MODULE 9 - CHRONIC RENAL CONDITIONS

Question 1

Explain the anatomy of the kidneys as a whole

Answer 1

Responsible for several functions, including hormone secretion, water and electrolytes, waste production excretion and acid-base balance.
The organs of the renal system are the paired kidneys (urine production), two ureters (transport of urine to bladder) the urinary bladder (stores the urine) and the urethra (transport from bladder).
Functions: 1.excretion 2.elimination 3.homeostatic regulation of the volume and solute concentration of the plasma of the blood

Question 2

What are the functions of the kidney?

Answer 2

• form urine
• balance solute and water transport
• excrete metabolic waste products, conserve nutrients, regulate acid-base balance and to secrete hormones to help regulate blood pressure, erythrocyte production and calcium metabolism

Question 3

Explain some of the steps involved in a physical assessment of the renal system

Answer 3

Physical assessment: the structure and function of the renal system is assessed by examination of the skin, abdomen, kidneys, bladder and urinary meatus.

Question 4

What are some of the age-related renal system changes?

Answer 4

Kidneys: decreased loss of renal mass, size of renal cortex and nephrons decrease, increased risk of atherosclerosis (may result in atrophy of the kidneys)

Renal tubes: decreased functions with less effective exchange of substances, water and sodium conservation, decreased plasma rein and aldosterone levels

Bladder: muscles weaken and bladder capacity decreases, more difficult to empty bladde

Question 5

What are the stages of chronic kidney disease?

Answer 5

STAGE 1: Kidney damage with normal kidney function
STAGE 2: Kidney damage with mild decrease in kidney function
STAGE 3 (a and b): Moderate decrease in kidney function 
STAGE 4: Severe decrease in kidney function 
STAGE 5: End-stage kidney disease

Stage 3 is divided into A & B to reflect the difference of the fact that the risk was similar for developing ESKD but there was an increased risk of cardiovascular disease in patients aged 75 years and over.

Question 6

What is CKD?

Answer 6

The progression of CKD involves glomerulosclerosis. Blood flow is impeded as is filtration. Glomeruli can never fully recover once sclerosed. The kidneys response always leads to localised tissue damage and formation of scar tissue or fibrosis. This fibrosis then leads to total disruption in the structure and function of the nephrons which then leads to the kidneys inability to maintain homeostasis.

Cause (potential): immunological medicated reaction or injury, renal cell tissue hypoxia and ischaemia.

Question 7

What are major risk factors for CKD?

Answer 7

• diabetes
• hypertension
• aged over 60 years
• smoking
• obesity
• family history of kidney disease
• Aboriginal or Torrres Strait Islander origin
• established CVD

Question 8

What are examples of the pharmacological and non-pharmacological management of CKD?

Answer 8

The focus of management is the prevention of complications and further progression of CKD

Pharmacological:

• Antihypertensives (ACE inhibitors/ARBs)
• diuretics (eg. frusemide)
• folic acid for anaemia
• phosphate binders (eg. calcium carbonate)
• sodium bicarbonate to correct mild acidosis

Non-pharmacological:

• optimising glycemic control
• optimising weight
• nutrition and fluid management
• maintaining blood pressure within normal range

Question 9

What are the treatment options for stage 5 CKD?

Answer 9

• kidney transplant
• home peritoneal dialysis (CAPD)
• centre based harm-dialysis
• non dialysis supportive care

Question 10

What are some examples of self-management for CKD?

Answer 10

• identification and self-management of co-morbidities
• learning about CKD
• being active participant in health decisions
• monitoring weight and BP
• understanding of medications
• managing dialysis treatment as much as possible
• knowing how to deal with health emergencies specific to. CKD
• planning for end-of-life care when/if required