Renal Failure Feb07

7/30/2019 Renal Failure Feb07

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Renal Failure

Wendy DeMartino, MD

PGY-2
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Objectives

Anatomy

Function

Acute Renal Failure (ARF) Causes

Symptoms

Management

Chronic Renal Failure (CRF) Causes

Symptoms

Dialysis


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Anatomy

2 Kidneys

2 Ureters

Bladder Urethra


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Kidney Function

Detoxify blood

Increase calcium absorption

calcitriol Stimulate RBC production

erythropoietin

Regulate blood pressure andelectrolyte balance renin


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Classifications

Acute versus chronic

Pre-renal, renal, post-renal

Anuric, oliguric, polyuric


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Acute Versus Chronic

Acute sudden onset

rapid reduction in urine output

Usually reversible

Tubular cell death and regeneration

Chronic Progressive

Not reversible

Nephron loss

75% of function can be lost before its

noticeable


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Acute Renal Failure

Pre-renal = 55%

Renal parenchymal (intrinsic)= 40%

Post-renal = 5-15%


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Causes of ARF Pre-renal =

vomiting, diarrhea, poor fluid intake, fever, use ofdiuretics, and heart failure

cardiac failure, liver dysfunction, or septic shock Intrinsic

Interstitial nephritis, acute glomerulonephritis, tubularnecrosis, ischemia, toxins

Post-renal = prostatic hypertrophy, cancer of the prostate or

cervix, or retroperitoneal disorders

neurogenic bladder

bilateral renal calculi, papillary necrosis, coagulatedblood, bladder carcinoma, and fungus


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Symptoms of ARF

Decrease urine output (70%)

Edema, esp. lower extremity

Mental changes Heart failure

Nausea, vomiting

Pruritus

Anemia

Tachypenic

Cool, pale, moist skin


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Diagnosis of Renal Failure


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Acute Renal FailureManagement

Make/think about the diagnosis

Treat life threatening conditions

Identify the cause if possible Hypovolemia

Toxic agents (drugs, myoglobin)

Obstruction

Treat reversible elements Hydrate

Remove drug

Relieve obstruction


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ARF: Life ThreateningConditions

Hyperkalemia

Volume overload

Vascular access


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Hyperkalemia Symptoms

Weakness

Lethargy

Muscle cramps Paresthesias

Hypoactive DTRs

Dysrhythmias


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Hyperkalemia & EKG

K > 5.5 -6

Tall, peaked Ts

Wide QRS Prolong PR

Diminished P

Prolonged QT QRS-T merge

sine wave


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Hyperkalemia Treatment

Calcium gluconate (carbonate)

Sodium Bicarbonate

Insulin/glucose

Kayexalate

Lasix

Albuterol

Hemodialysis


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Chronic Renal Failure

150200 cases per million people =new cases each year

Chronic renal failure and ESRDaffect more than 2 out of 1,000people in the U.S

Mortality = 20%


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Chronic Renal FailureCauses

Diabetic Nephropathy

Hypertension

Glomerulonephritis

HIV nephropathy

Reflux nephropathy in children

Polycystic kidney disease

Kidney infections & obstructions


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CRF Symptoms

Malaise

Weakness

Fatigue Neuropathy

CHF

Anorexia Nausea

Vomiting

Seizure

Constipation

Peptic ulceration Diverticulosis

Anemia

Pruritus

Jaundice Abnormal

hemostasis


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Acute Problems in CRF

Relating to underlying disease

Relating to ESRD

Dialysis related problems


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Problems Related to ESRD

Metabolic K/Ca

Volume overload

Anemia, platelet disorder, GI bleed

HTN, pericarditis

Peripheral neuropathy, dialysisdementia

Abnormal immune function


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Dialysis

of patients with CRF eventuallyrequire dialysis

Diffuse harmful waste out of body Control BP

Keep safe level of chemicals in body

2 types Hemodialysis

Peritoneal dialysis


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Hemodialysis

3-4 times a week

Takes 2-4 hours

Machine filters

blood and

returns it to

body


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Types of Access

Temporary site

AV fistula

Surgeon constructs by combining an arteryand a vein

3 to 6 months to mature

AV graft

Man-made tube inserted by a surgeon toconnect artery and vein

2 to 6 weeks to mature


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Temporary Catheter


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AV Fistula & Graft


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What This Means For You

No BP on same arm as fistula

Protect arm from injury

Control obvious hemorrhage Bleeding will be arterial

Maintain direct pressure

No IV on same arm as fistula

A thrill will be felt this is normal


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Access Problems

AV graft thrombosis

AV fistula or graft bleeding

AV graft infection Steal Phenomenon

Early post-op

Ischemic distally Apply small amount of pressure to

reverse symptoms


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Peritoneal Dialysis

Abdominal lining filters blood

3 types

Continuous ambulatory Continuous cyclical

Intermittent


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EMS Considerations

Make sure the dressing remainsintact

Do not push or pull on the catheter Do not disconnect any of the

catheters

Always transport the patient andbags/catheters as one piece

Never inject anything into catheter


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Dialysis Related Problems

Lightheaded give fluids

Hypotension

Dysrhythmias Disequilibration Syndrome

At end of early sessions

Confusion, tremor, seizure Due to decrease concentration of blood

versus brain leading to cerebral edema


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Renal Failure Feb07

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