Damaged kidneys are unable to produce adequate bicarbonate necessary to maintain acid-base balance in the body. The lack of bicarbonate (base) leads to metabolic acidosis. Patients with metabolic acidosis may attempt to compensate with Kussmaul breathing. This rapid, deep and labored breathing pattern is an attempt to blow off excess carbon dioxide (acid) to return the patient to a state of acid-base balance.
Severe uremia usually develops when a patient’s glomerular filtration rate reaches less than 10mL/min. Inadequate renal filtration causes an accumulation of waste products, such as urea, in the blood. Severe uremia can cause abnormal bleeding, changes in mental status, nausea, vomiting, and pruritus.
When renal filtration is compromised, excess potassium is not excreted, and levels can become dangerously elevated. When serum potassium levels are elevated, cardiac arrhythmias can occur.
Both sodium retention and reduced excretion of fluid due to renal damage can cause fluid retention. Retention of fluid can lead to complications such as edema, and worsening of hypertension. Patients should be monitored for signs of fluid overload.
Electrolyte imbalances and the accumulation of waste products in the body can lead to central nervous system (CNS) depression in patients with chronic kidney disease. CNS depression can cause patients to feel weak, dizzy, or disoriented.
Damaged kidneys do not produce enough erythropoietin to stimulate adequate red blood cell production. As a result, patients with chronic kidney disease may become anemic. These patients also have a tendency to bleed due to impaired platelet aggregation.
A decrease in glomerular filtration rate ultimately leads to a decrease in urine output. Oliguria occurs when a patient produces less than 400mL of urine per day. As the kidneys continue to fail, urine output may continue to decrease, until a patient becomes anuric, or produces less than 100mL of urine in 24 hours.
The accumulation of waste products in the body, due to reduced renal filtration, can lead to intense itching. Calcium and phosphorus deposits in the skin are thought to be one of the primary causes of pruritus in patients with chronic renal disease. In rare cases, a condition called uremic frost can develop when blood urea nitrogen (BUN) levels are exceptionally elevated (over 200mg/dL). In this condition, urea forms crystals on the skin.
ESRD is the final stage of renal failure in which dialysis or a transplant is needed in order for the patient to survive; the kidneys can no longer function on their own.
Glomerular filtration rate (GFR) is a value that describes how efficiently the kidneys are working. In patients diagnosed with ESRD, GFR is less than 15 mL/min.
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