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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.

PATHOPHYSIOLOGY

Predisposing Factors: Precipitating


Factors:
-Genetics -diabetic nephropathy
-Age -hypertensive
nephrosclerosis
-Gender

Renal Injury

Loss of nephrons Increased angiotensin II.

Glomerular capillary hypertension

Increased Glomerular permeability


and filtration

Proteinuria Systemic
hypertension

Increased Tubular protein


reabsorption

Tubulointerstitial
inflammation and
fibrosis

Renal scaring
EMERGENCY CARE MANAGEMENT:

 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
 X-RAY
 Kidney-ureter-bladder radiography
 Excretory urography
 Nephrotomography
 Renal scan
 Renal arteriography show reduced kidney size
 Abdominal X-RAY
 Abdominal CT Scan
 MRI
 Ultrasonography
 Renal biopsy
 EEG

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
diet
 Hemodialysis or peritoneal dialysis
 Kidney transplantation best choice of treatment

NURSING MAMNGEMENT:

 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
function
 Withhold the morning dose of antihypertensive on the day of dialysis,
check for disequilibrium syndrome.