Acute Renal Failure

1. Anatomy and physiology of the renal system.

1. The kidneys are two bean-shaped organs. They are located on each side of the vertebral column at the twelfth thoracic vertebrae at the posterior abdominal wall.

2. Each kidney has a ureter about 25-30 centimeters long, which connects to the bladder.

3. The function of the kidneys is to remove waste materials from blood and maintain proper fluid and electrolyte balance.

2. Definition of "acute renal failure."

1. Renal failure is the inability of kidneys to remove metabolic wastes from the blood.

2. Renal cells are damaged by decreased renal blood flow, and lack of oxygen and other nutrients to the cells.

3. Acute renal failure occurs in three stages:

1. Oliguric phase (little or no urine).

2. Diuretic phase (gradual increase in urine output).

3. Recovery phase.

3. Factors that may increase risk of renal failure.

1. Inadequate blood supply to the kidneys caused by heart disease, burns, hemorrhage, excessive diarrhea or vomiting, thrombosis, etc.

2. Adverse effects of trauma, chemicals, burns, drugs, kidney disease, high blood pressure, etc.

3. Obstruction such as tumors, calculi, or trauma.

4. Toxic substances (heavy metals, antibiotics, etc.).

4. Signs and symptoms of acute renal failure.

1. Nausea and vomiting.

2. Drowsiness or lethargy.

3. Headache.

4. Itchiness.

5. Convulsions.

6. Little or no urine output.

7. Diarrhea.

8. Dehydration.

9. Edema.

5. Measures to manage acute renal failure.

1. Follow prescribed diet closely.

2. Avoid infections, or get prompt treatment of infection.

3. Follow activity as ordered.

4. Monitor fluid status closely.

1. Weigh daily (same time, same scale, same amount of clothing).

2. Measure intake and output.

3. Monitor vital signs.

4. Restrict fluids as instructed.

5. Report any signs of edema.

5. Monitor and report any bleeding tendencies.

6. Monitor closely for electrolyte imbalances, especially potassium. (Refer to "Electrolyte Imbalance" handout.)

7. Monitor mental status, and report any changes.

6. Possible complications of acute renal failure.

1. Electrolyte imbalance (Provide "Electrolyte Imbalance" handout.)

2. Infection.

3. Anemia (fatigue, weakness, cold intolerance).

4. Cardiac complications (arrhythmias, hypertension, congestive heart failure, etc.).

5. Uremia (nausea, vomiting, headache, dizziness, change in level of consciousness and dizziness).

6. Hypervolemia (sudden weight gain, edema, increased blood pressure).

7. Hypovolemia (sudden weight loss, dry skin and mucous membranes, muscle cramps, fatigue, drop in blood pressure).