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Has three distinct phases Oliguric Diuretic Recovery 1-21 days usually reversible with treatment May progress into ESRD, prerenal azotemia, death Also known as acute kidney injury
Risk factors
Diabetes (Type I or II) Chronic renal insufficiency Heart disease (heart failure) Hypertension Advanced age Sepsis
Causes
Prerenal conditions do not damage the kidney, but can cause diminished kidney function. They are the most common cause of ARF Shock, hemorrhage, burns, CHF Postrenal conditions cause kidney failure by obstructing the urinary tract. inflammation of the prostate gland in men (prostatitis); enlargement of the prostate gland (benign prostatic hypertrophy); bladder or pelvic tumors; and kidney stone (renal calculi).
Intrarenal conditions involve kidney disease or direct injury to the kidneys. lack of blood supply to the kidneys (ischemia); the use of radiocontrast agents during diagnostic tests in patients with kidney problems; drug abuse or overdose; long-term use of nephrotoxic medications, like certain pain medicines; acute inflammation of the glomeruli, or filters, of the kidney; and kidney infections
Diagnostic
Blood tests ABG, platelet count, serum and electrolytes, Bun Urine tests Urine osmolality, urinalysis Culture & sensitivity CXR Renal Ultrasound/ Sonography ECG Renal biopsy MRI of abdomen CT Scan
Sx & symptoms
Oliguric phase- 1-21 days Diuretic phase Metabolic acidosis (pt may have anorexia Nause and vomiting Headache
Twitching convulsions due to uremia(severe) Hiccups, drowsines Lethargy Stupor present by the 6th day and coma by 10th death may occur after that
Complications
Renal shutdown Electrolyte imbalance Metabolic acidosis Acute pulmonary edema Hypertensive crisis HyperkalemiaI infection
Medical Management
Low protein, low potassium, low sodium diet. Carbs OK. Prerenal conditions may be treated with replacement fluids given through a vein, diuretics, blood transfusion, restricted salt intake, or medications. Postrenal conditions and intrarenal conditions may require surgery and/or medication. Dialysis & hemofiltration, to filter fluids and wastes from the bloodstream until the primary medical condition can be controlled
Nursing responsibilities
Measure and record I&O Weigh patient daily Maintain proper electrolyte balance Use sterile technique patients with ARF are highly susceptible to infection. Provide good mouth care. Monitor GI bleeding
Causes
Diabetes mellitus (type 1 or type 2 diabetes) and high blood pressure Accounts for 75% of CRF The most common cause of end-stage renal failure worldwide is IgA nephropathy Other causes: Polycystic kidney disease Autoimmune disorders
Stages
Stage 1 GFR 90+ Description Normal kidney function but urine or other abnormalities point to kidney disease Treatment Observation, control of blood pressure
60-89
Mildly reduced kidney function, urine or other abnormalities point to kidney diseas
30-59
15-29
14 or less
NDDNDD-CKD vs ESRD
The term non-dialysis dependent CKD, also abbreviated as NDD-CKD, is a designation used to encompass the status of those persons with an established CKD who do not yet require the life-supporting treatments for renal failure known as renal replacement therapy. Stages 1-4 The condition of individuals with CKD, who require either of the 2 types of renal replacement therapy is referred to as the end-stage renal disease (ESRD). Stage 5
Diagnostic Tests
Abdominal Ultrasound Serum creatinine Additional tests MAG3 scan DMSA scans *both MAG3 and DMSA are chelated with the radioactive element Technetium-99
Sx & symptoms
CKD is initially without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As the kidney function decreases: Hypertension Azotemia Uremia Uremic frost Pruritus Hyperkalemia
Anemia Edema Hyperphosphatemia Metabolic acidosis Lethargy Memory impairment Altered mental status *encepalopathy
Complications
Tertiary hyperparathyroidism Peripheral Neuropathy Cardiopulmonary complications GI complications Sexual dysfunction Skeletal defects Paresthesias
Treatment
- The goal of therapy is to slow down or halt the otherwise relentless progression of CKD to stage 5 Diuretics ACE inhibitors and ACE II inhibitors Replacement of erythropoietin and calcitriol or Alfacalcidol, two hormones processed by the kidney, is often necessary in patients with advanced CKD.
Phosphate binders (eg Phosex, Calcichew, Calcium 500, Renagel, Fosrenol) Diet: Low protein, salt, potassium and phosphate Hemofiltration Administer Aluminum Hyrdoxide gels as prescribed alternagel (antacids)
Nursing Management
Strict I&O monitoring, weigh the patient daily Prevent neurological complications Promote GI function Promote maintenance of skin integrity Monitor or assess signs of bleeding complications Assess for hyperphosphatemia
Provide care for patients receiving dialysis Prevention of heart disease, stroke and vascular disease Encourage smoking cessation Encourage exercise Discourage NSAIDS as they can worsen kidney function unless prescribed by AP.
PrePre-dialysis
Assess clients weight Assess vital signs before and every 30mins during procedure Withhold hypertensive drugs, sedatives and vasodilators Assemble specially prepared dialysate
PostPost-dialysis
Weigh patient Assess for signs of hypovolemic shock Asses for signs dialysis disequilibrium syndrome urea is more rapidly cleared from the plasma than from the brain Irritability, restlessness, nausea ,emesis, hypertension, blurred vision, asterixis, confusion
Complications of Hemodialysis
Complication
Fever
Cause
Bacteria or fever-causing substances (pyrogens) in the bloodstream Overheated dialysate Allergy to a substance in the dialyzer or blood tubing Removal of too much fluid or excessive fluid gain between dialysis Abnormal levels of potassium and other substances in the blood Low blood pressure Air entering blood in the machine Use of heparin to prevent clotting in the machine Bacteria entering the bloodstream through a dialysis catheter or through a needle inserted into veins for hemodialysis access
Life-threatening allergic reaction (anaphylaxis) Low blood pressure Abnormal heart rhythms