Need a Kidney Donor

So, for us to be able to understand CKD, we really need to delve into HOW the kidney works, first.

Our kidneys are star players in the body. Breaking down the anatomy of the kidneys, their functioning unit is called the nephron. So why is that important? The nephron’s job is to filter and form urine from blood. What is the purpose of urine? Urine is the metabolic wastes in the body and it is excreted out of the body. Those metabolites, specifically, are water, urea, uric acid, proteins, and dead blood cells (among other things, lets not get in the weeds.)

Lets break down two certain words I bolded, though. Urea. The thing about urea is that it is “ a colorless crystalline compound that is the main nitrogenous breakdown product of protein metabolism in mammals and is excreted in urine.” (According to Google Dictionary.)

What about water? This one should be pretty self explanatory. The kidneys also help regulate fluid volume in the body.

What is Chronic Kidney Disease? (patho)

Similar to acute kidney injury, CKD is a disorder in which the functioning kidney starts to decline and well…not function quite well. The big difference between CKD and AKI is all within the wordplay. CKD is chronic and irreversible malfunction of the kidney.

What causes the kidney to malfunction? (…causes)

So the causes of kidney disease are categorized into three sections: prerenal, intrarenal, and postrenal. Prerenal causes are things that usually take place BEFORE the kidneys. Another word for this is perfusion reduction. The first word I like to think about when I hear perfusion is obviously the heart.  A lot of these prerenal, perfusion, causes are dealing with the heart: hypertension, blood or fluid loss, heart attacks, heart failure, and dehydration.  If you think about it, if there’s not adequate blood pumping to any part of your body, its not going to work. 

Intrarenal causes are pretty easy for me to remember. I just think.. What could cause a problem from within the kidneys? The first thing that pops to my mind is INFECTION. We tend to see glomerulonephritis as a common intrarenal cause. The reason why is because this is a malfunction of the glomerulars and nephrons due to an acute or chronic infection (typically Staph). 

Postrenal causes are usually obstructive. This is where we can see kidney stones being a cause. However, before you jump straight to that, also remember that TUMORS can be an obstruction. If there’s an obstruction in the renal system, there will be impaired functioning, as excretion can not take place as well as normally.  So…

What does Chronic Kidney Disease Look Like? (s/s)

Remember how we said that the kidneys balanced fluids and electrolytes in the body? Well, most of your signs and symptoms are going to be similar to

fluid overload.

Why is that again? If you aren’t excreting out the fluids, they spread out into the body. The only thing is that these fluids are full of toxins. These are the toxins you normally excrete through your urine. 

So s/s of fluid overload: - JVD -Crackles -Edema -Tachypnea -Lethargy -Decreased H&H -Hyperkalemia and dilutional hyponatremia 

They will also have kidney and urinary symptoms: -Increased BUN and Cr -Proteinuria -Hematuria -Uremia -Azotemia

How do we treat it? (treatment)

Lets start with the basics: pharm.

So first thing is first. You do NOT want to give these patients nephrotoxic drugs. To name a few, these are your NSAIDs, ACE inhibitors, any contrast dyes, and ARBs. 

Since these patients have fluid volume excess and electrolyte problems, we are going to want to move fluids out of the body. What drugs do we usually prescribe for that? Diuretics. So since we have an excess of potassium, we’ll want to use Furosemide. Why furosemide? Furosemide is a potassium wasting diuretic. So it’s going to lower potassium levels.  We’re also going to give Digoxin. Here’s the thing though!!! Digoxin lowers serum potassium. Low potassium increases the risk for digoxin toxicity. Monitor for s/s of dig toxicity (n/v, anorexia, headache, bradycardia, tachycardia, swelling).

These patients have anemia AEB low H&H. Due to that, we’ll want to replace iron, i.e: epoetin alfa. This is a medication that stimulates production of RBCs.

Now lets get into the heavies: therapeutic procedures!

Patients with a bad kidney have the option of getting a kidney transplant. It is a very long waiting list. They need to be informed that the list is long and that, if they get a new kidney, they will have to take lifelong immunosuppressants (corticosteroids).  This is to help prevent an organ rejection. 

Also, the patient might have to get dialysis. Dialysis is used for a couple purposes and you need to educate the client on it: to balance fluids in the body, rid the body of toxins, and achieve acid-base balance. Dialysis can be either through the blood (hemodialysis) or through the peritoneal cavity (peritoneal dialysis). You need to explain to the patient what the difference between the two (I’ll get into this in a later review). The important things with this are to FEEL THE THRILL!!, monitor daily weights, do not take BP in the affected arm, and to follow their assigned diet strictly. 

I’m kind of glazing over dialysis, but I am going to have a review specifically for Dialysis coming up. I promise to cover more on it!!!

Dialysis is kind of like having a machine be your kidneys. The purpose of dialysis are the following:

 Rids the body of fluid excess and electrolyte excess

 Eliminates toxins that the kidneys have not been able to filter out

 Achieves acid-base balance

So if its doing the jobs of your kidneys, then you know one more thing: its for people with kidney malfunction. So what are some diseases this is indicated for?!

Kidney Disease

Acute Kidney Injury

Kidney Cancer

There are two different types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis sends blood through the dialyzer and then back into the body. 

Peritoneal Dialysis instills a hypertonic dialysate solution into the peritoneal cavity. It then drains and removes the waste products. 

So for hemodialysis, here are some nursing interventions you need to remember:

You need informed consent.

Assess the patency of the fistula.

Do not measure BP in affected extremity. 

Palpate the thrill!! Or as I love saying… feel the thrill!

Have protamine sulfate at hand to reverse heparin if needed. 

If nausea, dizziness, and headache occur, tell the pt to notify you or the doctor. 

Weights before and after. 

Here are your interventions for peritoneal dialysis:

Daily weights!

Monitor electrolytes!

Inform the client that they might feel fullness during the procedure.

Keep the outflow bag lower than the client’s abdomen.

Report cloudy dialysate! Its indicative of infection!