Renal Failure for Certified Emergency Nursing (CEN)

Renal Failure

Definition/Etiology:

• Acute renal failure is commonly defined as an abrupt decline in renal function. It usually manifests as an acute increase in BUN and Creatinine levels over the course of hours to weeks.

• The etiology of ARF is usually prerenal or postrenal. Prerenal causes are usually the result of hypovolemia secondary to conditions like hemorrhage, vomiting, diarrhea, poor oral intake, burns, excessive sweating, diuresis, impaired cardiac output, sepsis, and others.
  Postrenal causes are usually from some sort of obstruction

Pathophysiology:

• An increased understanding of the pathophysiology underlying AKI was revealed in the last few decades through molecular and animal studies that show oxidative stress, endothelial injury, mitochondrial injury (best described in the HIV) population treated with antiretroviral medications] and innate immunity as central mechanisms.

• Therapeutic or illicit drugs and toxins represent external insults. Numerous drugs can cause ARF. The most common are antibiotics (e.g. vancomycin), chemotherapeutics, angiotensin-converting enzyme inhibitors, lithium and over-the-counter supplements. Similar patterns of tubular injury have been reported in association with illicit drugs such as opioids and synthetic cannabinoids (Spice, K2, etc.). Drugs are such a common cause of ARF that, above and beyond any other causes, drug exposure should first and foremost be clinically excluded.

Clinical Presentation:

ARF can affect multiple systems:

Skin-

• Maculopapular rash
• Purpura

Cardio-

• Irregular rhythms
• Endocarditis
  Pericardial friction rub
• JVD

Abdomen-

• Pulsatile mass
• Abdominal or costovertebral angle tenderness
• Rhabdo

Pulmonary-

• Rales
• Hemoptysis

Collaborative Management:

Diagnostics start with labs:

• CBC
• CMP

Kidney function studies – BUN and Creatinine are essential

• GFR
• Serologic tests

Bladder pressure – in relation to abd compartment syndrome

• Renal biopsy

Management relates to correcting the underlying cause Correcting fluid overload with diuretics, correction of acidosis with some bicarb. Fluids (just watch for overload)

• Supportive therapy

Evaluation | Patient Monitoring | Education:

• Serial labs – BUN and CR
  Response to treatment of underlying conditions.
• Cardiac monitoring
• Education will involve proper follow up with nephrology as well as information on medications and diet

Linchpins: (Key Points)

• Common
• Labs