Chronic 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 on 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 the blood and maintain proper fluid and electrolyte balance.

2. Definition of "chronic renal failure."

1. It is the irreversible deterioration of renal function.

2. Symptoms may occur very rapidly, or very slowly over years.

3. Uremia, an excess of urea and other nitrogenous wastes, occurs.

3. Factors that may increase risk of chronic renal failure.

1. Obstruction of urinary tract.

2. Toxic agents.

3. Uncontrolled high blood pressure.

4. Diabetes.

5. Kidney diseases.

6. Recurrent infections.

4. Signs and symptoms of each stage of chronic renal failure.

1. Decreased renal reserve (no symptoms).

2. Renal insufficiency (symptoms are mild even though 75% of renal tissue has been destroyed).

1. Fatigue.

2. Weakness.

3. Voiding frequently at night.

4. Nausea and vomiting.

5. Irritability.

6. Confusion.

3. End stage renal failure (symptoms may vary).

1. Paleness or yellowness of skin.

2. Itchiness caused by uremic frost, a whit-powder substance on the skin.

3. Edema around eye and in extremities.

4. Increased blood pressure.

5. Nausea and vomiting.

6. Increased urine production progressing to little or no urine production.

7. Decreased level of consciousness.

8. Dizziness.

5. Measures to manage chronic renal failure.

1. Follow prescribed diet closely.

2. Avoid infections, or obtain prompt treatment of infections.

3. 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.

4. Monitor and report any signs of bleeding tendencies.

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

6. Monitor mental status, and report changes.

7. Avoid stress, which can aggravate symptoms.

8. Monitor blood pressure closely.

6. Possible complications of chronic renal failure.

1. Electrolyte imbalances. (Refer to "Electrolyte Imbalance" handout.)

2. Anemia (fatigue, weakness, and cold intolerance).

3. Infection.

4. Cardiac complications such as congestive heart failure, hypertension, or pulmonary edema.

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

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).