CKD Categories
Stage I
GFR >90
Asymptomatic
BONUS: Diagnoses and treatment; treat underlying HTN and DM
Hypocalcemia
D/T: Low active vitamin D
BONUS: Leads to hyperphosphatemia and renal osteodystrophy
F&E Imbalances
-I&O
-Daily weight
-Specific gravity
-Fluid restrictions
-Labs
KUB
Visualize size, shape, and position of kidneys and potential stones
F&E Imbalances
- Edema
- Hyperkalemia
- Hyperphosphatemia
- Hypermagnesemia
BONUS: metabolic acidosis
Stage II
GFR 60-89
Asymptomatic, possible HTN
BONUS: Treat HTN
Anemia
Nutritional therapy
- Renal diet
- Fluid restrictions
BONUS: How does dialysis alter a patients nutritional therapy?
IVP
Use of contrast to visualize kidneys, ureter, and bladder
BONUS: Bowel prep, assess iodine sensitivity, "flush feeling, FF afterwards, consider alternative if patient has increased Cr
Decreased Excretion
- Anorexia
- Malnutrition
- Pruritis
- CNS changes
Stage III
IIIA: GFR 45-59
IIIB: GFR 30-44
HTN, otherwise symptomatic
BONUS: Treat complications
Hyperkalemia
D/T: decreased excretion
BONUS: Cardiac dysrhythmias
DOUBLE BONUS: Fatality at 7-8
Medication
- Loop diuretic for volume overload
- Kayexalate for hyperkalemia
- Sodium bicarb for metabolic acidosis
- Calcium carbonate for hyperphosphatemia
- Calcitrol for renal osteodystrophy
- Erythropoietin for anemia
ACEI/ARB for HTN
Renal Biopsy
To identify the type of kidney disease you have, how severe it is, and the best treatment for it
BONUS: Consent, assess coag use, no ASA or warfarin use
DOUBLE BONUS: Apply pressure, keep on affected side for 30-60 minutes, 24-hour bed rest, VS q5-10 min for 1 hour, assess flank pain and signs of bleeding, no lifting for 7 days
Decreased Erythropoietin
Stage IV
GFR 15-29
Manifestations begin to appear; diagnoses often occurs here
BONUS: Prep for renal replacement therapy
Hyperglycemia & Hyperinsulinemia
D/T: Altered CHO metabolism
BONUS: Increase in lipids, DM
What To Report
- Weight gain >4 lbs.
- Increase in BP
- SOA
- Edema
- Increase in fatigue/weakness
- Confusion
- Lethargy
Retrograde Pyelogram
Done if IVP isn't adequate, patient is allergic to contrast, or has decreased renal function
- Cystoscope and ureteral catheter used
Decreased Vitamin D
- Hypocalcemia
- Renal osteodystrophy
Stage V
GFR <15
Uremic
BONUS: Renal replacement therapy (e.g., dialysis, CRRT, transplant)
Elevated BUN, normal Cr D/T: dehydration, GI bleed, tube feeding, keto diet
Elevated BUN, elevated Cr D/T: impaired kidney function
AV Fistula & Graft
- Don't lay on extremity
- No heavy lifting or compressing of extremity
- Encourage ROM
- Elevate extremity post-op
BONUS: Assess pulses and circulation of extremity, no IV, BP, or venipuncture in extremity
DOUBLE BONUS: Assess bruit and palpate thrill q4h
Cystoscopy
To inspect interior bladder
BONUS: Lithotomy position
DOUBLE BONUS: burning, frequency, and pink-tinged urine are normal initially. Bright red blood is not normal
*BONUS* UO
- Decreased then anuria
- Dark and concentrated