118 LECTURE BY MA’AM VAQUILAR

ACUTE RENAL FAILURE 4. RECOVERY

- OCCURS ABRUPTLY, CAN BE REVERSIBLE (can go back to - Complete recovery: 1-2 years
normal function however PROGNOSIS depends on the cause of - Body’s ability to go back to normal functions
the client’s condition/case –> e.g. Massive trauma to kidneys - Improve neurological
→ this may not resolve) → RAPID LOSS OF BLOOD IN THE - Increase strength
KIDNEYS → RENAL CELL DAMAGE → KIDNEYS - not all patients can recover especially older patients
→FILTRATION OF THE BOOD - sometimes result to acute renal failure
- HYPOPERFUSION: leads to cell death and lead to decompression Management:
of renal functions b. Monitor BP, urinary I&O
- Kidney: filter wastes from blood c. Monitor daily weight
d. Monitor labs (BUN, CREA)
STAGES e. Monitor level of consciousness
1. PRERENAL STAGE: Happens outside the kidney. Before blood f. Monitor Diet (low to moderate protein and increase
enters the body. carbohydrate diet)
▪ Causes: g. Restrict potassium (K) and sodium (Na) intake: depends on
Something to do with the VOLUME the physician
a. Intravascular volume depletion
b. Dehydration
c. Decrease cardiac output CHRONIC RENAL FAILURE
d. Decrease peripheral vascular resistance - SLOW PROGRESSIVE, IRREVERSIBLE LOSS IN KIDNEY
e. Decrease renovascular blood flow FUNCTION
Something to do with OBSTRUCTION - Occurs in stages and results in Anemia (end stage renal disease)
a. Prerenal infection → inflammation → decrease amount - HYPERVOLEMIA: kidneys inability to excrete sodium and water
of blood in the kidney • Filtration and waste: affect all major systems (to have kidney
b. Obstruction transplant to maintain life)-> wastes not secreted leading to
more systemic manifestations
2. INTRARENAL STAGE: Happens within the parenchyma of the - HYPOVOLEMIA: kidney cannot conserve Na and H2O
kidney → tubular necrosis, prolonged prerenal ischemia, intrarenal - Kidney: filters wastes
infection or obstruction and nephrotoxicity → lack of integrity of the
filtration system of the kidney. During filtration of the kidney. PRIMARY CAUSES:
a. Follow ARF
3. POST RENAL STAGE: Happens between the kidney and urethral b. Diabetes Mellitus (DM)
meatus. Problem in the secretion of urine. c. Hypertension (increases blood pressure to the kidneys leads
to destruction of nephrons)
CATEGORIES d. Chronic urinary obstruction
1. ONSET: Beginning with precipitating events e. Renal artery occlusion
2. OLIGURIC: f. Autoimmune disorders: cell of the body destroys cells of
✓ Normal: kidneys which leads to CRF
a. Sodium level; or*
✓ Elevated/ Increased: ASSESS:
a. BUN
b. Creatinine ▪ CHECK FOR MANIFESTATIONS OF CRF
c. Potassium ➔ Neurological manifestations:
d. Phosphorus asterixis, coma, ataxia, seizures
e. Volume (hypervolemia) ➔ Cardiovascular manifestations:
✓ Decreased: cardiac tamponade, HF, hypertension, peripheral
a. Specific gravity edema, cardiomyopathy
b. Glomerular filtration rate/ GFR ➔ Respiratory manifestations:
c. Creatinine clearance crackles, kussmal respirations, pleural effusions, uremic
d. *Sodium level halitosis, uremic pneumonia
e. Calcium ➔ Hematological manifestations:
Signs and symptoms abnormal bleeding and anemia
- Some clients have NORMAL Urine Output ➔ GI manifestations:
- Most: Oliguria (8-15 days) anorexia, diarrhea, stomatitis, uremic fetor, uremic
➔ The longer the duration= lesser chance of recovery gastritis, metallic taste in the mouth
➔ Dehydration / loss of electrolyte ➔ Urinary manifestations:
- Sudden drop of Urine Output (less than 400 mL/ day) → BP diluted urine, hematuria, anuria (happens later in the
increased (volume of water is a factor) stages of CRF) nocturia (early), proteinuria
Certain signs and symptoms lead to other conditions ➔ Integumentary manifestations:
a. Metabolic acidosis: kussmaul respirations decrease skin turgor, uremic frost (late stage of CRF)
b. Neurological changes: tingling, drowsiness, disorientation, ➔ Musculoskeletal manifestations:
coma bone pain, weakness, pathological fractures, renal
c. Pericarditis: result of friction of the heart → chest pain during osteodystrophy
inspiration ➔ Reproductive manifestations:
Management: ➔ decrease fertility, decrease libido,
a. Restrict fluid intake (hypervolemic – decrease urine) impotence/infrequent/absent menses
b. Administer meds (diuretics)
Additional Information:
3. DIURETIC: ✓ Avoid aspirin
- increased urine output (4-5 L/day) ✓ Soft bristles of tooth brush
- increased cell damage of kidneys → increase urine output ✓ Main management: kidney transplant
indications: damaged nephrons → recovering to excrete wastes ✓ Dialysis only decreases
Signs and symptoms:
a.dehydration, hypovolemia, decreased BP, tachycardia →
decrease H2O in the body of the patient.
Management:
a. Administer fluids by IV or oral.
Sarandi