Kidney failure may be an acute or chronic condition. Acute renal failure usually starts after a sudden illness or trauma to the kidney and is self limiting. Chronic renal failure typically occurs slowly over time and is not reversible. The National Kidney Foundation current data on kidney failure states that 26 million American adults have chronic kidney disease. Diabetes and hypertension are the two primary causes of kidney failure.
Acute Renal Failure
Acute renal failure (ARF) has three stages. In the initial stage, patients experience oliguria, which is a decreased urine output. Healthy adults need to make a minimum of 400 milliliters of urine per 24 hours. Oliguria is a urine output between 100 and 400 mL/day. During this first stage of ARF, azotemia develops. Azotemia is the buildup of nitrogenous waste products in the blood. Patients may experience nausea, vomiting, headache, dizziness, dry itchy skin, and an elevated heart rate and blood pressure. Donna D. Ignatavicius, MS RN, and M. Linda Workman, Ph.D, authors of the 2006 "Medical-Surgical Nursing: Critical Thinking for Collaborative Care" textbook, explain that if this condition is not corrected, patients will progress to convulsions, coma and death.
Patients experiencing ARF may need dialysis on a temporary basis until they progress to the second phase of ARF, which is the diuresis phase. In this stage patients begin to excrete large quantities of very dilute urine. The kidneys are repairing during this stage and do not effectively clear waste products from the body. During the diuresis stage patients may experience electrolyte imbalances. Sodium and potassium may become too low. This places patients at risk for irregular heart rhythms, weakness and fatigue.
The third phase of ARF, recovery, is not considered achieved until the kidneys are able to excrete a normal amount of concentrated urine. It can take as long as a year for a person to recover from ARF.
Chronic Renal Failure
Glomerular filtration rate (GFR) is the amount of blood your kidneys filter in one minute, which should be at least 90 milliliters per minute. The National Kidney Fund established the five stages of chronic renal failure based on GFR.
In stage one of CRF, diminished renal reserve, the only clinical finding is protein in the urine with a normal GFR and patients have no symptoms. Stage two shows a decreased GFR between 60 to 89 mL/min. According to Scott and White hospital patient information on kidney disease, patients may not have symptoms until the condition is advanced. Early symptoms include a general feeling of illness, fatigue, dry and itchy skin, headaches, a loss of appetite and nausea.
Stages three and four are referred to as the renal insufficiency stage where the GFR can be as low as 15 mL/min. Azotemia increases. Symptoms are more severe with difficulty concentrating, weakness, easy bruising, swelling, insomnia, muscle twitching and almost no urine output.
End-Stage Renal Disease
End-stage renal disease (ESRD) is stage five of chronic renal failure. Patients need dialysis if they wish to survive. When GFR is less than 10 mL/min, patients may apply to become a candidate for a kidney transplant.
References
- National Kidney Fund: 5 Stages of Kidney Disease
- "Medical-Surgical Nursing - Critical Thinking for Collaborative Care"; Donna D. Ignatavicius MS RN, & M. Linda Workman Ph.D; 2006
- Scott and White Hospital Patient Information: Chronic Kidney Disease
