Chronic_Kidney_disease

Kidney Function and Disease Types

• Difference Between Acute and Chronic Kidney Injury (AKI & CKD)

  • Acute Kidney Injury (AKI):

    • Reversible condition.

    • Patients can recover kidney function over time.

  • Chronic Kidney Disease (CKD):

    • Progressive and irreversible.

    • Once diagnosed, patients do not regain kidney function.

    • Staged from 1 (mild) to 5 (complete failure).

Manifestations of Chronic Kidney Disease

• Patients show various clinical signs due to decreased kidney function, including:

  • Hyperkalemia: Elevated potassium levels can lead to arrhythmias.

  • Acidosis: Inability to excrete hydrogen ions leads to metabolic acidosis, potentially with lactate accumulation.

  • Respiratory Changes: Kussmaul's respirations (increased rate and depth of breathing) occur in response to acidosis.

  • Bone Health: Low calcium levels can increase fracture risk due to chronic kidney disease.

  • Hypertension: Caused by renin-angiotensin-aldosterone system activation in response to perceived kidney failure.

Considerations for Fluid Management in Kidney Failure

• No universal approach to fluid management in kidney failure patients:

  • Pre-Renal Failure Patients: May require fluids if hypotensive due to volume loss (e.g., trauma).

  • Intra-Renal Failure Patients: Avoid fluids in cases of fluid overload, especially during oliguric phase.

Hypertension and Heart Failure Risks

• Hypertension can manifest in both AKI and CKD, particularly during fluid overload.

• Congestive Heart Failure (CHF): Can exacerbate kidney failure and vice versa, particularly in chronic stages due to fluid overload affecting heart function.

Neuro and Urinary Changes

• Neuro status can be affected, resulting in lethargy to coma and even seizures in severe cases.

• Urine Output: Declines progressively in CKD stages, contrasting with possible diuretic phase in AKI where high output may occur.

• Uremic Symptoms: Buildup of urea may cause a yellowish skin appearance, distinct from jaundice related to liver issues.

Laboratory Values to Monitor

• Creatinine: Normal range: 0.6 - 1.2 mg/dL; expected to be high in kidney disease.

• BUN (Blood Urea Nitrogen): Normal range: 10 - 20 mg/dL; also expected to be high.

• GFR (Glomerular Filtration Rate): Normal is >90; indicates kidney filtering ability. Lower values signify worsening function.

• Electrolytes and Acid-Base Balance: Expect imbalances, particularly acidosis (ABG changes).

• CBC (Complete Blood Count): Hemoglobin and hematocrit typically low in chronic kidney disease due to reduced erythropoietin production.

Nursing Interventions in Kidney Disease

• Dialysis: Required for chronic patients, with either hemodialysis or peritoneal dialysis options.

• Fluid Restrictions: Often necessary for chronic patients, sometimes limited to 1000 mL/day.

• Medications:

  • Sodium Polystyrene Sulfonate (KXylate): Used to treat hyperkalemia by exchanging sodium for potassium.

    • Monitor for diarrhea as a side effect and ensure adequate bowel care.

  • Epoetin Alpha: A synthetic erythropoietin used to treat anemia in CKD patients, necessitating routine monitoring of hematocrit/Hgb and renal function.

Complications of Chronic Kidney Disease

• Pulmonary Edema: Common complication leading to signs of respiratory distress, such as tachycardia and pink frothy sputum. Management includes:

  • High Fowler's position, supplemental oxygen, diuretics (e.g., IV Lasix), and possibly intubation.

• Drug Toxicity Concerns: Non-functioning kidneys could lead to toxic levels of medications. Common nephrotoxic drugs include:

  • Digoxin, Phenytoin, Ibuprofen, ACE inhibitors, Mycin antibiotics.

  • Limit use of magnesium-containing antacids due to potential accumulation.

Nutrition Considerations

• Protein Intake: Requires restriction in chronic kidney disease to prevent further damage, unlike acute cases where protein needs may be greater.

• Vitamin Supplementation: Important to counteract mineral deficiencies due to restricted diets.

• Electrolyte Management: Continuous monitoring and restriction of potassium, sodium, and phosphorus as required.

Peritoneal Dialysis Overview

• Indications: Primarily for chronic kidney disease patients who prefer flexibility and self-management versus traditional hemodialysis.

• Procedure Phases:

  • Fill Phase: Instillation of sterile dialysis fluid into the peritoneal cavity.

  • Dwell Phase: Duration where diffusion and osmosis occur, typically lasting 3-6 hours.

  • Drain Phase: Fluid is drained after the dwell period to remove waste products.

• Monitoring: Key aspects include patient tolerance, intake and output measurement, and vital signs.

  • Complication of Peritonitis: Monitor for symptoms such as cloudy effluent, pain, fever, and potentially stop the procedure if peritonitis is suspected.