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Chronic Kidney Disease for NP

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Chronic Kidney Disease (CKD) for the Nurse Practitioner Licensing Exam
Definition
  • Chronic Kidney Disease (CKD): Progressive and irreversible loss of kidney function over at least 3 months, identified by reduced glomerular filtration rate (GFR) or evidence of kidney damage (e.g., albuminuria, abnormal imaging).
  • Diagnosis:
    • GFR <60 mL/min/1.73 m² for ≥3 months, or
    • Evidence of kidney damage (e.g., albuminuria ≥30 mg/g, abnormal urinalysis).
Etiology
  • Diabetes Mellitus: The most common cause of CKD due to chronic hyperglycemia, which damages glomeruli over time.
  • Hypertension: Long-standing high blood pressure causes nephrosclerosis, contributing to progressive renal damage.
  • Glomerulonephritis: Immune-mediated glomerular inflammation can result in chronic kidney damage.
  • Polycystic Kidney Disease: A genetic disorder causing multiple renal cysts that lead to gradual renal failure.
  • Other Causes:
    • Chronic obstruction (e.g., kidney stones, benign prostatic hypertrophy).
    • Prolonged use of nephrotoxic medications (e.g., NSAIDs).
Clinical Presentation
  • Early Stages (Stages 1–3):
    • Often asymptomatic with subtle signs such as hypertension or proteinuria.
    • Fatigue and edema may occur due to fluid retention.
  • Late Stages (Stages 4–5):
    • Uremia: Symptoms include nausea, pruritus, fatigue, and confusion.
    • Fluid Overload: Dyspnea, peripheral edema, and pulmonary edema.
    • Anemia: Due to decreased erythropoietin production by the kidneys.
    • Bone Disease: Renal osteodystrophy due to disrupted calcium-phosphorus metabolism.
Signs & Symptoms of Chronic Kidney Disease
Diagnosis
  • Serum Creatinine and GFR: Used to assess kidney function.
  • Urinalysis: Detects proteinuria and hematuria, important markers of kidney damage.
  • Electrolytes: Advanced CKD often presents with hyperkalemia, hyperphosphatemia, and metabolic acidosis.
Management
  • Control of Underlying Conditions:
    • Diabetes: Tight glycemic control (HbA1c <7%).
    • Hypertension: ACE inhibitors or ARBs to lower BP and reduce proteinuria (target <130/80 mmHg).
  • Dietary Management:
    • Protein and sodium restriction to manage fluid overload and nitrogenous waste.
  • Complication Management:
    • Anemia: Erythropoiesis-stimulating agents (ESAs) and iron supplements.
    • Bone Disease: Phosphate binders, vitamin D analogs, and calcimimetics.
Complications
  • Cardiovascular Disease: Leading cause of death in CKD patients.
  • Electrolyte Imbalances: Hyperkalemia and metabolic acidosis can be life-threatening.
  • Bone Disease: Increased fracture risk due to renal osteodystrophy.
Key Points
  • CKD is diagnosed by reduced GFR (<60 mL/min/1.73 m²) or kidney damage for ≥3 months.
  • Leading causes are diabetes, hypertension, and glomerulonephritis.
  • Management focuses on controlling underlying conditions, dietary modifications, and managing complications like anemia and bone disease.
  • Cardiovascular disease is the most common cause of death in CKD patients.

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