Acute Kidney Injury [ Acute Renal Failure] or kidney failure

Acute kidney injury Previously called Acute Renal Failure is an abrupt loss of kidney functions that develops within 7 days.

It is characterized or manifested by decrease glomerular filtration rate, level of serum creatinine, and urea nitrogen rise and oliguria or anuria.
Its cause is numerous. Generally, it occurs because of damage to kidney tissue caused by decreased blood flow (ischemic kidney), low blood pressure or hypotension, exposure to substance harmful to the kidney, inflammatory process, or an obstruction of the urinary tract.

Definition | Etiology | Mechanism | Sign and Symptoms | Investigation | Management |

 

Definition:-

Acute kidney injury Previously called Acute Renal Failure is an abrupt loss of kidney functions that develops within 7 days.

It is characterized or manifested by decrease glomerular filtration rate, level of serum creatinine, and urea nitrogen rise and oliguria or anuria.

Etiology of Renal failure:-

Its cause is numerous. Generally, it occurs because of damage to kidney tissue caused by decreased blood flow (ischemic kidney), low blood pressure or hypotension, exposure to substance harmful to the kidney, inflammatory process, or an obstruction of the urinary tract.

The causes of Acute kidney failure can be categorized by into 3 major area’s:-

  1. Pre-Renal cause
  2. Intra-Renal cause
  3. Post Renal cause

1. Pre-Renal Cause:-

  • Pre-Renal causes are those that decrease effective blood flow to the kidney and cause to decrease in GFR.
  • The low blood volume in the body (hypovolemia) [due to vomiting, diarrhea, hemorrhage, burns, and excessive use of diuretics.].
  • Hypotension.
  • Decreased cardiac output.
  • Heart failure.
  • Renal artery stenosis.

2. Intra-Renal / Intrinsic cause :-

The process which directly damages the kidney itself :

  • Glomerular Nephritis.
  • Tubular Necrosis.
  • Renal Surgery.
  • Injury, Trauma, Crush.
  • Electric Shock.
  • Diabetes Mellitus.
  • Infectious Disease.
  • Rejection of the transplanted kidney.
  • Genetic Factors.

3. Post Renal cause:-

Caused by disease states/conditions downstream of the kidney.

  • Urinary tract obstruction.
  • Ureteral or urethral structures (stenosis).
  • B.P.H.
  • calculi.
  • cancer or tumor of bladders & ureters.
  • Surgical Accidents.
  • Spinal cord injury leads to decrease bladder emptying of functional obstruction.

Mechanism / Pathogenesis of Renal failure:-

The mechanism of Acute renal failure is not specific or not clear there are some mechanisms which is:-

  • Ischemic kidney.
  • Activation R.A.S.
  • Tubular injury or infection.
  • Fibrosis and scare formation.
  • Renal Calculi.
  • Decreased osmotic pressure.

Clinical Manifestation or Symptoms of Renal failure:-

  • Headache.
  • Fatigue.
  • Nausea, Vomiting.
  • Diarrhea.
  • Constipation.
  • Loss of Appetite.
  • Flank pain.
  • Edema.
  • Shortness of breath.
  • Hematuria.
  • Oliguria or Anuria.
  • Hypertension.
  • Hand tremors.
  • Decrease G.F.R.
  • Increase Serum Keratinine.
  • Acidosis.
  • Urea nitrogen level Increase.
  • Fluid and Electrolyte Imbalance.
  • Hyperkalemia.
  • Hyponatremia.
  • Hypocalcemia.
  • Hyperattrisemia.

Investigation of Renal failure:-

  • Serum Creatinine level (increases)
  • Blood urea nitrogen
  • Serum potassium
  • Urine analysis
  • Radiological study (CT, MRI, X-ray)

Management of Renal failure:-

The management of Acute Kidney Injury is divided into 4 stages or phases:-

  1. Initiating / onset phase:-  This phase covers the period from the precipitation event to the development of renal manifestation and continues until the sign and symptoms. It can last for a few hours to a week.
  2. Oliguric phase:- The most common initiative manifestation of Acute Kidney Injury is oliguria caused by a reduction in the G.F.R. oliguria usually occurs within 24 hours. The longer oliguric phase clast the poor prognosis for recovery of complete renal function. (1 to 8 week).
  3. Diuretic phase:- The diuretic of Acute kidney injury begin with a gradual increase in urine output of 1 to 3 lit. per day but may reach 3 to 5 liter per day or more although output increased in case nephrons are still not fully functioning. At this stage, the uremia may still serve as infected by the low creatinine clearance, elevated serum creatinine, BUN level, and persistent sign and symptoms of dehydration because of the large loss of fluid and electrolyte ( 25- 30 % of death dehydration).
  4. Recovery phase:- The recovery phase begins when the GFR increases allowing the BUN and serum creatinine levels to decrease some individuals do not recover or progress to chronic kidney failure. The older adults patient are less likely to recovery to fully kidney function. The treatment of the recovery phase lasts for some months or a year in severe cause dialysis or kidney transplantation may be prescribed.

Medical Management of Renal failure:-

  • Avoidance of substance that is toxic to the kidneys called Nephrotoxics, it includes NSAID.
  • Iodinated contrast or contrast medium used in radiographic examination especially CT scan and MRI.
  • Antibiotics.
  • In lower BP:- Non-epinephrine, Inotropes, steroid, Dobutamine.
  • In high BP:- calcium channel blocker, ACE inhibitor, Diuretics.
  • In metabolic acidosis administer sodium bicarbonate.

Surgical management of Renal failure:-

  • Nephrotomy.
  • Catheterization.
  • Dialysis.
  • Renal Transplantation.

Nursing Management of Renal failure:-

Nursing diagnosis –

  • Fluid volume excess related to an inability to the kidney to promote or excrete urine.
  • Fluid volume deficit.
  • Altered nutrition level.
  • The risk of infection.
  • Disturb thought process.
  • The risk of impaired normal skin integrity related to edema.

Related points:-

Pre-Renal Causes

Intra-Renal Causes 

Post-Renal Causes 

 

Related Post:- 

Chronic Kidney Failure

 

Chronic kidney disease ( chronic Renal failure ): Its causes, Pathophysiology, Sign And Symptoms, Medical and Nursing Management

Chronic kidney disease is a type of kidney disease in which there is a gradual loss of kidney function over a period of months or years. Chronic kidney disease is progressive irreversible destruction and dimension in renal function resulting in uremia and azotemia. It occurs from several days or months to years………..

Definition | Etiology | Pathophysiology | Clinical Manifestation | Investigation | medical Management | Nursing Management |

 

Definition:-

Chronic kidney disease is a type of kidney disease in which there is a gradual loss of kidney function over a period of months or years.

Chronic kidney disease is progressive irreversible destruction and dimension in renal function resulting in uremia and azotemia.

It occurs from several days or months to years.

Etiology of Chronic kidney disease:-

  • Diabetes mellitus
  • Hypertension
  • Recurrent episodes of Acute Kidney Injury
  • Chronic glomerulonephritis
  • Recurrent pyelonephritis
  • Hypotension
  • Polycystic Kidney Disease
  • Obstruction in the urinary tract
  • Renal artery obstruction or stenosis
  • Autoimmune disease (SLE)
  • Vesico ureteric reflex
  • Medication or Drugs
  • Poor intake of fluids

Pathophysiology of Chronic kidney disease:-

  • Due to the etiological factor
  • Deterioration or destruction of nephron with progressive loss of renal function
  • GFR (Glomerular filtration rate) falls and clearance of waste is reduced.
  • Serum creatinine and urea nitrogen level rise
  • Hypertrophy in remaining nephrons as they required to filter large load of solutes.
  • kidney losses their ability to concentrate urine adequately.
  • In an attempt to continue excreting the solutes. A large volume of dilute urine may be passed.
  • fluid depletion (loss)
  • Tubules gradually lose their ability to reabsorb electrolytes.
  • Polyurea and results a large amount of Na and water excretion
  • Disease progress toxic condition or toxicity
  • Renal Failure

 Clinical Manifestation of Chronic kidney disease:-

Nervous System:-

  • Confusion
  • Disorientation
  • Weakness
  • Fatigue, malaise, restlessness

Cardiovascular system:-

  • Hypertension
  • cardiac Disrrhythemia
  • Pericarditis
  • Pericardial Effusion
  • Myocarditis
  • Endocarditis

Intiguimatory System:-

  • Pallor appearance
  • Orange, green, or grey in the color of skin (because of retaining of Urochrome ligand)
  • Thin and brittle nails and hair
  • Ecchymosis (bruise) >1cm
  • Petechiae
  • Purpura
  • Pruritis (a severe form of itching)
  • Edema of Anasarca

G.I. Tract:-

  • Nausea, Vomiting
  • Constipation, Diarrhea
  • Hiccups
  • Anorexia
  • Mouth ulcers
  • Gastritis
  • Stomatitis
  • Gingivitis
  • Esophagitis
  • A bitter or salty taste
  • Ammonic or fishy odor from the breath

Respiratory System:-

  • Respiratory Distress
  • dyspnea
  • Shortness of breath

Blood or Hematology:-

  • Anemia

Reproductive System:-

  • amenorrhea
  • Infertility (impotence & sterility)
  • Oligospermia
  • Testicular atrophy
  • Decreased libido

Musculoskeletal System:-

  • Fatigue
  • Muscular cramps
  • Decrease muscular strength
  • Bone pain

Urinary system:-

  • Polyurea
  • Oliguria
  • Hematuria
  • Renal insufficiency with azotemia

Metabolic changes:-

  • Metabolic acidosis
  • Increased BUN (Blood urea nitrogen)
  • Serum creatinine
  • Serum uric acid
  • Decreased GFR (Glomerular filtration rate)

Investigation of Chronic kidney disease:-

  • History collection
  • Physical examination
  • Urine culture and urine routine
  • Urine measurement
  • BUN (Blood urea nitrogen)
  • CT scan of K.U.B.
  • I.V.P. (Intravenous pyelography)
  • Renal Angiography

Management of Chronic kidney disease:-

Medical Management:-

  • Calcium preparation and phosphorus binders.
  • Aluminum-based Antacids
  • Antihypertensive 
  • Diuretics
  • Vitamine and minerals supplements
  • Iron sulfate and folic acid (in severe anemia)
  • Sodium bicarbonate (administered to correct metabolic acidosis)

Surgical management:-

  • Catheterization
  • Dialysis
  • Renal transplantation

Nursing Management of Chronic kidney disease:-

  • Fluid volume excess related to the inability to kidney to promote or excrete urine.
  • Fluid volume deficit.
  • Altered nutrition level.
  • The risk of infection.
  • Disturb thought process.
  • The risk of impaired normal skin integrity related to edema.