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Chronic Renal Failure (End-stage Renal Failure)-is the progressive loss of

renal function over a period of months or years in which there is less than 10% of
remaining renal function and dialysis or kidney transplant is required to
sustained life.


Predisposing Factors: Precipitating

-Genetics -diabetic nephropathy
-Age -hypertensive

Renal Injury

Loss of nephrons Increased angiotensin II.

Glomerular capillary hypertension

Increased Glomerular permeability

and filtration

Proteinuria Systemic

Increased Tubular protein


inflammation and

Renal scaring

 Careful monitor of serum level to detect hyperkalemia

 Emergency treatment is Dialysis Therapy
 Administration of 50% hypertonic glucose I.V, regular insulin, calcium
glocunate I.V, sodium bicarbonate I.V and cation exchange resins such as
sodium polystyrene sulfate.
 Cardiac tamponade resulting from pericardial effusion may result require
emergency pericardial tap or surgery.

Diagnostic Test:

 Elevated BUN, serum Creatinine, sodium and potassium level

 Decreased arterial pH and bicarbonate levels
 Low Hct and Hgb
 Increased blood glucose level
 ABG analysis
 Kidney-ureter-bladder radiography
 Excretory urography
 Nephrotomography
 Renal scan
 Renal arteriography show reduced kidney size
 Abdominal X-RAY
 Abdominal CT Scan
 Ultrasonography
 Renal biopsy

Treatment and drugs:

 Low-protein diet
 High-calorie diet prevents Ketoacidosis
 Restrict sodium, phosphorus and potassium
 Maintaining fluid balance
 Monitoring vital signs, weight changes and urine volume
 Loop diuretic (furosemide)
 Cardiac glycosides in small amount does used to mobilize the fluids
causing the edema
 Antihypertensive
 Antiemetics given before meals
 Cimitidine, omreprazole or ranitidine may decrease gastric irritation
 Methylcellulose or docusate can help prevent constipation
 Folate supplements
 Severe anemia requires infusion of fresh frozen packed cells or washed
packed cells
 Synthethic erythropoietin (epoietin alfa)
 Antipruritic, such as trimeprazine or diphenydramine, can relieve itching,
 Aluminum hydroxide gel can lower serum phosphate levels
 Supplementary vitamins and essential amino acids
 Calcium and phosphorus imbalance may be treated with phosphate
binding agents, calcium supplements and reduction of phosphorus in the
 Hemodialysis or peritoneal dialysis
 Kidney transplantation best choice of treatment


 Provide good skin care, bath patient daily

 Provide good oral hygiene
 Offer small, palatable, nutritious meal
 Monitor patients hyperkalemia, watch for cramping of the legs and
abdomen and for diarrhea
 Carefully assess the patient’s hydration status
 Monitor for bone or joint complications
 Encourage the patient to perform deep-breathing and coughing exercise
to prevent pulmonary congestion
 Maintain aseptic technique
 Carefully observe and document seizure activity
 Observe for sings of bleeding
 Schedule medication administration carefully
 If patient requires dialysis, check the vascular access every 2 hours for
patency and the arm used for adequate blood supply and intact nerve
 Withhold the morning dose of antihypertensive on the day of dialysis,
check for disequilibrium syndrome.