NRSG 326 Week 3 - CKD

How does a history of hypertension contribute to CKD?

Puts more pressure on the glomerulus

How does a history of NIDDM contribute to CKD?

Causes high blood sugar and inflammation, which causes accumulation of sugars in the nephron, as well as inflammation. This leads to damage

Top 3 signs of kidney disease

Elevated BUN, elevated creatinine, decreased GFR/eGFR

Stage 1 kidney disease

Kidney damage with normal function

GFR > 90

% function = 90-100

Stage 2 kidney disease

Kidney damage with mild loss of function

GFR = 89-60

% function = 89-60

Stage 3a kidney disease

Mild to moderate loss of kidney function

GFR = 59-45

% function = 59-45

Stage 3b kidney disease

Moderate to severe loss of kidney function

GFR = 44-30

% function = 44-30

Stage 4 kidney disease

Severe loss of kidney function

GFR = 29-15

% function = 29-15

Stage 5 kidney disease

Kidney failure

GFR < 15

% function < 15

Albumin-creatinine ratio (ACR)

Marker of vascular endothelial dysfunction, prognostic marker for CKD in conjunction with eGFR

albumin (mg)/creatinine (mmol)

What ACR level is clinical significant

3-30 mg/mmol

> 2mg/mmol in pts with DM

Who should be screened for CKD

Those with hypertension, DM, family hx of stage 5 CKD or hereditary kidney disease, hx of vascular disease (CVD, stroke, TIA, PVD), hx of multi-system diseases with potential kidney involvement (lupus, HIV etc)

4 interventions that reduce CKD progression

Maintain BP < 140/90

Use of ACEIs or ARBS

Manage DM

Correct metabolic acidosis

Treatment options for advanced CKD

Peritoneal dialysis, (PD), hemodialysis, RRT, cycler, continuous ambulatory PD (CAPD)

S/S of metabolic complications of CKD

Kussmaul's, fatigue, weakness, changes in LOC, loss in muscle mass, increased calcium + decreased phosphate, heart disease, high BP

Why do metabolic changes occur due to CKD

Compensation for metabolic acidosis, fluid and electrolyte imbalances, anemia, muscle loss and bone deterioration

Tx for metabolic changes d/t CKD

Alkali therapy (bone loss), kayexalate, insulin + glucose concurrently, B-agonists, dialysis, increased in fruit/veg intake, IV EPO, iron supplementation, PT, electrolyte supplementation

Hematological complications d/t CKD

Anemia, platelet dysfunction

CVS complications d/t CKD

HTN, fluid overload, fluid excess, HF, arrhythmias, edema

Why do CVS complications occur with CKD

Increased fluid volume due to decreased urination puts pressure on vascular system, heart has to work harder so it leads to failure, arrhythmias d/t increased potassium

Tx for CVS complications d/t CKD

ACEIs, CCBs, diuretics (potassium-wasting), dialysis, dietary changes, daily weights and i/o tracking

S/S of respiratory complications d/t CKD

Increased WOB, increased RR, low O2 sat, Kussmauls, uremic pneumonitis, dyspnea, pulmonary edema

Why do respiratory complications occur d/t CKD

Fluid overload, metabolic acidosis compensation, uremia

Tx of respiratory complications d/t CKD

O2 therapy, treat fluid overload, reposition pt, monitor BG, oral alkali, dialysis

S/S of GI complications d/t CKD

Inflammation of mucosa, stomatitis, metallic taste, anorexia, NV, weight loss, malnutrition, dyspepsia

Why do GI complications occur d/t CKD

Uremia causing inflammation, build-up of toxins affects tastebuds, metabolic acidosis can affect appetite and cause anorexia, accumulation of wastes affects GI

Tx of GI complications d/t CKD

Topical tx in oral cavity, promote good oral hygiene, adjust medications, encourage supplements, use various spices etc for flavour changes, prescribe appetite stimulants, correct electrolyte imbalances, admin antiemetics, personalize meal plans, low protein diet

S/S of neurological complications d/t CKD

Cognitive and motor abnormalities, dementia, depression, mood and sleep disturbances

Why do neurological complications occur d/t CKD

Renal failure causes oxidative stress, which affects the hippocampus and frontal cortex

Accumulation of nitrogenous wastes changes cognitive status

Kidney disease causes nerve damage, which results in sensory and motor abnormalities

Tx of neurological complications d/t CKD

Antidepressants, anti-seizure medications (gabapentin), encourage proper sleep habits, dialysis

S/S of MSKL complications d/t CKD

Impaired function, swelling, redness, numbness, tingling, fatigue, muscle twitches

Why do MSKL complications occur d/t CKD

Kidneys are responsible for maintaining correct levels of phosphorus, calcium, parathyroid hormone and calcitriol. When out of balance, bones are used as resources to pull from, causing structural changes and wasting

Accumulation of nitrogenous wastes cause damage

Protein balance is shifted in the body, causing atrophy

Tx of MSKL complications d/t CKD

Treat edema via stockings/diuretics, decrease fluid intake, dialysis, PT, gabapentin for spasms, vitamin D, calcium supplements, calcium carbonate to bind phosphate in GI tract and remove it

S/S of GU and reproductive complications d/t CKD

Kidney damage, infertility

Why do GU complications occur d/t CKD

Impairment of follicle and low LH and FSH, leading to low estrogen and loss of ovulation in females

Testicular damage and decreased % of motile sperm, build up of uremic cellulites in males

Tx of GU complications d/t CKD

Education on IVF

Dialysis

Kidney transplants (men only, drugs taken after cause infertility in women)

S/S of integumentary changes d/t CKD

Dry skin, pruritus, infection, delayed wound healing, alopecia, rashes

Why do INT complications occur d/t CKD

Kidneys cannot remove wastes, so the accumulation causes dry and itchy skin, can lead to uremic frost, poor wound healing d/t impaired nutrient delivery and metabolic imbalances, inflammation of hair follicles leads to hair loss

Tx of INT complications d/t CKD

Moisturizers, humidifiers, nutritional support, UV therapy, good hygiene and skin care