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MED SURG: Chronic Kidney Disease

Terms in this set (38)

chronic kidney disease (CKD)
-involves a progressive, irreversible destruction of the kidneys' nephrons
-stages of CKD are based upon kidney function and GFR
-symptoms appear when 80% of nephron function is lost
-dialysis is required when 90% of nephron function is lost (we are born with 2 million nephrons)
*less intense than AKI but not reversible and more common*
stage 1 of CKD
GFR greater than 90
diagnosis and treatment; CVD risk reduction; slow progression
**watch weight and BP!
stage 2 of CKD
GFR 60-89
estimation of progression
stage 3a of CKD
GFR 45-59
evaluation and treatment of complications
when you begin to notice symptoms
stage 3b of CKD
GFR 30-44
more aggressive treatment of complications
when you begin to notice symptoms
stage 4 of CKD
GFR 15-29
preparation for RRT (dialysis or transplant)
stage 5 of CKD
GFR less than 15 or dialysis
RRT if uremia present and patient desires treatment; necessary to maintain life
End Stage Renal Disease (ESRD)
-final stage of kidney failure
-excessive accumulation of waste products, unable to maintain homeostasis
-will need dialysis or transplant to prevent death
-occurs when GFR is less than 15
leading cause of ESRD
diabetes and hypertension
nephrotic syndrome
-when an individual living with CKD is showing symptoms of kidney failure
nephrotic syndrome s/s
-proteinuria
-hypoalbuminemia
-elevated cholesterol and lipids
-edema (especially is hands, feet and ankles)
urinary manifestations
progression from POLYURIA to OLIGURIA to ANURIA
-depending upon the cause of kidney disease, protein, casts, blood and WBCs may be found in urine
-risk for UTI due to decrease in urine flow that removes bacteria from urinary tract
metabolic manifestations
-BUN and serum creatinine increase
-BUN affected by protein intake, steroids, fever and catabolism
-insulin resistance before starting dialysis
-increase in triglycerides from insulin impairment, leads to hyperlipidemia
best indicator of renal function
serum creatinine and creatinine clearance
*because BUN is affected by protein intake, steroids, fever and catabolism*
creatinine clearance test
Measures the rate at which creatinine is cleared from the blood by the kidney
decrease in renal function =
increase in creatinine in blood
electrolyte and acid base imbalances
hyperkalemia
normal or low sodium
hypocalcemia (d/t dilution)
hyperphophatemia
hypermagnesemia
metabolic acidosis
metabolic acidosis
-decreased pH in blood and body tissues as a result of an upset in metabolism
-kidneys are not able to excrete accumulating acids
-HCO3 (buffer) production is impaired
s/s of hyperkalemia
-cramping leg pain!!
-disturbed cardiac conduction
-peaked T wave on EKG due to rapid repolarization and shortened QT interval
-abdominal cramping and diarrhea
-muscle weakness
-cardiac arrest
hematologic manifestations
-anemia (related to decreased erythropoietin production)
-risk for bleeding due to the platelet dysfunction
-risk for infection due to leukocyte dysfunction and impaired immune system
*give erythropoietin, do not transfuse!*
cardiovascular manifestations
-hypertension
-left ventricular hypertrophy and heart failure (peripheral and pulmonary edema)
-accelerated atherosclerosis
-cardiac arrhythmia (peaked T wave on EKG)
-risk for pericarditis (friction rub, chest pain and low grade fever)
best meds to protect kidney
ACEs and ARBs
respiratory manifestations
-dyspnea
-Kussmaul respirations (bc of fluid on lungs and increases CO2 excretions)
-pulmonary edema
-pleural effusion on CXR
-risk for pulmonary infections
-foul smelling breath
GI manifestations
-n/v
-anorexia
-uremic fetor
-stomatitis
-weight loss
-risk for GI bleeding
-constipation or diarrhea
uremic fetor
smell of urine on the breath
neurological manifestations
-depression of the CNS (lethargy, apathy, decrease in concentration, irritability and fatigue)
-restless legs
-muscle twitching and asterixis
-seizures and coma with severe uremia
-dialysis dementia: uncommon
musculoskeletal manifestations
-renal osteodystrophy (risk for pathologic fracture)
-decreased Bit D activation, hypocalcemia
-decreased phosphate excretion
-hyperparathyroidism
-calcium deposition in blood vessels, joints, lungs, heart and eyes
integumentary manifestations
-yellow-gray skin discoloration
-pallor (no RBCs!)
-dry, scaly skin
-pruritus
-dry, brittle hair
-petechiae and ecchymoses (no platelets)
-uremic frost: rare
reproductive manifestations
-infertility
-decreased libido
-changes in menses
-decreased hormone production
-impotence from peripheral neuropathies and medications
psychological manifestations
-depression is common
-change in personality and behavior
-altered body image
-grieving for loss of kidney function, change in lifestyle and family responsibilities and altered financial status
diagnostic studies for CKD
-lab studies (electrolytes, BUN, creatinine, CBC)
-urinalysis
-24 hour creatinine clearance
-radiologic studies
-renal biopsy
goal for CKD
preserve remaining renal function, treat symptoms, prevent complications and maintain comfort
-manage hyperkalemia, HTN, anemia and calcium-phosphate imbalance
-eliminate nephrotoxin exposure (avoid NSAIDS and contrast dye)
low calcium=
high phosphate
6 D's of managing kidney failure
Diet
Drugs
Dialysis
Donor/transplanted kidney
Discussions
Dying with dignity
renal diet
-fluid and protein restriction
-potassium restriction
-sodium restriction
-phosphate restriction
-calcium, iron and folic acid supplements
-NO MEAT, NO DAIRY
pharmacologic therapy
-oral iron=black stools
-erythropoietic
-iron supplement (*IV or PO)
-phosphate binders (take prior or at meal)
-Vit D supplement
-calcium supplement
-anti-hypertensives
-folic acids and vitamins
-statins and folates
treating hyperkalemia
-binds with potassiums and best to poop it out
-restriction of potassium intake and meds that increase potassium levels
-polystyrene sulfonate (kayexalate) orally or as an enema, can cause diarrhea
-immediate treatment: IV glucose and insulin to shift K into the cells
-sodium bicarbonate to correct acidosis
-IV calcium gluconate for cardiac irritability
-dialysis
drug therapy cautions
-drug toxicity can be problematic if the drug is excreted by the kidney
-base drug doses on kidney function and levels when possible
-drugs of great concern: digitalis, antibiotics, contrast dye and pain meds like Aleve and Motrin
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