CHAPTER 22 Renal Disorders 561
Making the Connections—cont’d
Signs and Symptoms Treatment Chronic Kidney Disease | Deterioration of 90% to 95% of nephrons. ESRD. Kidneys cannot filter nitrogenous wastes or excrete fluid. All kidney functions diminished. Assessment Findings Diagnostic Tests
Hemodialysis. Medications to counteract complications such as diuretics, antihypertensives, erythropoietin-stimulating agents and iron supplements, calcitriol, calcimimetic agents, sodium bicarbonate, sodium polystyrene or pat- iromer, phosphate binders, SGLT2 inhibitors. Pruritus can be relieved with topical corticosteroids and antihis- tamines. Salt restriction and nutritional guidance. Do not use salt substitutes. Renal transplant can provide complete recovery.
Calculate GFR. Laboratory tests will show: Hyperkalemia.
High blood pressure. Oliguria. Edema. Pallor. Dyspnea. Muscle spasms or seizure. GI disturbances. Peripheral and autonomic neuropathy. Uremic fetor. Extreme pruritus.
Confusion, stupor, or coma caused by high nitrogenous wastes affecting brain. Bruising caused by thrombocytopenia. Fatigue and dyspnea on exertion caused by anemia. Edema caused by fluid overload, which can lead to heart failure. Lack of urine output. Muscle spasms or seizures caused by hypocalcemia. Bone breakdown. Amenorrhea, male and female infertility caused by lack of excretion of sex hormones. Sex hormones negatively feed back to organs.
Hypoalbuminemia. Hyperphosphatemia. Hypocalcemia. Secondary hyperparathyroidism. Urinalysis shows proteinuria, RBCs, and WBCs. Elevated serum creatinine and BUN. Arterial blood gases show meta- bolic acidosis. CBC shows anemia. Ultrasound, x-ray, CT, MRI can show kidney size, masses, stones, or cysts. A renal biopsy may be used to evaluate for intrarenal etiology.
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