Renal Failure: Chronic Kidney Disease Practice Questions with Answers and NCLEX® Review

Introduction to Renal Failure

The kidneys are a pair of organs located just below the rib cage on either side of the spine. Healthy kidneys filter a half cup of blood per minute, removing wastes and water and creating urine in the process, which maintains electrolyte balance.

When the kidneys fail, they can no longer remove waste and excess fluid from the body. If the condition is not treated, this can result in serious complications such as fluid accumulation in the lungs (pulmonary edema) or high blood pressure (hypertension).

There are two types of renal failure: acute and chronic.

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Acute vs Chronic Renal Failure

Acute renal failure is a sudden, severe loss of kidney function that can be caused by a variety of factors. In some cases, acute renal failure can be reversed and treated with dialysis; in others, it may require a kidney transplant. If it’s not stopped and reversed, it can lead to chronic renal failure.

Chronic renal failure develops over time and can be caused by diabetes, high blood pressure, glomerulonephritis, and other diseases. Chronic renal failure is often irreversible, but can be managed with dialysis or transplantation.

Acute Renal Failure Pathophysiology

The kidneys are responsible for filtering the blood, removing waste products and excess fluids, and regulating electrolyte levels. Acute renal failure occurs when the kidneys are unable to perform these functions. 

Three classifications of renal failure are:

1. Prerenal 

• Think decreased tissue “PRE-fusion”
• Low Blood Pressure 
• Low perfusion (shock, hypovolemia, dehydration from blood or volume loss)
• Obstruction blocks blood flow & oxygen (emboli, clots, tumors)
• Low mean arterial pressure (MAP) (<65)
• Low Cardiac Output

2. Intrarenal

• INside the renal
• CT Contrast (contrast kills the kidney!)
• Antibiotics
• Vancomycin
• Gentamicin
• Creatinine over 1.3 = bad kidneys

3. Post Renal 

• Past the renal
• Kidney stones, tumor, and BPH
• Creatinine Over 1.3 = bad kidneys
• BUN Over 20
• Urine output 30 ml/hr Less = kidneys in distress
• Metabolic ACIDosis pH below 7.35

Acute Renal Failure Causes

Acute renal failure, also known as acute kidney injury (AKI), is a medical condition that results in the sudden loss of kidney function. It’s characterized by changes in urine output, electrolyte levels, and kidney damage.

If left untreated, acute renal failure can be fatal. It’s usually caused by a condition that damages the kidneys, such as:

• Blood clots
• Kidney infection
• Kidney stones
• Pancreatitis
• Liver disease

4 Stages of Acute Renal Failure

There are four (4) stages of acute renal failure, and each stage has different symptoms and requires different treatments.

Stage 1: The Initiation phase (onset of injury)

Stage 2: The Oliguric phase (less than 400ml in twenty-four hours)

Stage 3: The Diuresis or polyuric phase (drain urine 3-6 L per day)

Stage 4: The Recovery phase (which is slow and requires up to one year for recovery)

5 Stages of Kidney Disease (Chronic)

Important facts about the five stages of chronic kidney disease:

Stage 1: Kidney damage (normal function = 90 + Glomerular filtration rate (GFR))

Stage 2: Kidney damage and mild loss of function (89-60 GFR)

Stage 3: Moderate to severe loss of function – 59-60 GFR

Stage 4: Severe loss of function (29-15 GFR)

Stage 5: End-stage renal disease and needing treatment to live(15 or Less GFR)

Signs and Symptoms of Chronic Renal Failure

Chronic renal failure is a loss of kidney function that occurs when one or both kidneys fail to filter out waste products from the blood. Renal failure can result from diabetes, high blood pressure, glomerulonephritis, and other diseases. Competency as a nurse requires the ability to identify signs and symptoms of chronic renal failure and understand the pathophysiology behind this condition.

Signs and symptoms of chronic renal failure include:

• High Sodium Na+ (normal range: 135-145)
• High Phosphorus (normal range: 3.0-4.5)
• High Potassium K+ (normal range: 3.5-5.0)
• Peaked T waves (6 – 7 mEq/L)
• ST elevation (7 – 8 mEq/L)
• Wide QRS complex (over 8 mEq/L)
• Oliguria (low urine output)
• Excess waste and electrolytes in the blood
• H+ ions (Acid)
• Urea output
• Uremic frost 
• Pruritus 

Causes of Chronic Renal Failure

Chronic renal failure is a long-term condition,which is defined by lasting six months or more. Client education consists of points to prevent chronic renal failure. Once a client has developed chronic renal failure, few treatments are available and become life-long.

In chronic renal failure, the kidneys are damaged and can’t filter waste products from the blood. As a result, these waste products build up in clients’ bodies, which can cause serious problems with how well they function.

The causes of chronic renal failure include:

• Difficulties with blood vessels that supply blood to the kidneys (arteries)
• High blood pressure
• Sickle cell disease
• Diabetes
• Kidney infection
• Elderly

Nursing Interventions for Renal Failure

Assess the client’s renal function, urine output, blood pressure, and respiratory rate. The health care provider (HCP) will prescribe the client’s creatinine level and blood urea nitrogen (BUN) levels. As a nurse, you’ll need to evaluate labs and report abnormal values to the HCP.

Monitor the client’s intake, output, urine color, and fluid intake to assess for dehydration.

Administer prescribed drugs that help alleviate symptoms, such as diuretics or vasodilators. These medications will help reduce swelling in the body and increase urine output, which helps prevent kidney damage.

Provide education about renal failure management to clients and their families. Points include; the process of the disease, how to maintain a healthy lifestyle while living with a chronic disease.

Encourage the client to drink plenty of fluids to increase hydration and flush out the toxins.

Avoid foods that are known as diuretics and medications that promote dehydration or cause potassium loss.

These drugs can cause kidney failure, and should be avoided with clients who have renal failure:

•  NSAIDS
•  Milk of Magnesia (Anti Acid)
•  Antibiotics: Vancomycin + Gentamicin

Renal Failure Conclusion

The kidneys are a pair of backward-facing organs that filter waste from the blood and are situated on either side of the spine. They also maintain fluid balance and control electrolytes.

When the kidneys are damaged, the body can no longer expel waste and extra fluid. If the disease is left untreated, it may lead to major side effects like high blood pressure or fluid retention in the lungs (pulmonary edema) (hypertension).

Acute renal failure is sudden and typically brought on by kidney damage, drug toxicity, or an infection. It can persist for up to a few weeks and is typically treatable. Although frequently permanent, chronic renal failure can be controlled with dialysis or transplantation.

Sources

https://www.hopkinsmedicine.org/health/conditions-and-diseases/end-stage-renal-disease-esrd

https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease 

https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521 

https://www.kidney.org/atoz/content/about-chronic-kidney-disease