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Management and treatment

- The management and treatment of acute renal failure depend on the cause and severity of the condition, as well as the presence of complications and comorbidities.

- The general goals of management and treatment are to:

  • Restore renal perfusion and function
  • Correct or eliminate any reversible causes of kidney injury
  • Provide supportive care to prevent or treat complications
  • Preserve residual kidney function and prevent progression to chronic kidney disease

- The specific interventions may include:

  • Fluid resuscitation: This involves administering intravenous (IV) fluids to restore fluid volume and blood pressure in patients with acute renal failure due to hypovolemia or hypotension. Isotonic crystalloids such as normal saline or lactated Ringer's solution are preferred over colloids as they have no clear renal or mortality benefit and may increase the risk of bleeding or infection. The amount and rate of fluid administration should be guided by the patient's hemodynamic status, urine output, serum creatinine, and BUN levels. Fluid overload should be avoided as it can worsen edema, pulmonary congestion, and heart failure.
  • Diuretics: These are medications that increase urine output by inhibiting sodium and water reabsorption in the kidneys. Diuretics may be used to treat fluid overload in patients with acute renal failure who are oliguric or anuric. Loop diuretics such as furosemide (Lasix) or bumetanide (Bumex) are preferred over thiazide diuretics as they are more effective in patients with low GFR. Diuretics should be used with caution as they can cause dehydration, electrolyte imbalances, ototoxicity, or nephrotoxicity. The dose and frequency of diuretics should be adjusted according to the patient's response and laboratory values.
  • Discontinuation of Nephrotoxic medications: These are medications that can cause or worsen kidney injury by affecting the blood flow to the kidneys or by directly damaging the kidney cells. Nephrotoxic medications should be discontinued or avoided in patients with acute renal failure whenever possible. Some examples of nephrotoxic medications include:
    • nonsteroidal anti-inflammatory drugs (NSAIDs), aminoglycosides,
    • amphotericin B,
    • vancomycin,
    • contrast media,
    • cyclosporine,
    • tacrolimus,
    • cisplatin,
    • and methotrexate.
  • Drug dose adjustment: This involves modifying the dose or frequency of medications that are eliminated by the kidneys according to the patient's renal function. Drugs that are renally excreted may accumulate in patients with acute renal failure and cause toxicity or adverse effects. The degree of dose adjustment depends on the drug's pharmacokinetics, therapeutic index, and toxicity profile. Some examples of drugs that require dose adjustment in patients with acute renal failure include:
    • digoxin,
    • lithium,
    • gabapentin,
    • metformin,
    • warfarin.
  • Dialysis: This is a process that removes waste products and excess fluid from the blood using a machine (hemodialysis) or the abdomen (peritoneal dialysis). Dialysis may also be indicated in patients with acute renal failure who have chronic kidney disease, volume overload, or drug overdose. The timing and modality of dialysis should be individualized based on the patient's clinical condition, preferences, and availability of resources.

  • Dialysis may be indicated in patients with acute renal failure who have life-threatening complications such as:

    • severe hyperkalemia,
    • metabolic acidosis,
    • uremic encephalopathy,
    • pericarditis,
    • pulmonary edema that is unresponsive to medical therapy.
  • Renal replacement therapy: This is a term that encompasses dialysis and kidney transplantation as methods of replacing kidney function in patients with end-stage renal disease. Renal replacement therapy may be initiated in individuals with nephrotic syndrome who progress to end-stage renal disease (ESRD). ESRD refers to the advanced stage of kidney disease where the kidneys can no longer function adequately to sustain life, necessitating the need for renal replacement therapy.

Questions on Management and treatment

Correct Answer is B

Explanation

Incorrect. Encouraging the client to drink water freely would exacerbate fluid overload and impair the body's ability to eliminate excess fluids.

Correct Answer is B

Explanation

Incorrect. Urinary tract obstruction is also associated with postrenal acute renal failure, not intrinsic causes.

Correct Answer is B

Explanation

Incorrect. Preventing infection and complications is important, but it is not the priority over assessing kidney function in acute renal failure.QUESTIONS

Correct Answer is B

Explanation

Incorrect. Deep breathing exercises are not specific interventions for correcting metabolic acidosis.

Correct Answer is A

Explanation

Incorrect. While a renal ultrasound can visualize the blood vessels in the kidneys, its primary purpose is to assess kidney structure, not blood flow.

Correct Answer is A

Explanation

Incorrect. While anemia can be associated with chronic kidney disease, it is not a specific risk factor for acute renal failure.

Correct Answer is C

Explanation

Incorrect. While the statement is partially true, it does not capture the acute and sudden nature of acute renal failure. The inability of the kidneys to filter waste products from the blood is one of the manifestations of AKI.

Correct Answer is C

Explanation

Incorrect. While a renal biopsy can provide information about the kidney's structure, its primary purpose is to obtain a tissue sample for histological examination, not to assess blood flow.

Correct Answer is B

Explanation

Incorrect. Increasing the dwell time would not address the issue of cloudy dialysis fluid and potential infection.

Correct Answer is C

Explanation

Incorrect. Chronic kidney disease (CKD. is a risk factor for intrinsic acute renal failure, not postrenal.

Correct Answer is C

Explanation

Incorrect. Excessive fluid intake may contribute to fluid overload and decreased urine output in prerenal acute renal failure, but it is not the primary pathophysiological process that leads to decreased urine output.

Correct Answer is B

Explanation

Incorrect. The description provided refers to the insertion of a urinary catheter for bladder drainage, not hemodialysis.

Correct Answer is A

Explanation

Incorrect. Chicken and fish are sources of protein and do not have high potassium content that would require restriction in most cases.

Correct Answer is B

Explanation

Incorrect. Increased respiratory rate and shallow breathing are not typical respiratory manifestations of acute renal failure.QUESTIONS

Correct Answer is A

Explanation

Incorrect. Antihypertensive agents are prescribed to manage hypertension and do not treat anemia in clients with renal failure.QUESTIONS

Correct Answer is D

Explanation

Correct. Loop diuretics are prescribed in acute renal failure to increase urine output and promote fluid excretion. This helps reduce fluid overload and decrease edema.

Correct Answer is B

Explanation

Incorrect. Renal ultrasound is an imaging test that provides information about the structure of the kidneys but does not directly measure GFR.

Correct Answer is C

Explanation

Incorrect. Excessive fluid intake and fluid overload may contribute to fluid retention and edema in prerenal acute renal failure, but they are not the primary pathophysiological process in acute renal failure.

Correct Answer is D

Explanation

Correct. Fresh fruits and vegetables are generally low in phosphate and are suitable for a low-phosphate diet. These foods can help meet the client's nutritional needs while adhering to the dietary restriction.

Correct Answer is C

Explanation

Incorrect. Increasing the client'sfluid intake is not appropriate during a hypotensive episode, as it may not rapidly improve blood pressure and could lead to fluid overload.

Correct Answer is D

Explanation

Correct. A renal nuclear scan, also known as a renal scintigraphy, involves injecting a small amount of radioactive material intravenously. The radioactive material is taken up by the kidneys, and the scan creates images that assess kidney function and blood flow.QUESTIONS

Correct Answer is C

Explanation

Incorrect. Elevated creatinine levels can be seen in both acute and chronic kidney diseases, but they are not exclusively seen in chronic kidney disease.

Incorrect. Gentle stretching exercises may not be appropriate for a client experiencing muscle cramps, as stretching could exacerbate the discomfort.

Correct. The nurse's best response is to encourage the client to follow their healthcare provider's instructions and avoid medications that may harm the kidneys. Compliance with prescribed treatment plans and avoiding nephrotoxic medications are essential to support kidney function and prevent furth

Incorrect. High blood sugar levels and frequent urination are not directly related to acute renal failure. These symptoms are more characteristic of diabetes mellitus.

Incorrect. Removing jewelry and metallic objects is a standard precaution for all imaging procedures, but it is not specific to a CT scan with contrast dye.

Incorrect. Decreased respiratory rate and shallow breathing are not directly associated with uremia.

Incorrect. Increased respiratory rate and depth are not typically associated with acute renal failure or its fluid and electrolyte imbalances.

Correct. Before an MRI scan, clients need to remove all metal objects and devices, including jewelry, piercings, hearing aids, and certain medical implants. Metal can interfere with the MRI's magnetic field and cause safety concerns during the procedure.

Incorrect. While ciprofloxacin and other antibiotics may have renal-related side effects, they are not a common cause of intrinsic acute renal failure.

Incorrect. Warm, flushed skin and headache are not directly related to metabolic acidosis.

Incorrect. Seasonal allergies are not associated with an increased risk of acute renal failure.

Incorrect. Fluid restriction is not typically recommended in acute renal failure, especially if the client is experiencing fluid depletion and dehydration.

Incorrect. Hypoactive bowel sounds and constipation are not directly related to fluid overload in acute renal failure.

Incorrect. The cost of CRRT and intermittent hemodialysis can vary based on the healthcare setting and the client's needs. The cost-effectiveness depends on individual factors and resource availability.

Incorrect. While UTIs and kidney stones can cause kidney injury, they are not the exclusive causes of acute renal failure, which can have various underlying etiologies.

Incorrect. Adhesive tape can cause skin irritation and damage when removed, especially in clients at risk for impaired skin integrity.

Incorrect. Promoting shallow breathing to retain carbon dioxide is not a recommended intervention for correcting metabolic acidosis. Respiratory acidosis and metabolic acidosis are different types of acid-base imbalances with distinct causes and treatments.

Incorrect. The timing of loop diuretic administration is determined by the healthcare provider's order and the client's specific needs. Taking diuretics at bedtime may result in increased nighttime urination and sleep disruption.QUESTIONS

Incorrect. Diabetes mellitus is a risk factor for chronic kidney disease, but it is not a specific risk factor for prerenal acute renal failure.

Incorrect. Thiazide diuretics may cause electrolyte imbalances and metabolic disturbances, but they are not a common cause of prerenal acute renal failure.QUESTIONS

Incorrect. Administering pain medication before passive range-of-motion exercises is not a standard practice and does not directly prevent complications of immobility.

Incorrect. Excessive thirst and dry mucous membranes are not specific to hyperkalemia and are not the most critical indicators of severe hyperkalemia.
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