Acute and Chronic Kidney Disease Nursing Notes
Acute Kidney Disease (AKI):
- Sudden decline in renal function (hours to days).
- Categories:
* Prerenal (decreased perfusion: shock, dehydration, hemorrhage)
* Intrarenal (damage to kidney tissue: nephrotoxic drugs, acute tubular necrosis)
* Postrenal (obstruction: stones, tumors, prostate enlargement)
- Clinical Features: decreased urine output, azotemia, edema, hyperkalemia, metabolic acidosis.
Phases of AKI:
1. Initiating phase – onset of kidney injury
2. Oliguric phase – urine output <400 mL/day, fluid overload, hyperkalemia
3. Diuretic phase – gradual increase in urine output, risk for dehydration and electrolyte imbalance
4. Recovery phase – kidney function improves, but may not return to baseline.
Chronic Kidney Disease (CKD):
- Irreversible, progressive decline in kidney function (>3 months duration).
- Stages: based on GFR (from mild impairment to ESRD).
- Common Causes: diabetes, hypertension, chronic glomerulonephritis, polycystic kidney disease.
- Manifestations: anemia, bone disease, uremic frost, pruritus, fatigue, cardiovascular
complications.
Complications:
- Anemia due to decreased erythropoietin production
- Renal osteodystrophy (calcium-phosphorus imbalance)
- Hypertension and heart disease
- Fluid overload leading to pulmonary edema
- Electrolyte imbalances (hyperkalemia, acidosis).
Nursing Interventions:
- Monitor renal labs (BUN, creatinine, GFR, electrolytes).
- Manage complications: treat anemia (erythropoietin, iron supplements), control hypertension,
prevent bone disease.
- Encourage dietary management: low protein, low potassium, low sodium, fluid restriction.
- Prepare patients for renal replacement therapy (dialysis or kidney transplant).
- Provide psychosocial support and patient/family education.
Patient Education:
- Importance of medication adherence
- Diet modification for renal health
- Infection prevention strategies
- Home monitoring of weight and blood pressure
- Recognizing early signs of complications.
