Chronic Renal Failure

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Chronic Renal Failure

• Jean Winterbottom
• Clinical Educator
• MRI

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Clarification of Terminology

• What do you understand by the following terms
• Chronic Renal Failure
• Damage to kidneys but treatment is not necessary
• End Stage Renal Failure
• Long term damage requiring renal replacement
  therapy 90-95 nephrons not functioning
• Acute Renal Failure
• Sudden decline in renal function at least 50
  decrease in GFR
• 50 patients recover others go on to CRF
• Acute on Chronic Renal Failure
• Acute episode which may require treatment then
  revert back to chronic, however the patient may
  then have reached end stage

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Common causes of Chronic Renal Failure

• Glomerulonephritis 25
• Diabetes Mellitus 25
• Hypertension 10
• Chronic pylonephritis/reflux 10
• Polycystic kidney disease 10
• Interstitial nephritis 5
• Obstruction 3
• Unknown 12

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Obesity

• Increase in obesity caused by
• Change in western diet
• Fast food
• High in sodium
• High in saturated fat
• Causes
• Hypertension
• Type 2 Diabetes

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Hypertension

• 3rd highest contributor to end stage renal
  failure programmes
• Causes
• Filtration failure, causing intravascular volume
  expansion
• Renal artery stenosis,
• Until BP extremely elevated patient will not
  experience symptoms
• Need to adhere to anti-hypertensive medication to
  keep within normal parameters (RA guidelines
  130/80)

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Type 2 Diabetes

• Sharp increase in people with Type 2 Diabetes due
  to obesity
• Poor control of glucose levels in blood
• Causes damage to kidney tissue
• Increase in projected numbers needing dialysis
  through Diabetic Nephropathy

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Classification of Renal Failure

• Early referral
• Delay may be caused by sudden onset of ureamic
  symptoms
• Many patients have already progressed to ESRF
  when identified
• Once referred investigations are carried out to
  determine progress of disease

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Diagnostics Tests

• Renal Ultrasound
• Obstruction in urinary collecting system
• Number,size symmetry of kidneys
• Bladder Xray
• Calculi, tumours cysts
• Renal Biopsy
• Determine extent of pathology, last resort

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Recognizing Clues

• Protein in urine
• Elevated biochemistry results i.e.
• Creatinine
• Urea
• Potassium
• Anaemia from decreased RBC production shortened
  RBC survival

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Recognizing Clues (2)

• Uraemia symptoms
• Bad breath (urinous,ammonia)
• Oedema (eyes, face, arms,hands, feet)
• Hypertension
• Extended neck veins
• Fatigue (anaemia,toxic substances)
• Neurological disturbances (lethargy,
  confusion,sleep disorders)

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Recognizing Clues (3)

• Nausea vomiting
• Headaches
• Pruritus (phosphate, calcium, aluminium)
• Breathlessness
• Bone joint problems (calcium/phosphate
  imbalances,VitD deficiency,demineralization)
• Bone pain

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Management of chronic renal failure

• Determine and treat cause
• Optimise salt and water balance
• Identify appropriate dietary advice
• Control hypertension
• Control electrolyte imbalance
• Prevent and treat renal bone disease

• Early detection and treatment of infection
• Modify drug therapy inline with decline in renal
  function
• Detect and treat any complications
• Prepare for dialysis and transplant programme

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Treating ESRD

• 4 forms of treatment
• HAEMODIALYSIS
• PERITONEAL DIALYSIS (CAPD)
• TRANSPLANTATION
• CONSERVATIVE

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Emotional Support

• Realisation that there is no cure can trigger
• Anxiety
• Denial
• Frustration
• Anger
• Depression
• Hopelessness

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Emotional Support (2)

• No specialized nurse counsellor
• Renal nurse must provide patient and families
  with
• Education
• Compassion
• Understanding
• So that they can manage treatment effectively

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Scenario

• A diabetic patient arrives on your ward. He has a
  history of running high blood glucose levels.
  What would indicate that he had renal impairment?