DEFINITION: Progressive and irreversible deterioration of function of
both kidneys as nephrons are destroyed and replaced by non-functional
tissue.
RELATED DIAGNOSTIC TESTS:
- Renal tests: BUN & creatinine levels
- CBC: decline in RBC’s, Hgb, Hct and WBC’s
- Electrolyte panel: critical values of K+, Ca++, Na+, etc.
- Radiology: CT scan, ultrasound, renal scan
- Urinalysis
ETIOLOGY: Often secondary to disease process: diabetic nephropathy,
HTN, glomerulonephritis, cystic kidney disease, urologic diseases, and
idiopathic means. Direct viral or bacterial infection (septic, UTI) can also
cause nephritis.
MEDICAL MANAGEMENT:
- Prescribe change in diet (decreased intake of protein and electrolytes,
esp. K+)
- Prescribe fluid restriction
- Treatment with erythropoietin
- Monitoring of dosages of any drug treatment as excretion of drugs
dependent on renal function
- Phosphate binding treatment to decrease renal calcification
- Anti-HTN treatment
- Drug therapy to increase kidney excretion (eg: diuretics)
- Dialysis
- Kidney transplant with immunosuppressant therapy
PATHOPHYSIOLOGY:
3 Stages of Progression:
1. Diminished renal reserve - symptoms may be absent and BUN may be
WNL due to compensation.
2. Renal insufficiency - GFR is 25 % of normal, BUN & creatinine are
elevated and symptoms are observed.
3. End-Stage Renal Disease (ESRD) - GFR < 5-10 % of normal, uremia at
this stage, unable to perform ADL’s.
Renal deterioration affects all body systems due to direct implications
(insufficient excretion of excess products, decreased hormone production
& release, fluid retention) or secondary ones (HTN, anemia).
NURSING MANAGEMENT:
- Assess signs and symptoms of renal failure and history of renal
problems.
- Implement appropriate diet and fluid intake.
- Monitor I & O: urinary output < 30 cc/hr, fluid volume excess?
- Monitor lab results for renal sufficiency.
- Monitor vital signs, esp. BP.
- Instruct patient on proper nutritional and fluid intake.
- Monitor any physical symptoms and any chance in mental status,
indicating an increase in renal insufficiency.
- Offer emotional support to patient for chronic self-care deficit,
change in self-esteem, etc.
SIGNS & SYMPTOMS:
- uremia or polyuria
- nocturemia
- nausea, headache, lethargy, vomiting, diarrhea
- metallic taste, urine-smelling breath
- Kussmaul’s breathing
- edema, anasarca
- HTN
- Labs: elevated BUN & creatinine, anemia ( decreased # of RBC’s)
HEALTH DEVIATION SELF-CARE REQUISITES:
- Follow strict dietary and fluid intake guidelines.
- Be aware of progressive symptoms.
- For dialysis, follow strict schedule.
- For transplant, follow prescribed immunosuppresant therapy and
monitor signs of infection or organ rejection (renal failure).
REFERNCE PAGES:
Lewis & Collier, Medical-Surgical Nursing, 4th Edition, p. 1379-1409