renal failure - kti.mtu.edu.iqkti.mtu.edu.iq/lectures/sehalectures/qasem/myocardial.pdf ·...
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Renal failure Prepare by
Qassim J. Oddaa
Master in medical
and surgical
nursing
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Renal failure Definition
Inability of the kidneys to regulate fluid and electrolyte
balance and remove toxic products from the body .
Two types from renal failure
Acute Renal Failure
Chronic Renal Failure
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Cause of acute renal failure 1. cardiovascular
Heart failure
Pulmonary embolism
Myocardial infarction
2. Hypovolemia
Burns
Dehydration
Hemorrhage
Diuretic abuse
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Cause of acute renal failure 3. Peripheral vasodilatation
• Antihypertensive abuse
• Sepsis
4.Renovascular
• Aterial embolism
• Aterial or venous thrombosis
• Tumor
5.Sever vasoconstruction
• Malignant hypertension
• vasculitis
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Cause of chronic renal failure
1. Chronic glomerular disease
2. Urinary tract obstruction
3. Diabetes mellitus
4. Vascular disease
5. Congenital abnormalities
6. nephrotoxic
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Clinical manifestation 1. Decrease urine out put
2. Hypotension or hypertension
3. Peripheral edema
4. Cardiac arrhythmia
5. Abdominal pain
6. Poor skin turgor
7. Dry mucous membrane
8. Uremic breath odor
9. Paler of skin
10. Brown line on nails
•.
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Diagnostic test
Blood chemistry : increase potassium ,phosphous, magnesium,
calcium, sodium
Hematology:- decrease Hb, pcv, increase PT and PTT
Urine chemistry:- albuminuria, proteinurea, increase red blood cells
Abdominal ultrasound :- small size of renal
Abdominal CT scan, MRI may show underlying cause
Renal biopsy
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Medical management
• Monitoring vital signs and laboratory studies
• diuretic such as furosemide (lasix)
• Peritoneal dialysis or hemodialysis
• Diet :-low-protein ,low sodium, low potassium, low phosphorus,
high calorie with fluid restrictions
• I.V therapy : fluids as needed
• Activity: as tolerated
• Erythropoietin
• Cardiac glycoside :- digoxin
• Vitamins :vitamin B6 and vitamin C
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Complications Renal
Failure • Electrolyte imbalance
• Arrhythmias
• Heart failure
• Pulmonary edema
• Anemia
• Platelet dysfunction
• Sexual dysfunction
• Metabolic acidosis
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Kidney transplantation Definition
Kidney transplantation is the organ transplant
of a kidney into a patient with end-stage renal
disease. Kidney transplantation is typically
classified as deceased-donor or living-donor
transplantation depending on the source of the
donor organ. Living-donor renal transplants are
further characterized as genetically related
(living-related) or non-related (living-unrelated)
transplants, depending on whether a biological
relationship exists between the donor and
recipient.
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The Indication For Kidney Transplantation
End-stage renal disease (ESRD) include:
1. malignant hypertension,
2. infections,
3. diabetes mellitus, and
4. focal segmental glomerulosclerosis;
5. genetic causes include polycystic kidney disease
6. autoimmune conditions such as lupus.
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Source kidney
Living donor
Approximately 1 in 3 donations
is now from a live donor.
Potential donors are carefully
evaluated on medical and
psychological grounds. This
ensures that the donor is fit for
surgery
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• Organ trade In the developing world
some people sell their organs illegally.
Such people are often in grave poverty
or are exploited by salespersons. The
people who travel to make use of
these kidneys are often known as
'transplant tourists
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Deceased donors.
Deceased donors can be
divided in two groups:
• Brain-dead (BD) donors
• Donation after Cardiac
Death (DCD) donors
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indications for kidney transplantation-Contra
• Cardiac disease
• Pulmonary insufficiency
• Hepatic problems
• Cancer
• Morbid obesity
• Heavy smoker
• Infectious disease such as HIV
• Mental illness with drug abuse
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Compatibility
• In general, the donor and
recipient should be ABO blood
group and cross match (human
leukocyte antigen — HLA)
compatible.
•
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Complications of kidney transplantation •
• Transplant rejection
• Infections and sepsis due to the immunosuppressant drugs that are required to
decrease risk of rejection
• Post-transplant lymphoproliferative disorder (a form of lymphoma due to the
immune suppressants)
• Imbalances in electrolytes including calcium and phosphate which can lead to bone
problems
• Other side effects of medications including gastrointestinal inflammation and
ulceration of the stomach and esophagus, hirsutism (excessive hair growth in a
male-pattern distribution) with ciclosporin, hair loss with tacrolimus, obesity, acne,
diabetes mellitus type 2, hypercholesterolemia, and osteoporosis
• Hypertension
• Proteinuria