ACUTE RENAL FAILUARE

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2 ACUTE RENAL FAILUARE PATHO PHYSIO PHARMA PRESENTED BY: SAJIDA PARVEEN (post RN BScN 2 nd semester, 1 st year) FACULTY: SIR RAJA Date : 21 st April 2016 (NEW LIFE COLLEGE OF NURSING)

3 BJECTIVES efine Renal Failure? efine Acute Renal Failure? escribe causes & Pathop physiology of Acute Rena ailure? igns and symptoms of Acute Renal Failure? nlist the diagnostic investigation? xplore the management of Acute Renal Failure?

4 enal Failure A condition in which the kidneys fail to emove metabolic end-products from the blood nd regulate the fluid, ele ectrolyte, and ph balance f the extracellular fluids. The underlying cause ay be renal disease, systemic disease, or rologic defects of nonrenal origin. Renal failure an occur as an ACUTE or a CHRONIC disorder. (Essentials of Pathophysiologyy Concepts of Altered Health States

5 cute Renal Failure Acute renal failure(arf) now called Acute idney Injury(AKI) represents a rapid decline in rena unction or is defined as an abrupt (within 48 hours) eduction in kidney function based on an elevation in erum creatinine level, a red duction in urine output, the eed for renal replacement therapy (dialysis) in onse nd often is reversible if recognized early and treated ppropriately. Acute renal failure is caused by differen onditions that produce an acute shutdown in rena unction

6 athophysiology &Causes Of ARF/AKI here are main THREE causes of ARF/AKI.Prerenal Failure rerenal failure, the most common form of acute renal failure, characterized by a marked decrease in renal blood flow. It is versible if the cause of the decreased renal blood flow can be entified and corrected before kidney damage occurs.

7 athophysiology & Causes Of ARF/AKI auses 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

8 athophysiology & Causes Of ARF/AKI. Intrinsic Renal Failure / Intra Renal ntrinsic or intrarenal renal failure results from onditions that cause damage to structures within the idney glomerular, tubular, or interstitial. The major auses of intrarenal failure are ischemia associated with rerenal failure, toxic insult to the tubular structures of e nephron, and intratubularr obstruction.

9 athophysiology & Causes Of ARF/AKI auses 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)

10 athophysiology & Causes Of ARF/AKI. Post Renal Failure ost renal failure results from obstruction of urine outflow from the idneys. The obstruction can occur in the ureter (i.e., calculi and rictures), bladder (i.e., tumors or neurogenic bladder), or urethra (i.e., rostatic hypertrophy). ost Renal Bilateral ureteral obstruction Bladder outlet obstruction Calculi (stones) Tumors Benign prostatic hyperplasia Strictures Blood clots

11 1. Pre-renal

12 1 ases or Stages ARF ation/onset: Begins with the initial disturbance and ends when oliguria develops. with ^ BUN and Creatinine possible decreased Urine Out Put (UOP). uric: UOP < 400/day, ^BUN, Cr, K+, may last up to 14 day. etic: Patient experiences gradually increasing urine output ratory values stop rising and eventually decrease. me of urinary output may reach normal or elevated levels, at end of this stage may n to see improvement. very: Things go back to normal or may remain insufficient and become chronic

13 igns 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

14 igns and symptoms of ARF/AKI Throat or Skin Infection Rash History of Nephrotoxic Agents Sign of uremia Anorexia Lethargic Hypertension Uremic Encephalopathy Seizures

15 iagnostic Investigation lood Counts: Low Hb% ---blood loss Leukocytosis---infection Platelet Counts---low in HUS, Renal Vein Thrombosis. lood Urea & Creatinine: Raised due to diminished renal function erum Calcium, Phosphate: Serum Calcium low Serum Phosphate raised

16 iagnostic Investigation erum Electrolytes : sodium low potassium high Bicarbonate low rine Examination: Urine Na if (increased) > 20 meq/l show intrinsic renal If (decreased)< 10 meq/l show pre-renal rine DR us, RBC s, White Cell Casts

17 iagnostic Investigation /S Abdominal CG(for hyperkalemia) enal Biopsy

18 anagement Of ARF/AKI If fluid resuscitation is required because of intravascular volume depletion, isotonic solutions (e.g., normal saline) are preferred. A reasonable goal is a mean arterial pressure greater than 65 mm Hg, which may require the use of vasopressors in patients with persistent hypotension. Monitor and maintain electrolytee imbalances (e.g., hyperkalemia, hypophosphatemia, hypomagnesaemia, hypernatremia, hypernatremia, metabolic acidosis) Diuretics

19 ursing 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

20 ursing Management Of ARF/AKI urinary symptoms, hypotensionn 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

21 2 hronic 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.

22 ymptoms 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 2

23 2 rdiovascular Neurological Cont. Hypertension Arrhythmias Pericardial effusion CHF Peripheral edema EEG changes Hematologic Anemia Blood loss from dialysis and GI bleed Burning, pain, and itching Motor nerve dysfunction Muscle cramping Shortened memory Drowsy, confused, seizures, coma,

24 Cont. 2 Gastro Intestinal Stomatitis Mouth Ulcer & bleeding Uremic breath Nausea Vomiting Constipation Respiratory ^ chance of infection Pulmonary edema Dyspnea Tachypania

25 2 Muscloskeletal Skin Cont. Muscle and bone pain Bone demineralization Pathological fractures Yellow-bronze skin with pallor Pruritus Purpura Thin, brittle nails Blood vessel calcifications in myocardium, joints, eyes, and brain Dry, brittle hair, and may have color changes

26 2 ab: findings CRF BUN Normal is 10-20mg/dL. When reaches 70 = dialysis Serum creatinine Normal is mg/dl. When reaches 10 + normal, it is time for dialysis Creatinine clearance is best determent of kidney function. Must be a hour urine collection. Normal is > 100 ml/min

27 2 ther abnormal findings Metabolic acidosis Fluid imbalance Anemia

28 2 otassium K+ Normal is ,mEq/L. maintains muscle contraction and is essential for cardiac function. Both elevated and decreased can cause problems with cardiac rhythm

29 2 edical 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

30 3 emodialysis Cont. 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

31 eferences Essentials of Pathophysiology Concepts of Altered Health States (book). Nephrology renewal manual, acute renal failure; pathophysiology and management. Medical-Surgical Nursing, 10th ed - Brunner & Suddarth(book). Acute Kidney Injury: A Guide to Diagnosis and Management, American Family Physician Volume 86, Number 7 October 1, 2012.