A female client is admitted for treatment of chronic renal failure (CRF). Nurse Julian knows that this disorder increases the client’s risk of:
A. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
B. A decreased serum phosphate level secondary to kidney failure.
C. An increased serum calcium level secondary to kidney failure.
D. Metabolic alkalosis secondary to retention of hydrogen ions.
Correct Answer: A. Water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
A client with CRF is at risk for fluid imbalance — dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause.
Option B: The most common chronic tubulointerstitial disease is polycystic kidney disease (PKD). Other etiologies include nephrocalcinosis (most often due to hypercalcemia and hypercalciuria), sarcoidosis, Sjogren syndrome, reflux nephropathy in children and young adults.
Option C: Electrolyte imbalances associated with this disorder result from the kidneys’ inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia.
Option D: CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to the inability of the kidneys to excrete hydrogen ions. Chronic prerenal disease occurs in patients with chronic heart failure or cirrhosis with persistently decreased renal perfusion, which increases the propensity for multiple episodes of an intrinsic kidney injury, such as acute tubular necrosis (ATN). This leads to progressive loss of renal function over time.
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