CHAPTER: 3 BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY. Renal Failure
Objectives } Anatomy } Function } Acute Renal Failure (ARF) } } } Causes Symptoms Management } } Causes Symptoms } Chronic } Dialysis Renal Failure (CRF)
Anatomy 2 Kidneys 2 Ureters Bladder Urethra
Kidney Function } Detoxify blood } Increase calcium absorption } calcitriol } Stimulate } erythropoietin } Regulate balance } RBC production renin blood pressure and electrolyte
Classifications } Acute versus chronic } Pre-renal, renal, post-renal } Anuric, oliguric, polyuric
Acute Versus Chronic Acute sudden onset rapid reduction in urine output Usually reversible Tubular cell death and regeneration Chronic Progressive Not reversible Nephron loss 75% of function can be lost before its noticeable
Acute Renal Failure } Pre-renal } Renal = 55% parenchymal (intrinsic)= 40% } Post-renal = 5-15%
Causes of ARF Pre-renal = vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure cardiac failure, liver dysfunction, or septic shock Intrinsic Interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia, toxins Post-renal = prostatic hypertrophy, cancer of the prostate or cervix, or retroperitoneal disorders neurogenic bladder bilateral renal calculi, papillary necrosis, coagulated blood, bladder carcinoma, and fungus
Symptoms of ARF } Decrease urine output (70%) } Edema, esp. lower extremity } Mental changes } Heart failure } Nausea, vomiting } Pruritus } Anemia } Tachypenic } Cool, pale, moist skin
Diagnosis of Renal Failure
Acute Renal Failure Management Make/think about the diagnosis Treat life threatening conditions Identify the cause if possible Hypovolemia Toxic agents (drugs, myoglobin) Obstruction Treat reversible elements Hydrate Remove drug Relieve obstruction
ARF: Life Threatening Conditions } Hyperkalemia } Volume overload } Vascular access
Hyperkalemia Symptoms Weakness Lethargy Muscle cramps Paresthesias Hypoactive DTRs Dysrhythmias
Hyperkalemia & EKG K > 5.5-6 Tall, peaked T s Wide QRS Prolong PR Diminished P Prolonged QT QRS-T merge sine wave
Hyperkalemia Treatment Calcium gluconate (carbonate) Sodium Bicarbonate Insulin/glucose Kayexalate Lasix Albuterol Hemodialysis
Chronic Renal Failure 150 200 cases per million people = new cases each year Chronic renal failure and ESRD affect more than 2 out of 1,000 people in the U.S Mortality = 20%
Chronic Renal Failure Causes Diabetic Nephropathy Hypertension Glomerulonephritis HIV nephropathy Reflux nephropathy in children Polycystic kidney disease Kidney infections & obstructions
CRF Symptoms } Malaise } Weakness } Fatigue } Neuropathy } CHF } Anorexia } Nausea } Vomiting } Seizure } Constipation } Peptic ulceration } Diverticulosis } Anemia } Pruritus } Jaundice } Abnormal hemostasis
Acute Problems in CRF Relating to underlying disease Relating to ESRD Dialysis related problems
Problems Related to ESRD Metabolic K/Ca Volume overload Anemia, platelet disorder, GI bleed HTN, pericarditis Peripheral neuropathy, dialysis dementia Abnormal immune function
Dialysis }½ of patients with CRF eventually require dialysis } Diffuse harmful waste out of body } Control BP } Keep safe level of chemicals in body } 2 types Hemodialysis } Peritoneal dialysis }
Hemodialysis 3-4 times a week Takes 2-4 hours Machine filters blood and returns it to body
Types of Access Temporary site AV fistula Surgeon constructs by combining an artery and a vein 3 to 6 months to mature AV graft Man-made tube inserted by a surgeon to connect artery and vein 2 to 6 weeks to mature
Temporary Catheter
AV Fistula & Graft
What This Means For You No BP on same arm as fistula Protect arm from injury Control obvious hemorrhage Bleeding will be arterial Maintain direct pressure No IV on same arm as fistula A thrill will be felt this is normal
Access Problems } AV graft thrombosis } AV fistula or graft bleeding } AV graft infection } Steal Phenomenon Early post-op } Ischemic distally } Apply small amount of pressure to reverse symptoms }
Peritoneal Dialysis Abdominal lining filters blood 3 types Continuous ambulatory Continuous cyclical Intermittent
EMS Considerations } Make sure the dressing remains intact } Do not push or pull on the catheter } Do not disconnect any of the catheters } Always transport the patient and bags/catheters as one piece } Never inject anything into catheter
Dialysis Related Problems Lightheaded give fluids Hypotension Dysrhythmias Disequilibration Syndrome At end of early sessions Confusion, tremor, seizure Due to decrease concentration of blood versus brain leading to cerebral edema