Is a sudden decline in renal function, usually marked by increased concentrations of blood urea nitrogen (BUN; azotemia) and creatinine; oliguria (less than 500 ml of urine in 24 hours); hyperkalemia; and sodium retention.

Acute renal failure are classified into following: 1. Prerenal failure results from conditions that interrupt the renal blood supply; thereby reducing renal perfusion (hypovolemia, shock, hemorrhage, burns impaired cardiac output, diuretic therapy). 2. Postrenal failure results from obstruction of urine flow. 3. Intrarenal failure results from injury to the kidneys themselves (ischemia, toxins, immunologic processes, systemic and vascular disorders).

The disease progresses through three clinically distinct phase which is oliguric-anuric, diuretic, and recovery, distinguished primarily by changes in urine volume and BUN and creatinine levels. Complication of ARF include dysrhythmias, increased susceptibility to infection, electrolyte abnormalities, GI bleeding due to stress ulcers, and multiple organ failure. Untreated ARF can also progress to chronic renal failure, end-stage renal disease, and

death from uremia or related causes. Assessment: 1. Oliguric-anuric phase: urine volume less than 400 ml per 24 hours; increased in serum creatinine, urea, uric acid, organic acids, potassium, and magnesium; lasts 3 to 5 days in infants and children, 10 to 14 days in adolescents and adults. 2. Diuretic phase: begins when urine output exceeds 500 ml per 24 hours, end when BUN and creatinine levels stop rising; length is availabe. 3. Recovery phase: asymptomatic; last several months to 1 year; some scar tissue may remain. 4. In prerenal disease: decreased tissue turgor, dryness of mucous membranes, weight loss, flat neck veins, hypotension, tachycardia. 5. In postrenal disease: difficulty in voiding, changes in urine flow. 6. In Intrarenal disease: presentation varies; usually have edema, may have fever, skin rash. 7. Nausea, vomiting, diarrhea, and lethargy may also occur. Diagnostic Evaluation: 1. Urinalysis shows proteinuria, hematuria, casts. Urine chemistry distinguishes various forms of ARF(prerenal, postrenal, intrarenal). 2. Serum creatinine and BUN levels are elevated; arterial blood gas (ABG) levels, serum electrolytes may be abnormal. 3. Renal untrasonography estimates renal size and rules out treatable obstructive uropathy. Therapeutic and Pharmacologic Interventions: 1. Surgical relief of obstruction may be necessary. 2. Correction of underlying fluid excesses or deficits. 3. Correction and control of biochemical imbalances. 4. Restoration and maintenance of blood pressure through I.V. fluids and vasopressors. 5. Maintenance of adequate nutrition: Low protein diet with supplemental amino acids and vitamins. 6. Initiation of hemodialysis, peritoneal dialysis, or continuous renal replacement therapy for patients with progressive azotemia and other life-threatening complications.

Nursing Interventions: 1. Monitor 24-hour urine volume to follow clinical course of the disease. 2. Monitor BUN, creatinine, and electrolyte. 3. Monitor ABG levels as necessary to evaluate acid-base balance. 4. Weigh the patient to provide an index of fluid balance. 5. Measure blood pressure at various times during the day with patients in supine, sitting, and standing positions. 6. Adjust fluid intake to avoid volume overload and dehydration. 7. Watch for cardiac dysrhythmias and heart failure from hyperkalemia, electrolyte imbalance, or fluid overload. Have resuscitation equipment available in case of cardiac arrest. 8. Watch for urinary tract infection, and remove bladder catheter as soon as possible. 9. Employ intensive pulmonary hygiene because incidence of pulmonary edema and infection is high. 10. Provide meticulous wound care. 11. Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories. 12. Institute seizure precautions. Provide padded side rails and have airway and suction equipment at the bedside. 13. Encourage and assist the patient to turn and move because drowsiness and lethargy may reduce activity. 14. Explain that the patient may experience residual defects in kidney function for a long time after acute illness. 15. Encourage the patient to report routine urinalysis and follow-up examinations. 16. Recommend resuming activity gradually because muscle weakness will be present from excessive catabolism.

Chronic Kidney Disease could be known if the following criteria has met:

1. Kidney damage for equal or more than 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR 2. GFR <60 mL/min/1.73m2 for greater than or equal 3 months, with or without kidney damage Stages of Chronic Kidney Disease This is according to National Kidney Foundation Stage Description GFR (mL/min/1.73m2 ) Kidney damage with Greater than or 1 normal or increased equal 90 GFR Kidney damage with 60-89 2 mild decrease of GFR Moderate decrease of 30-59 3 GFR Severe decrease of 15-29 4 GFR Kidney Failure Less than 15 5 (dialysis) Risk Factors 1. Diabetes most common cause of chronic kidney disease worldwide; obesity is an additional factor for diabetes 2. Hypertension systolic hypertension is of particular concern. Beginning at around age 50, systolic blood pressure rises and continues to rise with age. 3. Autoimmune disease 4. Systemic infection

5. Urinary stones or lower urinary tract obstruction 6. Exposure to certain toxic drugs cyclosporins and othe immunosuppressive agents and corticosteriods Diagnostic Evaluation: 1. Urinalysis reveal that casts found in urine are helpful in determining the type of kidney disease 2. Blood analyses may include levels of createnine, blood urea nitrogen, serum electrolytes and pH 3. Ultrasonography can detect a tumor or hydronephrosis 4. Computed tomography and magnetic resonance imaging demonstrate vessel disorders 5. Kidney arteriography and venography can show damage to kidney vasculature 6. Proteinuria screening persistent proteinuria is usually the first indicator of kidney damage. Signs and symptoms: 1. 2. 3. 4. swelling, usually of the lower extremities fatigue weight loss loss of appetite

5. nausea or vomiting 6. a change in urination (change in volume and frequency) 7. change is sleep pattern 8. headaches 9. itching 10. difficulties in memory and concentration Complications: 1. Cardiovascular disease hypertension may also contribute to the development and increase the risk of stroke 2. Anemia when kidneys are damaged there is a decrease in erythropoietine, a hormone that stimulates production of red blood cells 3. Bone disease disorders of calcium and phosphorus metabolism may develop early 4. Malnutrition alteration of the bodys response to insulin as well as other metabolic functions (such as erythropoietin formation and vitamin D matebolism) 5. Decreased functional status and well-being includes complex regimen, adverse effects and the possible or actual loss of job and income Medical Management: 1. Peritoneal dialysis 2. Hemodialysis

3. Kidney Transplantation Nursing Management: 1. Proper assessment for risk factors that might cause a rapid decline 2. Encourage self-management such a blood pressure monitoring and glucose monitoring 3. Administer prescribe medications ( ion exchange resin, alkalizing agents, antibiotics, erythropoietin, folic acid supplements) 4. Maintain strict fluid control 5. Encourage intake of high biologic value protein (eggs, dairy products and meats) 6. Encourage adequate rest