of ARF/AKI

• Anuria

• Oliguria

• Vomiting

• Diarrhea

• Fever

• Collapse Sunken Fontanels (Peads)

• Dry Tongue & Mucous Membranes

• Loss of skin turgor

• Irritability

• Feeble Pulses

• Anuria

• Oliguria

• Vomiting

• Diarrhea

• Fever

• Collapse Sunken Fontanels (Peads)

• Dry Tongue & Mucous Membranes

• Loss of skin turgor

• Irritability

• Feeble Pulses



• Throat or Skin Infection

• Rash

• History of Nephrotoxic Agents

• Sign of uremia

• Anorexia

• Lethargic

• Hypertension

• Uremic Encephalopathy

• Seizures

• Throat or Skin Infection

• Rash

• History of Nephrotoxic Agents

• Sign of uremia

• Anorexia

• Lethargic

• Hypertension

• Uremic Encephalopathy

• Seizures


Diagnostic Investigation

Blood Counts:

• Low Hb% ---blood loss

• Leukocytosis---infection

• Platelet Counts---low in HUS, Renal Vein Thrombosis.

Blood Urea & Creatinine:• Raised due to diminished renal function

Serum Calcium, Phosphate:

• Serum Calcium low

• Serum Phosphate raised

Blood Counts:









Blood Counts:








Blood Counts:









Serum Electrolytes :• sodium low• potassium high• Bicarbonate lowUrine Examination:• Urine Na if (increased) > 20 mEq/l show intrinsic renal• If (decreased)< 10 mEq/l show pre-renalUrine DRPus, RBC’s, White Cell Casts






U/S Abdominal

ECG(for hyperkalemia)

Renal Biopsy


Management Of ARF/AKI

• If fluid resuscitation is required because of intravascular volumedepletion, isotonic solutions (e.g., normal saline) are preferred.

• A reasonable goal is a mean arterial pressure greater than 65 mmHg, which may require the use of vasopressors in patients withpersistent hypotension.

• Monitor and maintain electrolyte imbalances (e.g., hyperkalemia,hypophosphatemia, hypomagnesaemia, hypernatremia,hypernatremia, metabolic acidosis)

• Diuretics




• Diuretics

Management Of ARF/AKI




• Diuretics




• Diuretics

Nursing Management Of ARF/AKI• Important Role in preventing and identifying early signs of

AKI• Risk Factors for AKI and for AKI progression• Signs and Symptoms of AKI• Strict Accurate Intake/Output, daily weights and calorie

counts• Monitor routine lab and imaging studies• Recognize and alert for any decline in UO(urine out put)• Dialysis

• Important Role in preventing and identifying early signs ofAKI

• Risk Factors for AKI and for AKI progression• Signs and Symptoms of AKI• Strict Accurate Intake/Output, daily weights and calorie


Nursing Management Of ARF/AKI• Important Role in preventing and identifying early signs of

AKI• Risk Factors for AKI and for AKI progression• Signs and Symptoms of AKI• Strict Accurate Intake/Output, daily weights and calorie


• Important Role in preventing and identifying early signs ofAKI

• Risk Factors for AKI and for AKI progression• Signs and Symptoms of AKI• Strict Accurate Intake/Output, daily weights and calorie


Nursing Management Of ARF/AKI

• urinary symptoms, hypotension or changes in S. Cr• Fluid Management• Metabolic Acidosis Management• Electrolyte Management• Immune System Management• Nutritional Management (low sodium, low fat, low fiber) diet• Patient Education


Nursing Management Of ARF/AKI



Chronic Renal Failure (CRF)

• Results form gradual, progressive loss of renal function• Occasionally results from rapid progression of acute renal

failure• Symptoms occur when 75% of function is lost but considered

chronic if 90-95% loss of function• Dialysis is necessary, accumulation or uremic toxins, which

produce changes in major organs.





Chronic Renal Failure (CRF)









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Symptoms CRF

• Subjective symptoms are relatively same as acute

• Objective symptoms• Renal

• Hypernaturmia• Dry mouth• Poor skin turgor• Confusion, salt overload, accumulation of K+ with muscle

cramps.• Fluid overload and metabolic acidosis• Proteinuria, glycosuria• Urine = RBC’s, WBC’s













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• Cardiovascular

• Hypertension• Arrhythmias• Pericardial effusion• CHF• Peripheral edema• EEG changes

• Hematologic• Anemia• Blood loss from dialysis and GI bleed

• Neurological

• Burning, pain, and itching• Motor nerve dysfunction• Muscle cramping• Shortened memory• Drowsy, confused, seizures, coma,

• Cardiovascular

• Hypertension• Arrhythmias• Pericardial effusion• CHF• Peripheral edema• EEG changes

• Hematologic• Anemia• Blood loss from dialysis and GI bleed

• Neurological


Cont….• Neurological


• Neurological


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• Gastro Intestinal

• Stomatitis• Mouth Ulcer & bleeding• Uremic breath• Nausea• Vomiting• Constipation

• Gastro Intestinal

• Stomatitis• Mouth Ulcer & bleeding• Uremic breath• Nausea• Vomiting• Constipation

Cont….

• Respiratory

• ^ chance of infection• Pulmonary edema• Dyspnea• Tachypania

• Respiratory

• ^ chance of infection• Pulmonary edema• Dyspnea• Tachypania

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• Muscloskeletal

• Muscle and bone pain

• Bone demineralization

• Pathological fractures

• Blood vessel calcifications in

myocardium, joints, eyes, and brain

• Skin

• Yellow-bronze skin with pallor

• Pruritus

• Purpura

• Thin, brittle nails

• Dry, brittle hair, and may have color

changes

• Muscloskeletal

• Muscle and bone pain

• Bone demineralization

• Pathological fractures

• Blood vessel calcifications in

myocardium, joints, eyes, and brain

• Skin


• Pruritus

• Purpura



changes

Cont….• Skin


• Pruritus

• Purpura



changes

• Skin


• Pruritus

• Purpura



changes

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Lab: findings CRF

• BUN –Normal is 10-20mg/dL. When reaches 70 = dialysis

• Serum creatinine –Normal is 3.5-5.5 mg/dl. When reaches 10 +normal, it is time for dialysis

• Creatinine clearance is best determent of kidney function. Must be a12-24 hour urine collection. Normal is > 100 ml/min










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Other abnormal findings

• Metabolic acidosis

• Fluid imbalance

• Anemia

• Metabolic acidosis

• Fluid imbalance

• Anemia

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Potassium

• K+• Normal is 3.5-5.0 ,mEq/L. maintains muscle contraction and is

essential for cardiac function.

• Both elevated and decreased can cause problems with cardiacrhythm










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Medical Treatment of CRF

• IV glucose and insulin

• Na bicarb, Ca, Vit: D, phosphate binders

• Fluid restriction, diuretics

• Iron supplements, blood, erythropoietin

• High carbs, low protein

• Dialysis - After all other methods have failed







Medical Treatment of CRF













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• Hemodialysis

• Vascular access

• Temporary – subclavian or femoral

• Permanent – shunt, in arm

• Care post insertion

• Can be done rapidly

• Takes about 4 hours

• Done 3 x a week

• Hemodialysis

• Vascular access






• Done 3 x a week

Cont….

• Hemodialysis

• Vascular access






• Done 3 x a week

• Hemodialysis

• Vascular access






• Done 3 x a week30

References

• Essentials of Pathophysiology Concepts of Altered Health States(book).

• Nephrology renewal manual, acute renal failure; pathophysiology andmanagement.

• Medical-Surgical Nursing, 10th ed - Brunner & Suddarth(book).

• Acute Kidney Injury: A Guide to Diagnosis and Management,American Family Physician www.aafp.org/afp Volume 86,Number 7◆ October 1, 2012.













acute renal failuare - kknursingcollege.comnew life college of nursing) date : 21st april 2016....

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