Nephrology Lecture: Kidney Disease Seminar

Nephrology Lecture: Acute and Chronic Illness Theory

• Objectives:
  • Describe pathophysiology, manifestations, and lab abnormalities of chronic and end-stage kidney disease.
  • Explain nursing assessments needed for patients with chronic and end-stage kidney disease.
  • Develop understanding of renal replacement therapies and how they work.
  • Discuss important assessments and ongoing monitoring for patients with renal disease undergoing dialysis and what to report.
  • Explain care necessary to promote health and prevent illness in patients with renal disease.

Terms to Consider

• Creatinine:
  • Breakdown product of creatinine phosphate in muscle.
  • Filtered by the kidney.
  • Used to estimate kidney function.
  • Higher creatinine = lower filtration (GFR).
• BUN (Blood Urea Nitrogen):
  • Urea formed from protein breakdown by the liver.
  • Filtered by the kidney and used to measure function.
  • High BUN reflects low filtration.
  • Some medications (steroids, antibiotics) can cause BUN to rise without affecting kidney function.
• Oliguria: 400-500 ml of urine in 24 hours.
• Anuria: < 100 ml of urine in 24 hours.

Acute Kidney Injury (AKI)

• AKI is a sudden episode of kidney failure or damage within a few hours or days.
• Causes build-up of waste products in the blood, difficult for kidneys to keep the right fluid balance in the body.
• Approximately 5-7% of hospitalized and critically ill patients develop AKI (often due to medication).

Risk Factors for AKI

• Advanced age
• Diabetes
• Hypotension
• Cardiovascular disease (CAD)

Causes of AKI

• Infection/sepsis
• Low cardiac output (kidneys receive 25% of total CO)
• Reduced blood flow to renal tubules
• Nephrotoxic drugs (aminoglycoside antibiotics, contrast dyes, ethylene glycol, diuretics, NSAIDs)

AKI Types and Phases

• AKI has 3 types (pre-renal, renal, post-renal) and 4 phases (onset, oliguric, diuretic, recovery). Specific details from the provided text.

Chronic Kidney Disease (CKD)

• Defined as abnormalities of kidney function or structure present for more than 3 months, with health implications.
• Includes people with markers of kidney damage and those with a glomerular filtration rate (GFR) of less than 60 ml/min/1.73 m² on at least 2 occasions separated by 90 days (with or without markers of kidney damage).
• Progressive, irreversible loss of kidney function.
• Nephron loss leads to decreased GFR and waste product accumulation in blood (azotemia).
• Common causes of renal failure: diabetes mellitus, hypertension.

GFR Categories (Glomerular Filtration Rate)

• This table provides categories of GFR levels and their corresponding descriptions in relation to levels relative to other adults:

Chronic Kidney Disease (CKD) Manifestations

• The text provides a comprehensive list of manifestations across various body systems (integumentary, cardiovascular, respiratory, renal, gastrointestinal, neurological, musculoskeletal & Hematological).

Nursing Assessments For Various Systems

• The text provides specific assessment strategies for each system affected by CKD These assessments vary based on the specific system and include inspection, palpation, auscultation, and laboratory monitoring for parameters such as blood pressure, heart rate, respiratory rate, and renal function tests.

Renal Replacement Therapies

• Used when kidneys can no longer function adequately (GFR < 15 mL/min).

• Peritoneal dialysis: Uses the abdominal peritoneum as a membrane to filter fluids. The dialysis fluid (dialysate) is introduced into the abdominal cavity. Fluid moves via osmosis and solutes move through diffusion to filter waste from the blood.

• Hemodialysis: Employs a dialysis machine to clean the blood. Approximately 2 liters of fluid is removed during each hemodialysis treatment. Venous access is required, such as an arteriovenous fistula (AVF).

• The document includes information on AVF creation, maturation, and care considerations. Includes assessment details.

Additional Topics

• Frequency of Treatment: Hemodialysis schedule and frequency (example: 3 times a week).
• Assessment and Care After Hemodialysis: Various assessments (e.g., dry weight, volume status, blood pressure, electrolytes, anemia, malnutrition, infections, medications, and diet). Specific details of dry weight determination and its significance.
• Acid-base and Electrolyte Imbalances: Pre and post dialysis; imbalances associated with CKD. Detailed descriptions from both pre and post-dialysis; explanation of assessments for such issues.
• Mineral and Bone Disorder (MBD): Includes the loss of calcium vitamin D, High phosphorus and parathyroid hormone.
• Anemia: Involves erythropoietin synthesis, RBC production, and clinical manifestations from decreased red blood cell production in the bone marrow.
• Infections: The increased susceptibility and potential complications of chronic wounds and infection.
• Renal Management: Dietary restrictions, medication management, and blood pressure control. Detailed guidance on medications and their use.
• Fluid Restrictions: The fluid allowances calculated using urine levels for dialysis patients; important considerations during treatment. Important information about fluid restriction needs.

This quiz covers key concepts in nephrology, focusing on acute and chronic kidney disease. Participants will explore the pathophysiology, nursing assessments, and renal replacement therapies, as well as important monitoring practices for renal patients. Test your knowledge of lab abnormalities and health promotion strategies in renal care.