J Winterbottom 2005 Chronic Renal Failure Jean Winterbottom Clinical Educator MRI

J Winterbottom 2005 Clarification of Terminology What do you understand by the following terms:  Chronic Renal Failure Damage to kidneys but treatment is not necessary  End Stage Renal Failure Long term damage requiring renal replacement therapy 90-95% nephrons not functioning  Acute Renal Failure Sudden decline in renal function at least 50% decrease in GFR 50% patients recover others go on to CRF  Acute on Chronic Renal Failure Acute episode which may require treatment & then revert back to chronic, however the patient may then have reached end stage

J Winterbottom 2005 Common causes of Chronic Renal Failure  Glomerulonephritis25%  Diabetes Mellitus25%  Hypertension10%  Chronic pylonephritis/reflux10%  Polycystic kidney disease10%  Interstitial nephritis5%  Obstruction3%  Unknown12%

J Winterbottom 2005 Obesity Increase in obesity caused by;  Change in western diet  Fast food  High in sodium  High in saturated fat Causes;  Hypertension  Type 2 Diabetes

J Winterbottom 2005

Hypertension  3 rd highest contributor to end stage renal failure programmes Causes;  Filtration failure, causing intravascular volume expansion  Renal artery stenosis,  Until BP extremely elevated patient will not experience symptoms  Need to adhere to anti-hypertensive medication to keep within normal parameters (RA guidelines 130/80)

J Winterbottom 2005

Type 2 Diabetes  Sharp increase in people with Type 2 Diabetes due to obesity  Poor control of glucose levels in blood  Causes damage to kidney tissue  Increase in projected numbers needing dialysis through Diabetic Nephropathy

J Winterbottom 2005 Classification of Renal Failure  Early referral  Delay may be caused by sudden onset of ureamic symptoms  Many patients have already progressed to ESRF when identified  Once referred investigations are carried out to determine progress of disease

J Winterbottom 2005 Diagnostics Tests  Renal Ultrasound Obstruction in urinary collecting system Number,size & symmetry of kidneys  Bladder Xray Calculi, tumours & cysts  Renal Biopsy Determine extent of pathology, last resort

J Winterbottom 2005 Recognizing Clues  Protein in urine  Elevated biochemistry results i.e. CreatinineUreaPotassium  Anaemia from decreased RBC production shortened RBC survival

J Winterbottom 2005 Recognizing Clues (2) Uraemia symptoms;  Bad breath (urinous,ammonia)  Oedema (eyes, face, arms,hands, feet)  Hypertension  Extended neck veins  Fatigue (anaemia,toxic substances)  Neurological disturbances (lethargy, confusion,sleep disorders)

J Winterbottom 2005 Recognizing Clues (3)  Nausea & vomiting  Headaches  Pruritus (phosphate, calcium, aluminium)  Breathlessness  Bone & joint problems (calcium/phosphate imbalances,VitD deficiency,demineralization)  Bone pain

J Winterbottom 2005 Management of chronic renal failure  Determine and treat cause  Optimise salt and water balance  Identify appropriate dietary advice  Control hypertension  Control electrolyte imbalance  Prevent and treat renal bone disease  Early detection and treatment of infection  Modify drug therapy inline with decline in renal function  Detect and treat any complications  Prepare for dialysis and transplant programme

J Winterbottom 2005 Treating ESRD 4 forms of treatment;  HAEMODIALYSIS  PERITONEAL DIALYSIS (CAPD)  TRANSPLANTATION  CONSERVATIVE

J Winterbottom 2005 Emotional Support Realisation that there is no cure can trigger;  Anxiety  Denial  Frustration  Anger  Depression  Hopelessness

J Winterbottom 2005 Emotional Support ( 2 ) No specialized nurse counsellor Renal nurse must provide patient and families with;  Education  Compassion  Understanding So that they can manage treatment effectively

J Winterbottom 2005 Scenario A diabetic patient arrives on your ward. He has a history of running high blood glucose levels. What would indicate that he had renal impairment?