j winterbottom 2005 chronic renal failure jean winterbottom clinical educator mri

J Winterbottom 2005J Winterbottom 2005

Chronic Renal FailureChronic Renal Failure

Jean WinterbottomJean Winterbottom

Clinical EducatorClinical Educator

MRIMRI


Clarification of TerminologyClarification of TerminologyWhat do you understand by the following terms:What do you understand by the following terms: Chronic Renal FailureChronic Renal FailureDamage to kidneys but treatment is not necessaryDamage to kidneys but treatment is not necessary

End Stage Renal FailureEnd Stage Renal FailureLong term damage requiring renal replacement therapy 90-95% nephrons Long term damage requiring renal replacement therapy 90-95% nephrons

not functioningnot functioning

Acute Renal FailureAcute Renal FailureSudden decline in renal function at least 50% decrease in GFRSudden decline in renal function at least 50% decrease in GFR

50% patients recover others go on to CRF50% patients recover others go on to CRF

Acute on Chronic Renal FailureAcute on Chronic Renal FailureAcute episode which may require treatment & then revert back to chronic, Acute episode which may require treatment & then revert back to chronic,

however the patient may then have reached end stagehowever the patient may then have reached end stage


Common causes of Chronic Common causes of Chronic Renal FailureRenal Failure

GlomerulonephritisGlomerulonephritis 25%25% Diabetes MellitusDiabetes Mellitus 25%25% HypertensionHypertension 10%10% Chronic pylonephritis/refluxChronic pylonephritis/reflux 10%10% Polycystic kidney diseasePolycystic kidney disease 10%10% Interstitial nephritisInterstitial nephritis 5%5% ObstructionObstruction 3%3% UnknownUnknown 12%12%


ObesityObesityIncrease in obesity caused by;Increase in obesity caused by; Change in western dietChange in western diet Fast foodFast food High in sodiumHigh in sodium High in saturated fatHigh in saturated fat

Causes;Causes; HypertensionHypertension Type 2 DiabetesType 2 Diabetes


HypertensionHypertension 33rdrd highest contributor to end stage renal highest contributor to end stage renal

failure programmesfailure programmesCauses;Causes; Filtration failure, causing intravascular volume Filtration failure, causing intravascular volume

expansionexpansion Renal artery stenosis, Renal artery stenosis, Until BP extremely elevated patient will not Until BP extremely elevated patient will not

experience symptomsexperience symptoms Need to adhere to anti-hypertensive Need to adhere to anti-hypertensive

medication to keep within normal parameters medication to keep within normal parameters (RA guidelines 130/80)(RA guidelines 130/80)


Type 2 DiabetesType 2 Diabetes

Sharp increase in people with Type 2 Sharp increase in people with Type 2 Diabetes due to obesityDiabetes due to obesity

Poor control of glucose levels in bloodPoor control of glucose levels in blood Causes damage to kidney tissueCauses damage to kidney tissue Increase in projected numbers needing Increase in projected numbers needing

dialysis through Diabetic Nephropathydialysis through Diabetic Nephropathy


Classification of Renal FailureClassification of Renal Failure

Early referralEarly referral Delay may be caused by sudden onset of Delay may be caused by sudden onset of

ureamic symptomsureamic symptoms Many patients have already progressed to Many patients have already progressed to

ESRF when identifiedESRF when identified Once referred investigations are carried out Once referred investigations are carried out

to determine progress of diseaseto determine progress of disease


Diagnostics TestsDiagnostics Tests

Renal Ultrasound Renal Ultrasound Obstruction in urinary collecting systemObstruction in urinary collecting system

Number,size & symmetry of kidneysNumber,size & symmetry of kidneys

Bladder XrayBladder XrayCalculi, tumours & cystsCalculi, tumours & cysts

Renal BiopsyRenal BiopsyDetermine extent of pathology, last resort Determine extent of pathology, last resort


Recognizing CluesRecognizing Clues

Protein in urineProtein in urineElevated biochemistry results i.e.Elevated biochemistry results i.e.

CreatinineCreatinine

UreaUrea

PotassiumPotassiumAnaemia from decreased RBC production Anaemia from decreased RBC production

shortened RBC survivalshortened RBC survival


Recognizing Clues (2)Recognizing Clues (2)

Uraemia symptoms;Uraemia symptoms;Bad breath Bad breath (urinous,ammonia) (urinous,ammonia)

Oedema Oedema (eyes, face, arms,hands, feet)(eyes, face, arms,hands, feet)

HypertensionHypertensionExtended neck veinsExtended neck veinsFatigue Fatigue (anaemia,toxic substances)(anaemia,toxic substances)

Neurological disturbances Neurological disturbances (lethargy, (lethargy, confusion,sleep disorders)confusion,sleep disorders)


Recognizing Clues (3)Recognizing Clues (3)

Nausea & vomitingNausea & vomitingHeadachesHeadachesPruritus Pruritus (phosphate, calcium, aluminium)(phosphate, calcium, aluminium)

BreathlessnessBreathlessnessBone & joint problems Bone & joint problems (calcium/phosphate (calcium/phosphate

imbalances,VitD deficiency,demineralization)imbalances,VitD deficiency,demineralization)

Bone painBone pain


Management of chronic renal Management of chronic renal failurefailure

Determine and treat Determine and treat causecause

Optimise salt and water Optimise salt and water balancebalance

Identify appropriate Identify appropriate dietary advicedietary advice

Control hypertensionControl hypertension Control electrolyte Control electrolyte

imbalanceimbalance Prevent and treat renal Prevent and treat renal

bone diseasebone disease

Early detection and Early detection and treatment of infectiontreatment of infection

Modify drug therapy Modify drug therapy inline with decline in inline with decline in renal functionrenal function

Detect and treat any Detect and treat any complicationscomplications

Prepare for dialysis Prepare for dialysis and transplant and transplant programmeprogramme


Treating ESRDTreating ESRD

4 forms of treatment;4 forms of treatment;

HAEMODIALYSISHAEMODIALYSISPERITONEAL DIALYSIS (CAPD)PERITONEAL DIALYSIS (CAPD)TRANSPLANTATIONTRANSPLANTATIONCONSERVATIVECONSERVATIVE


Emotional SupportEmotional Support

Realisation that there is no cure can trigger;Realisation that there is no cure can trigger;AnxietyAnxietyDenialDenialFrustrationFrustrationAngerAngerDepressionDepressionHopelessnessHopelessness


Emotional Support (Emotional Support (22))

No specialized nurse counsellorNo specialized nurse counsellor

Renal nurse must provide patient and families Renal nurse must provide patient and families with;with;

EducationEducationCompassionCompassionUnderstandingUnderstanding

So that they can manage treatment effectivelySo that they can manage treatment effectively


ScenarioScenario

A diabetic patient arrives on your ward. He A diabetic patient arrives on your ward. He has a history of running high blood glucose has a history of running high blood glucose levels. What would indicate that he had levels. What would indicate that he had renal impairment?renal impairment?

j winterbottom 2005 chronic renal failure jean winterbottom clinical educator mri

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