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Running Head: RENAL FAILURE

Renal Failure
Janelle Gosch, SN
University of South Florida

RENAL FAILURE

Evidence Based Paper: Renal Failure

Our kidneys are the organs that help filter waste products from our blood. The kidneys
are also involved in many homeostatic functions including regulating blood pressure, red blood
cell production in the body, and electrolyte balance (Girman et al., 2012 ). With the kidneys
playing such a vital role in our body, would we be able to survive without them? For the many
patients suffering from renal failure this is the question they are asking. This disease can
completely shut down kidney function but there are medical and nursing interventions to halt and
sometimes even reverse the effects of renal failure if caught in the early stages (Parker,2004 ).
Renal failure, also known as kidney failure or renal insufficiency is a fairly common
illness in the United States, affecting more than 20 million adults. (2014 National Chronic
Kidney Disease Fact Sheet, 2014). Renal failure occurs when which the kidneys fail to
adequately filter waste products from the blood (Girman et al., 2012). According to the CDC,
Kidney disease was ranked 8th as the leading cause of death in 2010. Renal failures two main
forms are acute kidney injury, which is often reversible with treatment, and chronic kidney
disease, which is often not reversible (Girman et al., 2012). In both cases, there is usually an
underlying cause. Acute renal insufficiency can be caused by multiple factors including injury,
shock, infection, obstruction, long term use of NSAIDs. Chronic kidney failure may be caused
by prolonged hypertension, diabetes, or prolonged alcohol consumption (Girman et al., 2012).
End-stage renal disease (ESRD) is a total or permanent loss of kidney function. Although risk
factors for renal failure are common among patients with diabetes and hypertension which can be
inherited. In the stages of end stage renal disease or ESRD, recent studies have shown that
genetic factors such as DNA single nucleotide polymorphism, may be influential in renal failure

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patients (Nordfors, Lindholm, & Stenvinkel ,2005, p.1). Symptoms of renal failure can be caused
by a build-up of waste products in the body that may lead to weakness, shortness of breath, and
confusion. Elevated electrolytes are also seen with kidney failure, if potassium is unable to be
removed from the bloodstream, hyperkalemia, this may lead to dysrhythmias or even sudden
death (Adams, Holland & Urban,2014). Some lab values to look for are elevated BUN and
creatinine as well as a decreased glomerular filtration rate (GFR) below 60 milliliters per minute
(Parker, 2004). Urine tests may also be done, if protein is found in urine it often signals kidney
damage. Other tests are used to diagnose kidney failure can be abdominal ultrasounds which can
assess the size of the kidneys and identify whether any obstructions present. Renal failure is a
deadly and serious disease, often it can lead to many other complications ranging from
encephalopathy, to inflammation of the heart lining ,pericarditis, to decreased muscle function
because of low calcium levels also known as hypocalcemia. In patients with acute renal failure,
there is a better chance of improving and even reversing symptoms. Unfortunately, chronic
kidney failure is often not reversible, yet there is still treatment to relieve symptoms.
There have been many medical advances in treating renal failure. In most chronic cases,
dialysis, a medical process through which a person's blood is cleansed of the toxins the kidneys
normally would flush out, is considered. A hemodialysis machine is used to physiologically aid
or replace the kidneys in renal failure (Crockell, 2012). Although, dialysis can be timeconsuming and labor-intensive. A patient receiving dialysis must make frequent trips to a dialysis
center to receive treatment. If a patient wants to live a more active lifestyle, free from the
lifelong dependence of dialysis, they may choose to surgically undergo a kidney transplant,
which is not an uncommon medical intervention. However, kidney transplants are not suitable
for everyone, especially those who are overweight or prone to infection (Crockell, 2012). In

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many cases, treatment of the underlying cause of kidney failure may return kidney function to
normal. Diuretics can also improve renal function, by increasing fluid excretion. Nurses should
watch for dehydration, orthostatic hypotension, and potassium and sodium imbalances that can
occur in patients taking diuretics. (Adams, Holland & Urban,2014). A nursing care plan should
include always assess patients daily body weight for liquid input and output, assess for areas of
edema, plan oral fluid replacement, and contact provider if changes in hearing occur. Diet is also
known to improve renal function, maintaining a high carb low protein diet will reduce protein
metabolism (Girman et al., 2012). Lifelong efforts to control blood pressure and diabetes are also
ways to prevent chronic kidney disease and its progression to kidney failure. Usually, kidney
function is gradually decreased over time.
While attending clinical on a nephrology specific floor for three weeks I saw numerous
cases of renal failure. In one specific case, a patient was admitted with altered mental status
secondary to overdose on opiate and benzodiazepines. What was odd was that the patient had
also been to the hospital 7 times this past year for the same reasons. The patient had been taking
the medication for chronic back pain, but had simultaneously wearing her kidneys out at the
same time. I suspected kidney failure when I took a look at her lab values. Her BUN level was
51 on admission which is significantly high. Blood urea nitrogen is an indication of renal health
normally in a range of 6 to 20 so a high BUN level suggests renal failure. Her creatinine level
was high as well at 5.5 with normal values being between 0.6 and 1.2. Creatinine is a chemical
waste molecule from muscle metabolism and rises when there is poor clearance of creatinine by
the kidneys (Adams, Holland & Urban,2014). This also explains her altered mental status upon
arrival. When these toxins are produced by our body and built up to a certain level, they threaten
our internal organs, central nervous system included (Crockell , 2012 ).

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Throughout this patient stay her blood urea nitrogen and creatinine levels were trending
downward steadily due to the use of heparin and metoprolol, for hypertension, that reduce the
heart rate and the hearts output of blood which lowers blood pressure as well as helps to slow
the progression of kidney disease.
She was also given Narcan an opioid antagonist. Opioids and benzodiazepines are known
to be toxic to the kidneys as well as other organs when used in large doses. The nursing care
applied correlates to the research studied as well, minimal differences were found between
research and nursing care plan observed. A factor in controlling renal failure as stated before is
controlling diet. In my nursing care plan I would have also monitored her diet more closely for
consumption of food / fluid, identifying nutritional deficiencies. The patient would be given diet
management teachings and well as put on a cardiac diet. In the hospital, she was assessed around
the clock for any signs of dehydration, orthostatic hypotension, and electrolyte imbalances as
well as weight, edema, fluid input and output. Careful management of diet and other external
factors can greatly influence someones progression of renal failure throughout their stay at a
hospital. It is also important that this lifestyle carry over to home life after discharge, so nursing
care should influence the importance of managing renal failure.
Renal failure can have many names but is a very serious complication that occurs in the
kidneys. For the patients with renal failure, lifestyles have to completely change for any progress
to be made. The medical and nursing interventions used to treat renal failure can very effective at
to halt and even reverse the effects of renal failure but only if caught in the early stages. With the
patient above I believe her renal failure has already developed into chronic kidney failure due to
her lack of remediation as exhibited by her repeated hospital visits, but could have been better

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managed if information was taught to her sooner with a meaningful impact. Nurses have a great
power in promoting successful interventions in controlling illnesses.

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References
2014 National Chronic Kidney Disease Fact Sheet. (2014, January 10). Centers for Disease
Control and Prevention. Retrieved July 16, 2014, from
http://www.cdc.gov/diabetes/pubs/factsheets/kidney.htm
Adams, M., Holland, N. & Urban, C. (2014). Pharmacology for nurses: A pathophysiologic
approach (4th ed.). Boston, MA: Pearson
Crockell, Y. J. (2012). Management of chronic kidney disease: An emphasis on delaying disease
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Girman, C. J., Kou, T. D., Brodovicz, K., Alexander, C. M., ONeill, E. A., Engel, S., ... & Katz,
L. (2012). Risk of acute renal failure in patients with type 2 diabetes mellitus.
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Nordfors, L., Lindholm, B., & Stenvinkel, P. (2005). Endstage renal diseasenot an equal
opportunity disease: the role of genetic polymorphisms. Journal of Internal
Medicine, 258(1), 1-12.
Parker, J. N., Parker, P. M., & Parker, J. N. (2004). Kidney disease : a medical dictionary,
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Parker and Philip M. Parker, editors. San Diego, CA : ICON Health, c2004.