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Chronic renal failure

By : Ahmad alzoubi 
Ghydaa samarh 
DR-Ibrahim Ayasreh
OUT LAINES
Identifying chronic renal failure-1
Determine the cause and Pathophysiology FOR Chronic-2
renal failure
Knowing the signs and symptoms of chronic renal-3
failure
Diagnosis and Treatment -4
Hemodialysis -5
Chronic renal failure
Chronic renal failure is usually the end result of gradual
tissue destruction and loss of kidney function. It can also
result from a rapidly progressing disease of sudden onset
that destroys the nephrons and causes irreversible kidney
.damage
This syndrome is fatal without treatment, but maintenance

on dialysis or a kidney transplant can sustain life
Pathophysiology
Nephron damage is progressive; damaged nephrons can't function
and don't recover. The kidneys can maintain relatively normal
.function until about 75% of the nephrons are nonfunctional
Surviving nephrons hypertrophy and increase their rate of

.filtration, reabsorption, and secretion
.Compensatory excretion continues as GFR diminishes

Pathophysiology
Chronic renal failure often progresses through
four stages
glomerular filtration rate (GFR) of 35% to 50% of normal-1
renal insufficiency has a GFR of 20% to 35% of normal-2
renal failure has a GFR of 20% to 25% of normal-3
end-stage renal disease has a GFR less than 20% of-4
normal
Pathophysiology
Urine may contain abnormal amounts of protein and •
.red (RBCs) and white blood cells or casts
As sodium delivery to the nephron increases, less is •

reabsorbed, and sodium deficits and volume depletion
follow. The kidney becomes incapable of concentrating
and diluting urine
Causes
Chronic glomerular disease (glomerulonephritis) .1
Chronic infection (such as chronic pyelonephritis and .2
tuberculosis)
Congenital anomalies (polycystic kidney disease) .3
Vascular disease (hypertension, nephrosclerosis) .4
Obstruction (kidney stones) .5
Nephrotoxic agents (long-term aminoglycoside therapy) .6
.Endocrine disease (diabetic neuropathy) .7
Signs and symptoms
Hypervolemia due to sodium retention .1
Hypocalcemia and hyperkalemia due to electrolyte .2
imbalance
Azotemia due to retention of nitrogenous wastes .3
Metabolic acidosis due to loss of bicarbonate .4
Signs and symptoms
Bone and muscle pain and fractures caused by calcium- .5
phosphorus imbalance and consequent parathyroid
malfunction
Peripheral neuropathy due to accumulation of toxins .6
Dry mouth, fatigue, and nausea due to hyponatremia .7
Hypotension due to sodium loss .8
Altered mental state due to hyponatremia and toxin .9
accumulation
Signs and symptoms
Irregular pulses due to hyperkalemia .10
Hypertension due to fluid overload .11
Gum sores and bleeding due to coagulopathies .12
Yellow-bronze skin due to altered metabolic processes .13
.Dry, scaly skin and severe itching due to uremic frost .14
Signs and symptoms
Muscle cramps and twitching, including cardiac .15
irritability, due to hyperkalemia
Infertility, decreased libido, amenorrhea, and .16
impotence due to endocrine disturbances
GI bleeding, hemorrhage, and bruising due to .17
thrombocytopenia and platelet defects
Pain, burning, and itching in legs and feet .18
associated with peripheral neuropathy
Diagnosis
Elevated blood urea nitrogen, serum creatinine, sodium, .1
and potassium levels
Increased aldosterone secretion related to increased .2
renin production
Hyperglycemia (a sign of impaired carbohydrate .3
metabolism)
Urinalysis results aiding in diagnosis include: proteinuria, .4
glycosuria, RBCs, leukocytes, casts, or crystals, depending
.on the cause
Treatment
Low-protein diet, to limit accumulation of end products .1
of protein metabolism that the kidneys can't excrete
High-protein diet for patients on continuous peritoneal .2
dialysis
High-calorie diet, to prevent ketoacidosis and tissue .3
atrophy
Sodium and potassium restrictions, to prevent elevated .4
levels
Treatment
Fluid restrictions .5
Loop diuretics .6
Transfusions, to treat anemia .7
Antihypertensives, to control blood pressure and edema .8
Antiemetics, to relieve nausea and vomiting .9
Iron and folate supplements or RBC transfusion for anemia .10
Treatment
Synthetic erythropoietin, to stimulate the bone .11
.marrow to produce RBCs
Peritoneal or hemodialysis .12
Renal transplantation (often the treatment of choice if .13
a donor is available)
Hemodialysis
Dialysis is a way of cleaning your blood when your kidneys •
can no longer do the job. It gets rid of your body's wastes, extra salt
.and water, and helps to control your blood pressure
In hemodialysis, a dialysis machine and a special filter called an •
artificial kidney, or a dialyzer, are used to clean your blood. To get your
blood into the dialyzer, the doctor needs to make an access, or
entrance, into your blood vessels. This is done with minor surgery,
.usually to your arm
Diffusion, osmosis, and ultrafiltration are the principles on which •
hemodialysis is based
Hemodialysis
.The access is placed by a minor surgery •
:The access could be •
A fistula, an access made by joining an artery and vein in -
.your arm
A graft, an access made by using a piece of soft tube to join - -
.an artery and vein in your arm
A catheter, a soft tube that is placed in a large vein, usually - -
.in your neck
Hemodialysis
The dialyzer, or filter, has two parts, one for your blood
.and one for a washing fluid called dialysate
A thin membrane separates these two parts. Blood cells,
protein and other important things remain in your blood
because they are too big to pass through the membrane.
Smaller waste products in the blood, such as urea,
creatinine, potassium and extra fluid pass through the
.membrane and are washed away
Nursing Management
MEETING PSYCHOSOCIAL NEEDS •
PROMOTING HOME AND COMMUNITY-BASED CARE •
Teaching Patients Self-Care •
Teaching Patients About Hemodialysis •
Patients undergoing hemodialysis who require medications (eg, •
cardiac glycosides, antibiotic agents, antiarrhythmic medications,
antihypertensive agents) are monitored closely to ensure that blood
and tissue levels of these medications are maintained without toxic
accumulation. In patients receiving dialysis, all medications and their
dosages must be carefully evaluated

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presentation

Chronic renal failure

This syndrome is fatal without treatment, but maintenance

Surviving nephrons hypertrophy and increase their rate of

.Compensatory excretion continues as GFR diminishes

As sodium delivery to the nephron increases, less is •

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