Chronic Renal Failure - PowerPoint PPT Presentation

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Chronic Renal Failure

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Title: Pathophysiology- Progression from CRF to ESRF Author: Georgina Follows Last modified by----- Created Date: 1/8/2005 9:05:24 PM Document presentation format – PowerPoint PPT presentation

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Title: Chronic Renal Failure


1
Chronic Renal Failure
  • Jean Winterbottom
  • Clinical Educator
  • MRI

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

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

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

5
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6
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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)

8
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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

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

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

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

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)

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

15
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

16
Treating ESRD
  • 4 forms of treatment
  • HAEMODIALYSIS
  • PERITONEAL DIALYSIS (CAPD)
  • TRANSPLANTATION
  • CONSERVATIVE

17
Emotional Support
  • Realisation that there is no cure can trigger
  • Anxiety
  • Denial
  • Frustration
  • Anger
  • Depression
  • Hopelessness

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

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?
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