Renal Failure

[kind-hearted08]

okay i'm studying the renal system and i never just quite understood it. can someone please help me to understand acute and chronic renal failure. i'm testing on monday.

thanks:banghead:

[Hypoxic]

Can you be a little more specific as to what you want to know. Explaining both is very long and lengthy. A little direction as to what exactly you don't understand would be a little helpful.

[kind-hearted08]

Why are they hyperkalemic and hypercalcemic. How and they become hyperkalemic? As for nursing care I know that you mainly want to monitor there intake and output is there is anything else for nursing care???

Thanks

[Bel-USA]

Hi kind-hearted08,

here is what I remember about acute/chronic renal failure.

In acute R.F.: it starts with the oliguric phase (so a decrease in urine ouput). This means that the body is not excreting enough fluid, thus hypervolemia (too much fluid in the body). Potassium is excreted with urine. If there is no urine, this means that the potassium can't leave the body. The potassium accumulates and results in hyperkalemia.

The second phase is the diuretic phase (urine output slowly increases). As the urine is excreted, follows the potassium. At some point, the body will get into a state of hypovolemia, to much potassium and sodium excreted

--> hypokalemia and hyponatremia.

Here is my thought about calcium:

There is hypocalcemia when the level of phosphate is high (and vice-versa). When there is no urine excreted, the phosphate stays in the body: hyperphosphatemia and hypocalcemia (I think the calcium from the bones needs a low phosphate level to leave the bones and get into the extracellular fluid.)

When the body fluids are finally excreted, so is the phosphate. This lowers the level of phosphate (giving you a normal or low level) and with that an increase in the level of calcium. If to much phosphate is excreted, you'll get hypophosphatemia and hypercalcemia.

In chronic R.F.: the same phenomenon happens except that in this case the destructive process takes longer. One of the kidney stops working properly and the other kidney will compensate (it will work for 2), so there is still urine excreted (nocturia and polyuria). But the healthy kidney can only do that job for so long, its ability to compensate will decrease --> not enough urine excreted --> oliguria --> edema. Chronic RF is irreversible, the patient will need dialysis or other treatment. In acute RF, the problems are temporary and usually don't end in irreversible kidney damages.

I hope I'm not telling you anything wrong... hopefully someone else will reply to your questions too so we can compare...

I'm sitting for the NCLEX-RN this Sunday (2nd time)... I wish you good luck for your test and your nursing career.

[hypocaffeinemia, BSN, RN]

From emedicine:

Overall, one of the most common causes of hypocalcemia is renal failure, which results in hypocalcemia because of inadequate 1-hydroxylation of 25-hydroxyvitamin D and hyperphosphatemia due to diminished glomerular filtration.

What this means in simpler terms is that not only do you become hyperphosphatemic in renal failure, Vitamin D, which is necessary to regulate Calcium and Phosphate levels, is no longer adequately broken down by your kidney into its active metabolites responsible for this regulation.

[kind-hearted08]

Thank you so much for the responses everyone. Good luck with your NCLEX on Sunday!