Jessica S., Abbie S., Erin A., Abriana K
Your kidneys filter waste and excess fluids from your blood and then excrete it in your urine. Renal failure is a significant loss of kidney function requiring dialysis. End stage renal failure is a renal function of less than 10 percent requiring dialysis or a transplant. When kidney failure reaches an advanced stage dangerous levels of fluid and waste build up in the body, leading to further complications.
- Nephron destruction eventually causes irreversible kidney damage.
- Disease may progress through stages based on the glomerular filtration rate (GFR).
- Stage 1 GFR is greater than 90 mL/minute/1.73 m²; stage 5 GFR is less than 15 mL/minute/1.73 m².
- Decreased urine output
- Hypotension or hypertension
- Altered level of consciousness
- Peripheral edema
- Cardiac arrhythmias
- Bibasilar crackles
- Pleural friction rub
- Gum ulceration and bleeding
- Uremic fetor
- Abdominal pain on palpation
- Poor skin turgor
- Pale, yellowish-bronze skin color
- Thin, brittle fingernails and dry, brittle hair
- Chronic infections such as chronic pyelonephritis
- Collagen diseases such as systemic lupus erythematosus and scleroderma
- Endocrine disease, such as diabetes
- Nephrotoxic agents
- Obstructive processes such as calculi
- Vascular diseases
- Renal artery stenosis
- Results of blood urea nitrogen level test are elevated, creatinine level (serum), sodium, potassium, phosphate, and ammonia levels are elevated.
- Arterial blood gas analysis shows decreased arterial pH and bicarbonate levels.
- Hematocrit and hemoglobin levels are low; red blood cell (RBC) survival time decreases.
- Serum albumin level may be decreased.
- Mild thrombocytopenia and platelet defects appear.
- Aldosterone secretion is increased.
- Hyperglycemia and hypertriglyceridemia occur.
- High-density lipoprotein levels are decreased.
- Urinalysis reveals proteinuria, glycosuria, and urinary RBCs, leukocytes, casts, and crystals.
- Kidney-ureter-bladder radiography, excretory urography, nephrotomography, renal scanning, and renal arteriography show reduced kidney size.
- Ultrasonography may reveal small kidneys or structural abnormalities.
- Renal scanning may identify renal artery stenosis.
- Computed tomography scanning (kidney) identifies renal masses or cysts.
- Renal biopsy allows histologic identification of the underlying pathology.
- Electroencephalography shows changes suggesting metabolic encephalopathy.
Renal dialysis - coping with kidney failure.avi
- Hemodialysis or peritoneal dialysis
- Control of hypertension
- Venous thromboembolism (VTE) prophylaxis if hospitalized
- Rest when needed
- Creation of access for dialysis
- Possible kidney transplant
- Low-protein (with peritoneal dialysis, high-protein), high-calorie, low-sodium, low-phosphorus, low-potassium diet
- Sodium and fluid restrictions
- Protein restriction for stage 5 disease based on serum protein and albumin levels
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers to control hypertension and progression of proteinuria
- Antidiabetic agents to control glucose levels
- Phosphate binders, such as calcium carbonate (Caltrate) or calcium acetate (PhosLo), for hyperphosphatemia
- Oral calcium carbonate and calcitriol (Rocaltrol) for hypocalcemia
- Erythropoietin alfa (Epogen), darbepoetin alfa (Aranesp), or iron salts such as ferrous sulfate (Feosol) for anemia
- Statins for hyperlipidemia
- Loop diuretics for fluid volume overload unless patient has reached stage 5 chronic renal disease
- Calcimimetic agents such as cinacalcet (Sensipar) to reduce parathyroid hormone levels
- Calcium supplements or calcitriol (Rocaltrol) for hypocalcemia
- Sevelamer (Renagel) to help reduce phosphate levels (doesn't induce hypercalcemia)
- Huether, S., & McCance, K. (2012). Understanding pathophysiology (5th ed.). St. Louis, Mo.: Mosby/Elsevier.
- Miller, S. (2013). Chronic kidney disease: MedlinePlus Medical Encyclopedia. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/000471.htm
- Renal Failure. (2015). Retrieved from http://lnareference.wkhpe.com/ref/view.do?key=e769b6ff969aeec99fb6cb6ba532d75a322f2df1&nmn=openMonographFromGlobalIdmonographId=CC.978-1-58255-511-9.chapter336&cssUrl=http://download.lww.com/docucare/assets/lns_branding/docucare-lns.css
- Sinert, R. (2015). Acute Renal Failure Complications. Retrieved from http://emedicine.medscape.com/article/777845-overview