Renal Failure Part 1 PDF

# Renal Failure Part 1 ## Kidney Function: - Urine formation - Excretion of waste products - Regulation of electrolytes - Regulation of acid base balance - Control of water balance - Control blood pressure - Renal clearance - Regulation of RBCs production - Synthesis of VD to active form - Secreti...

# Renal Failure Part 1 ## Kidney Function: - Urine formation - Excretion of waste products - Regulation of electrolytes - Regulation of acid base balance - Control of water balance - Control blood pressure - Renal clearance - Regulation of RBCs production - Synthesis of VD to active form - Secretion prostaglandins ## Regulation of water excretion: - Degree of concentration of urine - Measured by osmolality ## Excretion of waste products: - Blood BUN - Creatinine - Phosphate - Uric acid - Drug metabolites ## Regulation of acid excretion: - Kidney excretes about 70 mEq - pH of urine reaches 4.5 ## Secretion of prostaglandins: - Have a vasodilator effect - That maintain renal blood flow ## Regulation of RBCs production: - When kidney senses O2 tension - Releases erythropoietin ## Renal Failure: - Inability of nephrons to maintain fluid, electrolyte and acid base balances. - Excrete nitrogen waste products. ## Types of Renal Failure: - **Acute Renal Failure** - **Chronic Renal Failure** ## Acute Renal Failure: - Sudden, rapid function occurs hours to days - Reversible with early progressive treatment ## Chronic Renal Failure: - Progressive and irreversible damage occurs months to years. ## Causes of Renal Failure: - **Pre-renal** - Disrupt in renal blood flow - That causes ischemia and nephron damage - Hypovolemia, hemorrhage - ↓ cardiac output, MI - Vascular failure, severacidosis - Occlusion in renal arteries - **Intra-renal** - Destroy nephrons - Acute tubular necrosis - Acute glomerulonephritis - Polycystic disease - Nephrotoxic drugs, such as antibiotic - Trauma, systemic Lupus erythematosus - **Post-renal** - Obstructive problem in structures below kidney - Bilateral renal vein thrombosis - Ureteral calculi - Ureteral stricture - Ureteral and bladder tumor - Prostatic hypertrophy ## ARF progress through 4 phases: 1. **Initiation Phase** - Begins with the onset of contributing event 2. **Oliguric Phase:** - Urine <400 ml/h - Starts within 48h - May last for 10-14 days - **Signs and symptoms:** - Fluid volume excess - Azotemia - Neurologic changes 3. **Diuretic Phase:** - 1-5d - Begins as nephron recover - **Signs and symptoms:** - ↑ water in urine - BUN, K, Phosphate, creatinine ↑ 4. **Recovery Phase:** - 1 or more year - ↓ BUN and creatinine - GFR and tubular function restored ## Chronic Renal Failure: - There are several stages of CRF - **Stage 1:** Slight ↓ kidney function, GFR 90 or more - **Stage 2:** GFR of 60-89 - **Stage 3:** GFR of 30-59 - **Stage 4:** GFR of 15-29 - **Stage 5:** GFR of ≤15 - GFR = Albumin in urine ## Causes of CRF: - Diabetes, gout - Chronic glomerulonephritis - Cystic kidney disease - Renal vascular disease - Lupus nephritis - Renal tuberculosis ## Signs and symptoms of CRF: 1. **Urine output ↓** 2. **Puffy face** 3. **Skin changes:** - Gray-bronze - Dry skin - Dermic frost - Pruritus 4. **Cardiovascular effect:** - Hypertension, MI 5. **Respiratory effect:** - Kussmaul's respiration 6. **Hematologic effect:** - Anemia - Platelet dysfunction - Change in immune system 7. **Gastrointestinal effect:** - Metallic taste in mouth - Anorexia, bleeding - Diarrhea, constipation 8. **Metabolic dysfunction** 9. **CNS effect** 10. **PNS effect** ## Diagnostic findings: - BUN, creatinine, K, Mg, Phosphorus - Calcium - CBC - pH → acidosis - ↓ Specific gravity in urine - Intravenous pyelogram for urinary system - Percutaneous renal biopsy - Radiography and ultrasonography - Renal angiography ## Medical management: - Quickly treatment - Progressively fluid administering - Shock and hypotension are treated - Prevent sepsis - Vasodilation, diuretic drug - Protein for ↑ depending on type of renal failure ## Correction acid-base imbalance: 1. Kayexalate correction hyperkalemia 2. Glucose and insulin correct hyperkalemia. 3. pH restored by sodium bicarbonate 4. Erythropoietin correct anemia ## Chronic Renal Failure: - CRF can be managed with diet and fluid until GFR falls to 10-15% - Low protein diet about 50g/d - Depending on stage fluid and electrolyte may be restricted - If in fever, vomiting fluid ↑ - Na, K, P may restricted - PK is not restricted urine >1000 ml - K restricted level ↑5.5 mEq/L - V.B - Bcomplex, folic acid iron and zinc prescribed - PT long term dialysis - Protein is allowed fluid control - Calcium supplement - Anorexia, nausea and test change - PT take sufficient calories - End stage PT may undergo dialysis or kidney transplantation