Chronic Kidney Disease
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As a FNP, you will discover, treat and maintain many patients with chronic kidney disease. What are the categories of CKD (GFR)? Document what causes chronic kidney failure (CKF) and the guideline for diagnostics. What are the risk factors and how would you address cardiac, dietary, metabolic, and hematologic management? Also note which medications should not be used or used with caution. Use your Buttaro textbook along with at least one other source for your information.
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Made 12/15. Good job listing the categories of CKD. You have the causes but I wanted to also know what happens to the body to cause CKD. How does the kidney function reduce? (-2) Guidelines are listed for diagnostics along with risk factors. Good list of management ideas but what would you want the blood pressure for your patient and what would you educate on for diabetes (-1). Good list of meds
- What are the categories of CKD (GFR)?
- The glomerular filtration rate (GFR) categories of chronic kidney disease (CKD) are:
- G1 ≥90 Normal or high
- G2 60-89 Mildly decreased
- G3a 45-59 Mildly to moderately decreased
- G3b 30-44 Moderately to severely decreased
- G4 15-29 Severely decreased
- G5 <15 Kidney failure (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017)
- What causes chronic kidney failure (CKF) and the guideline for diagnostics?
- According to the National Kidney Foundation (n.d.), CKD is a gradual loss of kidney function over time that is caused by diabetes high blood pressure.
- According to Buttaro et al. (2017), CKD is diagnosed based on the cause, GFR, and albuminuria amount.
- The guidelines include:
- The markers of kidney damage are:
- Albuminuria (AER ≥30 mg/24 hr; ACR ≥30 mg/g [≥3 mg/mmol])
- Urine sediment abnormalities
- Electrolyte and other abnormalities caused by tubular disorders
- Abnormalities detected by histology
- Structure abnormalities
- Kidney transplantation (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017)
- Decreased GFR:
- GFR <60 mL/min/1.73 m2 (GFR categories G3a-G5) (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017)
- What are the risk factors?
- According to the National Kidney Foundation (n.d.), risk factors for CKD is a history of diabetes/hypertension, age (elderly), a family history of kidney failure, and race (African American, American Indians, Hispanics, Pacific Islanders, and Asians have a rate of diabetes and hypertension).
- How would you address cardiac, dietary, metabolic, and hematologic management?
- Cardiovascular management includes:
- Manage hypertension with the use of angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCB) or thiazide diuretics.
- Manage hyperlipidemia with the use of atorvastatin or fluvastatin.
- Hospitalization and urgent dialysis may be required for patients with end-stage renal disease (ESRD) with pulmonary edema and acute exacerbation of heart failure (HF). This must be reported to renal specialists, so adjustments could be made with the dialysate fluid (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017).
- Dietary and metabolic management includes:
- Balance the electrolytes calcium, phosphorus, and potassium.
- Prevent malnutrition.
- Maintain fluid volume balance.
- Refer patients with ESRD to a dietitian for optimum nutrition status (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017).
- Hematologic management includes:
- CKD-related anemia is treated with transfusion of red blood cells (RBCs), and erythropoiesis-stimulating agents (ESAs).
- Hemorrhage could be treated with the administration of coagulation factors such as cryoprecipitate and uremia could be reduced with emergent dialysis.
- CKD patients are at risk for infection and preventive measures, such as vaccination with influenza, pneumococcal, and hepatitis B vaccines should be considered (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017).
- Which medications should not be used, or used with caution?
- ACEI or ARBs should not be prescribed together or given to patients with bilateral renal artery stenosis. These drugs can increase the risk of hyperkalemia with CKD.
- Thiazide diuretics could be used for the management of hypertension and hyperkalemia.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) could increase the risk of hyperkalemia and should be avoided.
Metformin is contraindicated with a GFR less than 60 or those older than 80 (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017)
Chronic Kidney Diseases
- What happens to the body to cause chronic kidney disease (CKD)?
When the body experiences high blood pressure and suffers from diabetes, it causes CKD. Too much glucose in the blood damages the kidney filters of a person having diabetes. According to the National Institute of Diabetes and Digestive and Kidney diseases (n.d.), the kidneys will be damaged, making it difficult to do a great job of filtering extra fluids and filtering wastes in the blood. Also, protein is one’s urine is the first sign of kidney failure. Damaged filters pass out the albumin protein from the blood into the urine. A healthy kidney would not pass the albumin from the blood to the urine in the body. On the other hand, high blood pressure in the body damages blood vessels, making them not work correctly. Broken blood vessels in the kidney might fail to remove wastes and excess fluid from the body.
- How does the Kidney function reduce CKD?
A healthy body with good kidney function helps in reducing the chances of CKD. The kidney helps in regulating excess fluids and other wastes in the blood. Improved GFR among the CKD patients in the CKD stages (4-5) helps reduce kidney failure. Besides, the kidney functions by maintaining overall fluid balance in the body and creating hormones that help in regulating blood pressure, producing blood cells, and promoting bone health. It also functions by controlling and purifying minerals from the blood, as well as removing waste from pharmaceuticals and hazardous chemicals. Most importantly, Kidney functions operate to regulate blood pressure, which can harm blood vessels in the kidney, inhibiting filtration.
- What would you want the blood pressure for your patients
I would want the blood pressure for the patients to be below 130/80 especially for those suffering from CKD. Also, the patients need to receive medications for treating angiotensin that converts angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-converting receptor blockers (ARBs) (Diaz,2020). It is necessary for them also to know that high blood pressure is the major cause of kidney disease and kidney failure. Conducting laboratory tests will help determine whether the patient’s kidneys are eliminating waste products effectively. The test will involve blood urea nitrogen (BUN) serum creatinine and heightened levels of kidney damage. Excess proteins in the urine, which is an excellent marker of renal disease, will be detected by the lab tests.
- What would you educate on for diabetes (-1)?
What I would educate the diabetic patients is that they should make amicable decisions concerning diabetes. They should learn to work well with their health care team to acquire success (Center for Disease Control and prevention, 2021). I will educate them on the importance of taking care of themselves and checking one’s blood sugar level, eating healthy, and being active. Offering structured diabetes education could help in improving HbA1c results, enhance confidence in controlling personal health, reduce episodes of low and high blood glucose levels in the body, and make one’s life better. Furthermore, I will educate on preventing complications by keeping cholesterol and blood pressure under control, maintaining vaccines up to date, considering daily aspirin, scheduling regular physicals and eye exams. Individuals need to evaluate blood sugar levels to prevent diabetes problems such as kidney disease, eye diseases, and nerve damage. Therefore, educating on diabetes will help to reduce number of diabetic cases especially in the developing countries with high number of diabetic patients.
Centers for Disease Control and Prevention. (2021). Chronic kidney disease in the United States, 2021. US Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fkidneydisease%2Fpublications-resources%2F2019-national-facts.html
Diaz, J. H. (2020). Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. Journal of travel medicine. Retrieved from https://academic.oup.com/jtm/article-pdf/doi/10.1093/jtm/taaa041/33226377/taaa041.pdf
National Institute of Diabetes and Digestive and Kidney Diseases. Causes of Chronic Kidney Disease. Retrieved from https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/causes