Chronic Renal Failure or End-Stage Renal Disease ( ESRD ) is a progressive, irreversible

deterioration in renal function in which the bodys ability to maintain metabolic and fluid and
electrolyte balance fails, resulting in uremia ( a syndrome resulting from an exess of urea and
other nitrogenous wastes in the blood )
Etiology
Most common cause of chronic renal failure are diabetic neuropathy,
hypertension, glomerulonephritis, systemic lupus erythematosus, and cystic kidney
disease.
Pathophysiology

As renal function declines, the end products of protein metabolism, which are
normally excreted in urine , accumulate in the blood. There are imbalances in the
body chemistry and in the cardiovascular, hematologic, gastrointestinal, neurologic,
and skeletal systems. Skin and reproductive changes are also seen.
The patients tends to retain sodium and water, increasing the risk of edema
formation, congestive heart failure, hypertension, and, occasionally , ascites.
Hypertension may also result from activation of the rennin-angiotensin axis and the
concomstant increased aldosterone secretion.
Other patients have a tendency to lose salt, and they run the risk of
hypotension and hypovolemia. Episodes of vomiting and diarrhea may produce
sodium and water depletion, which vorsens the uremic state. Metabolic acidosis
occurs as a result of the reduced ability of the kidney to excrete hydrogen ions,
produce ammonia, and conserve bicarbonate.

Clinical Manifestations
Although at time the onset of chronic renal failure is sudden, in the majority o patients it
begins with one or more symptoms-fatigue and lethargy,headache, general weakness,
gastrointestinal symptoms ( anorexia, nausea, vomiting, diarrhea ) bleeding tendencies, and
mental confusion. There is decreased salivary flow, thirst, a metallic taste in the mount, loss
of smell and taste, and parotitis or stomatitis.
Management
With the deterioration of renal function, dietary intervention is necessary with careful
regulation of protein intake, fluid intake to balance fluid losses, sodium intake to balance

sodium losses, and some restriction of potassium. At the same time, adequate calorie intake
and vitamin supplementation must be ensured. There is come restriction of protein because
urea, creatinine, uric acid, and organic acids- the breakdown products of dietary and tissue
protein will accumulate rapidly in the blood when there is impaired renal clearance ( the
ability to remove or clear these substances from the blood ). The allowed protein must be
of high biologic value : dairy products, eggs, meats. High- biologic-value protein are those
that are complete proteins and supply the essential amino acids that are necessary for growth
and cell repair. Ussualy, the flui allowance is 500 to 600 ml of fluid more than the 24 hour
urine output.
Complications
Cronic renal failure has a variety of deleterious effects on the nervous system. The
mechanism of these effects is multi factorial and is due to a combination of uremia,
disturbances of electrolytes and water balance, impaired drug metabolism, anemia,
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associated comorbid illness, and the effects hemodialysis.

Nursing Diagnosis
a. Fluid volume excess and electrolyte imbalancerelated to decreased urine,
output , and dietary and fluid restrictions.
b. Altered nutrition : less than body requirements, related to anorexia,
gastrointestinal discomfort, and restrictions.
c. Knowledge deficit regarding condition and treatment regiment.
d. Activity intolerance related to fatigue.
e. Self-esteem disturbance related to dependency and role changes