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Chronic Renal Failure

-Progressive loss of renal function over a period of months or years
-5 stages ending in End Stage Renal Disease (occurs when GFR < 15 ml/min)
-Kidneys able to function until 80% of GFR is lost/90% of nephrons are lost

Risk Factors for Chronic Renal Failure

-Diabetic neuropathy
-Polycystic disease

Diagnostic Findings for Chronic Renal Failure

-Elevated BUN & creatinine clearance
-Urine specific gravity fixed at 1.01
-Uremia (urine in blood)
-Decreased platelets
-Loss of erythropoeiten
-Inadequate clearance of fluid & electrolytes

Electrolyte Values for Chronic Renal Failure

-Metabolic acidosis

Psychological Manifestations of Chronic Renal Disease


Cardiovascular Manifestations of Chronic Renal Disease


Gastrointestinal Manifestations of Chronic Renal Disease

-Uremic fetor
-GI bleeds
-Peptic ulcer

Uremic fetor

is a urine-like odor on the breath of persons with uremia.[1] The odor occurs from the smell of ammonia, which is created in the saliva as a breakdown product of urea.

Endocrine Manifestations of Chronic Renal Disease

-Thyroid abnormalities

Secondary hyperparathyroidism refers to the

excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia low blood calcium levels

Metabolic Manifestations of Chronic Renal Disease

-Carbohydrate intolerance

Hematologic Manifestations of Chronic Renal Disease

-Bleeding (platelet dysfunction)

Neurologic Manifestations of Chronic Renal Disease


Respiratory Manifestations of Chronic Renal Disease

-Uremic lung
-Pulmonary edema

Integumentary Manifestations of Chronic Renal Disease

-Yellow/Grey discoloration
-Dry, scaly skin

Peripheral Neuropathies of Chronic Renal Disease

-Motor weakness
-Restless legs syndrome

Prescribed Diet for Chronic Renal Failure

-Low protein w/ supplemental amino acids
-Fluid restriction
-Sodium restriction (no canned soups, prepared foods, cured meats)
-Potassium restriction (no salt subs, oranges, bananas, melons, tomatoes, prunes, legumes)
-Calcium replacement but phosphate restriction (no cheese, milk, ice cream)

Nursing Interventions for Chronic Renal Failure

-Monitor plan care for HTN & HF
-Prepare pt for dialysis or kidney transplant
-Monitor I/O
-Monitor VS


ant htn, diuretics
erythropoietin epogen procrit arancesp for anemia
phosphate binders adn vit d for renal osteodystrophy


fluid restriction 600-1000 based on output
avoid use of sedatives and hypnotics because of kidney problems

Nursing Interventions for Chronic Renal Failure

-Meds need to be evaluated d/t inability to excrete properly
-Monitor lab results (pH, electrolytes, BUN, creatinine, CBC)

Nursing Interventions for Chronic Renal Failure

-Medicate for N/V
-Observe for signs of infection
-Provide periods of rest between activities
-Weigh daily

stages of chronic renal failure

diminished renal reserve normal bun and creatinien levels no symptoms gfr 60-89%

stages of chronic renal failure

renal insufficiency
gfr 25% of normal
bun and creatinine are increased from azotemia decreased urine creatinine clearance
mild anemia

Azotemia is a

medical condition characterized by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.


All forms of azotemia are characterized by a decrease in the glomerular filtration rate (GFR) of the kidneys and increases in blood urea nitrogen (BUN) and serum creatinine concentrations.

stages of chronic renal failure

end stage renal failure uremia
gfr is less than 10% severe azotemia
high potassium, high sodium, and hyperphosphatemia

stages of chronic renal failure

end stage renal failure
metabolic acidosis
altered renin angiotension system
decreased erythropoietin production

endocrine effects

hyperparathyrodism cause low calcium and high phosphorous cause renal ostedystrophy

hematologic effects

aneamia and bleeding

cardiovascular effects

high blood pressure
pericardial effusion
heart disease

GI effects

ammonia odor uremic fector to breath

metabolic system effect

high blood sugar

neuro system effect

cns depression
peripheral neuropathy
sleep problems

MS system effect

renal osterdystrophy tissue calcification

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