Chronic renal failure or chronic kidney disease management, pharmacist role, medical management objectives, goals of the therapy . What are the risk factors of chronic renal failure, clinical manifestations of chronic renal failure, renal failure complications, pathophysiology of chronic renal failure.

1. CHRONIC RENAL
FAILURE
MANAGEMENT
Moses Dumbuya
University of Sierra Leone
Faculty of pharmaceutical Sciences

2. What is Chronic Renal Failure?
When the patient has sustained enough kidney
damage to require renal replacement therapy on a
permanent basis, the patient has moved into the fifth
or final stage of CKD, also referred to as chronic renal
failure.
Chronic renal failure (CRF) is the end result of a
gradual, progressive loss of kidney function.Causes
include chronic infections (glomerulonephritis,
pyelonephritis), vascular diseases (hypertension,
nephrosclerosis), obstructive processes (renal calculi),
collagen diseases (systemic lupus), nephrotoxic agents
(drugs, such as aminoglycosides), and endocrine
diseases (diabetes, hyperparathyroidism).
This syndrome is generally progressive and produces
major changes in all body systems.

3. What is Chronic Renal
Failure?
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Accumulation. As renal function declines, the end products of
protein metabolism (normally excreted in urine) accumulate in
the blood.
Adverse effects. Uremia develops and adversely affects every
system in the body.
Progression. The disease tends to progress more rapidly in
patients who excrete significant amounts of protein or have
elevated blood pressure than those without these conditions

4. What is chronic renal failure
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The final stage of renal dysfunction, end-stage renal disease (ESRD), is
demonstrated by a glomerular filtration rate (GFR) of 15%–20% of normal
or less.
Renal failure results when the kidneys cannot remove the body’s
metabolic wastes or perform their regulatory functions.
The substances normally eliminated in the urine accumulate in the body
fluids as a result of impaired renal excretion, affecting endocrine and
metabolic functions as well as fluid, electrolyte, and acid-base
disturbances.
Renal failure is a systemic disease and is a final common pathway of
many different kidney and urinary tract diseases.

5. Pathophysiology
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There are many diseases that cause chronic renal disease; each has its
own pathophysiology. However, there are common mechanisms for
disease progression.
Pathologic features include fibrosis, loss of renal cells, and infiltration of
renal tissue by monocytes and macrophages.
Proteinuria, hypoxia, and extensive angiotensin II production all contribute
to the pathophysiology. In an attempt to maintain GFR, the glomerular
hyperfiltration; this results in endothelial injury.
Proteinuria results from increased glomerular permeability and increased
capillary pressure.
Hypoxia also contributes to disease progression. Angiotensin II increases
glomerular hypertension, which further damages the kidney

6. Predisposing Factors & Precipitating
Factors
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Predisposing Factors
Age 60 or older
Kidney disease present at birth (congenital)
Family history of kidney disease
Autoimmune Disorder (Lupus erythematosus)
Bladder outlet obstruction (BPH and Prostatitis)
Race (Sickle cell disease)
Precipitating Factors
Occupational Hazard (overexposure to toxins and to some
medications)
Sedentary Lifestyle (hypertension, atherosclerosis)
Diet (High residue diet)

7. Clinical Manifestations
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Patients exhibit a number of signs and symptoms.
Peripheral neuropathy. Peripheral neuropathy, a disorder of the peripheral
nervous system, is present in some patients.
Severe pain. Patients complain of severe pain and discomfort.
Restless leg syndrome. Restless leg syndrome and burning feet can occur
in the early stage of uremic peripheral neuropathy.

8. Complications
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Potential complications of chronic renal failure that concern the nurse and
necessitate a collaborative approach to care include the following:
Hyperkalemia. Hyperkalemia due to decreased excretion, metabolic acidosis,
catabolism, and excessive intake (diet, medications, fluids).
Pericarditis. Pericarditis due to retention of uremic waste products and inadequate
dialysis.
Hypertension. Hypertension due to sodium and water retention and the malfunction
of the renin-angiotensin-aldosterone system.
Anemia. Anemia due to decreased erythropoietin production decreased RBC
lifespan, bleeding in the GI tract from irritating toxins and ulcer formation, and
blood loss during hemodialysis.
Bone disease. Bone disease and metastatic and vascular calcifications due to
retention of phosphorus, low serum calcium levels, abnormal vitamin D metabolism,
and elevated aluminum levels.

9. Assessment and Diagnostic Findings
• Laboratory studies required to establish the diagnosis of CRF include:
Volume: Usually less than 400 mL/24 hr (oliguria) or
urine is absent (anuria).
Color: Abnormally cloudy urine may be caused by
pus, bacteria, fat, colloidal particles, phosphates, or
urates. Dirty, brown sediment indicates presence of
RBCs, hemoglobin, myoglobin, porphyrins.
Specific gravity: Less than 1.015 (fixed at 1.010
reflects severe renal damage).
Osmolality: Less than 350 mOsm/kg is indicative of
tubular damage, and urine/serum ratio is often 1:1.
Creatinine clearance: May be significantly decreased
(less than 80 mL/min in early failure; less than 10
mL/min in ESRD).
Sodium: More than 40 mEq/L because kidney is not
able to reabsorb sodium.
Protein: High-grade proteinuria (3–4+) strongly
indicates glomerular damage when RBCs and casts
are also present.
Blood
BUN/Cr: Elevated
Glomerular filtration rate. GFR and
creatinine clearance decrease while
serum creatinine (more sensitive
indicator of renal function) and BUN
levels increase.
Sodium and water retention. Some
patients retain sodium and water,
increasing the risk for edema, heart
failure, and hypertension.
Acidosis. Metabolic acidosis occurs in
ESRD because the kidneys are unable to
excrete increased loads of acid.
Anemia. In ESRD, erythropoietin
production decreases and profound
anemia results, producing fatigue,
angina, and shortness of breath.
Urine

10. Assessment and Diagnostic Findings
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11. MEDICAL MANAGEMENT
• The goal of management is to maintain kidney function and homeostasis
for as long as possible

12. MEDICAL MANAGEMENT
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Assessment of a patient with ESRD includes the following:
Assess fluid status (daily weight, intake and output, skin turgor, distention
of neck veins, vital signs, and respiratory effort).
Assess nutritional dietary patterns (diet history, food preference, and
calorie counts).
Assess nutritional status (weight changes, laboratory values).
Assess understanding of cause of renal failure, its consequences and its
treatment.
Assess patient’s and family’s responses and reactions to illness and
treatment.
Assess for signs of hyperkalemia.

13. PLANNING & GOALS
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The goals for a patient with chronic renal failure include:
Maintenance of ideal body weight without excess fluid.
Maintenance of adequate nutritional intake.
Participation in activity within tolerance.
Improve self-esteem.
Pharmacist Priorities
Maintain homeostasis.
Prevent complications.
Provide information about disease process/prognosis and treatment needs.
Support adjustment to lifestyle changes.
REFERENCES
https://nurseslabs.com/chronic-renal-failure/
https://www.slideshare.net/samghany/renal-failure-managemen