renal failure

failure /fail·ure/ (fāl´yer) inability to perform or to function properly.

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acute congestive heart failure  rapidly occurring cardiac output deficiency marked by venocapillary congestion, hypertension, and edema.

backward heart failure  a concept of heart failure emphasizing the causative contribution of passive engorgement of the systemic venous system, as a result of dysfunction in a ventricle and subsequent pressure increase behind it.

bone marrow failure  failure of the hematopoietic function of the bone marrow.

congestive heart failure  (CHF) that characterized by breathlessness and abnormal sodium and water retention, resulting in edema, with congestion of the lungs or peripheral circulation, or both.

diastolic heart failure  heart failure due to a defect in ventricular filling caused by an abnormality in diastolic function.

forward heart failure  a concept of heart failure that emphasizes the inadequacy of cardiac output relative to body needs and considers venous distention as secondary.

heart failure  inability of the heart to pump blood at a rate adequate to fill tissue metabolic requirements or the ability to do so only at an elevated filling pressure; defined clinically as a syndrome of ventricular dysfunction with reduced exercise capacity and other characteristic hemodynamic, renal, neural, and hormonal responses.

high-output heart failure  that in which cardiac output remains high; associated with hyperthyroidism, anemia, arteriovenous fistulas, beriberi, osteitis deformans, or sepsis.

kidney failure  renal f.

left-sided heart failure , left ventricular failure failure of adequate output by the left ventricle, marked by pulmonary congestion and edema.

low-output heart failure  that in which cardiac output is decreased, as in most forms of heart disease, leading to manifestations of impaired peripheral circulation and vasoconstriction.

premature ovarian failure  premature menopause.

renal failure  inability of the kidney to excrete metabolites at normal plasma levels under normal loading, or inability to retain electrolytes when intake is normal; in the acute form, marked by uremia and usually by oliguria, with hyperkalemia and pulmonary edema.

right-sided heart failure , right ventricular failure failure of adequate output by the right ventricle, marked by venous engorgement, hepatic enlargement, and pitting edema.

systolic heart failure  heart failure due to a defect in the expulsion of blood that is caused by an abnormality in systolic function.

failure to thrive  physical and developmental retardation in infants and small children, sometimes from physical illness and sometimes from psychosocial effects such as maternal deprivation.

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renal failure

n.

Acute or chronic malfunction of the kidneys resulting from any of a number of causes, including infection, trauma, toxins, hemodynamic abnormalities, and autoimmune disease, and often resulting in systemic symptoms, especially edema, hypertension, metabolic acidosis, and uremia.

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Renal failure

Disorder characterized by the kidney's inability to filter wastes from the blood. It may be acute (occuring suddenly and usually reversable) or chronic (developing slowly over time as a result of permanent damage).

Mentioned in: Nephrotoxic Injury

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renal failure,

inability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes. The condition may be acute or chronic. Acute renal failure is characterized by oliguria and the rapid accumulation of nitrogenous wastes in the blood (azotemia). It results from hemorrhage, trauma, burn, toxic injury to the kidney, acute pyelonephritis or glomerulonephritis, or lower urinary tract obstruction. Many forms of acute renal failure are reversible after the underlying cause has been identified. Acute renal failure may have three typical phases: prodromal, oliguric, and postoliguric. Treatment includes restricted intake of fluids and of all substances that require excretion by the kidney. Antibiotics and diuretics are also used. Chronic renal failure may result from many other diseases. The early signs include sluggishness, fatigue, and mental dullness. Later, anuria, convulsions, GI bleeding, malnutrition, and various neuropathies may occur. The skin may turn yellow-brown. Congestive heart failure and hypertension are frequent complications, the results of hypervolemia. Urinalysis reveals greater than normal amounts of urea and creatinine, waxy casts, and a constant volume of urine regardless of variations in water intake. Anemia frequently occurs. The prognosis depends on the underlying cause. Treatment usually includes restricted water and protein intake and the use of diuretics. When medical measures have been exhausted, long-term hemodialysis or peritoneal dialysis is often begun, and kidney transplantation is considered. See also acute tubular necrosis.

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failure [fāl´yer]

inability to perform or to function properly.

adult failure to thrive a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a progressive functional deterioration of a physical and cognitive nature. The individual's ability to live with multisystem diseases, cope with ensuing problems, and manage his/her care are remarkably diminished.

bone marrow failure failure of the hematopoietic function of the bone marrow; see also bone marrow suppression.

congestive heart failure see congestive heart failure.

heart failure see heart failure.

kidney failure renal failure.

multiple organ failure failure of two or more organ systems in a critically ill patient; see also multiple organ failure.

renal failure see renal failure.

respiratory failure see respiratory failure.

failure to thrive (failure to thrive syndrome) physical and developmental retardation in infants and small children. The syndrome can be seen in children with a physical illness, but the term is most often taken to mean failure to thrive due to psychosocial effects such as maternal deprivation. The syndrome was first noticed when European psychiatrists studied the development of babies who had spent the first five years of their lives in institutions where they were deprived of the emotional warmth of a mother, father, or other primary caregiver.

Characteristics of the failure to thrive syndrome include lack of physical growth (for example, weight and height below the third percentile for age) and below normal achievement in fine and gross motor, social-adaptive, and language skills as assessed by psychometric testing using a tool such as the Denver Developmental Screening Test. Additionally, the child with this syndrome displays withdrawing behavior, avoidance of eye contact, and stiffness or flaccid posture when held. These children often have a history of irritability, feeding problems, and disturbed sleep patterns.

Parents of infants with failure to thrive syndrome typically display feelings of concern and inadequacy. The infant who is feeding poorly and is irritable may elicit a response in the caregiver that reflects tension and frustration. The need for comfort and nurturing by the infant may not be met, and this may lead to a cycle that exacerbates feeding problems.

Intervention encompasses identification of infants and mothers at risk for the syndrome and care of both mother or primary caregiver and infant. The major goals are to encourage the mother to express her feelings without fear of rejection, to model the role of mother and teach her nurturing behaviors, and to promote her self-esteem and confidence. Important nursing goals in the care of the infant include providing optimal nutrition, comfort, and rest; meeting the infant's psychosocial needs; and supplying emotional nurturance and sensory stimulation appropriate to the assessed developmental level.

ventilatory failure respiratory failure.

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renal [re´nal]

pertaining to the kidney; called also nephric.

renal clearance tests laboratory tests that determine the ability of the kidney to remove certain substances from the blood. The most commonly used is the creatinine clearance test, which is a measure of the glomerular filtration rate.

renal failure inability of the kidney to maintain normal function, so that waste products and metabolites accumulate in the blood. This affects most of the body's systems because of its important role in maintaining fluid balance, regulating the electrochemical composition of body fluids, providing constant protection against acid-base imbalance, and controlling blood pressure. Called also kidney failure.

Acute renal failure occurs suddenly and may be caused by physical trauma, infection, inflammation, or exposure to nephrotoxic chemicals. Nephrotoxic agents include drugs such as penicillins, sulfonamides, aminoglycosides, and tetracyclines; radiographic iodine contrast materials; and heavy metals. These agents inflict damage on the renal tubules, causing tubular necrosis, and may also indirectly harm the tubules by producing severe vasoconstriction of renal blood vessels with ischemia of kidney tissue. Other causes of tubular ischemia include circulatory collapse, severe dehydration, and hypotension in certain compromised surgical patients.



Acute renal failure may be classified as: prerenal, associated with poor systemic perfusion and decreased renal blood flow; intrarenal, associated with renal ischemia or toxins; or postrenal, resulting from the obstruction of urine flow out of the kidneys.

oliguria is the hallmark of tubular necrosis, but it is not always present. Other symptoms besides a marked decrease in urinary output are related to fluid and electrolyte imbalances, anemia, hypertension, and uremia. In addition to supportive measures to restore and maintain a tolerable internal environment during acute renal failure, it may be necessary to remove toxic wastes by hemodialysis or peritoneal dialysis.

Chronic renal failure is a progressive loss of kidney function that may eventually progress to end-stage renal disease. The clinical course is described in four stages. First there is decreased renal reserve, with diminishing renal function but without accumulation of the end products of protein metabolism; the patient has no symptoms. In the second stage, renal insufficiency, the glomerular filtration rate (GFR) is depressed to about 30 ml per minute and plasma chemistry begins to show abnormalities as waste products accumulate. The third stage, frank renal failure, is characterized by steadily rising serum creatinine and blood urea nitrogen levels accompanying a drop in the GFR. The fourth and final stage is uremia; levels of protein end products continue to rise, residual urine function is less than 15 per cent, and all body systems are impaired.



Causes of renal failure are many and can be roughly divided into three groups: (1) those that directly affect the kidney by infection, inflammation, and upper urinary tract obstruction; (2) those in which there is an obstruction of the lower urinary tract; and (3) systemic diseases and toxicities, such as hypercalcemia, hypertension, disseminated lupus erythematosus, atheroma, and diabetes mellitus.

Treatment. The treatment of chronic renal failure is highly complex owing to its impact on systems throughout the body. It involves prevention of imbalances in water and electrolytes whenever possible and correction of these imbalances when they do occur. Therapy may include phosphate binders to prevent absorption of phosphorus from the intestinal tract, antihypertensive agents to control high blood pressure, diuretics to manage hypervolemia, erythropoietin to manage anemia, and cardiac drugs to manage heart failure. Fluids often are restricted to a given amount during each 24-hour period. Dietary restrictions are aimed at minimizing urea toxicity, controlling various metabolic upheavals and providing optimal nutrition. Protein intake is an especially critical factor because the end products of the metabolism of protein and amino acids are excreted for the most part by the kidney.



Symptomatic relief of the many manifestations of end-stage renal disease is a challenge to every member of the health care team. Virtually every system within the body is adversely affected in some way. Pathophysiologic changes involve the gastrointestinal tract, the skin, the cardiovascular system, the lungs, bone, and blood, and the metabolism of glucose and protein.

Hemodialysis or peritoneal dialysis may be employed to rid the body of wastes that the kidney can no longer handle. For some patients transplantation of a human kidney is a viable alternative to continuous dialysis. Others who cannot withstand surgery and long-term immunosuppression are not good candidates for a kidney transplant.

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renal

pertaining to the kidney. See also kidney.

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renal abscess

results from infected emboli and infarcts. Usually without localizing signs unless they are very large and palpable, or when they extend into the renal pelvis and cause pyelonephritis.

renal adenoma

rare, incidental necropsy finding.

renal agenesis

failure of the renal tissue to develop; unilateral agenesis causes compensatory hypertrophy in the single kidney; bilateral is fatal. Commonly accompanies genital tract malformation.

renal artery

see Table 9.

avian renal hemorrhage

sporadic unexplained disease of turkeys; sudden death is common.

renal biopsy

is conducted usually with a biopsy needle introduced percutaneously through the flank. In food animals it is possible to fix the left kidney via a rectal manipulation, but the right kidney can be impossible to reach.

renal calculus

see urolithiasis.

renal capsular cyst

see feline perirenal cysts.

renal carcinoma

commonest in old male dogs. They are very large, spread locally and metastasize widely.

renal casts

see urinary cast.

renal clearance tests

laboratory tests that determine the ability of the kidney to remove certain substances from the blood. See also phenolsulfonphthalein clearance test, inulin clearance.

renal cortical fissures

external fissures created by the lobar structure of the large ruminant kidney.

renal cortical hypoplasia

see renal dysplasia (below).

renal cortical necrosis

results from patchy or complete renal ischemia and is part of the terminal state of many diseases, e.g. severe metritis, grain overload in cattle, azoturia in horses.

renal countercurrent system

see countercurrent.

renal cyst

incidental necropsy finding except for polycystic kidney disease. See also feline perirenal cysts.

renal cystadenoma

inherited as an autosomal dominant trait in middle-aged German shepherd bitches with generalized nodular dermatofibrosis.

renal diabetes insipidus

see nephrogenic diabetes insipidus.

renal dialysis

the application of the principles of dialysis for treatment of renal failure (below). See also hemodialysis and peritoneal dialysis.

renal diverticuli

diverticuli of the renal pelvis.

renal dysfunction

reduced capacity to excrete metabolic products which accumulate systemically and are detectable clinicopathologically by renal function tests. The early stage of uremia.

renal dysplasia

small, misshapen kidneys at birth. May be caused by intrauterine infection of the fetus by virus, but numerous inherited renal dysplasias occur in dogs. They occur in several breeds and are manifested by signs of chronic renal insufficiency, e.g. polyuria, polydypsia, poor growth and weight gain, pale mucous membranes, and renal secondary osteodystrophia fibrosa, from an early age.

renal ectopia

see pelvic kidney, horseshoe kidney.

renal erythropoietic factor

erythropoietin.

renal failure

inability of the kidney to maintain normal function. Impairment of kidney function affects most of the body's systems because of its important role in maintaining fluid balance, regulating the electrochemical composition of body fluids, providing constant protection against acid-base imbalance, and controlling blood pressure. See also kidney.

renal function tests

include blood urea nitrogen and serum creatinine estimations, tests of concentrating ability, tests of ability to excrete test substances, e.g. phenolsulfonphthalein (PSP) clearance test. Of the urine tests, only specific gravity (SG) has any significance in terms of a function test but abnormalities of urine should lead to a function test being conducted.

renal hilus

a fissure on the medial border of the kidney through which arteries, veins and ureter enter.

renal hypophosphatemic rickets

inherited as an X-linked dominant trait in children and mice; characterized by hypophosphatemia and normocalcemia due to failure of phosphate resorption in renal tubules, and skeletal deformities. Called also vitamin-resistant rickets.

renal infarct

results from embolic or thrombotic occlusion of renal arteries or branches. Clinical signs are those of renal colic initially followed by toxemia if the infarct is infected.

renal insufficiency

see renal dysfunction (above).

renal ischemia

a significant cause of renal dysfunction and cortical and medullary necrosis. Is usually part of a general state of shock, dehydration and severe toxemia.

renal lobe

a large mass of a kidney, comprising the tissue contributing to each pyramid; kidneys may be unilobar (unipyramidal), e.g. cats, dogs, small ruminants, horses, or multilobar (multipyramidal), e.g. cattle, pigs.

renal lobule

small masses of kidney tissue comprising a medullary ray and its associated nephrons.

renal medullary necrosis

necrosis of the renal medulla due to restriction of blood flow in medullary vessels, usually due to venous occlusion.

renal medullary washout

see medullary solute washout.

renal mineralization

see nephrocalcinosis.

renal osteodystrophy, renal osteitis fibrosa, renal osteitis fibrosa cystica

see renal secondary hyperparathyroidism.

renal oxalosis

deposition of oxalate crystals in renal tubules of patients poisoned by dietary oxalate, usually in poisonous plants.

renal papillae

see renal papilla.

renal papillary necrosis

necrosis of renal papillae due usually to obstruction to urinary flow or poisoning or dehydration.

renal pelvis

the chamber in the kidney into which the collecting tubules discharge urine and from which urine is voided into the ureter.

renal plasma flow

the effective rate of blood flow through the kidneys; the determining factor relative to the rate of glomerular filtration.

renal portal system

a system unique to birds; half to two thirds of the blood supply to the kidney comes from the hindlimbs via veins and terminates in peritubular capillaries where it is mixed with arteriolar blood coming from the glomeruli.

renal rickets

see renal secondary hyperparathyroidism.

renal shutdown

cessation of the excretory function of the kidney; oliguria.

renal spongiform encephalopathy

spongiform encephalopathy associated with renal failure.

renal tubular casts

see urinary cast.

renal vein thrombosis

commonly associated with renal amyloidosis in dogs.

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renal failure

Nephrology See Acute renal failure, Chronic renal failure, End-stage renal failure, Postpartum renal failure.