Hello everyone, thanks for joining me—Janet Warren—on another dive into the world of kidney care. Today, I want to set the groundwork by talking about what’s really going on inside the kidneys during chronic kidney disease, or C K D. You know, this isn’t like a quick injury that heals up; instead, it’s a gradual and, unfortunately, irreversible loss of nephron function. Picture all those tiny filtering units inside the kidney—those nephrons—slowly being chipped away over months to years. And as the damage creeps along, it doesn’t just target one bit. It messes with the glomeruli, the tubules, and even the blood vessels inside the kidney. That’s why, once you get structural changes, there’s no hitting the reset button. I always think about how many of these patients come in, feeling totally fine, but they’ve actually lost a huge chunk of their kidney function before anyone spots it.The main culprits? Diabetes mellitus is probably the lead, closely followed by high blood pressure. You’ll have heard these over and over, but they’re regularly at play. But there’s more—proteinuria actually speeds up the harm, and there are other risk factors too. For example, African American patients are at higher risk, and men, especially as they age, are more likely to get hit by CKD. I once had an older gentleman admitted for what we initially thought was just uncontrolled hypertension. He’d been feeling a bit tired, nothing specific. But after a run of labs and a look at his urine, we realized he was actually in advanced CKD—he probably hadn’t had any noticeable symptoms until he’d already lost a large percentage of his kidney function. That’s kind of the tragedy, isn’t it? Folks often don’t know anything’s even wrong until things are already quite serious. Where was I... right, I think that story just really shows how silent C K D can be, particularly at first.So, to sum it up a bit, C K D is this slow, sneaky process, often progressing right under our noses until there’s not much functional kidney left. That’s why catching those risk factors is absolutely vital, even before symptoms show. And speaking of symptoms—let’s get into what those look like next.Now, let’s talk about what C K D actually looks like in the real world—because, honestly, it’s rarely just one thing. You’ll see signs that show up across many organ systems. Some are specific to the kidneys—like protein in the urine, hematuria, and that funny fixed low urine specific gravity. Basically, the kidneys just lose the ability to concentrate urine, so it’s always kind of dilute. Then there’s fluid retention; you’ll see patients with swollen ankles, puffiness around the eyes, sometimes full-blown edema. Electrolyte imbalances come up a lot. I always keep an eye out for hyperkalemia—high potassium—which is really dangerous. It can push patients into life-threatening arrhythmias if it gets bad enough.C K D doesn’t stop there though. There’s a risk of metabolic acidosis, because the kidneys can’t clear acids as they should. Then you’ve got anemia—because the kidney’s production of erythropoietin drops off, so you see pale, tired patients, often with a bit of mental fog. There’s even bone disease, what we call renal osteodystrophy, due to disturbed calcium and phosphate balance. I might be misremembering, but I think I read that up to 90% of folks with severe CKD end up with some bone-related issue. You’ll notice things like bone pain or maybe even spontaneous fractures.Oh! And don’t forget infection risks—the immune system starts to take a bit of a beating, so people with C K D are more susceptible. When the disease is advanced, you’ll get these “uremic symptoms”—people feeling generally unwell, nausea, apathy, even cognitive changes. I’ve seen patients become very withdrawn or confused, especially as they drift into later stages. It’s easy to miss the seriousness if you don’t know what you’re looking for.So, what can nurses do? Well, I’d say recognizing early cues is absolutely crucial. Sometimes, it’s the lab trends—like gradually rising creatinine, persistent proteinuria, or dropping hemoglobin. Other times, it’s more subtle, like a change in urine color or routine swelling. The most urgent clinical manifestations? Without a doubt, hyperkalemia or sudden fluid overload. Those need addressing right away, because they can quickly turn into emergencies. It’s a challenge, but it’s also our job—and, honestly, it’s kind of what makes this field so rewarding. Okay, let’s shift gears now and talk about how nursing really fits into all this, from catching those cues to planning and acting effectively.Nursing care—this is where we get to roll up our sleeves, really make a difference. A lot of it starts with good clinical judgment: learning to recognize cues, spot lab trends, notice subtle changes in a patient’s urine or weight. I always tell the students, don’t just look at one lab value in isolation—trends matter so much more. Prioritizing risks is next, and, as I mentioned, hyperkalemia jumps straight to the top. But it’s not just about correction—fluid and electrolyte management, meticulous monitoring of intake and output, daily weights, and quick response if things go off-track.Essential therapies aren’t only about pills or infusions; they often start with blood pressure control. ACE inhibitors are the gold standard for slowing progression, provided the patient can tolerate them. Dietary restrictions follow: less sodium, less protein (but higher quality protein), and careful management of potassium and phosphate. Sometimes, prepping a patient—and a family—for dialysis, both practically and emotionally, is just as important as any medication. Speaking of meds, always double-check doses. Many drugs hang around longer in the system when kidney function drops, so nephrotoxicity is a very real risk if you’re not vigilant, especially with things like gentamicin or even Over The Counter medications such as NSAIDs.For anemia, supporting with iron and sometimes erythropoietin is necessary, but closely monitored. But honestly, a lot of the power comes from patient education and support in daily living. I still remember this one patient—she was readmitted a few times for volume overload, and we were trying everything. The turning point came when we spent extra time teaching her and her husband how to read sodium values on food labels and really track her daily fluid intake using a simple journal. That, more than any medication, reduced her hospital stays. Empowering patients in self-management—it really changes outcomes in C K D, particularly when so much care happens outside the hospital.So, to wrap things up for today—C K D’s a complex, relentless process, but good nursing makes all the difference. From recognizing early cues to supporting education and safe medication management, we’ve got a central role in helping our patients live better, not just longer. Thanks for tuning in, and keep an eye out—there’s plenty more to discuss next time.

Episodes

Understanding Chronic Kidney Disease Pathophysiology