Pre-renal
Before the kidneys. Due to low blood flow to kidney from MI, hypovolemia, hemorrhage, burns, GI losses, & vasodilation.
Acute and Chronic Renal Failure
Acute Kidney Injury
Post-renal
Obstructions or blockages in the urinary tract, renal stones, blood clots, tumors, BPH, bladder cancer, & cervical/prostate cancer.
Intra-renal
 Damage to the inside of the kidneys due to myoglobinuria (muscle damage), nephrotoxic drugs (NSAIDs, aminoglycosides, chemo drugs, contrast dyes), & infections such as glomerulonephritis.
May be reversible
Potentially reversible but may end up in chronic renal failure
Renal Failure
Phases of renal failure
- Phases of renal failure
- Oliguria: urine output < 400 mL/ 24 hours.
- Diuretic: Large amount of urine output.
- Recovery or end up on chronic renal failure.
Signs and Symptoms
- Shortness of breath
- Chest Pain from fluid overload
- Cardiac arrest from hyperkalemia
- Hyperkalemia
- Fatigue
- Nausea
- Swelling
Interventions
- Monitor EKG (Due to hyperkalemia)
- Intake & Output
- Daily Weight (Monitor for fluid overload)
- Monitor BUN, Creatinine, and Potassium.
- Avoid nephrotoxic drugs
Chronic Renal Failure
Dialysis
Dialysis at End-Stage-Renal Disease stage 5 with GFR < 15 ml/min. Glomerular Filtration Rate (GFR) is a measure used to assess how well the kidneys are functioning in filtering waste and excess fluid from the blood. It represents the volume of fluid that is filtered by the glomeruli (tiny blood vessels in the kidneys) per unit of time. GFR is expressed in ml/min. Healthy kidneys GFR = > 90 ml/min
Symptoms
Oliguria, proteinuria, hematuria, heart failure, anemia, fluid overload, lethargy, anorexia, hypertenison, metallic taste, impaired immune system, bone disease, uremic fetor or ammonia breath.Â
Causes
Hypertension #1 cause. Diabetes Mellitus #2 causes: Others: untreated acute renal failure, genetics, infections, or autoimmune disorders.
Laboratory changes
⇑ BUN/Creatinine, ⇑ Potassium, ⇑ Magnesium, ⇑ Phosphorus. ⇓ Hemoglobin/Hematocrit (due to lack of erythropoetin), ⇓ Calcium (Due to ⇓ Calcitriol).
Hemodialysis
Hemodialysis: Clients are connected to a dialysis machine 3-5Â times a week in order to remove toxins/fluids and normalize electrolytes.
Access for Hemodialysis
An artery and a vein are connected through an anastomosis to provide access for hemodialysis needles to be inserted. The access takes weeks to mature or grow. Meanwhile, a central catheter is used for dialysis.
Peritoneal Dialysis
Peritoneal Dialysis: A catheter is surgically inserted in the peritoneal cavity in order to infuse dialysate, let it dwell and then let it drain out. High risk for peritonitis.