Renal Failure (Acute & Chronic) By Rnpedia.Com

Acute renal failure refers to a sudden and rapid decline in kidney function. This condition occurs abruptly and is characterized by a significant decrease in the kidney's ability to filter waste products and maintain electrolyte balance in the body. Acute renal failure can be caused by various factors such as dehydration, kidney infection, kidney stones, or drug toxicity. Prompt medical intervention is necessary to address the underlying cause and prevent further damage to the kidneys.

Chronic renal failure refers to a gradual and progressive deterioration of kidney function over time. This condition is characterized by the slow destruction of nephrons (the functional units of the kidneys) and a decrease in renal mass. It can often go unnoticed for an extended period, as the symptoms may be mild or absent in the early stages. The term "chronic" indicates that the condition is ongoing and long-term, in contrast to acute renal failure, which is sudden and typically reversible.

Nephrotoxins are agents that damage the kidney tissue. They can be substances such as drugs, chemicals, or toxins that have a toxic effect on the kidneys. These substances can impair the normal functioning of the kidneys and lead to kidney damage or dysfunction. Nephrotoxins can cause inflammation, cell death, or disruption of the kidney's filtration and reabsorption processes. It is important to identify and avoid exposure to nephrotoxins to prevent kidney damage and maintain proper kidney function.

Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Kidneys play a crucial role in maintaining the balance of electrolytes in the body, including potassium. In kidney disease, the kidneys are unable to effectively remove excess potassium from the body, leading to a buildup of potassium in the bloodstream. This can result in various complications, including irregular heart rhythms and potentially life-threatening cardiac arrhythmias. Therefore, hyperkalemia is considered the most serious electrolyte disorder in kidney disease.

Diabetes Mellitus is the leading cause of end-stage renal disease (ESRD) because it can damage the small blood vessels in the kidneys over time. This damage can lead to decreased kidney function and eventually ESRD. Hypotension, anemia, and prostate cancer may contribute to kidney problems, but they are not the primary cause of ESRD.

Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.

Acute renal failure is typically diagnosed by oliguria, which is defined as a urine output of less than 400 mL per day. This means that if a person's urine output is consistently below 400 mL per day, it may indicate that their kidneys are not functioning properly and they are experiencing acute renal failure. Oliguria is a common symptom of this condition and is used as a diagnostic criterion.

When the kidneys have too few nephrons to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, the client is said to have end-stage renal disease (ESRD). This is the final stage of Chronic Renal Failure where the kidneys are no longer able to function properly. In ESRD, the kidneys have lost almost all of their ability to function, and the patient may require dialysis or a kidney transplant to survive. Renal insufficiency refers to a lesser degree of kidney dysfunction, while acute tubular necrosis is a specific type of kidney injury. Dialysis is a treatment option for ESRD but not a term used to describe the condition itself.

The normal minimum urine output is 30 ml/hr. This means that a person should produce at least 30 milliliters of urine every hour. Urine output is an important indicator of kidney function and hydration status. If the urine output falls below 30 ml/hr, it may indicate dehydration or a problem with the kidneys. Monitoring urine output is crucial in assessing a person's overall health and ensuring proper kidney function.

Anti-hypertensive therapy in patients with chronic renal disease is necessary for both renal and cardiovascular protection. Chronic renal disease often leads to high blood pressure, which can further damage the kidneys and increase the risk of cardiovascular events such as heart attacks and strokes. By controlling blood pressure, anti-hypertensive therapy helps to protect the kidneys from further damage and reduces the risk of cardiovascular complications. Therefore, both renal and cardiovascular protection are important goals of anti-hypertensive therapy in patients with chronic renal disease.

Although all of these findings are abnormal, the elevated potassium is a life threatening finding and must be reported immediately.

During the diuretic phase of acute renal failure, the client experiences increased urine output. This can lead to a decrease in fluid volume in the body, resulting in hypovolemia. Hypovolemia is characterized by symptoms such as decreased blood pressure, increased heart rate, dry mucous membranes, and decreased urine output. It is important to carefully assess the client for these signs to prevent complications and provide appropriate interventions to restore fluid balance.

Cloudy dialysate can be an indication of infection and peritonitis in a client on peritoneal dialysis. Peritonitis is an inflammation of the peritoneum, the lining of the abdominal cavity, and is a common complication of peritoneal dialysis. It can be caused by bacteria entering the peritoneal cavity during dialysis. Cloudy dialysate is often accompanied by other symptoms such as abdominal pain, fever, and an increase in white blood cell count. Prompt treatment with antibiotics is necessary to prevent further complications and to preserve the function of the peritoneal membrane.

NSAIDs (Nonsteroidal anti-inflammatory drugs) are known to be nephrotoxic, meaning they can cause damage to the kidneys. These drugs inhibit the production of certain chemicals in the body that cause inflammation and pain, but they can also reduce blood flow to the kidneys and impair their function. Prolonged use or high doses of NSAIDs can lead to kidney damage, including acute kidney injury or chronic kidney disease. Therefore, NSAIDs are considered nephrotoxic drugs.

A normal value of Blood Urea Nitrogen (BUN) is typically in the range of 5-20 mg/dL. BUN is a measure of the amount of nitrogen in the blood that comes from the waste product urea, which is produced by the liver during the breakdown of proteins. Higher levels of BUN may indicate kidney dysfunction or dehydration, while lower levels may suggest liver disease or malnutrition. Therefore, a range of 5-20 mg/dL is considered normal for BUN levels.

The correct answer is "All of the above". Electrolytes are ions that carry an electric charge and are present in urine. Sodium (Na), potassium (K), chloride (Cl), and bicarbonate (HCO3-) are all examples of electrolytes that can be found in urine.

Postrenal failure is caused by obstruction of urine flow, such as in cases of urethral obstruction by an enlarged prostate or tumor, or ureteral or kidney pelvis obstruction by calculi. This obstruction prevents the normal flow of urine from the kidneys to the bladder, leading to a build-up of pressure in the urinary system. This can result in kidney damage and ultimately kidney failure.

Intrarenal failure is the correct answer because it refers to damage that occurs within the kidneys themselves. This damage can be caused by acute damage to renal tissue and nephrons, such as acute tubular necrosis. This type of failure is characterized by a sudden decline in tubular and glomerular function, often due to prolonged ischemia or exposure to nephrotoxins. Other causes of intrarenal failure include conditions like acute glomerulonephritis, malignant hypertension, ischemia, nephrotoxic drugs or substances, red blood cell destruction, and muscle tissue breakdown due to trauma or heatstroke.

In the diuretic phase fluid retained during the oliguric phase is excreted and may reach 3 to 5 liters daily, hypovolemia may occur and fluids should be replaced.

During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesn’t take precedence over fluid limitation. Controlling pain isn’t important because ARF rarely causes pain.

After nephrectomy, it is necessary to measure urine output hourly. This is done to assess the effectiveness of the remaining kidney also to detect renal failure early.

Uremia is a medical condition characterized by the presence of urine in the blood. It occurs when the kidneys are unable to effectively filter waste products and toxins from the bloodstream, leading to a buildup of urea and other waste products in the blood. This can result in various symptoms such as fatigue, nausea, loss of appetite, and changes in urine output. If left untreated, uremia can lead to serious complications and organ damage.

Acute glomerulonephritis is also associated with varicella zoster virus, hepatitis B, and Epstein-Barr virus.
Acute renal failure is associated with hypoperfusion to the kidney, parenchymal damage to the glomeruli or tubules, and obstruction at a point distal to the kidney.
Chronic renal failure may be caused by systemic disease, hereditary lesions, medications, toxic agents, infections, and medications.
Nephrotic syndrome is caused by disorders such as chronic glomerulonephritis, systemic lupus erythematosus, multiple myeloma, and renal vein thrombosis.

Prerenal failure refers to a condition where there is a decrease in blood flow to the kidneys, leading to impaired blood supply. This can be caused by factors such as dehydration, hemorrhage, heart failure, or shock. In this case, the impaired blood supply to the kidney is the cause of the failure, which aligns with the given correct answer "prerenal."

Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don't usually occur with acute renal failure and aren't treated with glucose, insulin, or sodium bicarbonate.

End-stage renal disease is defined as a Glomerular Filtration Rate (GFR) less than 15 ml/min per 1.73m2. GFR is a measure of kidney function and indicates how well the kidneys are able to filter waste products from the blood. A GFR of less than 15 ml/min per 1.73m2 indicates severe kidney damage and signifies the need for kidney replacement therapy, such as dialysis or kidney transplantation.

ESRD stands for End-Stage Renal Disease, which is the final stage of chronic kidney disease. The GFR (glomerular filtration rate) is a measure of how well the kidneys are functioning. A GFR of less than 15 ml per minute indicates that the kidneys are severely impaired and are not able to effectively filter waste products from the blood. This is a critical threshold at which patients usually require dialysis or a kidney transplant to survive.

The signs and symptoms of acute kidney rejection that the nurse should teach the patient to observe for include fever and painful transplant site. This is because fever is a common symptom of infection or inflammation, which can indicate rejection of the transplanted kidney. Additionally, a painful transplant site can suggest the presence of rejection, as the body's immune system may be attacking the new organ. Monitoring these symptoms is important for early detection and prompt medical intervention to prevent further complications.

Clients with chronic renal failure should notify the physician of a gain of 5 pounds over a 2 day period. This sudden and significant weight gain could indicate fluid retention, which is a common symptom of renal failure. It may be a sign that the kidneys are not functioning properly and are unable to remove excess fluid from the body. Prompt medical attention is necessary in order to prevent further complications and manage the condition effectively.

Based on the client's statement, it can be inferred that she is glad to start dialysis because it will allow her to eat and drink what she wants. This suggests that she may not have a clear understanding of the treatment plan and how it relates to her dietary restrictions. Therefore, the nursing diagnosis of ineffective management of therapeutic regimen related to lack of knowledge of treatment plan is the most appropriate choice.

The kidneys release renin, which controls angiotensin. Angiotensin, in turn, controls aldosterone. Aldosterone is responsible for regulating the levels of Na+ and K+ in the body. This process allows the kidneys to maintain the balance of these electrolytes and ensure proper functioning of various bodily systems.

Creatinine, phosphate, sulfates, and uric acid should be found in urine.

Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.

A client with renal failure should be on a diet that includes adequate calorie intake to maintain their energy levels, high carbohydrate to provide fuel for the body, and limited protein to reduce the workload on the kidneys. This type of diet helps to manage the symptoms of renal failure and prevent further damage to the kidneys. High protein and low carbohydrate diets can put additional strain on the kidneys and are not recommended for individuals with renal failure. Low calorie diets may not provide enough energy for the body's needs.

The client has just returned from dialysis and is experiencing symptoms such as headache, nausea, and restlessness. These symptoms could indicate a potential complication or adverse reaction to the dialysis treatment. Therefore, it is important to notify the physician so that they can evaluate the client's condition and provide appropriate medical intervention if necessary. Monitoring the client is important, but notifying the physician takes precedence in this situation. Elevating the head of the bed may provide some relief for the client, but it does not address the underlying cause of their symptoms. Medicating the client for nausea may provide temporary relief, but it is important to determine the cause of the symptoms before administering any medication.

The second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of up to 10L/day of dilute urine. Loss of fluids and electrolytes occur.

Fixed Specific Gravity (1.010) and/or Fixed osmolality (300 mOsm/l) are tests and results that can prove the presence of dilute urine. Dilute urine refers to urine that has a lower concentration of solutes and a higher concentration of water. A fixed specific gravity of 1.010 indicates that the urine is relatively less concentrated, while a fixed osmolality of 300 mOsm/l also suggests a lower concentration of solutes. Therefore, these tests and results can be used to confirm the presence of dilute urine.

Clients on continuous ambulatory peritoneal dialysis (CAPD) need to empty their peritoneal cavity and replace the dialysate every 4-6 hours. This is necessary to ensure that waste products and excess fluid are effectively removed from the body. By regularly replacing the dialysate, the process of dialysis can continue uninterrupted, helping to maintain the client's overall health and well-being.

Urine mostly consists of water (H2O). Water makes up the majority of urine volume, typically around 95%. It is a crucial component for maintaining hydration and eliminating waste products from the body. The other substances listed, such as salt (NaCl), urea, and potassium chloride (KCl), are also present in urine but in much smaller quantities compared to water.

Renal clearance/creatinine clearance is considered the number 1 renal function test because it measures the rate at which the kidneys remove creatinine from the blood. Creatinine is a waste product produced by the muscles and is filtered out of the blood by the kidneys. By measuring the amount of creatinine in the urine and comparing it to the amount in the blood, renal clearance can be calculated. This test provides valuable information about the overall function of the kidneys and their ability to filter waste products from the blood.

Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

The normal serum sodium level is 135 – 145 mEq/L. The client’s serum sodium is below normal. Hyponatremia also manifests itself with abdominal cramps and nausea and vomiting

Infection is responsible for one third of the traumatic or surgically induced death of clients with renal failure as well as medical induced acute renal failure (ARF)

Creatinine clearance is the most appropriate diagnostic test to monitor glomerular filtration rate and renal function. Creatinine is a waste product that is filtered by the kidneys, and its clearance rate provides an accurate measure of the kidneys' ability to remove waste from the blood. By measuring the amount of creatinine in both the blood and urine over a specific period of time, creatinine clearance can be calculated. This test is commonly used to assess kidney function and detect any abnormalities or impairments in the glomerular filtration rate.

When the kidneys are unable to effectively regulate fluid and electrolyte balance and eliminate metabolic waste products, it is necessary to limit the intake of fluid and sodium. This is because excessive intake of these substances can further burden the kidneys and worsen the imbalance. By limiting the intake, the kidneys are given a chance to better manage the fluid and electrolyte levels in the body and prevent the accumulation of waste products.

Normal kidneys excrete approximately 1-2 liters of water each day. This is considered to be the average amount of urine produced by a healthy individual. The kidneys play a crucial role in maintaining the body's water balance by filtering waste products and excess fluids from the bloodstream. The amount of urine excreted can vary depending on factors such as hydration levels, diet, and overall health.

Chronic kidney disease is defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) as evidence of structural or functional kidney abnormalities that persist for at least 3 months, with or without a decreased GFR. This means that in order for a diagnosis of chronic kidney disease to be made, there must be evidence of kidney abnormalities that have been present for at least 3 months. This can be determined through abnormal urinalysis, imaging studies, or histology. It is important to note that a decreased glomerular filtration rate (GFR) may or may not be present in chronic kidney disease.

Hyperkalemia refers to an abnormally high level of potassium in the blood. When kidneys fail, they are unable to properly filter and remove excess potassium from the body, leading to hyperkalemia. This condition can be life-threatening as high levels of potassium can disrupt the normal electrical activity of the heart, potentially leading to cardiac arrest and death. Therefore, hyperkalemia is considered the number one cause of death when kidneys fail.

During the maintenance phase of Acute Renal Failure, Oliguria develops and the kidneys cannot efficiently eliminate metabolic wastes, water, electrolytes, and acids. This phase is characterized by a significant decrease in urine output, usually less than 400 ml per day. The kidneys are unable to regulate fluid and electrolyte balance properly, leading to the buildup of waste products and imbalances in the body. Treatment during this phase focuses on managing fluid and electrolyte levels and addressing the underlying cause of the renal failure.

The correct answer is fluid overload because continuous renal replacement therapy (CRRT) is commonly used in patients with acute renal failure who have fluid overload. CRRT helps remove excess fluid from the body by continuously filtering the blood and removing waste products. This treatment is particularly beneficial in cases where diuretics are not effective or when there is a risk of fluid overload leading to complications such as pulmonary edema or heart failure.