CHRONIC RENAL FAILURE

PATHOPHYSIOLOGY

is a medical condition in which the kidneys gradually lose their ability to filter waste and toxins from the blood. It is caused by a number of different underlying conditions, such as diabetes, hypertension, glomerulonephritis, or chronic pyelonephritis.

CLINICAL MANIFESTATIONS

electrolyte imbalance

fluid volume

RISK FACTORS

• Diabetes • Hypertension • Cardiovascular Disease • Chronic Kidney Disease • Kidney Stones • Obstructive Uropathy • Autoimmune Disorders • Congenital Kidney Defects • Polycystic Kidney Disease • Excessive Alcohol Consumption • Overuse of Nonsteroidal Anti-inflammatory Drugs • Age (over 60)

LABS/DIAGNOSTICS

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• Urine Analysis: to check for protein, blood, and other waste products in the urine

• Urine Culture: to detect the presence of bacteria or other microorganisms

• Blood Urea Nitrogen (BUN): to measure the amount of urea nitrogen in the blood

• Creatinine: to measure the level of creatinine in the blood

• Complete Blood Count (CBC): to measure the number of red and white blood cells in the blood

• Glomerular Filtration Rate (GFR): to measure the rate at which the kidneys filter waste • Ultrasound: to view the kidneys

• CT Scan: to view the kidneys

TREATMENTS

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• Dialysis: an artificial process that filters waste and toxins from the blood

• Kidney Transplant: a procedure in which a healthy kidney is transplanted into the patient

• Medication: medications can be used to relieve symptoms and help manage underlying conditions

• Diet and Lifestyle Changes: a diet low in salt and protein and high in fiber can help improve kidney function

• Exercise: regular exercise can help improve kidney function

NURSING CONSIDERATIONS

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• Monitor fluid balance and electrolytes levels

. • Monitor renal function tests.

• Monitor for signs and symptoms of infection.

• Educate clients at risk for CRF on lifestyle changes and preventive measures that can reduce their risk for the disease.

• Educate clients who are already diagnosed with CRF on managing their condition with treatments and lifestyle changes

. • Assess for signs and symptoms of fluid and electrolyte imbalances. • Assess for signs and symptoms of anemia.

• Monitor for decreased perfusion due to CRF.

• Monitor for signs and symptoms of end-stage renal disease.

• Provide emotional support to clients with CRF and their families.

references

Bleyer, A. J., & Brown, P. (2012). Chronic renal failure: diagnosis, management, and treatment. American Family Physician, 85(12), 1181–1190.

Isea, R. A., & Ghose, A. (2012). Chronic kidney disease: diagnosis, management, and treatment. Primary Care: Clinics in Office Practice, 39(4), 663–676.

As the kidneys become damaged, they are unable to properly filter waste and toxins, leading to an accumulation of these substances in the blood and other organs.

can be divided into two main categories: hyponatremia and hypernatremia. Hyponatremia occurs when the serum sodium level is lower than normal and can result in a variety of symptoms such as nausea, vomiting, confusion, muscle cramps, fatigue, and confusion. Hypernatremia occurs when the serum sodium level is higher than normal and can cause symptoms such as headache, restlessness, irritability, and thirst.

can lead to dehydration due to the decreased ability of the kidneys to concentrate and excrete excessive water. This can lead to symptoms such as dry mouth and skin, fatigue, dizziness, and confusion. In severe cases, dehydration can become severe and lead to hypovolemic shock, a life-threatening condition characterized by low blood pressure and rapid heart rate.

edema, which is the accumulation of fluid in the body’s tissues. This can cause swelling in the limbs, face, and abdomen, as well as shortness of breath.