For you to be able to understand what happens and how to care for a patient with chronic kidney disease, here are some easy-to-remember study points:
- Anatomy & Physiology: What Is the Normal Function of the Kidneys?
- Definition: What Happens if the Kidney Fails?
- Pathophysiology: What Happens to the Kidneys and the Body of a Person With Chronic Kidney Disease?
- Risk Factors: Who Are at Risk of Developing Chronic Kidney Disease?
- Causes: How Does Chronic Kidney Disease Develop?
- The 5 Stages of Chronic Kidney Disease
- Signs, Symptoms & Diagnostic Tests: How Do You Know if a Patient Has or Is Developing Chronic Kidney Disease?
- Treatment: How Is Chronic Kidney Disease Treated?
- Nurse’s Notes: What Is the Plan of Care for a Patient With Chronic Kidney Disease?
Anatomy & Physiology
What Is the Normal Function of the Kidneys?
The normal function of the kidneys is to filter the waste materials found in the blood in order to pass them out as urine. When you’re studying for the NCLEX, here are the seven functions of the kidneys you should remember, take note of the acronym A WET BED.
- A: ACID-BASE balance control
- W: WATER balance control
- E: maintaining ELECTROLYTE balance
- T: removal of TOXINS and waste materials in the body
- B: BLOOD PRESSURE regulation
- E: production of ERYTHROPOIETIN hormone
- D: Vitamin D activation
Definition
What Happens if the Kidney Fails?
If the kidney fails, it can’t filter the blood and excrete the wastes properly out of the body. In Chronic kidney disease (or Chronic renal failure) there is a gradual loss of kidney function. The damage in the kidneys is “chronic” because it happens slowly over a long period of time. Chronic kidney disease may lead to other health problems and life-threatening complications.
Pathophysiology
What Happens to the Kidneys and the Body of a Person With Chronic Kidney Disease?
In a person with chronic kidney disease, the filtering structure called Glomerulus cannot filter normally. As a result, the Glomerular Filtration Rate (GFR) is decreased. The normal GFR rate should be 90 mL/min or higher.
Risk Factors & Causes
Who Are at Risk of Developing Chronic Kidney Disease?
The persons who are at risk of developing chronic kidney disease are:
- 60 years old and above
- Smokers
- Obese people
- Those with family history of kidney disease
- Race: Native American, Asian-American, African-American
- Other conditions: Polycystic kidney disease, Glomerulonephritis, Acute kidney injury, lupus, kidney cancer
- Existing high blood pressure, diabetes, cardiovascular disease
The 5 Stages of Chronic Kidney Disease
There are 5 stages of chronic kidney disease and to easily understand the points for your NCLEX review, here’s what you should remember:
| Stage | GFR | Description | Intervention |
| 1 | 90+ | Normal renal function but with kidney damage | Control of blood pressure |
| 2 | 60-89 | Mild loss of kidney function | Control of blood pressure |
| 3 | 30-59 | Mild to severe loss of kidney function | Control of blood pressure |
| 4 | 15-29 | Severe loss of kidney function | Plan for end-stage renal failure |
| 5 | below 15 | End-stage kidney disease | Treatment choices |
Signs, Symptoms & Diagnostic Tests
How Do You Know if a Patient Has or Is Developing Chronic Kidney Disease?
As a nurse, you should be able to detect if the patient has or is developing Chronic kidney disease. Early detection is the key to the prevention of chronic kidney disease. Here are the signs and symptoms of chronic kidney disease and the diagnostic tests that can confirm its presence.
- anemia
- blood in urine
- dark urine
- decreased urine output
- edema
- fatigue
- hypertension
- insomnia
- persistent itchy skin
- loss of appetite
- Erectile dysfunction
- frequent urination
- muscle cramps
- muscle twitches
- nausea
- lower back pain
- panting
- protein in urine
- unexplained headache
Diagnostic Tests:
- Blood Test: To test creatinine levels in the blood.
- Urine Test: To check for albumin and creatinine levels.
- Ultrasound, MRI, CT Scan, a Kidney biopsy
Treatment: How Is Chronic Kidney Disease Treated?
Unfortunately, there is no known cure for chronic kidney disease. The treatment plan for patients with CKD is to relieve the symptoms and prevent it from getting worse. The treatment will depend on the symptoms and the stage of CKD. The doctor will usually advise some of this management:
- Lifestyle changes: Healthy diet and exercise.
- Medicines: To control the blood pressure and high cholesterol levels
- Dialysis: This is usually recommended for End-stage kidney disease.
- Kidney Transplant: This is usually recommended for End-stage kidney disease.
Nurse’s Notes: What Is the Plan of Care for a Patient With Chronic Kidney Disease?
As a nurse, you should remember that the patient is experiencing uremia, waste build-up, metabolic acidosis, electrolyte imbalances, anemia, decreased urinary output, and fluid overload. As for the nursing interventions, here’s what you should remember depending on the symptom:
- Confusion: Ensure the patient’s safety and assess neuro status.
- Itching Skin: Low protein diet because the patient already has uremia.
- Kussmaul Breathing: Assess for deep or rapid breathing, this may be a compensatory mechanism that indicates the presence of metabolic acidosis.
- Anemia: Drink vitamins and minerals as advised (iron, folic acid, and vitamin B12)
- Hyperkalemia (normal level 3.5 – 5.1 mEq/L): Restrict potassium-rich foods, monitor EKF, monitor potassium levels. Expect doctor’s order of oral or rectal Kayexalate.
- Hyperphosphatemia (normal level 2.7-4.5 mg/dL) and Hypocalcemia (normal level 8.6-10 mg/dL): Expect doctor’s order to administer calcium carbonate to decrease phosphate levels given with meals. Low phosphate diet (e.g. fish, poultry, nuts, dairy, soda, and oatmeal). Ensure safety as the patient may have weak bones.
- Hypermagnesemia (normal 1.6-2.6 mg/dL): Monitor EKG, magnesium levels, diminished or absent tendon reflexes, and lethargy. Avoid administering laxatives or magnesium-based antacids. Low magnesium diet.
- Diet: Remember that all electrolyte levels may increase in CKD, so the diet will be low sodium, low potassium, low phosphate, low magnesium, and low protein.
- Other Nursing Intervetniosn: Monitor patient’s intake and output (strict monitoring), monitor daily weight, assess lung sounds for crackles, monitor blood pressure.
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