10.3 Acute and Chronic Kidney Disease
5 min read•july 24, 2024
Kidney diseases can drastically affect our body's ability to filter waste and maintain balance. (AKI) happens suddenly, while (CKD) develops over time. Both conditions have stages that reflect how well our kidneys are working.
Risk factors like age, diabetes, and high blood pressure can lead to kidney problems. AKI and CKD can cause symptoms like fatigue, swelling, and changes in urine output. Treatment focuses on managing underlying causes, controlling symptoms, and sometimes using or transplantation to replace kidney function.
Understanding Acute Kidney Injury and Chronic Kidney Disease
Definitions of AKI and CKD
Top images from around the web for Definitions of AKI and CKD
Recent developments in the detection and management of acute kidney injury | Archives of Disease ... View original
Is this image relevant?
New ABC Chronic Kidney Disease Classification View original
Is this image relevant?
New ABC Chronic Kidney Disease Classification View original
Is this image relevant?
Recent developments in the detection and management of acute kidney injury | Archives of Disease ... View original
Is this image relevant?
New ABC Chronic Kidney Disease Classification View original
Is this image relevant?
1 of 3
Top images from around the web for Definitions of AKI and CKD
Recent developments in the detection and management of acute kidney injury | Archives of Disease ... View original
Is this image relevant?
New ABC Chronic Kidney Disease Classification View original
Is this image relevant?
New ABC Chronic Kidney Disease Classification View original
Is this image relevant?
Recent developments in the detection and management of acute kidney injury | Archives of Disease ... View original
Is this image relevant?
New ABC Chronic Kidney Disease Classification View original
Is this image relevant?
1 of 3
-
Acute Kidney Injury (AKI)
- Sudden decrease in kidney function occurring over hours to days leads to rapid accumulation of waste products and fluid imbalance
- Stages based on KDIGO criteria reflect severity and guide management:
- Increase in 1.5-1.9 times baseline or 0.3 mg/dL indicates mild kidney dysfunction
- Increase in serum creatinine 2.0-2.9 times baseline suggests moderate impairment
- Increase in serum creatinine 3.0 times baseline or 4.0 mg/dL signifies severe kidney failure
-
Chronic Kidney Disease (CKD)
- Progressive loss of kidney function over months to years results in gradual decline of filtration capacity
- Stages based on (eGFR) indicate disease progression:
- eGFR 90 mL/min/1.73 m² with kidney damage (protein in urine)
- eGFR 60-89 mL/min/1.73 m² with kidney damage shows mild decline 3a. eGFR 45-59 mL/min/1.73 m² indicates mild to moderate reduction 3b. eGFR 30-44 mL/min/1.73 m² suggests moderate to severe decline
- eGFR 15-29 mL/min/1.73 m² represents severe kidney dysfunction
- eGFR < 15 mL/min/1.73 m² signifies kidney failure requiring dialysis or transplant
Risk factors and manifestations
- Risk factors for AKI
- Advanced age increases susceptibility due to reduced renal reserve
- Preexisting kidney disease compromises ability to compensate
- Cardiovascular disease affects renal perfusion (heart failure)
- damages kidney structures over time
- strains renal vasculature and filtration systems
- Causes of AKI
- Prerenal: Decreased renal perfusion reduces blood flow to kidneys
- Hypovolemia (severe dehydration), heart failure, sepsis
- Intrarenal: Direct damage to kidney structures impairs function
- Acute tubular necrosis (toxins), glomerulonephritis (inflammation)
- Postrenal: Urinary tract obstruction blocks urine outflow
- Kidney stones, tumors, enlarged prostate (benign prostatic hyperplasia)
- Prerenal: Decreased renal perfusion reduces blood flow to kidneys
- Clinical manifestations of AKI
- Decreased urine output (oliguria < 400 mL/day or anuria < 100 mL/day)
- Fluid overload and edema (swelling in extremities, pulmonary edema)
- Electrolyte imbalances (, )
- Metabolic acidosis alters pH balance
- symptoms (nausea, fatigue, confusion) due to waste product accumulation
- Risk factors for CKD
- Diabetes mellitus damages kidney structures over time (diabetic nephropathy)
- Hypertension strains renal vasculature leading to damage
- Family history of kidney disease indicates genetic predisposition
- Obesity increases metabolic demands on kidneys
- Smoking damages blood vessels including those in kidneys
- Causes of CKD
- Diabetic nephropathy results from long-term hyperglycemia
- Hypertensive nephrosclerosis damages renal arteries and glomeruli
- Glomerulonephritis involves inflammation of kidney filtering units
- Polycystic kidney disease is an inherited disorder causing cyst formation
- Chronic pyelonephritis leads to scarring from recurrent infections
- Clinical manifestations of CKD
- Fatigue and weakness due to anemia and metabolic disturbances
- Anemia from decreased erythropoietin production
- Bone and mineral disorders (renal osteodystrophy)
- Cardiovascular complications (hypertension, atherosclerosis)
- Uremic symptoms (nausea, pruritus, cognitive changes) as disease progresses
Pathophysiology of kidney diseases
- Pathophysiological changes in AKI
- Decreased (GFR) reduces waste elimination
- Tubular cell injury and dysfunction impair reabsorption and secretion
- Altered renal hemodynamics affect blood flow within kidneys
- Activation of inflammatory mediators contributes to tissue damage
- Cellular apoptosis and necrosis lead to loss of functional kidney tissue
- Pathophysiological changes in CKD progression
- Progressive loss of nephrons reduces overall kidney function
- Glomerular hyperfiltration in remaining nephrons causes further damage
- Renal fibrosis and scarring replace functional tissue with non-functional tissue
- Alterations in mineral metabolism lead to bone disorders
- Secondary hyperparathyroidism develops as compensatory mechanism
- Anemia occurs due to decreased erythropoietin production in kidneys
Management of AKI and CKD
- Nursing management for AKI
- Continuous monitoring of fluid balance and electrolytes prevents complications
- Administration of medications as prescribed (antibiotics, diuretics)
- Prevention of complications (infections, pressure ulcers) through proper care
- Patient education on condition and treatment plan improves outcomes
- Treatment options for AKI
- Addressing underlying cause (treating infection, removing obstruction)
- Fluid and electrolyte management maintains homeostasis
- Medication adjustments prevent further kidney damage
- Renal replacement therapy if necessary (dialysis for severe cases)
- Nursing management for CKD
- Regular assessment of kidney function and comorbidities guides treatment
- Medication management and patient education ensure adherence
- Dietary counseling and support help maintain proper nutrition
- Monitoring for complications allows early intervention
- Treatment options for CKD
- Blood pressure control reduces further kidney damage
- Glycemic control in diabetic patients slows disease progression
- Anemia management improves quality of life (erythropoiesis-stimulating agents)
- Mineral and bone disorder management prevents complications
- Preparation for renal replacement therapy includes education and access planning
- Renal replacement therapy
- Hemodialysis
- Extracorporeal blood filtration removes waste and excess fluid
- Typically 3-4 times per week for 3-4 hours each session
- Peritoneal dialysis
- Uses peritoneum as natural filter for waste removal
- Continuous (CAPD) or intermittent (APD) options available
- Kidney transplantation
- Living or deceased donor provides functioning kidney
- Immunosuppression therapy required to prevent rejection
- Hemodialysis
Psychosocial impact and nursing support
- Psychosocial impact of CKD
- Anxiety and depression often accompany chronic illness
- Changes in body image and self-esteem due to treatment effects
- Financial stress from treatment costs and potential loss of income
- Alterations in family dynamics and roles as disease progresses
- Social isolation may occur due to treatment demands and fatigue
- Role of the nurse in providing support and education
- Assess patient's understanding of the disease and treatment to identify knowledge gaps
- Provide emotional support and encourage coping strategies (relaxation techniques)
- Educate patients and families about:
- Disease progression and management to promote self-care
- Dietary restrictions and medication adherence for optimal outcomes
- Importance of regular follow-ups to monitor disease progression
- Facilitate access to support groups and resources (patient organizations)
- Assist in decision-making regarding treatment options (dialysis modalities)
- Promote self-management skills and patient empowerment for better outcomes
Key Terms to Review (24)
Acute kidney injury: Acute kidney injury (AKI) is a rapid decline in kidney function that occurs over a period of hours to days, leading to the accumulation of waste products in the blood and disruption of fluid and electrolyte balance. It is characterized by an increase in serum creatinine levels and/or a decrease in urine output. Understanding AKI is crucial as it can occur as a result of various factors such as decreased blood flow to the kidneys, direct damage to the kidneys, or obstruction of urine flow, and it can significantly impact overall health and recovery.
Chronic kidney disease: Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney function over time, often leading to kidney failure. This condition can result from various underlying diseases and can progress silently for years before symptoms manifest, making early detection crucial for management and treatment. CKD is associated with significant morbidity and mortality, emphasizing the need for ongoing monitoring and intervention.
Diabetes mellitus: Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to insulin resistance, insufficient insulin production, or both. It can lead to various complications affecting multiple organ systems, including the kidneys, heart, and nervous system, underscoring its significant role in overall health and disease management.
Dialysis: Dialysis is a medical procedure that removes waste products and excess fluid from the blood when the kidneys are unable to function properly. This process is crucial for patients with acute or chronic kidney disease, as it helps maintain a balance of electrolytes and prevents the buildup of harmful substances in the body. Dialysis can be life-saving and can either be done through hemodialysis, which filters blood outside the body, or peritoneal dialysis, which uses the lining of the abdomen to filter blood internally.
Dietary modifications: Dietary modifications refer to changes made to an individual’s diet to address specific health concerns, improve nutritional intake, or manage chronic conditions. These adjustments can include altering the types of foods consumed, modifying portion sizes, and incorporating or eliminating certain nutrients. Such modifications play a vital role in managing health issues related to digestion, liver function, and kidney health.
Estimated glomerular filtration rate: The estimated glomerular filtration rate (eGFR) is a calculated measurement used to assess kidney function by estimating how well the kidneys filter waste from the blood. It is based on serum creatinine levels, age, gender, and race, and serves as a key indicator in diagnosing and managing both acute and chronic kidney disease. Understanding eGFR helps healthcare providers evaluate the severity of kidney impairment and monitor changes over time.
Fluid Restriction: Fluid restriction is a medical guideline that limits the intake of fluids for patients, especially those with conditions like kidney disease, to prevent fluid overload and related complications. This practice is crucial for managing fluid balance, particularly in individuals with acute or chronic kidney disease, as their ability to excrete excess fluid may be impaired, leading to serious health issues such as edema and hypertension.
Glomerular filtration rate: Glomerular filtration rate (GFR) is a test that measures how well the kidneys are filtering blood, specifically the amount of blood that passes through the glomeruli each minute. It is a critical indicator of kidney function and overall health, as it helps in diagnosing and monitoring acute and chronic kidney diseases. A reduced GFR signifies impaired kidney function, which can lead to serious health complications if not addressed promptly.
Hyperkalemia: Hyperkalemia is a medical condition characterized by an elevated level of potassium in the bloodstream, specifically above 5.0 mEq/L. This condition can disrupt the normal electrical activity of the heart and muscles, potentially leading to serious complications. It is closely linked to imbalances in fluid and electrolytes, often seen in various forms of kidney disease, as the kidneys play a crucial role in regulating potassium levels.
Hypertension: Hypertension, commonly known as high blood pressure, is a chronic medical condition characterized by consistently elevated blood pressure levels in the arteries. It can lead to serious health complications, including heart disease and stroke, affecting various body systems and organ functions.
Hyponatremia: Hyponatremia is a medical condition characterized by low sodium levels in the blood, specifically when serum sodium concentration falls below 135 mEq/L. This electrolyte imbalance can lead to various health issues, as sodium is crucial for maintaining fluid balance, nerve function, and muscle contraction. The condition is often connected to changes in fluid volume or distribution within the body, which is critical in understanding both fluid and electrolyte balance as well as kidney function.
Monitoring electrolytes: Monitoring electrolytes refers to the systematic assessment of the levels of key minerals in the body, such as sodium, potassium, calcium, and magnesium, which are crucial for various bodily functions. This process is especially important in understanding kidney function and assessing fluid balance, as the kidneys play a significant role in regulating these electrolytes. In conditions like acute and chronic kidney disease, changes in electrolyte levels can indicate worsening kidney function and influence treatment decisions.
Renal transplant: A renal transplant is a surgical procedure in which a healthy kidney from a donor is placed into a recipient whose kidneys are no longer functioning properly. This procedure is often considered for patients suffering from end-stage renal disease, either due to acute or chronic kidney conditions. The goal of a renal transplant is to restore normal kidney function, improve quality of life, and reduce the need for dialysis.
Serum creatinine: Serum creatinine is a waste product in the blood that is produced from muscle metabolism, specifically from the breakdown of creatine phosphate, which is involved in energy production in muscles. Elevated levels of serum creatinine indicate impaired kidney function, as healthy kidneys filter creatinine out of the blood and excrete it in urine. This makes serum creatinine a crucial marker in evaluating glomerular and tubular disorders as well as both acute and chronic kidney disease.
Stage 1 CKD: Stage 1 Chronic Kidney Disease (CKD) is the initial phase of a progressive decline in kidney function characterized by a glomerular filtration rate (GFR) of 90 mL/min or greater, with no symptoms and normal or mildly abnormal laboratory findings. In this stage, kidney damage may be present due to various factors such as diabetes or hypertension, but the kidneys are still functioning adequately, and patients usually do not experience any noticeable symptoms.
Stage 2 CKD: Stage 2 Chronic Kidney Disease (CKD) is characterized by mild kidney damage with a glomerular filtration rate (GFR) between 60 and 89 mL/min. At this stage, the kidneys are still functioning relatively well, but there is evidence of kidney damage, which can be identified through blood tests, urine tests, or imaging studies. Understanding Stage 2 CKD is crucial because it serves as an early warning sign of declining kidney function and indicates the need for monitoring and lifestyle modifications to prevent further progression.
Stage 3a CKD: Stage 3a chronic kidney disease (CKD) is characterized by a moderate decline in kidney function, with an estimated glomerular filtration rate (eGFR) ranging from 45 to 59 mL/min/1.73 m². This stage indicates that the kidneys are not functioning optimally, leading to potential health complications if not managed effectively. Patients in this stage may begin to experience symptoms and require regular monitoring to slow disease progression and manage risk factors such as hypertension and diabetes.
Stage 3b CKD: Stage 3b chronic kidney disease (CKD) is a classification indicating moderate to severe reduction in kidney function, with an estimated glomerular filtration rate (eGFR) between 30 and 44 mL/min. This stage reflects significant impairment, where kidneys are unable to effectively filter waste and excess fluids from the blood, leading to potential complications that require careful management and monitoring.
Stage 4 CKD: Stage 4 Chronic Kidney Disease (CKD) is a critical phase in the progression of kidney disease where the kidneys are severely impaired, typically with a glomerular filtration rate (GFR) of 15-29 mL/min. At this stage, patients often experience significant symptoms and complications, requiring careful management to delay progression to end-stage renal disease (ESRD) and prepare for potential dialysis or kidney transplant.
Stage 5 CKD: Stage 5 Chronic Kidney Disease (CKD) is the final stage of kidney disease, characterized by a significant decline in kidney function, leading to kidney failure. In this stage, the kidneys are functioning at less than 15% of their normal capacity, resulting in the accumulation of waste products and excess fluid in the body. Patients at this stage often require dialysis or a kidney transplant to survive, as the kidneys can no longer adequately filter blood or maintain fluid and electrolyte balance.
Symptom Recognition: Symptom recognition is the ability to identify and interpret physical or psychological signs that indicate an underlying health issue. This process is crucial in distinguishing between acute and chronic conditions, as well as determining the appropriate course of action for diagnosis and treatment. Recognizing symptoms can lead to timely interventions, improving patient outcomes and reducing complications.
Tubular reabsorption: Tubular reabsorption is the process in which the kidneys reclaim water, electrolytes, and nutrients from the filtrate back into the bloodstream. This crucial function helps maintain fluid and electrolyte balance in the body and prevents the loss of essential substances. In the context of kidney function, tubular reabsorption plays a vital role in regulating blood pressure, maintaining homeostasis, and adapting to the body’s changing needs.
Uremia: Uremia is a clinical syndrome resulting from the accumulation of waste products in the blood due to kidney dysfunction, leading to a variety of systemic effects. This condition is most commonly associated with advanced chronic kidney disease or acute kidney injury, where the kidneys can no longer effectively filter out toxins. Symptoms of uremia can include nausea, fatigue, and confusion, reflecting the serious implications of impaired renal function.
Urinalysis: Urinalysis is a laboratory test that examines the content and properties of urine, providing valuable insights into a person’s health, particularly regarding kidney function and urinary tract conditions. This test can reveal the presence of abnormal substances, such as proteins, glucose, or blood, which may indicate underlying glomerular or tubular disorders as well as acute or chronic kidney diseases. By analyzing urine samples, healthcare providers can assess renal function and diagnose various medical conditions.