1112
42
Acute Renal
Injury and
Chronic Kidney
Disease
Renal
failure is a condition in which the kidneys fail to remove
metabolic end products from the blood and regulate the fluid,
electrolyte, and pH balance of the extracellular fluids. The under-
lying cause may be renal disease, systemic disease, or urologic
defects of nonrenal origin. Renal failure can occur as an acute
or a chronic disorder. Acute renal injury is abrupt in onset and
often is reversible if recognized early and treated appropriately.
In contrast, chronic kidney disease is the end result of irrepa-
rable damage to the kidneys. It develops slowly, usually over the
course of a number of years. In fact, 80% of the nephrons need
to be nonfunctioning before the symptoms of chronic kidney
disease are manifested. Approximately 26 million American
adults, or 1 in 9 adults, have some form of renal disease.
1
ACUTE RENAL INJURY
After completing this section of the chapter, you should
be able to meet the following objectives:
••
Describe acute renal injury in terms of its causes,
treatment, and outcome.
••
Differentiate the prerenal, intrarenal (acute renal injury),
and postrenal forms of acute renal injury in terms of the
mechanisms of development and manifestations.
Acute renal injury or also termed acute kidney injury (AKI)
represents a rapid decline in kidney function sufficient to
increase blood levels of nitrogenous wastes and impair fluid
and electrolyte balance.
1
Unlike chronic kidney disease
(CKD) and failure, acute renal injury is potentially reversible
if the precipitating factors can be corrected or removed before
permanent kidney damage has occurred.
Sheila Grossman
ACUTE RENAL INJURY
Types of Acute Renal Injury
Prerenal Failure
Postrenal Failure
Intrarenal Renal Failure or Acute Kidney Injury
Diagnosis and Treatment
CHRONIC KIDNEY DISEASE
Definition and Classification
Assessment of Glomerular Filtration Rate and Other
Indicators of Renal Function
Clinical Manifestations
Accumulation of Nitrogenous Wastes
Fluid, Electrolyte, and Acid–Base Disorders
Disorders of Calcium and Phosphorus Metabolism
and Bone Disease
Hematologic Disorders
Cardiovascular Disorders
Gastrointestinal Disorders
Neuromuscular Disorders
Altered Immune Function
Disorders of Skin Integrity
Sexual Dysfunction
Elimination of Drugs
Treatment
Measures to Slow Progression of the Disorder
Dialysis and Transplantation
Dietary Management
CHRONIC KIDNEY DISEASE IN CHILDREN AND OLDER
ADULTS
Chronic Kidney Disease in Children
Etiology
Clinical Manifestations
Treatment
Chronic Kidney Disease in Older Adults
Etiology and Diagnosis
Clinical Manifestations
Treatment
