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Chronic Renal Failure

Chronic Renal Failure

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Chronic Renal Failure

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  1. Chronic Renal Failure Jean Winterbottom Clinical Educator MRI J Winterbottom 2005

  2. 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 J Winterbottom 2005

  3. 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% J Winterbottom 2005

  4. Obesity Increase in obesity caused by; • Change in western diet • Fast food • High in sodium • High in saturated fat Causes; • Hypertension • Type 2 Diabetes J Winterbottom 2005

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  7. 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) J Winterbottom 2005

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  9. 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 J Winterbottom 2005

  10. 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 J Winterbottom 2005

  11. 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 J Winterbottom 2005

  12. Protein in urine Elevated biochemistry results i.e. Creatinine Urea Potassium Anaemia from decreased RBC production shortened RBC survival Recognizing Clues J Winterbottom 2005

  13. 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) J Winterbottom 2005

  14. Recognizing Clues (3) • Nausea & vomiting • Headaches • Pruritus (phosphate, calcium, aluminium) • Breathlessness • Bone & joint problems (calcium/phosphate imbalances,VitD deficiency,demineralization) • Bone pain J Winterbottom 2005

  15. 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 Management of chronic renal failure J Winterbottom 2005

  16. Treating ESRD 4 forms of treatment; • HAEMODIALYSIS • PERITONEAL DIALYSIS (CAPD) • TRANSPLANTATION • CONSERVATIVE J Winterbottom 2005

  17. Emotional Support Realisation that there is no cure can trigger; • Anxiety • Denial • Frustration • Anger • Depression • Hopelessness J Winterbottom 2005

  18. 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 J Winterbottom 2005

  19. 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? J Winterbottom 2005