Uremia causes nausea, anorexia, fatigue, pruritus, a metallic taste, uremic frost, and altered mental status.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with chronic obstructive pulmonary disease has lived with chronically elevated PaCO2. The nurse understands the kidneys compensate over time by performing which action?
Answer: A. In chronic respiratory acidosis, the kidneys compensate by retaining bicarbonate and excreting hydrogen ions, raising the serum HCO3 to buffer the chronically high CO2 and normalize the pH. Renal compensation is slower than respiratory compensation but is sustained in chronic conditions.
Question 2 of 5
A client with chronic kidney disease has anemia. The nurse understands this anemia is primarily caused by which mechanism?
Answer: A. The kidneys produce erythropoietin, the hormone that stimulates red blood cell production in the bone marrow. In chronic kidney disease, damaged kidneys make insufficient erythropoietin, causing a normocytic, normochromic anemia. Treatment often includes erythropoiesis-stimulating agents. The cause is not iron loss in urine, intrinsic factor deficiency, or hemolysis.
Question 3 of 5
A client with chronic kidney disease has a serum phosphorus of 6.5 mg/dL. The nurse anticipates which serum value will be inversely affected?
Answer: B. Phosphorus and calcium have an inverse (reciprocal) relationship. As phosphorus rises in chronic kidney disease, serum calcium falls, producing hypocalcemia. This is why phosphate binders are prescribed to lower phosphorus and protect calcium balance and bone.
Question 4 of 5
A client with chronic kidney disease has a calcium of 6.9 mg/dL and phosphorus of 6.5 mg/dL. The nurse anticipates administering which medication with meals?
Answer: A. Phosphate binders such as calcium acetate or sevelamer are given with meals to bind dietary phosphorus in the GI tract, lowering serum phosphorus in chronic kidney disease.
Question 5 of 5
A client with chronic kidney disease has anemia. The nurse understands this is primarily due to:
Answer: B. The diseased kidneys produce less erythropoietin, leading to anemia. Treatment includes erythropoiesis-stimulating agents and iron. It is not from excess red-cell production.
Keep the streak going with more questions like these, each with a full rationale.
What is chronic kidney disease?
The leading causes are diabetes and hypertension. End-stage renal disease (GFR under 15) requires dialysis or transplant to sustain life. As function declines, the kidneys fail to excrete wastes, regulate fluid and electrolytes, activate vitamin D, and produce erythropoietin.
Key points to remember
- Uremia causes nausea, anorexia, fatigue, pruritus, a metallic taste, uremic frost, and altered mental status.
- Hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis develop as function declines.
- Anemia results from decreased erythropoietin production by the failing kidneys.
- Renal osteodystrophy (bone disease) results from low calcium, high phosphorus, and impaired vitamin D activation.
- Fluid overload causes hypertension, edema, and pulmonary congestion.
- GFR staging: Stage 1 normal/high, declining to Stage 5 (ESRD) at GFR below 15 mL/min.
Signs & symptoms
- edema, HTN, uremia, pruritus
- anemia (↓EPO), bone disease
- metallic taste, fatigue, N/V
Nursing priorities
- Monitor fluid status with daily weights, intake and output, and breath/heart sounds.
- Administer phosphate binders WITH meals to lower phosphorus and protect bones.
- Give erythropoiesis-stimulating agents and iron for anemia, and active vitamin D/calcium as ordered.
- Enforce dietary restrictions: limit sodium, potassium, phosphorus, and fluid; provide high-quality protein per stage.
- Manage blood pressure and glucose tightly to slow progression.
Labs & values
Patient teaching
- Take phosphate binders with every meal and avoid high-phosphorus foods (dairy, cola, processed foods).
- Limit high-potassium foods (bananas, oranges, potatoes, tomatoes) and follow fluid limits.
- Protect the dialysis access arm and keep all dialysis appointments.
Red flags: report now
- Hyperkalemia with ECG changes - life-threatening dysrhythmia risk.
- Pericardial friction rub, chest pain, or hypotension may signal uremic pericarditis or tamponade - escalate.
- Never give magnesium-containing antacids or enemas (e.g., Milk of Magnesia, magnesium citrate) to CKD patients.
- Sudden change in level of consciousness may indicate severe uremia or dialysis disequilibrium - report.
References
Clinical references for this topic
