Chapter 51: Acute Kidney Injury & Chronic Kidney Disease

Acute kidney injury represents a rapid deterioration in renal function characterized by azotemia and fluid-electrolyte disturbances, with causes categorized as prerenal conditions involving decreased renal perfusion, intrarenal pathology including acute tubular necrosis from nephrotoxic agents or ischemia, and postrenal obstructions that impede urine flow. The chapter utilizes the RIFLE classification system to standardize severity assessment from risk through end-stage kidney disease, while describing the typical progression through oliguric phases marked by decreased urine output and dangerous electrolyte imbalances, diuretic phases featuring excessive fluid loss, and recovery phases requiring careful monitoring of gradually improving glomerular filtration rates. Chronic kidney disease presents as progressive, irreversible nephron loss most commonly resulting from diabetes mellitus and hypertension, leading to complex systemic manifestations including uremic toxicity, renal anemia, mineral bone disorders, cardiovascular complications, and neurological changes that dramatically increase morbidity and mortality risks. Management strategies encompass both conservative approaches focusing on blood pressure control, glycemic management, dietary modifications targeting protein and electrolyte intake, pharmacological interventions including erythropoiesis-stimulating agents and phosphate binders, and advanced interventions such as renal replacement therapies. The chapter thoroughly examines hemodialysis with arteriovenous access considerations, peritoneal dialysis offering patient autonomy with infection prevention protocols, continuous renal replacement therapy for critically ill patients, and kidney transplantation as the optimal treatment for end-stage renal disease requiring lifelong immunosuppressive therapy. Throughout, nursing care emphasizes comprehensive assessment techniques, medication safety particularly regarding nephrotoxic substances, meticulous fluid balance monitoring, patient education regarding dietary restrictions and medication adherence, psychosocial support for lifestyle adaptations, and specialized considerations for elderly populations who demonstrate increased vulnerability to both acute and chronic renal complications.