Acute Renal Failure Introduction
- Renal failure is a disorder in which the kidney is unable to remove waste and body fluid.
- Renal failure is divided into –
- Acute renal failure
- Chronic renal failure
- Acute renal failure is also called acute kidney Disease (AKD).
Acute renal failure sudden, rapid loss of kidney function and is associated with increased creatinine and blood urea nitrogen (BUN).
- Acute kidney Disease is a transient, temporary and reversible disorder.
- Recovery of acute renal disorder depends upon the cause, condition and loss of the client.
renal failure Cause
- Prerenal cause
- Intrarenal cause
- Post renal cause
renal failure Prerenal cause
- Sever fluid and blood loss.
- Haemorrhage and pancreatitis.
- Decrease cardiac output
- Burn and sepsis
- Decreased renal perfusion
- Decrease renal vascular blood flow.
renal failure Intrarenal cause
- Acute tubular necrosis
- Damage structure of renal parenchyma
- Injury in the glomerulus, nephron and renal tubules
- Vascular disease such as inflammation and occlusion
- Nephrolithiasis and nephrotoxic
- Diabetic nephropathy.
Post renal cause
- Urolithiasis and tumour
- Benign prostatic hyperplasia ( BPH )
- Bladder neck obstruction
- Ureteral obstruction
renal failure Signs and symptoms
- Acute renal failure affects renal function like excretion and regulation of body fluid and electrolytes.
- Stages of clinical manifestation –
- Stage of oliguria
- Stage of diuresis
- Stage of recovery.
Stage of oliguria
- Oliguria is defined as urine output less than 400 ml/day.
- Hypervolemia and hypertension
- Right ventricular failure
- Metabolic acidosis
- Kussmaul respiration
- Tingling of extremities
- Pericarditis and chest pain
- Anorexia, nausea, vomiting
Stage of diuresis
- In this stage, urine output more than 2 litre ( polyuria )
- Excessive urine output
- Hypovolemia and hypotension
Stage of recovery
- Strength pelvic muscles
- Return normal urine output
- Regain renal functions
- CNS – improved
- Blood pressure return normal
- Diagnostic investigations are normal.
- History collection and physical examination
- BUN and creatinine ( increased )
- Urine analysis
- Urine electrolytes
- Serum electrolytes
- Renal USG
- CT scan and MRI
- Renal Biopsy
- Monitor and correct fluid and electrolyte balance.
- Provide diuretic therapy ( furosemide and mannitol )
- Sodium bicarbonate and sodium lactate used to treat metabolic acidosis.
- Proton pump inhibitor
- Dialysis – Dialysis helps to remove waste from the kidney, and improve renal functions.
- High-calorie diet.
- Low protein, low sodium and low potassium diet.
- Parenteral nutrition.
- Sometime avoid sodium and potassium diet.
- Chronic renal failure
- Pulmonary edema.
- Nurses monitor vital signs, fluid and electrolyte balance.
- Maintain patient hydration status.
- Administer IV fluid as prescribed.
- Identify the stage of renal failure.
- Monitor urine input and output and urine characteristics.
- Monitor daily weight.
- Provide prescribed medications.
- Provide soda bicarbonate for metabolic acidosis.
- Nurse monitor sign of infection and WBC count.
- Provide the modified diet.
- The nurse prepared for dialysis.
- Nurses provide emotional and physiological support.
- Urine output less than 400 ml/day – oliguria.
- Urine output less than 100 ml/day – Anuria.
- Reversible renal failure disorder – Acute kidney Disease.
- Nursing action, when patient on diuretic therapy –Check daily patient weight.
- Common finding diuretic therapy – Polyuria.
Reference – NCLEX Sounders 2nd Edition Page no. 822-823