Pediatric Nursing Demystified

Renal Failure

What Went Wrong?

Renal failure is the sudden or progressive decrease in renal function. The two

types of renal failure are acute and chronic.

Acute renal failure is the sudden decrease in renal function. It is reversible

following intensive treatment of the underlying condition. Acute renal failure

is divided into three categories:

Prerenal stage:Diminished renal perfusion is caused by a disorder

occurring before blood reaches the kidneys such as fluid loss, third-spacing

of fluids, congestive heart failure, or medication such as diuretics.

Renal stage:Diminished renal perfusion is caused by tubular necrosis

within the kidney related to pyelonephritis, glomerulonephritis, medica-

tion, or allergic reaction.

Postrenal stage:Diminished renal perfusion is caused by a urinary tract

obstruction due to a stone, tissue growth, or compressed ureter.

Chronic renal failure is the progressive decrease in renal function second-

ary to diabetes mellitus, hypertension, glomerulonephritis, HIV infection,

polycystic kidney disease, or ischemic nephropathy. Chronic renal failure is

an irreversible, permanent loss of kidney function.

Signs and Symptoms

Abdominal bruit with ischemic nephropathy

Peripheral edema with third spacing of fluids

Decreased urinary output

Uremic pruritus

Prerenal stage:

• Tachycardia


• Orthostatic hypotension


• Dry skin


• Mucous membranes
  Chronic renal failure:


• Anemia related to kidneys production of erythropoietin


• Weight loss

Test Results

Serum: Elevated BUN, creatinine, and BUN-to-creatinine ratio

Urinalysis: Casts, RBC, WBC, proteinuria, glomerular filtration rate

decreased in chronic disease, creatinine clearance decreased

Renal ultrasound: Decrease in renal size in chronic renal failure; dilation

and fluid buildup in postrenal failure

Treatment

Resolve underlying cause.

Administer IV fluids to replace hypovolemia (acute renal failure prerenal

stage).

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CHAPTER 12/ Genitourinary Conditions^267