Download Renal Failure Acute and Chronic

Renal Failure
Acute and Chronic
DR.FAROOQ ALAM
M.B.B.S-M.phil
Acute renal failure
Renal failure
Chronic renal failure
Acute Renal Failure
The kidney has a remarkable ability to recover
from insult. The objectives of treatment of ARF
are to restore normal chemical balance and
prevent complications.
The medical management includes maintaining
fluid balance, avoiding fluid excesses, or possibly
performing dialysis.
 Maintenance of fluid balance is based on
daily body weight, serial measurements of
central venous pressure, serum and urine
concentrations, fluid losses, blood pressure,
and the clinical status of the patient.
 The parenteral and oral intake and the output,
including insensible loss, are calculated and
are used as the basis for fluid replacement.
Medical Management
Because excessive administration of parenteral fluids may
cause pulmonary edema, extreme caution must be used to
prevent fluid overload (Characterized by dyspnea,
tachycardia, distended neck veins, and crackles) .
Generalized edema is assessed by examining the presacral
and pretibial areas several times daily.
Mannitol, furosemide, or ethacrynic acid may be prescribed
to initiate a diuresis and prevent or minimize subsequent
renal failure.
 Adequate blood flow to the kidneys in patients
with pre-renal causes of ARF may be restored
by intravenous fluids or blood product
transfusions.
 Dialysis may be initiated to prevent serious
complications of ARF, such as:
 hyperkalemia, severe metabolic acidosis,
pericarditis, and pulmonary edema.
Pharmacologic
Therapy
[Hyperkalemia]
Hyperkalemia is a life-threatening
condition. Therefore, the patient is
monitored for:
Serum potassium levels
Electrocardiogram (ECG) changes
(tall, tented, or peaked T waves)
Signs and symptoms (muscle
weakness, diarrhea, abdominal
cramps)
Pharmacologic Therapy
(Continued…)
Hyperkalemia may be reduced by administering
cation-exchange resins (sodium polystyrene
sulfonate [Kayexalate]) orally or by retention
enema.
Kayexalate exchanges a sodium ion for a potassium
ion in the colon (major site for potassium exchange).
Sorbitol is often administered in combination with
Kayexalate to induce a diarrhea-type effect.
Pharmacologic Therapy
(Continued…)
Administration of a retention enema requires a rectal
catheter with a balloon to facilitate retention for 30
to 45 minutes. Afterward, a cleansing enema is
administered to remove the Kayexalate resin as a
precaution against fecal impaction.
Immediate dialysis.
Intravenous glucose and insulin or calcium
gluconate may be used as emergency measures to
treat hyperkalemia.
Nursing Management of ARF
Monitoring fluid and electrolyte balance. The
nurse:
monitors the patient’s serum electrolyte levels and
physical indicators of fluid and electrolyte
imbalances.
carefully screens parenteral fluids, all oral intake,
and all medications to ensure that hidden sources
of potassium are not inadvertently administered or
consumed.
monitors the patient closely for signs and
symptoms of hyperkalemia.
Nursing Management of ARF
monitors fluid status by paying careful
attention to fluid intake, urine output,
apparent edema, distention of the jugular
veins, breath sounds, and increasing
difficulty in breathing.
maintains accurate daily weight, and
intake and output record.
reports to physician indicators of
deteriorating fluid and electrolyte status,
and prepares for emergency treatment.
Nursing Management of ARF
(Continued…)
Reducing metabolic rate. The nurse:
should reduce the patient’s metabolic rate to reduce
catabolism and the subsequent release of potassium and
accumulation of waste products (urea and creatinine).
may keep the patient on bed rest to reduce exertion and
the metabolic rate during the most acute stage of ARF.
should prevent or promptly treat fever and infection to
decrease the metabolic rate and catabolism.
Nursing Management of ARF
(Continued…)
Promoting pulmonary function. The nurse:
assist the patient to turn, cough, and take deep breaths frequently to
prevent atelectasis and respiratory tract infection.
• Preventing infection. The nurse:
– strictly observes aseptic technique when caring for the patient to
minimize the risk of infection and increased metabolism.
– avoids, when possible, inserting an indwelling urinary catheter as it
is a high risk for urinary tract infection (UTI).
Chronic renal failure
Treatment.
Treatment
focuses
on
controlling
the
symptoms, minimizing complications, and
slowing the progression of the disease
Three basic stages in treatment
Preserve remaining nephrons
Conservative treatment of uraemic syndrome
Renal dialysis and transplantation
.
Preserve remaining nephron function
Control of hypertension and heart failure
Treatment of superimposed urinary tract infection
Correction of salt and water depletion
Careful prescribing of drugs that are potentially nephrotoxic
Dietary protein restriction
Conservative management of uraemic syndrome
Reduce protein intake
Aluminium hydroxide to reduce intestinal phosphate
absorption
Vitamin D and calcium supplements to increase serum
calcium
Allopurinol to reduce serum uric acid
Erythropoietin to correct anaemia
 Dialysis is the option for ongoing treatment, often
used while waiting for a suitable transplant
opportunity.
 Kidney transplant, in which a functioning kidney
from a donor is surgically grafted into the patient,
has a good rate of success
Differences
Acute renal failure
Most causes of acute renal failure can be treated and
the kidney function will return to normal with time.
Replacement of the kidney function by dialysis
(artificial kidney) may be necessary until kidney
function has returned.
Chronic renal failure
Chronic kidney damage is usually not reversible and if
extensive, the kidneys may eventually fail completely.
Dialysis or kidney transplantation will then become
necessary
Chronic Renal Failure
Nursing care
Frequent monitoring
Hydration and output
Cardiovascular
function
Respiratory status
E-lytes
Nutrition
Mental status
Emotional well being
Ensure proper
medication regimen
Skin care
Bleeding problems
Care of the shunt
Education to client
and family
Chronic Renal Failure
Transplant
Must find donor
Waiting period long
Good survival rate – 1 year 95-97%
Must take immunosuppressant’s for life
Rejection
Watch for fever, elevated B/P, and pain over
site of new kidney
Chronic Renal Failure
Post op care
ICU
I/O
B/P
Weight changes
Electrolytes
May have fluid volume deficit
High risk for infection
Transplant Meds
Patients have decreased resistance to infection
Corticosteroids – anti-inflammarory
Deltosone
Medrol
Solu-Medrol
Cytotoxic – inhibit T and B lymphocytes
Imuran
Cytoxan
Cellcept
T-cell depressors - Cyclosporin
Any questions???