Renal Failure Symptoms - Acute and Chronic

1. Pre – Renal Cause

– from factors outside of kidneys
- circulatory collapse, cardiovascular disorders, hypovolemia, severe vasoconstriction

2. Intra – Renal Cause

- renal parenchyma failure or disease, nephrotic damage (due to poisons, antibiotics); blood transfusion reaction; acute pyelonephritis.

3. Post – Renal Cause

- obstruction in collecting system: renal calculi, prostatic tumor, gynecological or urological problems.


Phases of Acute Renal Failure

1. Oliguric Phase

- decrease urine output (<400 ml for 24 hours) caused by acute renal ischemia and tubular necrosis. This retains waste products and leads to metabolic acidosis.
- last for 1 to 8 weeks

2. Diuretic Phase

- return of GFR and level of BUN signal diurertic phase (1,000 to 2,000 ml per day of urine output that may cause dehydration).

3. Recovery Phase

- return to pre-renal failure activity level
- recovery last for 3 to 12 months


Assessment or Acute Renal Failure Symptoms

• Changes in urine output
• Sudden weight gain
• Headache
• Nausea and vomiting
• Elevated BP
• Changes in LOC
• Uremic smell (halitosis)
• Dry itchy purpuric skin
• Increased potassium, BUN, creatinine
• Decreased pH, Hct, and Hgb
• Hyperkalemia is the most dangerous imbalance because of its effect in cardiac activity
• Hyponatremia is an effect of dilution rather than a true lack of sodium


Nursing Care for Acute Renal Failure

• Daily weight, vital signs, and CVP monitoring
• Fluids and diuretics (lasix, mannitol) as ordered
• High carbohydrates diet with low protein, low potassium and low sodium. Very important part of client's treatment plan is the Kidney Diets!
• Management of hyperkalemia
• Insulin (to force potassium back in the intracellular compartment)
• Sodium bicarbonate (K and H ions are best friends)• Kayexalate enema or orally (exchange resins for K elimination); or dialysis
• Supportive management


Chronic Renal Failure Symptoms

- it is Irreversible progressive reduction of functioning renal tissue that can’t maintain body’s internal environment.
- Most common causes of CRF are diabetic and hypertensive nephropathy, glomerulonephritis, chronic pyelonephritis.


Types of Chronic Renal Failure

1. Reduced Renal Reserve – high BUN but there is no clinical symptoms

2. Renal Insufficiency – mild azotemia with impaired urine concentration with nocturia

3. Renal Failure – severe azotemia, acidosis, impaired urine dilution, severe anemia, electrolyte imbalance

4. End-Stage Renal Failure – deranged excretory and regulatory mechanism; and distinctive groupings of symptoms


Assessment for Chronic Renal Failure

• Oliguria
• Increased BUN, creatinine
• Uriniferous breath odor
• Stomatitis and GI bleeding (Urea is converted back to ammonia which irritates the mucous membrane)
• Uremic frost
• Decreased libido, impotence, infertility


Management for Chronic Renal Failure

• Monitor I and O
• High CHO, limit Na, K, P, CHON
• Administer phosphate-binding agents as prescribed such as AlOH (Amphogel)
• Meticulous skin care
• Dialysis


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