ACUTE RENAL FAILURE IN ENGLISH

                                              

                          ACUTE RENAL FAILURE IN ENGLISH

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ARF-

            Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys. ARF may result in a wide range of potentially life-threatening metabolic complications can occur, including metabolic acidosis as well as fluid and electrolyte imbalances.

CAUSES-

            Causative factors of ARF is not always known, many times there is a specific underlying problem. Some of the factors may be reversible if identified and treated promptly, before kidney function is impaired.

            Based on causative factors ARF is divided into three major categories . These are-

             Prerenal ARF (due to hypoperfusion of kidney)- causative factors may include (1) hypovolemia; (2) hypotension; (3) reduced cardiac output and heart failure; and (4) bilateral obstruction of the renal arteries and veins.

            Intrarenal ARF (due to actual damage to kidney tissue)- causative factors may include infection, trauma and kidney stones.

             Post renal ARF (due to obstruction to urine flow)- causative factors may include ureteral or bladder stones, clot in lower urinary tract or anatomic and functional urinary tract anomalies

            Some patients have decreased renal function with normal amounts of urine output (2 L/day or more). This is the nonoliguric form of renal failure and is caused by exposure of the patient to nephrotoxic agents, burns, traumatic injury, and the use of halogenated anesthetic agents.

CLINICAL MANIFESTATIONS-

Ø  Almost every system of the body is affected with failure of the normal renal regulatory mechanisms. Sign and symptoms may include-

Ø  The patient may appear critically ill and lethargic.

Ø  The skin and mucous membranes are dry.

Ø  Urine output decreases (oliguria- less than 500 mL/day ) or suddenly anuria (less than 50 mL/day)occurs

Ø   Central nervous system signs and symptoms include-

Ø  drowsiness,

Ø  headache,

Ø  muscle twitching, and

Ø  seizures.

 

DIAGNOSTIC  INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of ARF)

Ø  Urine output details.

Ø  Ultra sonography.

Ø  Urine specific gravity.

Ø  S. electrolytes and CBC.

Ø  S. urea and creatinine.

TREATMENT-

            The objectives of treatment of ARF are to restore normal chemical balance and prevent complications. Medical Management includes-

Ø  Eliminating the underlying cause;

Ø  Maintaining fluid balance;

Ø  Avoiding fluid excesses; and,

Ø  when indicated, providing dialysis therapy

Ø  Prerenal ARF is treated by optimizing renal perfusion, whereas

Ø  postrenal ARF is treated by relieving the obstruction. and

Ø  Intrarenal ARF is treated with supportive therapy, with removal of causative agents,

Ø  Shock and infection, if present, are treated promptly

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and nursing care plan is prepared.

Ø  The nurse monitors for complications, participates in emergency treatment of fluid and electrolyte imbalances.

Ø  The nurse monitors intake and output and record in the intake output chart.

Ø  The nurse assesses the patient’s progress and response to treatment, and provides physical and emotional support.

Ø  The nurse prepare for IV fluid therapy as per prescription along with electrolyte replacement.

Ø  The nurse the nurse keeps family members informed about the patient’s condition, helps them understand the treatments, and provides psychological support.

Ø  Bed rest may be indicated to reduce exertion and the metabolic rate during the most acute stage of the disorder, the patient is encouraged for bed rest.

Ø  Fever and infection, both of which increase the metabolic rate and catabolism, are prevented or treated promptly.

Ø  The Nurse monitors pulmonary functions, and the patient is assisted to turn, cough, and take deep breaths frequently to prevent atelectasis and respiratory tract infection.

Ø  The skin may be dry or susceptible to breakdown as a result of edema; therefore, proper skin care is important, such as bathing the patient with cool water, frequent turning, and keeping the skin clean and well moisturized.

Ø  Provide adequate hydration to patients at risk for dehydration including: Before, during, and after surgery.

Ø  The Nurse provides health education regarding prevention of reoccurrence ARF during discharge planning such as adequate hydration, early identification and prompt treatment of predisposing factors etc.