Nephrons, which house the capillary network called glomeruli, are the functional units of the kidneys. In chronic renal disease, the damaged glomeruli do not function normally. Therefore, urine output decreases, anemia develops and electrolyte imbalances become an ongoing battle. Because diabetes and high blood pressure are the leading causes of chronic renal disease, blood sugar levels and blood pressure should be managed meticulously to prevent chronic renal disease from advancing to end-stage renal disease, according to "American Family Physician," a peer reviewed journal of the American Academy of Family Physicians.
Stages of Chronic Renal Disease
At stage one, reduced renal reserve, 25 to 60 percent of kidney function remains, and symptoms of chronic renal disease are not usually present. At stage two, which is called renal insufficiency, the nephrons function at 10 to 25 percent, which is when most experience symptoms, according to "Medical-Surgical Nursing." (See Reference 2) When urine output decreases, waste materials increase within the bloodstream; therefore, to prevent chronic renal disease from advancing to stage three, end-stage renal disease, treatment must be initiated. According to "Medical-Surgical Nursing," once someone reaches end-stage renal disease, dialysis must be initiated, which is the process of a dialyzer, man-made machine, functioning as the kidneys. (See Reference 2)
Decreased Urine Output
Normal functioning kidneys excrete metabolic waste material through urine; however, when functioning abnormally, the rate of urine excretion decreases. One of the first signs recognized by most people diagnosed with chronic renal disease is changes in urine output, according to Suzanne Smeltzer, RN, EdD, and Brenda Bare, RN, MSN, authors of "Medical-Surgical Nursing."
Presence of Preexisting Conditions
In most cases, chronic renal disease presents itself in the presence of preexisting conditions, such as high blood pressure and diabetes. Chronically high blood pressures and high blood sugars damage blood vessels within the kidneys, as evidenced by protein found in urine. Physicians perform a 24-hour urine collection to test for the amount of protein. The amount of protein found in urine directly relates to the amount of damage to the kidneys.
Treatment of Preexisting Conditions
Aggressively managing preexisting conditions preserves the remainder of the functioning kidneys. The American Academy of Family Physicians recommends ACE-inhibitors, such as Lisinopril, to maintain blood pressure measurement below 130/80 mm Hg. Also, the American Academy of Family Physicians recommends maintaining the hemoglobin A1C level below 7 percent. The hemoglobin A1C measurement indicates controlled or uncontrolled blood sugar over the course of five to six weeks, according to "Medical-Surgical Nursing."
Chronic Anemia
Anemia occurs due to the kidneys' inability to activate the hormone erythropoietin, which stimulates bone marrow to produce more red blood cells. To prevent blood transfusions, physicians prescribe the medication, epoietin alfa, which acts as erythropoietin, thereby stimulating the bone marrow to produce more red blood cells. The goal is to maintain hemoglobin concentration of 11 to 12 g/dL. Because the medication, epoietin alfa, carries a risk of blood clots and increases blood pressure, close regular monitoring of the hemoglobin concentration by a physician is necessary. Once the hemoglobin rises above 12 g/dL, the risk of clot development increases, according to the U.S. Food and Drug Administration.
References
- "American Family Physican": Chronic Kidney Disease: Prevention and Treatment of Common Complications
- "Medical-Surgical Nursing: Volume 2. 10th Edition"; Suzanne Smeltzer, RN, EdD, and Brenda Bare, RN, MSN; 2004
- U.S. Food and Drug Administration: Medication Guide: Procrit
