RENAL PATHOLOGY

ACUTE RENAL FAILURE CHRONIC RENAL FAILURE

Structure
85% of tissue

15% of tissue

functional unit

RENAL FUNCTION is maintained with 33% functional nephrons.

Serum indicators of renal function

BUN Creatinine pH Sodium 10-20 mg/dl 0.5-1.5 mg/dl 7.35-7.45 135-145 mEq/L

RENAL DYSFUNCTION Increased BUN and crea Decreased pH and sodium

ACUTE RENAL FAILURE

Sudden/ abrupt loss of renal function Possible causes Decreased renal blood flow Structural damage

Phases of ARF
Oliguric Urine output under 400 ml/day BUN, crea, UA, K and Mg levels Nonoliguric RF: high output failure

Phases of ARF
Diuretic Increasing urine output, sometimes more than 3L per day; urine is very dilute MONITOR for hypokalemia, hyponatremia, and dehydration

Phases of ARF
Recovery Some permanent loss of renal function, but sufficient to maintain healthy life. Can result to complications of secondary infection, which may lead to death.

PRERENAL
Results from decreased renal perfusion from RENAL ISCHEMIA Arterial or venous problems Episodes of decreased volume Vasodilation Pump failure Episodes of increased renal vascular resistance

INTRARENAL
KIDNEY TISSUE DISEASE Due to the inflammatory/ immunologic process affecting glomeruli. Acute tubular necrosis is the most common cause. Ischemic injury Nephrotoxins

POST-RENAL
Caused by obstruction of the urinary system causes increased hydrostatic pressure within the renal system decreases renal filtering ability

Assessment
Urinalysis Serum chemistry Vital signs

Clinical manifestations
MULTIPLE BODY SYSTEMS AFFECTED Cardiovascular Respiratory Hematological Neurological Fluid and electrolyte imbalances

Treatment plan
MEDICAL Fluid challenges: Diuretic therapy serum K levels: Kayexalate PO or via retention enema; Sorbitol (osmotic cathartic) Metabolic acidosis: IV administration of NaHCO renal blood flow: IV dopamine

Treatment plan
DIETARY Fluid restriction; I and O monitoring Regulated intake of protein, potassium, and sodium according to serum plasma levels

Nursing interventions
TO MAINTAIN NORMAL HOMEOSTASIS and RENAL FUNCTION. I and O Daily weights, same time Assess for fluid balance, electrolytes and renal parameters Monitor BP: evaluate for hypotension and HTN

Avoid nephrotoxic medications Heavy metals: mercury, lead, arsenic Antibiotics: sulfonamides, aminoglycosides, cephalosporins NSAIDs: aspirin, ibuprofen Other medications: cimetidine, allopurinol, phenytoin, cyclosporine

TO MAINTAIN NUTRITION. Dietary restrictions on sodium, potassium and protein CHO and fats intake for energy source Small frequent feedings with fluid restrictions Total parenteral nutrition (TPN)

TO PREVENT INFECTION. Avoid use of indwelling catheters, if possible. Assess for development of infectious process (compromised immune system). Assess for and prevent UTI.

TO PREVENT SKIN BREAKDOWN. Frequent turning and positioning. Use of protective devices to prevent pressure ulcers. Frequent ROM and activities to increase circulation.

CHRONIC RENAL FAILURE

Uremic syndrome, end-stage renal disease Progressive, irreversible loss of nephron function Nephrons left intact are subjected to an increased workload, resulting in hypertrophy and inability to concentrate urine.

Stages
Decreased/ diminished renal reserve Renal insufficiency ESRD (uremia)

Decreased/ diminished renal reserve

Normal BUN and serum creatinine levels Absence of symptoms The healthier kidney tissue compensates for the diseased tissue.

Renal insufficiency
GFR is 25% of normal BUN and creatinine levels are increased (AZOTEMIA); decreased urinary creatinine clearance Mild anemia Impaired urine concentration leading to polyuria Headaches

Assessment
Hypertension assessment Uremic syndrome from increased nitrogenous wastes and salivary urea: halitosis similar to odor of urine Fatigue, dyspnea, weakness, and lethargy from anemia Increased susceptibility to bleeding: easy bruising, epistaxis, and GI bleeding

 GI disorders associated with anorexia, nausea, and vomiting Stomatitis from acidosis or fluid and electrolyte imbalances: oliguria and anuria Pleural effusion: dyspnea, and pleuritic pain

Interventions
Similar to ARF Apply lotion to dry, flaky skin Potential complications

Thank you!