Types of Renal Failure: A Comprehensive Nursing Guide

Understanding renal failure is crucial for nursing students, as kidney dysfunction affects multiple body systems. This guide breaks down the types of renal failure, their causes, pathophysiology, and nursing considerations in a lecture-style format.

types of acute renal failure with two kidneys holding a help sign

Table of Contents

  1. Introduction
  2. Acute Renal Failure (ARF/AKI)
    • Definition
    • Causes
    • Nursing Goals
  3. Chronic Renal Insufficiency (CRI)
    • Definition
    • Causes
    • Nursing Goals
  4. End-Stage Renal Disease (ESRD)
    • Definition
    • Causes
    • Nursing Goals
  5. Pre-Renal, Intra-Renal, Post-Renal: Detailed Breakdown
  6. Nursing Assessment & Interventions
  7. Quick Reference Table
  8. FAQ
  9. Summary & Study Tips

1. Introduction

Renal failure occurs when the kidneys lose the ability to filter waste and maintain fluid, electrolyte, and acid-base balance. It is classified into acute, chronic, and end-stage renal failure. Understanding these distinctions helps nurses prioritize care, recognize early signs, and manage treatment effectively.

2. Acute Renal Failure (ARF/AKI)

Definition:
Acute renal failure, also known as acute kidney injury (AKI), occurs when the kidneys suddenly lose function after a previously normal state. It often develops rapidly and may be reversible if detected early.

Causes:

  • Pre-Renal: Decreased renal perfusion from inadequate circulation (e.g., hypovolemia, shock, heart failure)
  • Intra-Renal: Direct damage to kidney tissues, usually the tubules (e.g., nephrotoxic drugs, rhabdomyolysis, infections, chemotherapy)
  • Post-Renal: Obstruction preventing urine excretion (e.g., kidney stones, BPH, urethral strictures)

Nursing Goals:

  • Identify and treat the underlying cause
  • Prevent further kidney damage
  • Initiate temporary renal replacement therapy if needed (e.g., dialysis)

Remember: Early detection can prevent progression to chronic kidney disease.

3. Chronic Renal Insufficiency (CRI)

Definition:
Chronic renal insufficiency is a long-term, gradual loss of kidney function. Patients may maintain adequate kidney function (e.g., creatinine levels 1–3 mg/dL) but are at risk for further deterioration.

Causes:

  • Diabetes mellitus
  • Hypertension
  • Chronic glomerulonephritis
  • Polycystic kidney disease

Nursing Goals:

  • Avoid further kidney insults
  • Adjust nephrotoxic medications
  • Protect kidneys during procedures (e.g., NaHCO3 and Mucomyst prophylaxis before CT contrast, IV fluids before and after contrast)
  • Monitor labs and educate patients on lifestyle modifications

4. End-Stage Renal Disease (ESRD)

Definition:
End-stage renal disease occurs when kidney function is no longer sufficient to sustain life without intervention.

Causes:

  • Progression of chronic kidney disease
  • Long-standing diabetes or hypertension
  • Chronic glomerular or tubular disease

Nursing Goals:

  • Implement permanent renal replacement therapy (hemodialysis, peritoneal dialysis, or kidney transplant)
  • Monitor fluid and dietary restrictions
  • Adjust medications for renal clearance
  • Educate patients on lifestyle modifications and dialysis schedules

5. Pre-Renal, Intra-Renal, Post-Renal: Detailed Breakdown

Pre-Renal

  • Mechanism: Decreased blood flow to kidneys reduces glomerular filtration rate (GFR) without damaging renal tissue.
  • Causes: Hypovolemia, decreased cardiac output, NSAIDs, ACE inhibitors, renal artery stenosis.
  • Nursing Tip: Monitor vital signs, maintain perfusion, avoid nephrotoxins.

Intra-Renal

  • Mechanism: Direct damage to kidney structures (tubules, glomeruli).
  • Causes: Nephrotoxic drugs, rhabdomyolysis, infections, chemotherapy.
  • Nursing Tip: Identify nephrotoxins, provide fluids as appropriate, monitor labs closely.

Post-Renal

  • Mechanism: Obstruction prevents urine from leaving the kidney.
  • Causes: Kidney stones, benign prostatic hyperplasia (BPH), urethral strictures.
  • Nursing Tip: Assess for urinary retention, bladder distention, flank pain; facilitate removal of obstruction.

6. Nursing Assessment & Interventions

Key Assessments:

Interventions:

  • Maintain hydration and perfusion
  • Monitor labs and adjust medications
  • Prepare for dialysis if indicated
  • Educate patients on diet, fluid restrictions, and medication adherence

NCLEX Tip: Remember “Pre, Intra, Post – PIP” to quickly classify renal failure causes.

7. Quick Reference Table

TypeDefinitionCommon CausesNursing Goals
Acute (ARF/AKI)Sudden loss of kidney functionPre-renal: hypovolemia, low CO; Intra-renal: nephrotoxins; Post-renal: obstructionTreat cause, prevent damage, temporary dialysis if needed
Chronic (CKD/CRI)Gradual, sustained loss of functionDiabetes, hypertension, CKD progressionAvoid insults, adjust meds, protect kidneys during procedures
End-Stage (ESRD)Kidney function insufficient to sustain lifeProgression of CKD, chronic diseasesPermanent dialysis/transplant, lifestyle modifications, med adjustments

8. FAQ

Q1: Can acute renal failure become chronic?
Yes. If underlying causes persist or kidney damage is severe, AKI can progress to chronic kidney disease.

Q2: What lab values are important to monitor?
Creatinine, BUN, GFR, electrolytes (K+, Na+, Ca2+), urine output.

Q3: What’s the difference between intra-renal and pre-renal failure?
Pre-renal: caused by decreased blood flow (functional change).
Intra-renal: caused by direct kidney tissue damage.

Q4: Can ESRD patients live without dialysis?
No. Without renal replacement therapy (dialysis or transplant), ESRD is fatal.

Q5: What nursing interventions are universal for all types?
Monitor labs, fluid status, vital signs; avoid nephrotoxins; patient education; assess for complications.

9. Summary & Study Tips

  • Remember PIP: Pre-Renal, Intra-Renal, Post-Renal
  • Acute vs Chronic vs ESRD: Quick timeline reference helps classify type
  • Nursing priorities: Maintain perfusion, prevent injury, educate patient, monitor labs
  • Use tables and mnemonics for exam prep
  • Keep a daily log for fluid balance and urine output for real-world practice

Quick Tip: Visualizing kidney failure as a “traffic system” helps: Pre-renal = low traffic into the kidney, Intra-renal = damage in the middle of the road, Post-renal = blockage at the exit.

Conclusion:
Understanding types of renal failure and their nursing management is essential for patient safety and exam success. Use this guide as a lecture-style reference to connect pathophysiology with nursing care.


Bookmark this guide for quick NCLEX review and daily clinical rotations. Share with classmates to strengthen your renal system knowledge!

Test your knowledge:

Renal Quiz

Renal Quiz for Nursing Students

Know the kidneys. Protect the balance.

This Renal Quiz is designed to help nursing students apply foundational renal physiology and pathophysiology concepts to real-life clinical scenarios. From fluid and electrolyte balance to acid-base regulation and kidney disorders, this quiz features NCLEX-style questions that challenge your critical thinking and strengthen your exam readiness.

This quiz is perfect for:

  • Reviewing renal system anatomy and function
  • Practicing NCLEX-style application questions
  • Preparing for nursing school exams
  • Building confidence in managing fluid, electrolyte, and acid-base imbalances

Master the renal system and get one step closer to confident, competent clinical care.

1 / 18

You are caring for a 56-year-old patient with a history of hypertension who was admitted
for an acute kidney injury (AKI) secondary to dehydration. When evaluating the morning
lab results, which of the following would be most indicative of an AKI:

2 / 18

You are the nurse caring for a patient with a history of newly diagnosed end stage renal
disease (ESRD). The patient is complaining about pruritis and is asking why this is
happening. The nurse understands that:

3 / 18

The nurse is caring for a patient who takes Lisinopril for hypertension. The nurse knows
to monitor for what electrolyte disturbance while the patient is taking this medication:

4 / 18

The nurse is caring for a patient who was found to have an acute kidney injury (AKI) on
admission. The patient normally takes lisinopril at home for high blood pressure,
however the medication has been held by the provider. The patient asks the nurse why
the medication has been held. As the nurse, you understand the reason for this is:

5 / 18

You are the nurse caring for a patient recently admitted to the intensive care unit for
septic shock requiring vasopressors. The patients current weight is 100kg and their urine
output has been 40mL/hr for the last three hours. What statement is true about this urine
output:

6 / 18

You are the nurse caring for a patient newly admitted to the intensive care unit who is
being treated for septic shock and requiring vasopressors. During rounds, the provider
tells you to let them know if the patient begins experiencing decreased urine output. As
the nurse, you know that the minimum normal urine output is:

7 / 18

You are the nurse caring for a patient with end stage renal disease (ESRD) receiving
dialysis. The patient has a fistula on their right arm for dialysis access. As the nurse, you
know which of the following interventions is contraindicated on the right arm, select all
that apply:

8 / 18

You are caring for a patient who was found to have an acute kidney injury (AKI) on
admission. The patient asks, “How will you know if my kidneys are getting better?” As
the nurse, you know which of the following is the most accurate lab for monitoring renal
function:

9 / 18

The nurse is caring for a patient with chronic kidney disease stage 3 who is to receive
iodinated contrast for a computed-tomography (CT) scan tomorrow. In preparation for
this, the provider puts in a communication to avoid nephrotoxic medications 24 hours
prior to the scan. The nurse understands that which of the following medications is safe
to give to this patient:

10 / 18

You are caring for a patient recently admitted for nephrolithiasis. The patient asks why
he is receiving all of this intravenous (IV) fluid. Which of the following is the best
response from the nurse.

11 / 18

You are assessing a patient with a newly created arteriovenous (AV) fistula. As the
nurse, you know which of the following assessment findings is normal for a functioning
fistula.

12 / 18

Your patient with end-stage renal disease (ESRD) is prescribed PhosLo, a phosphate
binder medication. Which of the following statements from the patient shows an
understanding of how to properly take the medication.

13 / 18

You are caring for a patient who receives peritoneal dialysis for their end-stage renal
disease (ESRD). The nurse understands that what finding would prompt evaluation by
the provider.

14 / 18

You are caring for a patient with newly diagnosed end-stage renal disease (ESRD) who
is getting ready for discharge. What statement by the patient indicates the need for
further teaching by the nurse?

15 / 18

You are caring for a 37-year-old patient with history of chronic kidney disease (CKD) and
Type 2 Diabetes Mellitus. The patient is prescribed lisinopril for management of
hypertension. The nurse knows that this class of medications provides what other benefit
for this patient given their comorbidities?

16 / 18

The nurse is caring for a patient with end-stage renal disease (ESRD) requiring dialysis.
The patient states they have not been to dialysis in over a week due to not feeling well.
The nurse knows that which of the following can result from missed dialysis
appointments in these patients. Select all that apply:

17 / 18

The nurse is caring for a patient with a history of end-stage renal disease (ESRD). The
patient is prescribed Erythropoietin, an erythropoiesis-stimulating agent. The nurse
knows that the expected therapeutic response from this medication is:

18 / 18

You are taking care of a patient diagnosed with nephrotic syndrome. What is the
hallmark characteristic of this condition?

Your score is

The average score is 83%

0%

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