logging in or signing up Chronic renal failure jijoallsaints Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 1102 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: July 18, 2012 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript ANATOMY AND PHYSIOLOGY OF KIDNEY: ANATOMY AND PHYSIOLOGY OF KIDNEYKIDNEY: KIDNEY The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about ¼ pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus .PowerPoint Presentation: The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.ANATOMY OF URINARY TRACT: ANATOMY OF URINARY TRACTPowerPoint Presentation: The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as ca l cium ,sodium and potassium in the blood.PowerPoint Presentation: CHRONIC RENAL FAILURE CHRONIC KIDNEY DISEASE END-STAGE RENAL DISEASE(ESRD)PowerPoint Presentation: DEFINITION Chronic kidney disease involves progressive, irreversible loss of kidney function .It is defined as either the presence of kidney damage of GFR<60ml/min for 3 months or longer.PowerPoint Presentation: INCIDENCE Since 1973 many death have been prevented through the use of maintenance of dialysis and renal transplantation. most patients are treated with dialysis because: There is a lack of donated organs. Some patients are physically or mentally unsuited for transplantation. Some patients do not want transplants. The incidence of ESRD has increased by almost 8% per year for the past 5 years. In united states ,more than 280,000 patients with chronic renal failure (65%)are receiving hemodialysis. More than 120,000(28%)have functioning renal transplants. More than 24,000(7%)are receiving peritoneal dialysis.STAGES OF CHRONIC KIDNEY DISEASE : STAGES OF CHRONIC KIDNEY DISEASEPowerPoint Presentation: ETIOLOGY Diabetes mellitus : Type 1 and type2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease. Hypertension: If not controlled, can damage the kidneys over time. Chronic glomerulonephritis: A bilateral, non –infectious inflammation of the kidneys, which can damage the filtration system of the kidneys. Pyelonephritis (Inflammation of the renal pelvis) Obstruction of the urinary tract by stones ,an enlarged prostate, strictures and cancers. Polycystic kidney (It is a hereditary disease in which where the both kidneys have multiple cyst) POLYCYSTIC KIDNEY: POLYCYSTIC KIDNEYPowerPoint Presentation: Medications: Use of analgesics such as acetaminophen and ibuprofen .regularly over long duration of time can cause analgesic nephropathy, which is the another cause of chronic kidney disease. Atherosclerosis: Clogging and hardening of the arteries leading to a kidneys causes a condition called ischemic nephropathy ,which is the another cause of chronic kidney disease. Environmental and occupational agents: It includes lead , cadmium, mercury and chromium. Other causes: It includes HIV infections, sickle cell disease, heroin abuse, kidney stones, chronic kidney infections and certain cancers.PowerPoint Presentation: RISK FACTORS Diabetes mellitus Type1 and 2. High blood pressure. High cholesterol. Heart disease. Liver disease. Sickle cell disease. Vascular disease such as arteritis, vasculitis etc. Regular use of anti-inflammatory medications. Family history of kidney disease. Advanced age. Obese. Smokers.PowerPoint Presentation: PATHOPHYSIOLOGY Due to etiological factors renal functions declines Nephron damage is progressive ,damage nephron cannot function and do not recover Decreased glomerular filtration rate Remaining nephron undergo changes to compensate for those damage nephrons Compensatory excretion continues as GFR diminishes Filtration of more concentrated blood by the remaining nephronsPowerPoint Presentation: Damage of nephrons results in hypertrophy and hyperphosphotemia of remaining nephrons Urine may contain abnormal amount of protein,RBC’S WBC’S or casts Increased serum creatine , BUN level and retension of urea and other nitrogenous waste Further damage of the nephrons 80-90% damage ,GFR10-20 % Chronic renal failurePowerPoint Presentation: CLINICAL MANIFESTATIONS Neurologic: Weakness and fatigue Confusion Inability to concentrate Altered level of consciousness Headache Sleep disturbances Lethargy Disorientations Seizures Behaviour changes Muscle twitchingPowerPoint Presentation: Restlessness of legs Burning of soles of feet Integumentary: Severe pruritis Thin brittle nails Coarse thinning hair Dry ,flaky skinPowerPoint Presentation: Grey –bronze skin colour Puffiness around the eyesPowerPoint Presentation: Cardio vascular: Hypertension Pitting edema( feets,hands,sacrum ) Peritoneal edema Heart failure and pulmonary edema Pericarditis Engorged neck veinsPowerPoint Presentation: Hyperkalemia Hyperlipidemia Pulmonary : Crackles Thin,tenacious sputum Pleuretic pain Shortness of breath Tachycardia Dyspnea Kussmaul -type of respirations Pulmonary edemaPowerPoint Presentation: Gastro intestinal: Anorexia Nausea Vomiting Peptic ulcer Stomatitis Gastritis Uremic fector Gastro intestinal bleeding Metallic taste Hicupps Constipation and diarrheaPowerPoint Presentation: Urinary: Polyuria Nocturia Oliguria(If CKD worses ) Anuria ( ie ,<100ml/24 hrs ) Proteinuria, casts, pyuria , hematuria (If patient is still producing urine) Hematologic: Anemia Thrombocytopenia Endocrine: HyperthyrodismPowerPoint Presentation: Reproductive: Amenorrhea Decreased level of estrogen, progesterone and lutenizing hormones in women. Decreases testosterone level,low sperm count,testicular atropy in men. Infertility and decrease libido (in both sex). Musculoskeletal: Muscle cramps Loss of muscle strength Renal osteodystrophy Bone pain Bone fractures Foot dropPowerPoint Presentation: DIAGNOSTIC EVALUATIONS History collection Physical examinations Renal ultrasound: Ultrasound helps to estimate the prognosis of chronic kidney disease. It also checks whether urine flow from the kidneys is blocked. An ultrasound also may help find causes of kidney disease, such as obstruction or polycystic kidney disease, kidney stones and also to assess the blood flow into the kidneys. CT Scans and MRI Scans: Helps to identify renal masses and cysts. Renal Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Serum Creatinine : Creatinine is a waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises and the doctor should use the results of your serum creatinine test to calculate your GFR.PowerPoint Presentation: Glomerular Filtration Rate (GFR): Glomerular filtration rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, race, gender and other factors. Blood Urea Nitrogen (BUN): Urea nitrogen is a normal waste product in your blood that comes from the breakdown of protein from the foods you eat and from your body metabolism. It is normally removed from your blood by your kidneys, but when kidney function slows down, the BUN level rises. BUN can also rise if you eat more protein, and it can fall if you eat less protein. Serum electrolyte level: Kidney dysfunction causes imbalances in electrolytes , especially potassium, phosphorus, and calcium. High potassium ( hyperkalemia ) is a particular concern. .PowerPoint Presentation: Blood cell counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells. Urine Protein: When your kidneys are damaged, protein leaks into your urine. A simple test can be done to detect protein in your urine. Persistent protein in the urine is an early sign of chronic kidney disease. Micro albuminuria: This is a sensitive test that can detect a small amount of protein in the urine. Urine Creatinine : This test estimates the concentration of your urine and helps to give an accurate protein result. Twenty-four hour urine tests: This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products (urea nitrogen, and creatinine ). The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR).PowerPoint Presentation: COMPLICATIONS Hyperkalemia - Due to decreased excretion ,metabolic acidosis and excessive intake ( diet,medication fluids) Pericarditis – Due to pericardial effusion Hyertension - Due to sodium and water retension and malfunction of the renin- angiotension -aldosterone system. Anemia- Due to decreased erythropoietin production ,bleeding in the GI tract and blood loss during hemodialysis. Bone Disease- Due to retension of phosphorous ,low serum calcium levels,abnormal vitamin D metabolism.PowerPoint Presentation: MANAGEMENT Medical management: The main goal of management is to maintain kidney function and homeostasis for as long as possible. The management is accomplished primarily with medications and diet therapy ,although dialysis may also may needed to decrease the level of uremic waste products in the blood and to control electrolyte balance. Pharmacologic Therapy Calcium and phosphorous binders: Hyperphosphatemia and hypocalcemia are treated with medication that bind dietary phosphorous in the GI tract .binders such as calcium carbonate or calcium acetate are prescribed,but there is arisk of hypercalcemia .if calcium is high or the calcium-phosphorous products exceeds 55mg/dl ,a polymeric phosphate binder such as sevelamer hypochloride ( Renagel ) may be used.all the binding agents must be administered with food to be effective.PowerPoint Presentation: Antihypertensive and cardiovascular agents Hypertension is managedby intravascular volume control and variety of antihypertensive agents.heart failure and pulmonary edema may also require treatment with fluid retension ,low sodium diets,diuretic agents,inotropic agents such as digoxin ( lanoxin )or dobutamine . Antiseizure agents If seizure occurs IV diazepam (valium)or phenytoin is usually administered to control seizures. Erythropoietin Anemia associated with chronic renal failure is treated with recombinant human erythropoietin ( Epogen ). Erythropoietin is administered intravenously or subcutaneously 3 times a week in ESRD.it may take 2-6 weeks for the hematocrit to increase.PowerPoint Presentation: Diet Therapy Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you. Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure. Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake. Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes. Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.PowerPoint Presentation: Dialysis Dialysis is an artificial means of removing waste products and extra fluid from your blood when your kidneys aren't able to perform these functions. There are two types of dialysis. In hemodialysis, blood is pumped out of your body to a machine that works like an artificial kidney, filtering waste out of your blood. The blood is then pumped back into your body. Another type of dialysis, called peritoneal dialysis, involves pumping a dialysis solution into your abdominal cavity. Peritoneal dialysis relies on your body's network of tiny blood vessels to carry waste products and excess fluids to your abdominal cavity where the dialysis solution absorbs them. The dialysis solution is then pumped out of your body with carrying the waste and excess fluids . Surgical Management: Kidney Transplant If you have no life-threatening medical conditions other than kidney failure, a kidney transplant may be an option for you. Kidney transplant involves surgically placing a healthy kidney from a donor inside your body. Transplanted kidneys can come from deceased donors or from living donors.PowerPoint Presentation: Nursing Management: Excess fluid volume related to decreased urine output, dietary excesses and retension of sodium and water. Monitor respiratory pattern for symptoms of respiratory difficulty ( eg : dyspnea, tachycardia, shortness of breath etc )that are indicators of fluid excess. weigh patient daily. Maintain Intake and output chart. Assess for Skin turgor . Check for the presence of edema . Limit fluid intake to prescribed volume. Provide or encourage frequent oral hygiene. Assist patient to cope with the discomforts resulting from fluid restriction. Explain to patient and family rationale for fluid restriction.PowerPoint Presentation: Imbalanced nutrition ;less than body requirement related to anorexia , nausea,vomiting ,dietary restriction and altered oral mucous membranes. Assess for factors( anorexia,nausea,vomiting,stomatitis )contributing to altered nutritional intake. weigh patient daily. Provide oral care before meals to prevent stomatitis,remove bad taste and increase patients appetite. Provide pleasant surroundings at meal-times. Encourage for high- calorie,low - protein,low-sodium,low potassium diet. Explain to the patient and family about dietary intake.PowerPoint Presentation: Risk for infection related to suppressed immune system, malnutrition secondary to dialysis and uremia. Monitor for systemic and localized signs and symptoms of infection( eg:pain on urination,hematuria,chills,fever ) Limit number of visitors to decrease risk of infection. Ensure aseptic handling of all IV lines to prevent the introduction of organisms. Wash hands before and after patient care activity to prevent transmission of pathogens. Teach patient and family about signs and symptoms of infection and when to report them to the health care provider to obtain early treatment.PowerPoint Presentation: Risk for injury related to alterations in bone structure due to decreased calcium absorption,retension of phosphate and altered vitamin D metabolism. Monitor trends in serum level of calcium. Administer appropriate prescribed calcium salt ( eg:calcium carbonate,calciumchloride,calcium gluconate ) Provide adequate intake of vitamin D to facilitate GI absorption of calcium to prevent and treat the bone demineralization. Instruct patient on measures to control /minimize symptoms( eg:taking calcim and vitamin D suppliments ) Activity intolerance related to fatigue , anemia,retension of waste products and dialysis procedure. Assess factors contributing to activity intolerance ( eg : fatigue,anemia,fluid and electrolyte imbalance, retension of waste products,depression ) Promote independence in self care activities as tolerated ;assist if fatigued. Encourage alternating activity with rest. Encorage patient to rest after dialysis treatment.PowerPoint Presentation: Deficient knowledge regarding condition and treatment Assess understanding of cause of renal failure ,consequences of renal failure,and its treatment. Cause of patients renal failure. Meaning of renal failure. Understanding of renal function. Relationship of fluid and dietary restriction to renal failure. Rationale for treatment. Provide explanation of renal function and consequences of renal failure at patients level of understanding and guided by patients readiness to learn. Provide oral and written information as appropriate about: Renal function and failure. Fluid and dietary restriction . Medications. Reportable problems,signs and symptoms. Follow -up schedule. Treatment options.PowerPoint Presentation: PATIENT AND FAMILY TEACHING GUIDE Explain dietary ( protein,sodium,potassium,phosphate )and fluid restrictions. Explain signs and symptoms of electrolye imbalance ,especially high potassium. Explain the importance of reporting any of the following: Weight gain greater than 2 kg. Increasing BP. Shortness of breath. Edema. Increase fatigue and weakness. Confussion and lethargy. Explain the rationale for prescribed drugs and common side effects. Phosphate binders should be taken with meals. Calcium suppliments should be taken on an empty stomach. Iron suppliments should be taken between meals. Encourage patient and family to share concern about lifestyle changes,living with chronic illness,and decisions about type of dialysis or transplantations.: THANK U You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.