Report rapidly rising creatinine/BUN, decreasing urine output, or worsening edema (declining kidney function).
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse reviews labs for a client with diabetes. Which finding is the earliest indicator of diabetic nephropathy?
Answer: A. Microalbuminuria (small amounts of albumin in the urine) is the earliest clinical sign of diabetic nephropathy, appearing before a rise in serum creatinine or overt proteinuria. Annual urine albumin screening allows early intervention with blood pressure and glucose control and ACE inhibitors or ARBs.
Question 2 of 5
Before a client receives IV contrast, the nurse confirms which lab to reduce risk of nephropathy?
Answer: A. Check serum creatinine/eGFR; impaired renal function increases contrast-induced nephropathy risk. Hydration and holding nephrotoxins help.
Question 3 of 5
A nurse develops a care plan for a client at risk for diabetic foot ulcers. Which teaching point is the priority for preventing foot ulceration?
Answer: B. Because diabetic neuropathy reduces sensation, clients may not feel injuries, so daily inspection of the feet (including the soles, using a mirror if needed) and well-fitting protective footwear are priorities. Clients should never go barefoot, should avoid soaking the feet, and should keep skin moisturized (avoiding between the toes).
Question 4 of 5
A client scheduled for a contrast CT takes metformin. The nurse anticipates the provider will:
Answer: B. Metformin is typically held around the time of iodinated contrast to reduce the risk of lactic acidosis/contrast nephropathy, and resumed after renal function is confirmed.
Question 5 of 5
A client returns from a renal angiography with contrast. The nurse monitors for which complication related to the dye?
Answer: B. Iodinated contrast can cause contrast-induced nephropathy — monitor urine output and creatinine, ensure hydration, and assess for allergic reaction. Also monitor the puncture site for bleeding.
Keep the streak going with more questions like these, each with a full rationale.
What is diabetic nephropathy?
The earliest sign is albuminuria (microalbuminuria), which progresses to overt proteinuria, declining GFR, hypertension, and eventual kidney failure. Tight glucose and blood pressure control are the key preventive measures.
Key points to remember
- The earliest detectable marker is microalbuminuria, so annual urine albumin screening is recommended in diabetics.
- Tight glycemic control (target A1C generally around 7%) and strict blood pressure control slow progression.
- ACE inhibitors or ARBs are preferred because they reduce intraglomerular pressure and proteinuria and protect the kidneys.
- As function declines, patients develop hypertension, edema, rising creatinine/BUN, and electrolyte disturbances.
- Nephrotoxins (NSAIDs, IV contrast, aminoglycosides) should be avoided or used cautiously.
- Dietary protein and sodium are moderated, and as CKD advances, potassium and phosphorus are also restricted.
Nursing priorities
- Promote tight glucose control and monitor A1C and blood glucose.
- Monitor and control blood pressure, administering ACE inhibitors/ARBs as prescribed.
- Monitor renal function (creatinine, BUN, GFR, urine albumin) and fluid/electrolyte status.
- Teach avoidance of nephrotoxic agents and ensure hydration around contrast studies.
- Reinforce dietary modifications (sodium, protein, and later potassium/phosphorus) per stage.
Labs & values
Patient teaching
- Keep blood glucose and blood pressure in target range to protect your kidneys.
- Take ACE inhibitor/ARB as prescribed and get yearly urine albumin checks.
- Avoid NSAIDs and tell providers about your kidney status before any contrast imaging.
- Follow the recommended sodium and protein limits and report swelling or decreased urination.
Red flags: report now
- Report rapidly rising creatinine/BUN, decreasing urine output, or worsening edema (declining kidney function).
- Report signs of hyperkalemia (muscle weakness, dysrhythmias) as kidney function falls.
- Avoid NSAIDs and unnecessary IV contrast; report any planned contrast study so the kidneys can be protected.
References
Clinical references for this topic
