Chronic Kidney Disease: Additional Risk Factors (Nursing)

00:00 Okay, let's go into the other risk factors.

00:03 We've got six more to look at.

00:05 Now there's examples of auto immune disease.

00:08 That means autoimmune means self in immune.

00:13 So my body turns against me and instead of attacking antigens or foreign substances.

00:19 It starts attacking my own body.

00:21 Some things can even attack the basement membrane in the nephron and you end up with clogging all that up.

00:29 So someone has an autoimmune disease that particularly goes after the kidneys.

00:34 They're going to be at risk for chronic kidney disease.

00:37 Sadly as we all age your kidneys don't function as efficiently at age 75 as they did it 15.

00:44 So there are some challenges as we age and there's normal aging of the kidney and then there could be accelerated aging of the kidney if they have these additional risk factors.

00:55 If you have a family history of renal disease, you need to be extra cautious, with the care of your kidneys, so we've talked about diabetes and high blood pressure.

01:04 Now autoimmune diseases that can end up kind of clogging up the kidneys, let's just call it that for now, as we age kidney function goes down.

01:13 If you know that you have a family history of renal disease.

01:17 That's also another factor that you want to keep in mind.

01:20 And if you've had a previous event of an acute kidney injury.

01:24 Okay, so now we're at how many? Right.

01:29 We have looked at six reasons.

01:31 Let's look at number 7.

01:34 Now patients who receive a kidney transplant and those who donate a kidney are at a risk factor for chronic kidney disease.

01:42 So we want to keep a really close eye on those patients and watch their kidney function.

01:47 So that would be something that their primary care physician or their internal medicine doctor, their nephrologist would keep Extra Care in screening them and watching kidney function.

01:57 Now, let's look at this one. Look at all those there.

02:01 I know that's a lot of words.

02:03 So let's just think back and make that list and Like it has a meaning some framework to it.

02:09 You see that shriveled-up kidney we have in the middle, right? That's a kidney that's not functioning well.

02:15 So what do you already remember about what happens, what changes do you see in a patient's urine if their kidney is not functioning well.

02:25 What are things that we find that shouldn't be there? Yeah protein in your urine.

02:30 That's a sign of leaky glomeruli. Right? A glomerulus is one of three important parts of the Nephron If it's not working right and it's kind of got starting to leak, protein enters into the urine instead of staying in the bloodstream.

02:47 You might see some changes in the urinary sediment or there could also be some structural changes to the kidney that could put them at risk for chronic kidney disease.

02:55 Alright, so we've got all the risk factors there for you.

02:59 Diabetes and high blood pressure top 2.

03:01 Patient may have an autoimmune disease.

03:04 They might be aging.

03:05 So if they've got aging plus one of these factors that makes it extra important for us to watch those factors.

03:12 They have a family history, if they have a history of an acute kidney injury before, if they have been a kidney donor or a kidney recipient, or for seeing abnormalities in their urinalysis or blood work.

03:27 So I want to show you how this is defined.

03:29 Now, this is not something you want to memorize, okay? This is just to give you a feel, There are five stages.

03:37 Stage 1 is normal or high GFR.

03:40 Stage 5 is end-stage renal disease or complete renal failure.

03:45 So in stage 1, we have a GFR that's greater than 90.

03:49 Now, that's still not as high as patients can run when they're perfectly healthy, but we still call that stage 1.

03:58 Normal, it's got a high GFR.

04:00 We're not really concerned here.

04:01 We're keeping an eye, but we're not concerned.

04:03 Stage 2, you're starting to see some changes.

04:06 Look how the GFR is decreased from what we said in stage 1.

04:11 Now, you can also see we see the picture of the kidney changing as we move toward these more progressive challenges.

04:17 Stage 3, A and B.

04:19 It's moderate chronic kidney disease.

04:22 Look at the range for the GFR for 3A and for 3B.

04:27 Now compare those back to stage one.

04:30 Stage 4, same problem.

04:33 Now we're into severe chronic kidney disease, GFR is 15 to 29 and we've got significant issues here.

04:41 Stage 5, It's the end of the line, right? This is a GFR of less than 15.

04:48 Let that sink in, stage one is what? Greater than 90.

04:53 So less than 15 is a really big deal.

04:56 This is end-stage chronic kidney disease.

05:00 Patients is in likely on something like dialysis, Hemodialysis, where they take the blood out and run it through a machine and put it back in or peritoneal dialysis where they put fluid into the patient's abdomen through a catheter.

05:16 They let it dwell or hang out in there for a little while, it draws substances into the fluid and then you drain it back out.

05:23 But either way a patient in Stage 5, is going to have to have some type of support in that manner.

05:29 So what's our goal? We want to recognize acute kidney injury early so we can prevent a patient from having to get to Stage 5 of chronic kidney disease.

05:40 Now we talked about that GFR just want to remind you again that it's impacted by several things.

05:45 Your age, your sex and your body size all affect your estimated GFR.

05:50 So a normal for males is 130, for females is 120.

05:55 Now, wait a minute, go back to those stages.

05:57 Look at what we looked at there, what is stage 1? Yes, It just has to be greater than 90.

06:04 Remember I told you, that's still not even top of the line for healthy functioning, right? Because for males were looking at 130 females 120, but we don't really get concerned as long as it's greater than 90.

06:18 Now the GFR will just kind of give you an estimate or tell you how well the kidney is functioning or impaired so we can follow disease progression, look at trends, see how the patient is doing, but it doesn't tell us what happened to the kidney or why the kidney struggling so that's a really important point.

06:37 GFR tells me how the kidney is functioning in the moment that we did the test, but it doesn't tell me why is the kidney struggling, why are there problems, it just tells us that there is a problem.

06:50 So, how do we learn more? What do we figure out? What would a healthcare provider do? What can I do as a nurse? Well often a full year analysis will be involved and that involves microscopy and looking at the settlement and a really complete urine analysis.

07:06 that will let us look at urinary protein excretion.

07:09 And if we need to the urine analysis gives us enough of an idea that there's a problem.

07:14 They might order some real logical studies or even a biopsy of the kid.

07:18 Any, okay.

07:19 So let's look back at that.

07:20 The GFR tells us there is a problem but doesn't tell us what the cause of the problem is, but a full urinalysis and looking at protein excretion will give us a better idea of what's going on and what the cause is and if need be they'll order radiologic studies or even a kidney biopsy and that means they would go in and take some tissue from the kidney and look at it under a microscope.