Chronic Renal Failure
CFR: progressive and irreversible destruction of nephrons in both kidneys. Affects all organ systems
Creatinine Clearance <10 ml/min; needs diaylsis or transplant
Three stages:
1. Diminished renal reserve
2. Renal insufficiency
3. End-stage renal disease (ESRD)
Clinical Manifestations:
Due to retained urea, creatinine, hormones, electrolyte imbalance
1. Urinary system
Polyuria leads to oliguria leads to anuria
2. Metabolic disturbances
Increased BUN and creatinine
Insulin resistance and hyperglycemia
Elevated triglycerides
3. Electrolyte/Acid-base Imbalance
Hyperkalemia
Hypocalcemia (decreased Vit D activation leads to decreased Ca absorption)
Hyperphosphatemia (diminished renal excretion)
Sodium (low-normal; dilutional hyponatremia)
Metabolic acidosis (inability to excrete acids or retain/produce HCO3)
4. Hematologic system
Anemia
Bleeding tendency
Infection
5. Cardiovascular system
Hypertension
Peripheral edema
Arrythmias
Pericarditis
Athersclerosis
6. Respiratory system
Kussmaul's respirations
Dyspnea
Infections
7. GI system
Excess urea
Metallic taste
GI irritation
Diarrhea/constipation
8. Neurological system
CNS depression
Encephalopathy
Peripheral neuropathy
Parathesia feet/legs
9. Integument
Yellowish skin
Pale, dry, scaly skin
Pruritis
Uremic frost
10. Musculoskeletal
Renal osteodystrophy
Renal failure leads to decreased activation Vit D; leads to decreased Ca absorption; leads to hypocalcemia; leads to increased PTH; leads to resorption Ca and PO4 from bone; leads to increased serum Ca & PO4
Ca & PO4 deposits in body
Osteomalacia; osteitis fibrosis; matastatic calcification
Reproductive
Infertility and decreased libido
Impotence and anorgasmy
Endocrine
Hypothyroidism
Psychological/Emotional
Emotional lability, withdrawal, depression
Management CRF:
Treat reversible causes of CRF
Conservative RX (meds, diet) before dialysis: RX symptoms & prevent complications
Pharmacologic and Other Management CRF:
1. Hyperkalemia
IV Insulin & glucose, Kayexelate & Sorbital
Dietary restriction
2. Hypertension
Na & fluid restrictions
Antihy[pertensives (ACE inhibitors; Ca channel blockers)
control BP
3. Renal osteodystrophy
Restict phosphate intake\Phosphate binders (Tums)
Avoid magnesium-based agents (Maalox, Mylanta)
Ca supplements
Active Vit D (calcitrol)
Total/sub-total parathyroidectomy
4. Anemia
Human erythropoietin
Iron and Folic acid
Medication cautions:
Adjust dosage if excreted by kidneys!
No Demerol!!
Nutritional management:
Restrict protein
Vitamin supplement
Adequate calories
Fluid restrictiom
Na & K restriction
Teaching:
Daily weights, BP, S/S electrolye imbalances, dietary restrictions, medications use, etc.