Chronic Kidney Disease (CKD) Lecture Notes

Introduction

• Presented by: Sarah from EdsternurseRN.com
• Topic: Chronic Kidney Disease (Chronic Renal Failure)
• Part of NCLEX review series on the renal system
• Reminder: Free quiz available at the end of the video

Definition of Chronic Kidney Disease (CKD)

• Significant decrease in renal function over a long period
• Irreversible condition
• Different from Acute Kidney Injury (AKI) which is sudden and reversible

Kidney Function and Structure

• Functional unit: Nephrons (millions in each kidney)
• Nephrons filter blood through the glomerulus
• Key substances filtered: water, ions (electrolytes), bicarbonate, urea, creatinine
• Proteins and blood cells should not be in the filtrate unless glomerulus is damaged

Glomerular Filtration Rate (GFR)

• GFR measures how well kidneys filter waste, ions, and water
• Normal GFR: >90 mL/min
• Stages of CKD based on GFR:
  • Stage 1: Kidney damage with normal function (GFR >90 mL/min), proteinuria present
  • Stage 2: Mild loss of function (GFR 60-89 mL/min), proteinuria
  • Stage 3: Mild to severe loss of function (GFR 30-59 mL/min), proteinuria
  • Stage 4: Severe loss of function (GFR 15-29 mL/min)
  • Stage 5: End-stage renal disease (GFR <15 mL/min), requires dialysis or transplant

Symptoms and Effects

• Waste build-up: Increased BUN and creatinine leading to azotemia, uremia
• Fluid overload: Hypertension, pulmonary edema, decreased urine output (oliguria, anuria)
• Electrolyte imbalances:
  • Hyperkalemia (high potassium)
  • Hyperphosphatemia (high phosphate)
  • Hypocalcemia (low calcium)
  • Hypermagnesemia (high magnesium)
• Loss of proteins and blood in urine: Edema, anemia
• Hormonal effects:
  • Decreased erythropoietin (EPO) leading to anemia
  • Increased renin causing hypertension
  • Decreased activation of Vitamin D affecting calcium absorption

Causes of CKD

• Diabetes Mellitus: Uncontrolled hyperglycemia damages kidney arteries
• Hypertension: High blood pressure damages kidney arteries
• Other causes: Acute kidney injury, polycystic kidney disease, infections, nephrotoxic drugs

Treatment for CKD

• Early stages: Control blood pressure and glucose levels
  • Medications: ACE inhibitors, ARBs
  • Regular monitoring of GFR and blood pressure
• Advanced stages: Regular dialysis or kidney transplant

Nursing Interventions

• Manage waste build-up:
  • Monitor signs of uremia (itching, confusion)
  • Implement low-protein diet
  • Monitor pH for metabolic acidosis
• Address anemia:
  • Iron supplements, EPO injections, blood transfusions
  • Monitor for fatigue, pallor, shortness of breath
• Fluid management:
  • Monitor intake/output, daily weights
  • Assess for edema, pulmonary edema
  • Blood pressure and respiratory status checks
• Electrolyte balance:
  • Monitor for hyperkalemia, restrict potassium-rich foods
  • Administer phosphate binders
  • Avoid magnesium-rich foods and supplements

Conclusion

• Importance of understanding CKD stages and management
• Encourages taking the quiz and subscribing for more educational content