Chapter 48: Managing Kidney Disorders

Managing Kidney Disorders addresses the identification and clinical management of numerous kidney disorders, providing essential knowledge for nurses across all clinical settings. A core focus is on maintaining systemic homeostasis, as renal dysfunction profoundly impacts fluid and electrolyte balance, often leading to issues like fluid overload or deficit, and critical disturbances such as hyperkalemia and metabolic acidosis. Accurate daily weight monitoring is emphasized as the most reliable indicator of fluid status. The content thoroughly differentiates chronic kidney disease (CKD), categorized into five stages based on glomerular filtration rate (GFR) criteria, from acute kidney injury (AKI), characterized by a rapid loss of function and classified using the RIFLE system. AKI is further subdivided into prerenal (hypoperfusion), intrarenal (direct tissue damage, commonly acute tubular necrosis or ATN), and postrenal (obstruction) categories, each progressing through initiation, oliguria, diuresis, and recovery phases. Specific kidney pathologies discussed include nephrosclerosis (hardening of renal arteries), nephrotic syndrome (massive proteinuria and increased glomerular permeability), polycystic kidney disease (PKD), and various forms of primary glomerular inflammation, such as acute nephritic syndrome. When kidney function progresses to end-stage kidney disease (ESKD), renal replacement therapies (RRT) become necessary. Hemodialysis (HD) involves filtering blood through a dialyzer utilizing the principles of diffusion, osmosis, and ultrafiltration, requiring dedicated vascular access like an arteriovenous fistula (AVF) or graft. Peritoneal dialysis (PD), including continuous ambulatory (CAPD) and continuous cyclic (CCPD), uses the peritoneal membrane for solute and fluid exchange, though patients must be monitored for complications like peritonitis. For hemodynamically unstable patients, continuous renal replacement therapy (CRRT) provides a gentler alternative. Kidney transplantation is presented as the optimal treatment choice for suitable ESKD patients, involving comprehensive preoperative donor and recipient screening. Post-transplant care is critical, revolving around preventing hyperacute, acute, or chronic rejection using lifelong immunosuppressive agents, which necessitates vigilance against infection and management of adverse effects like hypertension or nephrotoxicity. Finally, the chapter covers management of renal cancer and traumatic kidney injuries, underscoring the vital role of nursing assessment, meticulous monitoring of inputs and outputs, dietary and fluid restriction adherence, and providing necessary psychosocial support throughout the disease trajectory.