A patient with renal dysfunction develops uremia, when his GFR is?

PGIMS Rohtak NO - 2017

Medical & Surgical Nursing

Easy

Appeared in: PGIMS Rohtak NO - 2017

Explanation

Uremia is the clinical syndrome that manifests when the kidneys can no longer adequately filter waste products from the blood.
This condition is the hallmark of Stage 5 Chronic Kidney Disease (CKD), also known as End-Stage Renal Disease (ESRD).
Stage 5 CKD is defined by a Glomerular Filtration Rate (GFR) of less than 15 mL/min.
At this severe level of renal insufficiency, patients typically develop symptoms of uremia and require renal replacement therapy (dialysis or transplantation) to survive.

Option B: A GFR of 30 mL/min or higher falls into Stage 3 CKD. At this stage, kidney function is moderately impaired, but not severely enough to cause the systemic symptoms of uremia.
Option C: A GFR of 45 mL/min or higher corresponds to Stage 3a CKD. Kidney function is still sufficient to prevent the accumulation of toxins that lead to uremia.
Option D: A GFR of 60 mL/min or higher is classified as Stage 2 CKD (mildly decreased GFR) or Stage 1 (normal GFR with kidney damage). This level of function is far from the point where uremia develops.

Clinical Relevance

Nursing practice connection: Use the key finding related to Relationship between Glomerular Filtration Rate (GFR) and the development of uremia in Chronic Kidney Disease (CKD) to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant in monitoring patients with advanced CKD for signs of uremia, including nausea, loss of appetite, fatigue, confusion, and pruritus (itching), as these indicate a critical decline in function.
Patient education is a key nursing responsibility, focusing on dietary restrictions (low protein, potassium, phosphorus), fluid limits, and medication adherence to manage symptoms and slow CKD progression.
What if? If a patient's GFR was 25 mL/min, they would be in Stage 4 CKD. The nursing priority would be to provide intensive education and support to prepare the patient and family for impending renal replacement therapy, including discussing the options of hemodialysis, peritoneal dialysis, and kidney transplantation.

How to Approach the Question

First, identify the core concepts in the question: 'uremia' and 'GFR' (Glomerular Filtration Rate).
Recall that uremia is a serious clinical syndrome that occurs when the kidneys fail.
Connect 'kidney failure' to the staging system for Chronic Kidney Disease (CKD). Uremia is characteristic of the most severe, final stage.
Remember the GFR value that defines the final stage of CKD (Stage 5 or End-Stage Renal Disease).
Compare this critical GFR value with the options provided.
Select the option that matches the GFR threshold for Stage 5 CKD and the development of uremia.

Concept Tested & Keywords

Concept Tested: Relationship between Glomerular Filtration Rate (GFR) and the development of uremia in Chronic Kidney Disease (CKD).
Stem keywords: renal dysfunction, uremia, GFR
Lead-in keywords: when
Negative lead-in flag: false

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E6 Medicine Harrison 22e Part 1 p. 378-380

E6 Medicine Harrison 22e Part 2 p. 266-268