NURS5205 Chap.7 Kidney Function, Injury and Chronic Disease
Kidney Function, Injury and Chronic Disease
Kidney-function estimates support disease tracking and medicine dosing, but each result must be interpreted with patient size, stability, disease trajectory and medicine-specific handling.
This chapter separates acute kidney injury from chronic kidney disease, highlights urgent complications such as severe hyperkalaemia, and shows why one precise-looking eGFR cannot safely generate a new regimen without clinical judgement and authorised review.
What this chapter covers
- 01
eGFR and kidney-function estimation
- 02
Estimate limitations and body size
- 03
Renal medicine elimination
- 04
Acute kidney injury and instability
- 05
Severe hyperkalaemia escalation
- 06
Chronic kidney disease progression
- 07
Kidney replacement therapy considerations
Worked example · free
Reviewing accumulation during acute illness
- +1The marks here are not a published University assessment scheme. Compare the result with baseline, timing, urine output, hydration, observations and clinical course.
- +1Review the indication, recent doses, renal elimination, concentration-related effects and interacting medicines.
- +1Escalate the drowsiness and changing kidney function for prompt clinical and pharmacy review.
- +1Continue ordered monitoring and document the trend, actions and response, considering estimate limitations.
Key terms
- Estimated GFR
- An estimate of glomerular filtration used to assess kidney function and support many dosing decisions.
- Albuminuria
- Albumin in urine that contributes important evidence about kidney damage alongside filtration estimates.
- Hyperkalaemia
- Elevated potassium that can become a medical emergency because of life-threatening cardiac arrhythmia risk.
- Kidney replacement therapy
- Dialysis or transplantation used when kidney function can no longer meet the body's needs.
Kidney Function, Injury and Chronic Disease FAQ
Why is eGFR useful but not sufficient for dosing?
It estimates kidney function and is adequate for many decisions, but stability, body size, medicine-specific evidence, acute illness and clinical context can alter interpretation. Some cases require an absolute rather than indexed estimate or another dosing approach.
How does AKI change medicine safety?
Kidney function and fluid status may change quickly, making previous doses or intervals inappropriate and increasing accumulation risk. The response uses trends, medicine reconciliation, patient observations and prompt authorised review rather than one delayed laboratory value alone.
What makes severe hyperkalaemia urgent?
The lecture identifies potassium above 6.5 mmol/L as a medical emergency because of life-threatening arrhythmia risk. Escalation and protocol-led treatment take priority over a routine discussion of chronic kidney-disease medicine optimisation.
Why must AKI and CKD be separated?
AKI can change rapidly and make exposure unstable, while CKD management addresses persistent disease, progression and complications. A person can have both, so the timeline and baseline are essential to interpretation.
What does albuminuria add to kidney assessment?
Urinary albumin provides evidence of kidney damage and risk that filtration estimates alone do not capture. It helps complete the clinical picture rather than acting as a substitute for eGFR or patient assessment.
How can body size affect dosing interpretation?
Automated eGFR is indexed to a standard body surface area. In very large or small patients, de-indexing or another recommended approach may be needed for particular medicines, with clinical and pharmacy review.
Does dialysis remove every medicine equally?
No. Removal depends on medicine properties and the kidney replacement method. Communicate the modality, schedule, recent doses and symptoms so specialist guidance can account for treatment timing and residual function.
Why does the kidney-function trend matter?
A change from baseline can reveal acute instability that one isolated value cannot show. Timing relative to illness, fluids, urine output and medicine exposure helps determine whether prompt review is required.
What makes a renal medicine substantially cleared?
The relevant evidence is the proportion eliminated unchanged and the medicine guidance for impaired function. Do not infer renal dependence only from the route or assume every medicine in one class behaves identically.
How do fluid changes affect medicine reasoning?
Dehydration or overload can alter haemodynamics, distribution and the clinical tolerance of therapy. The patient's observations and trajectory therefore belong beside the laboratory estimate in a safe dosing review.
Why document recent doses in AKI?
Timing helps the team judge possible accumulation and relate symptoms to exposure while kidney function changes. A medicine name without the last administration time leaves an important safety gap.
Exam move
Revise renal content as three layers: estimating function, recognising acute or chronic disease, and adjusting medicine reasoning. Draw an emergency branch for severe potassium disturbance, pulmonary oedema, acidosis and uraemic features. For dosing cases, write patient, disease and medicine factors before using the estimate.
Compare AKI instability with CKD progression and complications, then add how dialysis may change fluid balance and drug removal. Practise explaining why a reported number is an estimate and when body size or rapid change limits it. Build medicine-reconciliation cases around accumulation, nephrotoxic exposure and dialysis timing. Always close with the observation and authorised review required.
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