Mansoura University Faculty of Nursing Master preparatory course 2011- 2012

RENAL FAILURE
By: Safaa mohammed abd- elghany
Amany el sayed amer Noha Safia abdo Gazia abdallah

Under supervision :
Ass.Prof.Dr:sahar soliman DR /Samar Al-hosin

General objectives:

Provide a prevention of renal failure.

Specific objectives:

Define renal failure. Identify Types of. Renal failure. Identify clinical manifestation of renal failure how community deal with renal failure Nutritional management in renal failure Self care at home

Out line: Introduction. Types of Renal Failure Acute Renal Failure Chronic renal failure how community deal with renal failure utritional management in renal failure

Self care at home

Introduction. Renal failure is a major public health problem and has significant morbidity and mortality because kidney play important role in maintaining homeostasis and early detection and management maintain quality of life Definition:Defined as a medical condition characterized by loss of functioning of the kidneys in performing their most vital function, which is the elimination of wastes and urine out of the body and thus helping maintain the electrolytic balance inside the body. Magnitude of the problem The pattern of disease morbidity and mortality throughout the world is changing both in the developed and the emerging world. During the 20th century, infectious diseases were the major cause of death and disability. However in this century, no communicable, noninfectious diseases have become the major cause of mortality and morbidity around the world1,2. This change is reflected in the type of diseases causing chronic kidney failure and in their presentation and progression. Today, the major cause of end-stage renal failure is diabetes as a result of the global pandemic of type 2 diabetes. The rate of progression is extraordinary, and it is predicted that there will be a doubling of the number of patients with type 2 diabetes around the world in the next 25 years3. This will lead to a corresponding increase in the number of patients with chronic kidney disease and the number requiring end-stage renal failure management, particularly dialysis. Types of renal failure Acute Renal Failure Chronic renal failure

Risk factors Acute kidney failure almost always occurs in connection with another medical condition or event. Conditions that can increase your risk of acute kidney failure include:
y y y y y y

Being hospitalized, especially for a serious condition that requires intensive care Advanced age Blockages in the blood vessels in your arms or legs (peripheral artery disease) Diabetes High blood pressure Heart failure

lassification of RF Renal failure can be divided into two categories: acute kidney injury or chronic kidney disease. acute renal failure (ARF), is a rapidly progressive loss of renal function, generally characterized by Liguria (decreased urine production, quantified as less than 400 ml per day in adults and fluid and electrolyte imbalance. Chronic renal failure: Is gradual and irreversible loss of function of the kidneys over time which continues until the residual kidney function is insufficient to support life? Stages of CRF y decrease renal reserve; in this stage GFR %40-%50 of normal ,blood urea serum ceratinize normal and patient asymptomatic

y Renal insufficiency; in this stage gfr%20-%40 of normal, blood urea serum creatinine begin to rise and mild symptoms appeared. y renal failure; in this stage gfr %10-%20 of normal, blood urea serum creatinine increase and anemia,azotemia,metabolic acidosis, and symptoms of renal failure occur. y End-stage renal disease; in this stage GFR<%1020 of normal, blood urea serum creatinine increase and anemia, azotemia, metabolic acidosis, Liguria and symptoms of renal failure occur. Clinical manifestation of renal failure 1- High levels of urea in the blood, which can result in: vomiting and/or diarrhea, which may lead to dehydration nausea weight loss nocturnal urination more frequent urination, or in greater amounts than usual, with pale urine y less frequent urination, or in smaller amounts than usual, with dark colored urine y blood in the urine y pressure, or difficulty urinating y Unusual amounts of urination, usually in large quantities. 2- Increase amount of phosphate in blood may cause y y y y y y itching y bone damage 3- Muscle cramps (caused by low levels of calcium) 4- A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause

y abnormal heart rhythms

y

muscle paralysis

5- Failure of the kidney to remove excess fluid may cause: y shortness of breath due to extra fluid on lung y swelling of the legs ,face and hands 6- Anemia which result in y y y y y feeling tired and/or weak memory problems difficulty concentrating dizziness low blood pressure:

7- Other symptoms include: y appetite loss, a bad taste in the mouth y difficulty sleeping y darkening of the skin y excess protein in the blood a- causes of acute renal failure? 1- Perennial causes (Pre=before + renal=kidney) causes are due to decreased blood supply to the kidney. Dehydration from loss of body fluid (for example, vomiting, diarrhea, sweating, fever);
y

poor intake of fluids; medication, for example, diuretics ("water pills") may cause excessive water loss;

Abnormal blood flow to and from the kidney due to obstruction of the renal artery or vein.

2-renal causes of kidney failure (Damage directly to the kidney itself) include:
y

Sepsis: the body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually does not occur with urinary tract infections.

Medications: some medications are toxic to the kidney, including no steroidal anti-inflammatory drugs like ibuprofen and naproxen. Others potentially toxic medications include antibiotics like amino glycosides [gentamicin (garamycin), tobramycin], lithium (eskalith, lithobid), and iodine-containing medications such as those injected for radiology dye studies.

Rhabdomyolysis: this is a situation in which there is significant muscle breakdown in the body, and the damaged muscle fibers clog the filtering system of the kidneys. This can occur because of trauma, crush injuries, and burns. Some medications used to treat high cholesterol can cause rhabdomyolysis.

multiple myeloma Acute glomerulonephritis or inflammation of the glomeruli, the filtering system of the kidneys. Many diseases can cause this inflammation including systemic lupus erythematosus, wegener's granulomatosis, and goodpasture syndrome.

3-post renal causes of kidney failure (Post=after + renal= kidney) are due to factors that affect outflow of the urine:

Obstruction of the bladder or the ureters can cause back pressure because the kidneys continue to produce urine, but the obstruction acts like a dam, and urine backs up into the kidneys. When the pressure increases high enough, the kidneys are damaged and shut down. y Prostatic hypertrophy or prostate cancer may block the urethra and prevents the bladder from emptying.

y y

Tumors in the abdomen that surround and obstruct the ureters. Kidney stones. Usually, kidney stones affect only one kidney and do not cause kidney failure. However, if there is only one kidney present, a kidney stone may cause the lone kidney to fail.

B- Causes of chronic renal failure Develops over months and years. The most common causes of chronic renal failure are related to:
y y y

poorly controlled diabetes, poorly controlled high blood pressure, and Chronic glomerulonephritis.

Less common causes of chronic renal failure include: y polycystic kidney disease, y reflux nephropathy, y kidney stones, and y prostate disease Diagnostic evaluation 1-laboratory studies y Kidney function tests y Electrolyte level y Complete blood count y Urine analysis - Renal biopsy

2-radiographic studies y Renal ultrasound y Ct scan, MRI Management of renal failure a- Conservative management 1-Associated diseases that cause or result from CRF must be controlled as hypertenshon, congestive heart failure, kidney stones, diabetes mellitus and other disorder should be treated. 2-Blood transfusion and medications such as Phosphorus-lowering medications (calcium carbonate [caltrate], calcitriol [rocaltrol], sevelamer [renagel]) y red blood cell production stimulation (erythropoietin, darbepoetin [aranesp]) y red blood cell production (iron supplements) y blood pressure medications y vitamins 3-dietary intervention y Control intake of sodium, potassium, phosphate and fluids. Foods high in potassium include bananas, apricots, and salt substitutes . Foods with high phosphorus content include milk, cheese, nuts, and cola drinks y Low protein diet y Low salt diet

B-Replacement therapy To replace lost kidney function, patients have two options; dialysis or transplantation.

1. Dialysis y Is process used to remove fluid, waste products and toxic substances from the blood when the kidneys are unable to do.. There are two types of dialysis; 1) hem dialysis, and 2) peritoneal dialysis. A-Hem dialysis y . Hemdialysis works by circulating the blood through special filters. The blood flows across a semi-permeable membrane (dialyzer or filter).along with solutions that facilitate removal of toxins. Complication of hemodialysis 1-acute complication y y y y y hypotension,nausea,vomiting,fatigue infection such as viral hepatitis HBV, HCV electrolyte imbalance and leg cramps bleeding from the access site air embolism, cardiac ischemia

2-long - term complication y Dialysis dementia y Cardiovascular disease such as, pericarditis, arteriosclerosis y Blood loss y growth retardation Dialysis treatments normally occur three times a week and last a few hours at a time. B-Peritoneal dialysis Peritoneal dialysis uses the lining of the abdominal cavity as the dialysis filter to rid the body of waste and to balance electrolyte levels. a catheter

is placed in the abdominal cavity through the abdominal wall by a surgeon and is expected to remain there for the long-term. The dialysis solution is then dripped in through the catheter and left in the abdominal cavity for a few hours and then is drained out. In that time, waste products leech from the blood normally flowing through the lining of the abdomen (peritoneum). Indication of peritoneal dialysis Renal failure patients who unable to undergo hemodialysis or kidney transplantation y cardiovascular disease y old age patients y patient who cannot take heparin y patient with poor vascular access If kidney failure occurs and is non-reversible, kidney transplantation is an alternative option to dialysis. 2- Kidney transplantation Is surgical procedure to remove ahealthy, functioning kidney from living or brain-dead donor and transplant it into patient with non-functioning kidney. During kidney transplantation the surgeon implants the kidney above the pelvic bone and below the existing, on-functioning kidney by suturing the kidney artery and vein to the patient iliac artery and vein. The ureter of the new kidney is attached directly to the bladder of the patient. The diseased kidney may or may not be removed.

The patient will need to take anti-rejection medications that reduce the ability of the immune system to fight infection. The body can try to reject the kidney or the transplanted kidney may fail to work. As with any operation, there is a risk of bleeding and infection. Kidney transplants may provide better quality of life than dialysis. If the transplanted kidney fails, the alternative is another kidney transplant or a return to dialysis. Contraindication of kidney transplantation Patients with a history of heart disease, lung disease, cancer or hepatitis