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Objectives
y y y y y y
Define acute & chronic renal failures. Identify causes of ARF & CRF. List the signs and symptoms. Describe the management & care. List the complications. Discuss relevant patient / family education.
names y Renal failure acute; Kidney failure; Kidney failure - acute; Renal failure; Arf
chronic; Renal failure - chronic; Chronic renal insufficiency; CRF; Chronic kidney failure
Definition
yDefinition yAcute renal failure is y Definition . y Chronic renal failure is
sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes. ("Acute" means sudden, "renal" refers to the kidneys.)
a gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.
Causes ( ARF )
y Decreased blood flow y Severe acute nephritic syndrome y Acute tubular necrosis (ATN) y Direct injury to the kidney y Myoglobinuria (myoglobin in the
urine)
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Causes ( ARF )
Causes (ARF)
radiographic contrast materials, certain antibiotics, and other medications or substances y In young children, hemolytic uremic syndrome
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Causes (CRF)
y Decreased blood flow is one cause
of kidney damage y Acute tubular necrosis y Direct injury to the kidney y Disorders of the blood
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Causes (CRF)
y Infections y Urinary tract obstruction y Tumors y Kidney stones
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Symptoms (ARF)
y Decreased urine output y Decreased urine volume (oliguria) y No urine output (anuria) y Urination, excessive at night (can occur
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Symptoms (ARF)
y Generalized swelling, fluid retention y Decrease in sensation, especially
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Symptoms (ARF)
y Seizures y Hand tremor y Nausea, vomiting y May persist for days y Morning sickness y Vomiting blood
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Symptoms (ARF)
y Prolonged bleeding, bruising easily y Stools, bloody y Nosebleed y Growth, slow (child 0-5 years)
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Symptoms (ARF)
y Changes in mental status or mood y Agitation y Drowsiness, lethargy y Delirium or confusion y Coma y Fluctuating mood y Difficulty paying attention (attention deficit) y Hallucinations
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Symptoms (ARF)
y Flank pain y Fatigue y Ear noise/buzzing y Breath odor y Breast development in males y Blood pressure, high
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Symptoms (CRF)
Initial symptoms may include the following: y Unintentional weight loss y Nausea, vomiting y General ill feeling y Fatigue y Headache
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Symptoms (CRF)
y Frequent hiccups y Generalized itching (pruritus)
Later symptoms may include the following: y Increased or decreased urine output
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Symptoms (CRF)
y Need to urinate at night y Easy bruising or bleeding; y May have blood in the vomit or in stools y Decreased alertness y Drowsiness, somnolence, lethargy y Confusion, delirium y Coma
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Symptoms (CRF)
y Muscle twitching or cramps y Seizures y Uremic frost -- deposits of white
crystals in and on the skin y Decreased sensation in the hands, feet, or other areas
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Symptoms (CRF)
Additional symptoms that may be associated with this disease: y Excessive nighttime urination y Excessive thirst
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Symptoms (CRF)
y Abnormally dark or light skin y Paleness y Nail abnormalities y Breath odor y High blood pressure y Loss of appetite y Agitation
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Signs (ARF)
Lab values may change suddenly (within a few days to 2 weeks): y Urinalysis may be abnormal. y Serum creatinine may increase by 2 mg/dl or more over a 2-week period. y Creatinine clearance may be decreased.
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Signs (ARF)
y BUN may increase suddenly. y Serum potassium levels may be
increased. y Arterial blood gas and blood chemistries may show metabolic acidosis.
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Signs (ARF)
y Kidney or abdominal ultrasound is
usually the best test, but abdominal xray, abdominal CT scan or abdominal MRI may also reveal the cause of acute renal failure. Kidney size is usually normal or slightly large.
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Signs (ARF)
y Chemical tests of blood and urine
may also help to distinguish the causes. A clean catch urine specimen will indicate if the cause is infection within the urinary tract.
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Signs (ARF)
y Renal angiography (renal
arteriography) may be used to diagnose causes within the blood vessels of the kidney.
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Signs (CRF)
y Blood pressure may be high, with
mild to severe hypertension. A neurologic examination may show polyneuropathy. Abnormal heart or lung sounds may be heard with a stethoscope.
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Signs (CRF)
y A urinalysis may show protein or
other abnormalities. An abnormal urinalysis may occur 6 months to 10 or more years before symptoms appear. y Creatinine levels progressively increase.
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Signs (CRF)
y BUN is progressively increased. y Creatinine clearance progressively
decreases. y Potassium test may show elevated levels. y Arterial blood gas and blood chemistry analysis may show metabolic acidosis.
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Signs (CRF)
y Changes that indicate chronic renal
failure, including both kidneys being smaller than normal, may be seen on: y Renal or abdominal x-ray. y Abdominal CT scan. y Abdominal MRI. y Abdominal ultrasound.
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Signs (CRF)
y This disease may also alter the results
of the following tests: y Urinary casts y Renal scan y Pth y Serum magnesium - test y Erythropoietin
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preventing excess accumulation of fluids and wastes, while allowing the kidneys to heal and gradually resume their normal function. Hospitalization is required for treatment and monitoring.
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dangerous hyperkalemia (increased blood potassium levels). A variety of different medications may be used, including IV (intravenous) calcium, glucose/insulin, and oral or rectal administration of potassium exchange resin (kayexalate).
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waste and fluids. This often makes the person feel better and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is frequently lifesaving, particularly if serum potassium is dangerously high.
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of dialysis include decreased mental status, pericarditis, increased potassium levels, total lack of urine production, fluid overload, and uncontrolled accumulation of nitrogen waste products (serum creatinine > 10 mg/dl and BUN > 120 mg/dl).
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the symptoms, minimizing complications, and slowing the progression of the disease.
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from chronic renal failure must be controlled. Hypertension, congestive heart failure, urinary tract infections, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated as appropriate.
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and erythropoietin supplements may be needed to control anemia. Fluid intake may be restricted, often to an amount equal to the volume of urine produced. Dialysis or kidney transplant may be required eventually.
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the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting. Salt, potassium, phosphorus, and other electrolytes may be restricted.
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Complications (ARF)
increased risk of infections y gastrointestinal loss of blood y chronic renal failure y End-stage renal disease y Damage to the heart or nervous system y Hypertension
y
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Complications (CRF)
y End-stage renal disease y Pericarditis y Cardiac tamponade y Congestive heart failure
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Complications (CRF)
y Hypertension y Platelet dysfunction y Decreased immune response
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Complications (CRF)
y Loss of blood from the gastrointestinal tract y Ulcers y Hemorrhage y Anemia y Hepatitis B, hepatitis C, liver failure y Decreased functioning of white blood cells
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Complications (CRF)
y Increased incidence of infection y Peripheral neuropathy y Seizures y Encephalopathy, nerve damage,
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Complications (CRF)
y Joint disorders y Changes in glucose metabolism y Electrolyte abnormalities including hyperkalemia y Decreased libido, impotence y Miscarriage, menstrual irregularities, infertility y Skin dryness, itching/scratching with resultant
skin infection
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output or other symptoms indicate the possibility of acute renal failure. y Call your health care provider if nausea or vomiting persists for more than 2 weeks. y Call your health care provider if decreased urine output or other symptoms of chronic renal failure occur.
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Any Question ?
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